Complicaciones asociadas al reservorio ileal en colitis ulcerativa versus poliposis familiar adenomatosa: Impacto en la calidad de vida del paciente / Ileal reservoir-associated complications in ulcerative colitis versus familial adenomatous polyposis: Impact on patient quality of life

Antecedentes: La proctocolectomía con reservorio es el procedimiento quirúrgico de elección para los pacientes con colitis ulcerosa y poliposis adenomatosa familiar. Objetivos: Evaluar las complicaciones posoperatorias a largo plazo (1994-2019) en pacientes operados por poliposis familiar adenomatosa (PFA) y colitis ulcerativa (CU) y el grado de satisfacción con la intervención. Métodos: Estudio observacional basado en el análisis de una base de datos retrospectiva con seguimiento prospectivo en 115 pacientes consecutivos: 79 con CU y 36 con PFA. Se ha realizado el seguimiento de un total de 88 pacientes, 60 con CU y 28 con PFA. Resultados: Se evaluaron 48 varones (54,4%) con una edad media de 44,8 ± 10,6 años. Las indicaciones para la cirugía fueron enfermedad intratable en 54 pacientes (47%), displasia/cáncer en 43 (37%), sangrado severo en cuatro (4%) y perforación en tres (3%). Se realizó una proctectomía y mucosectomía del muñón rectal en 67 (76,1%), y una técnica de doble grapado en 21. Se realizó una ileostomía protectora en todos los pacientes con CU y PFA. No se encontraron diferencias en las complicaciones tempranas entre los dos grupos. Las complicaciones tardías mostraron una mayor tasa de reservoritis en los pacientes de la CU respecto a la PFA (44,9 vs. 14,3%, p = 0,001), con más reservoritis refractaria en el grupo de la CU (13,3 vs. 0%, p = 0,04) sin diferencias en cuanto a obstrucción intestinal, estenosis o fístulas anastomóticas. La satisfacción general y la adaptación se consideraron buenas en el 87% de los pacientes con CU y solo en el 57% del grupo de PFA (p < 0,01). Conclusiones: La proctocolectomía con reservorio ileal tiene una morbilidad y mortalidad comparables, excepto por la mayor tasa de reservoritis en los pacientes con antecedentes de CU, a pesar de esta contingencia hay una mejor calidad de vida y mayor aceptación de la cirugía en los pacientes con CU que en los pacientes con PFA.(AU)

Background: Proctocolectomy with ileal reservoir is the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. Objectives: To evaluate long-term postoperative complications (1994-2019) in patients operated for familial adenomatous polyposis (FAP) and ulcerative colitis (UC) and the degree of satisfaction with the procedure. Methods: Observational study based on the analysis of a retrospective database with prospective follow-up in 115 consecutive patients: 79 with UC and 36 with FAP. A total of 88 patients were followed up, 60 with UC and 28 with PFA. Results: 48 males (54.4%) with a mean age of 44.8 ± 10.6 years were evaluated. Indications for surgery were intractable disease in 54 patients (47%), dysplasia/cancer in 43 (37%), severe bleeding in 4 (4%) and perforation in 3 (3%). A proctectomy and mucosectomy of the rectal stump was performed in 67 (76.1%), and a double stapling technique in 21. A protective ileostomy was performed in all patients with UC and FAP. No differences were found in early complications between the two groups. Late complications showed a higher rate of reservoritis in UC patients compared to FAP (44.9 vs. 14.3%, p = 0.001), with more refractory reservoritis in the UC group (13.3 vs. 0%, p = 0.04) with no differences in bowel obstruction, strictures, or anastomotic fistulas. Overall satisfaction and adaptation were considered good in 87% of UC patients and only 57% in the FAP group (p < 0.01). Conclusions: Proctocolectomy with ileal reservoir has comparable morbidity and mortality, except for the higher rate of reservoritis in patients with a history of UC, despite this contingency there is a better quality of life and greater acceptance of surgery in UC patients than in FAP patients.(AU)

Ileal reservoir-associated complications in ulcerative colitis versus familial adenomatous polyposis: Impact on patient quality of life. / Complicaciones asociadas al reservorio ileal en colitis ulcerativa versus poliposis familiar adenomatosa: Impacto en la calidad de vida del paciente.

BACKGROUND: Proctocolectomy with ileal reservoir is the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. OBJECTIVES: To evaluate long-term postoperative complications (1994-2019) in patients operated for familial adenomatous polyposis (FAP) and ulcerative colitis (UC) and the degree of satisfaction with the procedure. METHODS: Observational study based on the analysis of a retrospective database with prospective follow-up in 115 consecutive patients: 79 with UC and 36 with FAP. A total of 88 patients were followed up, 60 with UC and 28 with PFA. RESULTS: 48 males (54.4%) with a mean age of 44.8 ± 10.6 years were evaluated. Indications for surgery were intractable disease in 54 patients (47%), dysplasia/cancer in 43 (37%), severe bleeding in 4 (4%) and perforation in 3 (3%). A proctectomy and mucosectomy of the rectal stump was performed in 67 (76.1%), and a double stapling technique in 21. A protective ileostomy was performed in all patients with UC and FAP. No differences were found in early complications between the two groups. Late complications showed a higher rate of reservoritis in UC patients compared to FAP (44.9 vs. 14.3%, p = 0.001), with more refractory reservoritis in the UC group (13.3 vs. 0%, p = 0.04) with no differences in bowel obstruction, strictures, or anastomotic fistulas. Overall satisfaction and adaptation were considered good in 87% of UC patients and only 57% in the FAP group (p < 0.01). CONCLUSIONS: Proctocolectomy with ileal reservoir has comparable morbidity and mortality, except for the higher rate of reservoritis in patients with a history of UC, despite this contingency there is a better quality of life and greater acceptance of surgery in UC patients than in FAP patients.

Determinación de los factores predictivos para complicaciones en cirugía electiva de pacientes con cáncer colorrectal. Experiencia del Instituto de Cancerología Las Américas Auna (Colombia, 2016-2019) / Determination of predictive factors for complications in elective surgeryof colorectal cancer patients. Experience of the Instituto de CancerologíaLas Américas Auna (Colombia, 2016-2019)

Introducción. El pilar fundamental del tratamiento del cáncer colorrectal es la cirugía, situación que expone a los pacientes a la posible presentación de complicaciones, morbimortalidad, pobre calidad de vida, recurrencia tumoral o la muerte. El objetivo de este estudio fue determinar las variables clínicas y quirúrgicas que inciden en el riesgo de la aparición de complicaciones en los pacientes con cáncer colorrectal llevados a cirugía electiva entre los años 2016 y 2019. Métodos. Estudio observacional, descriptivo, transversal y retrospectivo. Se incluyeron pacientes mayores de 18 años con cáncer colorrectal sometidos a cirugía electiva. Se realizó un análisis multivariado para determinar los factores que se relacionan con las complicaciones postquirúrgicas. Resultados. Se incluyeron 298 pacientes, 68 % mayores de 60 años, 52,3 % mujeres, 74,2 % presentaban comorbilidades y 48,3 % fueron diagnosticados en estadio III. El 48,3 % presentó complicaciones postoperatorias. De ellos, el 68,1 % no tenía tamización nutricional y el 61,8 % no tenía preparación del colon; un 55 % fueron cirugías del recto, 69,1 % de las cirugías fueron por vía laparoscópica y 71,8 % presentaron sangrado inferior a 500 ml. La mayoría de las complicaciones fueron clasificadas como Clavien-Dindo I-III. Discusión. Las características de los pacientes fueron similares a los presentados en otros estudios, aunque hubo mayor incidencia de íleo postoperatorio. El análisis multivariado mostró una mayor probabilidad de presentar una complicación en pacientes con diabetes mellitus, hipertensión arterial, falta de tamización nutricional o preparación de colon, cirugía de recto y el sangrado mayor a 500 ml

Introduction. The fundamental pillar of colorectal cancer treatment is surgery, a situation that exposes patients to the possible presentation of complications, morbidity and mortality, poor quality of life, tumor recurrence or death. The objective of this study was to determine the clinical and surgical variables that affect the risk of the appearance of complications in colorectal cancer patients taken to elective surgery between 2016 and 2019.Methods. Observational, descriptive, cross-sectional and retrospective study. Patients over the age of 18 with colorectal cancer undergoing elective surgery were included. A multivariate analysis was performed to determine the factors related to postsurgical complications. Results. We included 298 patients, 68% over 60 years of age, 52.3% women, 74.2% had comorbidities and 48.3% were diagnosed in stage III. 48.3% presented postoperative complications; of these, 68.1% had no nutritional screening, and 61.8% had no colon preparation; 55% were rectal cancer surgeries, 69.1% underwent laparoscopic surgeries, and 71.8% had bleeding less than 500 ml. Most complications were classified as Clavien Dindo I-III. Discussion. The characteristic of the patients was similar to those presented in other studies, even though we had more incidence of postoperative ileus. The multivariate analysis showed a higher probability of complications in patients with: diabetes, hypertension, lack of nutritional screening, bleeding over 500cc, lack of colon mechanical preparation and rectal cancer surgery.Patient characteristics were similar to those presented in other studies, although there was a higher incidence of postoperative ileus. The multivariate analysis showed a greater probability of presenting a complication in patients with diabetes mellitus, arterial hypertension, lack of nutritional screening, colon preparation, rectal cancer surgery, and bleeding greater than 500 ml