RESUMO
BACKGROUND: Underwater endoscopic mucosal resection (UEMR) without submucosal injection has been described as an alternative technique to the endoscopic resection of adenomas and colorectal serrated lesions. We aimed to assess the feasibility, safety, and efficacy of UEMR in a Brazilian setting. METHODS: This was a prospective observational study of consecutive patients who underwent UEMR between January and July 2019, in a single tertiary care center. Inclusion criteria were lesions without endoscopic stigmata of deep submucosal invasion in patients referred for endoscopic resection of colorectal adenomas, and serrated lesions detected in a previous colonoscopy. The following features were assessed: complete resection rate, en bloc resection rate, resection time, adverse events, and resection infeasibility. RESULTS: A total of 36 patients underwent UEMR for 51 colorectal lesions. The mean/median lesion size was 16.24/13 mm and the mean/median resection time was 16.97/9.19 min. Histopathology revealed the following: tubular adenoma (43.1%), tubulovillous adenoma (13.7%), serrated lesions (41.2%), and intramucosal adenocarcinoma (2%). Complete resection was achieved in 86.3% of cases; 52.9% of the lesions were removed en bloc, while 47.1% were resected in a piecemeal fashion. UEMR was feasible in 96.1% of cases and failed on 2 occasions, requiring conversion to standard endoscopic mucosal resection. Minor intraoperative bleeding occurred in 5 patients (9.8%) and only 1 presented with delayed bleeding (2%), all controlled endoscopically. CONCLUSION: UEMR for removal of adenomas and colorectal serrated lesions was demonstrated to be feasible, safe and effective.
RESUMO
Introdução: o câncer colorretal (CCR) é um tumor maligno frequente do aparelho digestivo e, no Brasil, representa a quarta causa de óbito. A sobrevida dos portadores de CCR é influenciada por uma série de variáveis, destacando-se o estadiamento tumoral. A principal modalidade terapêutica com perspectiva de cura é a cirúrgica, tendo como tratamentos adjuvantes a quimioterapia e a radioterapia. Objetivo: avaliar a sobrevida, bem como a taxa de complicações anastomótica dos pacientes com CCR acompanhados entre janeiro de 2007 e janeiro de 2013. Métodos: foi realizado estudo descritivo - série de casos com 171 pacientes. A variável dependente foi o tempo de sobrevida do CCR e as independentes foram faixa etária, sexo, sítio anatômico do tumor, infiltração tumoral e metástaselinfonodal. Resultados: a sobrevida global dos pacientes com CCR no pós operatório em 12, 24 e 36 meses de acompanhamento foi, respectivamente, de: 83,21, 76,56 e 63,47%. Acometimento linfonodal e o grau de infiltração tumoral representaram as variáveis relacionadas a pior prognóstico. Os sítios tumorais mais comuns foram o reto alto e sigmoide (43,75%), seguido do reto médio (18,75%) e reto baixo (18,75%). A deiscência anastomótica foi a complicação pós-operatória mais frequente (6,43%). Conclusão: a infiltração tumoral na parede intestinal e o número de linfonodos positivos influenciaram negativamente o tempo de vida dos pacientes com CCR. A fístula compreendeu a principal complicação anastomótica pós-operatória.
Introduction: Colorectal cancer (CRC) is a common malignant tumor of digestive tract and, in Brazil, is the fourth leading cause of cancer. The survival of patients with CRC is influenced by a number of variables, especially the tumor staging. The main therapeutic modality with the prospect of cure is surgical, and as adjuvant chemotherapy and radiotherapy treatments. Objective: Evaluate survival, and the rate of anastomotic complications of patients with CCR followed between January 2007 and January 2013. Methods: This is a descriptive - series of cases study of 171 patients. The dependent variable was the survival time of the CCR and the independent variables were age, gender, anatomic site of the tumor, tumor infiltration and lymph node metastasis. Results: The overall survival of patients with CRC postoperatively in 12, 24 and 36 months follow-up, were respectively 83.21%, 76.56% and 63.47%. The presence of lymph node involvement and the degree of tumor infiltration accounted for variables related to worse prognosis. The most common tumor sites were the rectum and sigmoid high (43.75%), followed by the rectum (18.75%) and lower rectum (18.75%). The anastomotic leak was the most common postoperative (6.43%) complication. Conclusion: The tumor infiltration in the intestinal wall and the number of positive nodes influenced negatively on the survival of patients with RCC. The fistula understood the main postoperative anastomotic complication
