RESUMO
To develop enhanced recovery protocol for elderly and old patients in elective colon cancer surgery. In Russia as in the most world countries the biggest frequency of colon cancer are among elderly and old people. At the same time surgery treatment of elderly patients compared with young patients accompanied with increased frequency of complications, length of stay in hospital and mortality. Based on own and literature trials authors proposed enhanced recovery protocol for gerontological colon cancer patients. Protocol established on multidisciplinary approach to elderly and old patients treatment and include all stages of perioperative period.
Assuntos
Neoplasias do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Assistência Perioperatória/métodos , Idoso , Protocolos Clínicos/normas , Neoplasias do Colo/terapia , Humanos , Tempo de Internação , Complicações Pós-Operatórias , Fatores de TempoRESUMO
The article presents the results of surgery outcomes in 127 elderly patients with colon cancer. The patients were divided into two groups: the main group (prospective, n = 52) and control group (retrospective, n = 75). The combined preoperative nutritive status assessment by BMI and a prognostic hypotrophy index were used. It included the optimization of nutritive support on all stages and an early tube removal, an enteral feeding during postoperative period. It was stated, that it significantly reduced the level of complications, period of intensive care unit stay on 2 days and a hospital stay on 4 days in main group. All the patients of the main group improved the quality of life during 7 days (EORTC QIQ CR29). Proposed nutritive support program allowed improvement of the quality of life and positive treatment outcomes in elderly patients with colon cancer.
Assuntos
Neoplasias do Colo , Apoio Nutricional/métodos , Complicações Pós-Operatórias/prevenção & controle , Desnutrição Proteico-Calórica , Idoso , Idoso de 80 Anos ou mais , Colectomia/efeitos adversos , Colectomia/métodos , Colo/patologia , Colo/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Avaliação Geriátrica/métodos , Humanos , Tempo de Internação , Masculino , Estadiamento de Neoplasias , Avaliação Nutricional , Estado Nutricional , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/terapia , Qualidade de Vida , Resultado do TratamentoAssuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos/farmacologia , Biomarcadores Tumorais/análise , Colectomia , Neoplasias do Colo , Procedimentos Cirúrgicos de Citorredução/métodos , Hepatectomia/métodos , Neoplasias Hepáticas , Inibidores da Angiogênese/administração & dosagem , Bevacizumab , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pré-Operatórios/métodos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/administração & dosagemRESUMO
Colorectal cancer (CRC) is one of the commonest malignancies of Western countries, with approximately half the incidence occurring in patients > 70 years of age. Elderly CRC patients, however, are insufficient to fully examined, therefore, they receive inadequate treatment and underrepresented in clinical trials. The International Society of Geriatric Oncology created a task force with a view to assessing potential for developing guidelines for the treatment of elderly (geriatric) patients. A review of the evidence presented by the task force members confirmed the paucity of clinical trial data in elderly people and the lack of evidence-based guidelines. However, recommendations have been proposed on the basis of the available data and on the emerging evidence that treatment outcomes for fit, elderly CRC patients can be similar to those of younger patients. This gives hoped that such efforts will pave the way for formal treatment guidelines based upon solid scientific evidence in the future.
Assuntos
Neoplasias Colorretais/terapia , Geriatria/normas , Oncologia/normas , Guias de Prática Clínica como Assunto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/normas , HumanosRESUMO
Complex examination of 32 patients with gastric cancer in terms of more than 6 months after radical operations included endoscopic, radial and laboratory methods with the determination of indices of the carcinoembryonic antigen and carbohydrate antigens 19-1 and 72-4 every six months. It was established that normal concentration of all the three tumor markers within 12 months after surgery was a practically reliable sign of the absence of metastases and recurrence of gastric cancer. The increased level of one or two oncomarkers within 12 months after radical operation points to progression of gastric cancer with probability of 57.1% or the development of other surgical pathology (cholecystolithiasis, gastric stump polyps and others) in 28.6% of observations. In all cases of progressing gastric cancer in terms of more than 6 months after operation there was a more that 1.5 times elevation of any one or two tumor markers.
Assuntos
Biomarcadores Tumorais/sangue , Gastrectomia , Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Neoplasias Gástricas/diagnóstico , Progressão da Doença , Endoscopia Gastrointestinal , Seguimentos , Humanos , Metástase Neoplásica , Estadiamento de Neoplasias/métodos , Tomografia por Emissão de Pósitrons , Prognóstico , Neoplasias Gástricas/sangue , Neoplasias Gástricas/secundário , Tomografia Computadorizada EspiralRESUMO
Preoperative indices of cancer embryonic antigen (CEA), carbohydrate antigens 19-9(CA)19-9, 72-4(CA)72-4, and alfa-fetaprotein (AFP) in 60 patients with gastric cancer were compared with the results of postoperative staging of the malignant process. It was found that increased concentration of one of the tumor markers were not a significant diagnostic sign of the metastases of gastric cancer. CEA is considered as an exception since its more than one and a half elevation (more than 3.75 ng/ml) suggests the presence of metastases with 80% probability. An increased concentration of any two oncomarkers (CEA, CA19-9, CA 72-4) points to the metastases of gastric cancer with 83.3% probability and usually coincides with the presence of distant metastases. A simultaneous elevation of indices of three tumor markers does not occur in gastric cancer. AFP is not informative in cases of gastric cancer and its dissemination.
