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1.
Colorectal Dis ; 26(3): 408-416, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38247221

RESUMO

AIM: Several papers have shown that use of indocyanine green (ICG) decreases incidence of anastomotic leakage (AL) during colonic surgery, but no clear evidence has been found for rectal cancer surgery. Therefore, with this systematic review and meta-analysis of randomized controlled trials (RCTs) we aimed to assess if ICG could also reduce risk of AL in rectal cancer surgery. METHOD: PubMed, Scopus, CINAHL and Cochrane databases were searched for RCTs assessing the effect of intraoperative ICG on the incidence of AL of the colorectal anastomosis. Pooled relative risk (RR) and pooled risk difference (RD) were obtained using models with random effects. Risk of bias was evaluated with the Rob2 tool and the quality of evidence was assessed using the GRADE Pro tool. RESULTS: Four RCTs were included for analysis, with a total of 1510 patients (743 controls and 767 ICG patients). The rate of AL was 9% in the ICG group (69/767) and 13.9% (103/743) in the control group (p = 0.003, RR -0.5, 95% CI -0.827 to -0.172, heterogeneity test 0%, p = 0.460). The RD in terms of incidence of AL was significantly decreased by 4.51% (p = 0.031, 95% CI -0.086 to -0.004, heterogeneity test 28%, p = 0.182) when using ICG. CONCLUSION: Our meta-analysis suggested that use of ICG during rectal cancer surgery could reduce the rate of AL.


Assuntos
Fístula Anastomótica , Neoplasias Retais , Humanos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Verde de Indocianina , Angiofluoresceinografia , Cuidados Intraoperatórios , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/cirurgia , Neoplasias Retais/complicações , Anastomose Cirúrgica/efeitos adversos
2.
Ann Surg ; 269(1): 10-17, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29099399

RESUMO

OBJECTIVE: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. METHODS: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. RESULTS: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60-400) vs 300 mL (150-500), P = 0.001] and hospital stay [8 (6-12) vs 9 (7-14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22-34] versus 31 (95% CI, 26-36) months (P = 0.929). CONCLUSIONS: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Pontuação de Propensão , Idoso , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/mortalidade , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Laparoscopia/métodos , Tempo de Internação/tendências , Masculino , Estadiamento de Neoplasias , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Taxa de Sobrevida/tendências , Resultado do Tratamento
3.
J Crohns Colitis ; 13(5): 572-577, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-30452620

RESUMO

BACKGROUND AND AIMS: Faecal diversion [FD] can be proposed in patients with refractory anoperineal Crohn's disease [APCD]. This study aimed to assess long-term results of this strategy, following the advent of the anti-tumour necrosis factor [TNF] era. METHODS: All patients who underwent FD for refractory APCD between 2005 and 2017 were included, excluding patients with a history of ileal pouch-anal anastomosis. A multivariate analysis regarding absence of stoma reversal [SR] was performed. RESULTS: A total of 65 consecutive patients who underwent FD for APCD (comprising anoperineal fistula [n = 40, 62%], rectovaginal fistula [n = 21, 32%], fissures and/or ulceration [n = 9, 14%], and/or anal stricture [n = 5, 8%]) were included. At the time of FD, 34 patients [52%] presented with small bowel Crohn's disease [CD] involvement, 29 [45%] with colonic involvement, and 19 [29%] with rectal involvement. Following FD, 54 patients [83%] were treated with anti-TNF therapy, prescribed for isolated APCD [n = 10, 15%] or luminal CD with APCD [n = 44, 68%]. After a mean follow-up of 49 ± 29 [7-120] months, SR was not possible in 32 patients [49%], including 17 patients [26%] requiring a subsequent proctectomy with abdominoperineal excision. In multivariate analysis, rectal CD involvement was the only independent factor associated with a reduced rate of SR (odds ratio: 4.0 [1.153-14.000]; p = 0.029), and anti-TNF therapy had no impact on SR rate. CONCLUSIONS: FD can be performed in selected patients with refractory APCD, to avoid abdominoperineal resection. However, this strategy should be proposed with caution in patients presenting with rectal CD involvement. Anti-TNF therapy has no impact on SR rate.


Assuntos
Doenças do Ânus/cirurgia , Colostomia , Doença de Crohn/cirurgia , Ileostomia , Adolescente , Adulto , Idoso , Doenças do Ânus/etiologia , Doença de Crohn/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Falha de Tratamento , Resultado do Tratamento , Adulto Jovem
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