RESUMO
BACKGROUND: Meta-analyses have indicated that preoperative mechanical bowel preparation (MBP) confers no clear benefit and may indeed be harmful for patients with colorectal cancer. The effects of bowel preparation on longer-term outcomes have not been reported. The aim was to compare long-term survival and surgical complications in patients who did or did not receive MBP before surgery for colonic cancer. METHODS: This was a retrospective cohort study of all patients undergoing potentially curative surgery for colonic cancer after routine hospital admission in the West of Scotland between January 2000 and December 2005. Clinical audit data were linked to cancer registrations and death certificates. Kaplan-Meier and Cox proportional hazards models were used to explore determinants of survival. RESULTS: A total of 1730 patients underwent potentially curative surgery for colonic cancer, of whom 886 (51·2 per cent) were men. The mean(s.d.) age was 69·7(10·6) years. Some 1460 patients (84·4 per cent) received MBP. Median follow-up was 3·5 (range 0·1-6·7) years. There were no statistically significant differences in 30-day postoperative complication rates between groups. The unadjusted hazard ratio (HR) for death from all causes for patients treated with MBP (versus no MBP) was 0·72 (95 per cent confidence interval 0·57 to 0·91). Multivariable analysis with adjustment for age, sex, socioeconomic circumstances, disease stage and presentation for surgery showed that MBP had no independent effect on all-cause mortality (HR 0·85, 0·67 to 1·10). CONCLUSION: Neither postoperative complications nor long-term survival are improved by MBP before colonic cancer surgery.
Assuntos
Neoplasias do Colo/cirurgia , Enema/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Catárticos/uso terapêutico , Neoplasias do Colo/mortalidade , Enema/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/mortalidade , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
BACKGROUND: Early detection of colorectal cancer could reduce cancer-specific mortality. The aim of this trial was to evaluate the effect of faecal occult blood test (FOBT) screening on colorectal cancer mortality in a Swedish population. METHODS: All 68,308 citizens in Göteborg born between 1918 and 1931 were randomized to a screening or a control group at the age of 60-64 years. All were screened two to three times with rehydrated Hemoccult-II. Compliance was 70.0 per cent (23,916 individuals). Those with a positive test result were offered sigmoidoscopy and a double-contrast enema. The primary endpoint was death from colorectal cancer. RESULTS: After a mean of 9 years from the last screening, there was a significant reduction in colorectal cancer mortality in the screening group compared with the control group. The overall risk ratio of death from colorectal cancer was 0.84 (95 per cent confidence interval 0.71 to 0.99). The groups did not differ in incidence of colorectal cancer or in overall mortality. CONCLUSION: FOBT screening significantly reduces colorectal cancer mortality.
Assuntos
Neoplasias Colorretais/mortalidade , Programas de Rastreamento/métodos , Sangue Oculto , Estudos de Coortes , Neoplasias Colorretais/diagnóstico , Enema/métodos , Enema/mortalidade , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Sigmoidoscopia/métodos , Sigmoidoscopia/mortalidade , Análise de Sobrevida , Suécia/epidemiologiaRESUMO
Thousands of barium enemas are performed in the United States each year without incident. Occasionally complications arise, only a few of which are fatal. Perforation is the most frequent serious complication of this procedure. Two instances of fatal perforation, one colonic and the other vaginal, are described, and the relevant literature is reviewed.
