Resultados de la cirugía resectiva de pacientes con Cáncer de Colon no complicado en un centro privado y regional de salud / Results of resective surgery in patients with non-complicated Colon Cancer in a private and regional health establishment

El tratamiento estándar del cáncer de colon (CC), continúa siendo la resección radical del segmento intestinal comprometido con márgenes libres (al menos 5 cm por encima y debajo del tumor), pudiendo o no asociarse a terapias complementarias. El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia actuarial global (SVAG) a 5 años en pacientes resecados por CC no complicado. La metodología usada fue serie de casos retrospectiva de pacientes con CC no complicado, sometidos a colectomía subtotal y linfadenectomía, de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2007 y 2017. La variable resultado fue SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria, MPO, y recurrencia. Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 43 pacientes (58,1 % hombres), con una mediana de edad de 66 años. La localización y estadios más frecuentes fueron colon derecho (18 casos, 41,9 %); y IIIA, IIIB, respectivamente. La resecabilidad de la serie fue 100 %. La medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fueron de 100 minutos, 30 y 5 días, respectivamente. La MPO fue 30,2 % (13 casos). Con una mediana de seguimiento de 55 meses, se verificó una recurrencia de 13,9 %; y SVAG a 5 años de 69,8 % para la totalidad de la serie. Los resultados obtenidos, en términos de MPO, mortalidad y SVAG a 5 años, fueron similares a series de nacionales e internacionales.

The standard treatment of colonic cancer (CC) continues to be the radical resection of the intestinal segment compromised with free margins, associated or not with adjuvant therapies. The aim of this study was to determine postoperative morbidity (POM) and 5-year overall survival (OS) in patients resected by non-complicated CC. The methodology used was a series of cases in retrospective of patients with non-complicated CC undergoing colectomy and lymphadenectomy, consecutively, at RedSalud Mayor Temuco Clinic, between 2007 and 2017. The outcome variable was 5-years OS. Other variables of interest were: surgical time, the number of resected lymph nodes, hospital stay, POM, and recurrence. Patients were followed clinically. Descriptive statistics were used (measures of central tendency and dispersion), and OS analysis was applying Kaplan Meier curves. 43 patients (58.1% men) were intervened, with a median age of 66 years. The most frequent localization and stages were the right colon (18 cases, 41.9%); and IIIA, IIIB respectively. Median surgical time, the number of resected lymph nodes and hospital stay were 100 min, 30 and 5 days respectively. MPO was 30.2% (13 cases). With a median follow-up of 55 months, a recurrence of 13.9% was verified, and a 5-year OS of 69.8% was observed. The results, in terms of POM, mortality and 5-year OS, were similar to the national and international series.

Bowel dysfunction after sigmoid resection for cancer and its impact on quality of life.

BACKGROUND: Several studies have explored functional outcomes after rectal cancer surgery, but bowel dysfunction after sigmoid resection for cancer has hardly been considered. The aim of this study was to identify the prevalence and pattern of bowel dysfunction after resection for sigmoid cancer, and the impact of bowel function on quality of life (QoL) by comparison with patients who had polypectomy for cancer. METHODS: This was a national cross-sectional study. Data were collected from the Danish Colorectal Cancer Group database, and a questionnaire regarding bowel function and European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL questionnaire was sent to all Danish colonic cancer survivors treated with sigmoid resection or polypectomy between 2001 and 2014. RESULTS: A total of 3295 patients (3061 sigmoid resection, 234 polypectomy) responded to the questionnaire (response rate 63·8 per cent). Twelve bowel symptoms were more prevalent after sigmoid resection, including: excessive straining, fragmentation, bloating, nocturnal defaecation, bowel false alarm, liquid stool incontinence, incomplete evacuation and sense of outlet obstruction. QoL impairment owing to bowel symptoms was reported in 16·6 per cent of patients in the resection group and 10·1 per cent after polypectomy (P = 0·008). Obstructed defaecation symptoms (ODS) were encountered significantly more often after sigmoid resection than following polypectomy (17·9 versus 7·3 per cent; P < 0·001). In the resection group, patients with ODS had substantial impairment on most aspects of QoL assessed by the EORTC QLQ-C30. CONCLUSION: Sigmoid resection for cancer is associated with an increased risk of long-term bowel dysfunction; obstructed defaecation is prevalent and associated with substantial impairment of QoL.

Recovery of upper gastrointestinal bowel movement after rectosigmoid cancer surgery: a pilot transit analysis.

Postoperative gastrointestinal bowel transit right after colorectal resection has not yet been clarified. Thirty patients with rectosigmoid cancer were treated in this pilot study. The nasogastric tube was removed on the first postoperative day. One Sitzmarks capsule was given to each patient on the second postoperative day. Abdominal X-rays were taken at 3, 6, 8, 24, 48, and 72 hours after capsule intake. Distribution of the remaining Sitzmarks capsules were counted on X-ray films to clarify postoperative gastrointestinal movement after bowel resection. All Sitzmarks capsules were observed in the stomach at 3 and 6 hours after capsule intake. At 8 hours (second postoperative day), the Sitzmarks capsules were distributed from the stomach to the small intestine. Sitzmarks capsules were distributed in the right side colon at 24 hours (third postoperative day) after intake. Although the main distribution was still in the right side colon, several patients had evacuations accompanied by the disappearance of the Sitzmarks capsules. In 50% of the patients, it took approximately 72 hours (fifth postoperative day) for the first defecation after intake of the capsules. However, the Sitzmarks capsules remained mainly in the right side colon. Eight hours after intake, the majority of the Sitzmarks capsules shifted to the small intestine. Therefore, medication or feeding should be safely possible starting on the second postoperative day. There was no particular impact of bowel resection on upper gastrointestinal transit in patients with rectosigmoid cancer.

Metástasis testicular de un adenocarcinoma de colon: reporte de un caso / Testicular matastases in colon adenocarcinoma: a case report

Reportamos el caso de un paciente con metástasis hepáticas, secundarias a adenocarcinoma de colon, quien presentaba una masa paratesticular dolorosa, cuya aparición coincidió con una progresión de la neoplasia de base. La resección quirúrgica de la masa identificó células neoplásicas provenientes del adenocarcinoma de colon.

We report the case of a patient with hepatic metastases secondary to colon adenocarcinoma. Who presented a par testicular and pain mass, which apparitions coincide with a progression of his basic neoplasic. The surgical resection of the mass identifies neoplásica cells with colon adenocarcinoma origin.

Postoperative colonic motility in patients following laparoscopic-assisted and open sigmoid colectomy.

Clinical reports on laparoscopic-assisted sigmoid colectomy (LASC) suggest that the period of postoperative inhibition of gastrointestinal motility is shortened as compared to open sigmoid colectomy (OSC). We aimed to specifically investigate whether colonic motility increases more rapidly following LASC compared to OSC. LASC was performed in 11 patients and OSC in nine patients for recurrent diverticulitis or carcinoma. During surgery a manometry catheter was inserted into the colon via the anus, and the tip was placed in the splenic flexure. Continuous manometric recordings were performed from the day of surgery until postoperative day 3 with a four-channel microtransducer manometry system combined with a portable data logger. The postoperative colonic motility index was 101+/-18, 199+/-30, and 163+/-27 mm Hg/min on days 1, 2, and 3 after LASC, respectively, which was increased compared to indexes of 53+/-15, 71+/-18, and 76+/-23 following OSC (mean+/-standard error of the mean; P<0.05). The amplitude but not the frequency of contractions was higher following LASC compared to OSC. Following LASC, patients requested a similar amount of pain medication but resumed oral food more rapidly on postoperative days 2 and 3 (P<0.05), and they were discharged from the hospital earlier (P<0.05). Colonic motility in particular and the patient's condition in general seem to improve more rapidly following LASC compared to the open procedure.

Colon carcinoma after thymectomy for myasthenia gravis: report of a case.

A 74-year-old Japanese man was admitted to our hospital with anemia, 4 years after a thymectomy for thymoma associated with myasthenia gravis. A diagnosis of sigmoid colon carcinoma was confirmed, followed by surgical resection. This case is presented to reinforce that physicians should bear in mind the possibility of extrathymic malignancies in patients with thymoma.

Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions.

BACKGROUND: Total pelvic exenteration (TPE) for the treatment of advanced colorectal cancer usually involves a double stoma for faecal and urinary excretion, which reduces patient quality of life. In this study, a stomaless reconstruction method for patients normally requiring TPE was evaluated. METHODS: Five patients underwent stomaless TPE. After removal of the tumour with an adequate surgical margin, the urethra was transected at the urogenital diaphragm and the rectum at the anal canal. An ileal neobladder was constructed and coloanal anastomosis was performed. The major omentum was used to construct a septum between the anastomoses. A transgastric ileus tube was used as an intestinal stent to prevent ileus. RESULTS: All patients were alive 12-39 months after operation. Faecal continence was preserved in four patients whose diverting colostomies were closed. All five patients were able to void urine spontaneously, with daytime continence. All but one, in whom cancer recurred, were mobile in the community. CONCLUSION: Stomaless TPE may be considered for locally advanced colorectal cancers that invade the genitourinary organs, provided that neither the anal canal nor the urogenital diaphragm is affected.

Total colectomy and J-pouch ileorectal anastomosis for obstructed tumours of the rectosigmoid junction.

BACKGROUND: Subtotal colectomy with ileosigmoid or ileorectal anastomosis is one of the standard procedures for obstructed tumours of the left colon. The lower the level of the anastomosis, the greater the number of bowel motions per day. The aim of the present study was to assess whether an ileal pouch-rectal anastomosis is associated with fewer bowel motions per day. METHODS: In four patients with obstructed carcinoma of the rectosigmoid junction and upper rectum, a total colectomy with removal of the upper rectum for adequate tumour clearance was used, followed by construction of a 10 cm ileal J-pouch that was subsequently anastomosed to the distal rectal stump. RESULTS: Postoperative recovery was uneventful in all patients. At 3 months postoperatively, anorectal manometry showed anal resting and squeeze pressures at lower normal limits and a neorectal capacity ranging from 160 to 310 mL. One year postoperatively, all patients experienced one to three normal bowel motions daily and no episodes of incontinence. CONCLUSIONS: Total colectomy with ileal J-pouch-rectal anastomosis is a reasonable operative alternative in cases with obstructed tumours of the rectosigmoid junction, which necessitate removal of the upper rectum.

Tumors of the appendix and colon.

This collective review includes all available case reports of smooth muscle (stromal) tumors of the appendix and large intestine in the world literature. When compiling this review, we endeavored to examine cumulative as well as recently collected data on both benign and malignant smooth muscle tumors spanning the period 1875 to 1996. In total, there were reports of 331 leiomyomas (LMs) and 263 leiomyosarcomas (LMSs). The peak age of incidence of LM was 30 to 39 years, and the peak age of incidence of LMSs was 50 to 59 years. The female/male ratio was slightly higher for LM, and the male/female ratio was higher for LMS. The descending colon and sigmoid colon were the most common sites of both benign and malignant smooth muscle tumors. The growth of LMs most often occurred extraluminally, whereas LMSs tended to grow within the lumen of the colon. With both tumor types pain was the most frequent presenting complaint, followed less commonly by complaints of a palpable mass or gastrointestinal bleeding. LMSs tended to be larger at diagnosis than LMs, though the duration of symptoms for both types of tumor was most often reported to be between 1 month and 1 year. Finally, LMSs were found to metastasize mo

[The transesophageal echocardiographic evaluation of the hemodynamic effects of the pneumoperitoneum in laparoscopic hemicolectomy]. / Valutazione con ecocardiografia transesofagea degli effetti emodinamici del pneumoperitoneo nell'emicolectomia per via laparoscopica.

MATERIALS AND METHODS: Ten patients undergoing laparoscopic left hemicolectomy were monitored by transesophageal echocardiography in order to assess the effects of pneumoperitoneum and head-down tilt on the following parameters: end-diastolic left ventricular volume, stroke volume, cardiac output, left ventricular ejection fraction, mean blood pressure and cardiac frequency. Pneumoperitoneum, by a mean CO2 pressure of 13 mmHg, was performed in five of them; for the other patients, mechanical abdominal wall suspension was used, without any increase in abdominal pressure. RESULTS: The group treated by abdominal wall suspension underwent an increase in end-diastolic left ventricular dimension, stroke volume, cardiac output and blood pressure, while the group treated by pneumoperitoneum had no significant changes in hemodynamic parameters. CONCLUSIONS: In this surgical context, pneumoperitoneum seems to be safe and to have a low hemodynamic impact, as its effects on venous return seem to be opposite to those of the Trendelenburg position.

Electrosigmoidogram in the various pathologic conditions of the sigmoid colon.

The current study investigates the electrosigmoidographic (ESG) patterns in 50 patients with sigmoid colon pathologies and 10 healthy controls. Three electrodes were applied to the skin of the lower abdomen and the reference electrode was placed on the lower limb. Ulcerative colitis patients showed a "tachyarrhythmic" ESG; the PPs had a higher frequency with a lower amplitude and velocity than the normal controls. The sigmoid diverticulitis exhibited a "bradyarrhythmic" pattern; the PP variables were lower than normal. The PPs in sigmoid polyposis were "scarce" and were recorded only occasionally. In sigmoid colon cancer, the electric waves were normal proximal to the tumor and absent opposite and distal to it; a "silent" ESG was recorded in sigmoidectomy patients. Various ESG patterns were recordable in the different pathologic conditions of the sigmoid colon. It is thus suggested that percutaneous ESG can be included as an investigative tool in the diagnosis of sigmoid colon pathologies. The method is simple, easy, non-invasive and non-radiologic.

Validation of a new transit time ultrasound flowmeter for measuring blood flow in colonic mesenteric arteries.

OBJECTIVE: To validate a transit time ultrasound flowmeter (CardioMed CM 4000) for measuring blood flow in isolated colonic mesenteric arteries. DESIGN: Experimental and clinical study. SETTING: Teaching hospital, Denmark. ANIMALS AND SUBJECTS: One female pig, and 6 patients being operated on for carcinoma of the sigmoid colon and rectum. INTERVENTIONS: Volume blood flow measured by Cardiomed CM 4000 and pump withdrawal flow recordings. MAIN OUTCOME MEASURES: Correlation between the two methods. RESULTS: There was good agreement between transit time flow recordings and pump withdrawal flow recordings (correlation coefficient of 1.0). Of the differences between the two methods, 95% were between -0.16 ml min(-1) and 1.29 ml min(-1), mean 0.57 ml min(-1), or (in percentages) 105, 95% lying between 97-115. There was also good reproducibility in transit time flow recordings, the mean difference between repeated measurements being 0.06 ml min(-1), 95% lying between -0.66 ml min(-1) and 0.78 ml min(-1). CONCLUSION: Ultrasound transit time flow recordings gave precise measurements of blood flow in isolated colonic mesenteric arteries.

Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers.

BACKGROUND: Total mesorectal excision (TME) is advocated for rectal cancer but the indications and extent of resection vary widely between surgeons. METHODS: Seventy-six consecutive patients (61 elective, 15 acute admission) with rectal or rectosigmoid cancer were admitted to a unit where TME was the preferred surgical option for potentially curative cancer at all levels of the rectum. RESULTS: Procedures undertaken were anterior resection (38 patients), abdominoperineal resection (18), Hartmann's procedure (ten) and transanal excision (one). Six patients had proximal faecal diversion alone and surgery was withheld in three. Anastomotic leaks occurred in six of 37 patients who had anterior resection with primary anastomosis, resulting in one early death. The presence of a proximal stoma did not influence the rate or seriousness of anastomotic dehiscence. After potentially curative TME in 45 patients, there have been eight local recurrences, four associated with systemic metastases and four which occurred in isolation (median follow-up 34 months). CONCLUSION: Curative TME was deemed appropriate in 59 per cent of unselected patients with rectal cancer. It was associated with few local recurrences but a morbidity rate that questions its role in treatment of upper third tumours.

Carcinomatous perforation of the sigmoid colon presenting as a thigh mass.

We report a patient presenting with a left psoas abscess causing necrotizing fasciitis of the upper thigh. The patient underwent exploration of the left thigh through a medial approach, confirming necrotizing fasciitis of the adductor compartment and the femoral triangle. The infective process also involved the left psoas. This was explored retroperitoneally through a left pararectal laparotomy incision. Further exploration revealed a carcinomatous ulcer of the sigmoid colon. Despite active resuscitation, antibiotic therapy, and further debridement, the patient died three days after admission.

Biopathologic characteristics of DNA content in crypt cells of transitional mucosa adjacent to carcinomas of the rectum and rectosigmoid.

The transitional mucosa (TM) adjacent to carcinomas of the large bowel shows histologic and mucin histochemical changes that may indicate premalignant change and may be of prognostic value after radical resection. In this study, 10 anterior resection specimens from patients with carcinomas of the rectum and rectosigmoid were used to compare the nuclear DNA content in TM with those in cancer tissue and with those in nontransitional mucosa (N-TM; i.e., uninvolved mucosa remote from tumors showing normal histologic and mucin histochemical features). The nuclear DNA content was assessed using DNA image cytometry on Feulgen-stained sections. As compared with N-TM, crypts in TM contained greater numbers of cells, were elongated, and were more likely to be branched with marked sialomucin secretion, accompanied by a marked reduction in the normal sulfomucin content. The mean nuclear DNA content in the upper, middle, and lower thirds of crypts was significantly higher in TM than in N-TM, and the nuclear DNA content in TM exhibited no correlation to that in tumors. The results suggest that TM adjacent to carcinomas of the rectum and rectosigmoid has higher proliferative activity, providing further evidence that TM may be an unstable premalignant change.

Symptoms of rectosigmoid carcinoma.

The presenting symptoms of 167 patients with carcinoma of the rectum, sigmoid, and rectosigmoid were reviewed. The earliest symptom was a change in bowel habits and the most frequent symptom was visible blood in the stool followed by a change in bowel habits. The duration of symptoms was not related to survival or the stage of tumor found during surgery.