Rectal cancer: early postoperative morbidity and mortality after radical resection Introduction: There has been progress in surgical treatment of rectal cancer (CR) in the past decade due to a better knowledge of the disease and the adoption of new methods of preoperative staging and treatment. The aim of this report is to analyze the early postoperative morbidity and mortality in a ten year series of patients with CR submitted to radical resection. Methods: In the database of colorectal cancer patients prospectively maintained, all patients with CR submitted to curative radical resection electively between January 2000 and December 2010 were identified. Early postoperative (30 day) morbidity and mortality were described and analyzed in a multivariate analysis to identify predictive factors. Results: A total of 308 patients were included, 55.2% male with a median age of 62 years. Over two thirds of tumors were located in the mid or lower rectum. Anterior resection was performed in 83.1%, and neoadyuvant radio-chemotherapy was used in 37.7%. Overall morbidity and mortality were 13.6% and 0.3% respectively. In multivariate analysis, American Society of Anesthesiologists had an or of 3.343 (1.601-6.982) for postoperative morbidity, and laparoscopic approach 0.188 (0.054-0.649). Conclusion: The morbidity rate of this series is similar to the one observed in other studies. The ASA score is an independent risk factor for postoperative complication and the laparoscopic approach would be a protective factor. In this series, preoperative chemoradiation was not a risk factor for postoperative morbidity.
Laparoscopic colorectal surgery in ChileThe development of laparoscopic colorectal surgery began 20 years ago; however it took several years before gaining its acceptance by the international surgical community. The fi rst report in Chile was published in 1995. However, were necessary many years, until the middle of this decade, to know the fi rst prospective series experiences. Out of these reports, no reliable data exist regarding the development of laparoscopic colorectal surgery in Chile, related to the number of centers performing laparoscopic colorectal surgery or the number of procedures performed. For record these data, a standardized questionnaire was send to colorectal chairmans of all hospitals that had reported to be developing laparoscopic colorectal surgery in our country. Ten of 15 hospitals responded to the survey. Most of the procedures performed were hemicolectomies, principally for cancer and diverticular disease. The average conversion rate was 7% and hospital stay was 5 days. Morbidity and mortality rates were 12% and 0.4% respectively. In the last year was seen an increase in the number of laparoscopic procedures in relation to the previous period. In conclusion, laparoscopic colorectal surgery is a recent technique in Chile, which is being implemented progressively, with good overall results. ResumenEl desarrollo de la cirugía laparoscópica colorrectal (CLCR) se inició en la década de los 90, sin embargo, pasaron varios años antes de lograr su aceptación por la comunidad quirúrgica internacional. En Chile, los primeros relatos en congresos datan del año 1995 y las primeras experiencias de series prospectivas fueron Rev.
Laparoscopic Resection in Stage III Rectal Cancer: Better than we expected?Introduction: Laparoscopic approach to management of rectal cancer (CR) has shown similar results compared to conventional technique. In some series, patients in stage III showed a better survival function in laparoscopic approach. The aim of this study is to compare disease specific survival (SE) and disease free survival (SLE) in patients with stage III rectal cancer treated with radical surgery via laparoscopy or laparotomy. Method: Historic cohort study, all stage III patients treated with elective radical surgery for CR in the period between August 2005 and May 2012 were included. Demographic, surgical specimens and survivor function for SE and SLE were compared. Results: A total of 51 patients were included, 29 laparoscopic and 22 open. The groups were similar in demographic data. Number of lymph nodes, compromised lymph nodes and distal margin distance was significantly higher in the open approach. The percentage of low lymph node count was 9.1% in the open group and 34.5% in the laparoscopic group (p = 0.03). SE estimated at 5 years was 50% and 80% in the open and laparoscopic approach respectively (p = 0.019). On multivariate analysis, laparoscopic approach was an independent factor for better SE and SLE. Tumor size was an independent risk factor for poor SLE. Conclusion: In our series, laparoscopic approach would be and independent factor for better survival in patients with stage III CR. Tumor size would be associated with poor SLE.
Exactitud de la endosonografía rectal en la estadifi cación tumoral en pacientes con cáncer de recto sin quimio-radioterapia preoperatoria* Drs. GONZALO AbstractAccuracy of endoscopic ultrasound in tumor staging of rectal cancer patients not treated with preoperative chemo-radiation Introduction: Preoperative T staging of rectal cancer is essential for an adequate treatment strategy. Endoscopic ultrasonography (EUS) is one of the available modalities. The reported accuracy of this technique for T staging is variable. This inconsistency might be due to neoadyuvancy, and its downstaging properties. Aim: Determine the accuracy of rectal EUS for T staging of middle and lower rectal tumors in patients not treated with neoadyuvant chemo-radiotherapy. Materials and Methods: Clinical records of all consecutive patients evaluated by rectal EUS between years 2001-2009 in the Catholic University Clinical Hospital were accessed. Of 2.120 patients, 294 had the exam performed for middle or lower rectal cancer. Those who did not receive neoadyuvant chemo-radiation and whose histopathology was available were analyzed. Result: Data was obtained for 69 patients. The overall accuracy of EUS for T staging was 85%. For T1 tumors, the sensibility, specifi city and accuracy were 82%, 96% and 94% respectively. For T2 tumors the sensibility, specifi city and accuracy were 72%, 83% and 78 respectively. For T3 tumors the sensibility, specifi city and accuracy were 82%, 83% and 83% respectively. Conclusion: Rectal EUS continues to be a valuable staging procedure for tumor depth invasion, with an overall accuracy of 85%.Key words: Endoscopic ultrasonography, rectal cancer, accuracy. ResumenIntroducción: La estadifi cación tumoral (T) preoperatoria es esencial para el tratamiento del cáncer de recto. La endosonografía rectal (ER) es una de las modalidades disponibles. La exactitud de esta técnica para la estadifi cación tumoral es variable en la literatura, y se sospecha que esta inconsistencia se debe a la neoadyuvancia, por el descenso de estadio que esta produce. Objetivo: Analizar la exactitud de la endoso- Los autores no refi eren confl ictos de interés.
giant fecaloma in an adolescent patient *Recibido el 2 de octubre de 2013 y aceptado para publicación el 28 de diciembre de 2013. Los autores no refieren conflictos de interés.
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