RESUMO
PURPOSE: Anal bleeding is a frequent complaint in the coloproctological practice. Although usually associated with common anorectal disorders, it may represent a sign of an occult colorectal carcinoma. Our purpose was to evaluate the accuracy of the colonoscopy for detection of neoplastic lesions in patients under 50 years of age with rectal bleeding. METHODS: This systematic review and meta-analysis searched publications in PubMed, Web of Science, and Cochrane Library databases up to August, 2023. Cross-sectional and case-control studies including patients under 50 years with rectal bleeding evaluated by colonoscopy were included. Primary outcome was prevalence of neoplastic lesions (adenomas and adenocarcinomas). Secondary outcomes were prevalence of those lesions according to age and anatomic location. The study was registered on PROSPERO (CRD42021257859) on July 5, 2021. RESULTS: Nine studies comprising 4162 patients were analyzed. A total of 398 patients with adenomas and 40 patients with adenocarcinoma were identified. Prevalence of neoplastic lesions (adenomas and carcinomas) was 10%. In patients under 40 years, the prevalence of neoplastic lesions was 7% (6% of adenomas, 1% of carcinomas). Among patients aged 40-50 years the prevalence was 15%, 14%, and 1%, respectively. Most lesions (71%) were located distally to splenic flexure. CONCLUSION: About 10% of patients under 50 years with anal bleeding will have a neoplastic lesion detected through colonoscopy. The greatest benefit of the procedure is observed between 40 and 50 years. Almost 30% of the neoplastic lesions were found in the proximal colon and could not be detected without the performance of a complete colonoscopy.
Assuntos
Adenocarcinoma , Carcinoma , Humanos , Pessoa de Meia-Idade , Estudos Transversais , Colonoscopia , Colo , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologiaRESUMO
BACKGROUND: although preservation of bowel continuity is a major goal in rectal cancer surgery, a colorectal anastomosis may be considered an unacceptably high-risk procedure, particularly for patients with multiple comorbidities. We aimed to assess rates of surgical complications in rectal cancer patients according to the type of procedure they had undergone. MATERIALS AND METHODS: this cohort included all rectal cancer patients undergoing elective resection at a referral academic hospital over 16 years. There were three study groups according to the type of performed operation: (1) rectal resection with anastomosis without defunctioning stoma (DS); (2) rectal resection with anastomosis and DS; and (3) Hartmann's procedure (HP). Postoperative complications and clinical outcomes were assessed. RESULTS: four-hundred and two patients were studied. The 118 patients in group 3 were significantly older (>10 years), had higher Charlson Comorbidity Index scores, and more ASA class ≥3 than patients in the other two groups. Sixty-seven patients (16.7%) had Clavien-Dindo complications grade ≥ III, corresponding to an incidence of 11.8%, 20.9%, and 14.4% in groups 1, 2, and 3, respectively (p=0.10). Twenty-nine patients (7.2%) had major septic complications that required reoperation, with an incidence of 10.8%, 8.2% and 2.5% in groups 1, 2 and 3, respectively (p=0.048). Twenty-one percent of the group 2 patients did not undergo the stoma closure after a 24-month follow-up. CONCLUSION: HP was associated with a lower incidence of reoperation due to intra-abdominal septic complications. This procedure remains an option for patients in whom serious surgical complications are anticipated.
Assuntos
Colostomia , Neoplasias Retais , Anastomose Cirúrgica , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/cirurgia , Reto/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
ABSTRACT Background: although preservation of bowel continuity is a major goal in rectal cancer surgery, a colorectal anastomosis may be considered an unacceptably high-risk procedure, particularly for patients with multiple comorbidities. We aimed to assess rates of surgical complications in rectal cancer patients according to the type of procedure they had undergone. Materials and Methods: this cohort included all rectal cancer patients undergoing elective resection at a referral academic hospital over 16 years. There were three study groups according to the type of performed operation: (1) rectal resection with anastomosis without defunctioning stoma (DS); (2) rectal resection with anastomosis and DS; and (3) Hartmann's procedure (HP). Postoperative complications and clinical outcomes were assessed. Results: four-hundred and two patients were studied. The 118 patients in group 3 were significantly older (>10 years), had higher Charlson Comorbidity Index scores, and more ASA class ≥3 than patients in the other two groups. Sixty-seven patients (16.7%) had Clavien-Dindo complications grade ≥ III, corresponding to an incidence of 11.8%, 20.9%, and 14.4% in groups 1, 2, and 3, respectively (p=0.10). Twenty-nine patients (7.2%) had major septic complications that required reoperation, with an incidence of 10.8%, 8.2% and 2.5% in groups 1, 2 and 3, respectively (p=0.048). Twenty-one percent of the group 2 patients did not undergo the stoma closure after a 24-month follow-up. Conclusion: HP was associated with a lower incidence of reoperation due to intra-abdominal septic complications. This procedure remains an option for patients in whom serious surgical complications are anticipated.
RESUMO Introdução: embora a preservação do trânsito intestinal seja um dos objetivos principais na cirurgia do câncer retal, a anastomose colorretal pode ser considerada um procedimento de altíssimo risco, particularmente para pacientes com múltiplas comorbidades. Nosso objetivo foi avaliar as taxas de complicações cirúrgicas em pacientes com câncer retal de acordo com o tipo de procedimento a que foram submetidos. Materiais e Métodos: esta coorte incluiu todos os pacientes com câncer retal submetidos a ressecção eletiva em hospital universitário de referência ao longo de 16 anos. Houve três grupos de estudo de acordo com o tipo de operação realizada: (1) ressecção retal com anastomose, sem estoma desfuncionalizante (ED); (2) ressecção retal com anastomose e ED; e (3) procedimento de Hartmann (PH). Avaliamos as complicações pós-operatórias e os resultados clínicos. Resultados: estudamos 402 pacientes. O grupo 3 tinha 118 pacientes, estes sendo significativamente mais idosos (>10 anos), com pontuações mais altas no Índice de Comorbidade de Charlson e mais frequentemente classificados como ASA ≥ 3 do que os pacientes dos outros dois grupos. Sessenta e sete pacientes (16,7%) apresentaram complicações de Clavien-Dindo grau ≥ III, correspondendo à incidência de 11,8%, 20,9% e 14,4% nos grupos 1, 2 e 3, respectivamente (p = 0,10). Vinte e nove pacientes (7,2%) apresentaram complicações sépticas graves, necessitando reoperação, com incidência de 10,8%, 8,2% e 2,5% nos grupos 1, 2 e 3, respectivamente (p = 0,048). Vinte e um por cento dos pacientes do grupo 2 não foram submetidos ao fechamento do estoma após acompanhamento de 24 meses. Conclusão: o PH foi associado à menor incidência de reoperação por complicações sépticas intra-abdominais. Este procedimento continua sendo uma opção para pacientes com alto potencial de desenvolver complicações cirúrgicas graves.
Assuntos
Humanos , Neoplasias Retais/cirurgia , Colostomia , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reto/cirurgia , Reoperação , Anastomose Cirúrgica , Estudos Retrospectivos , Estudos de Coortes , Resultado do Tratamento , Procedimentos Cirúrgicos EletivosAssuntos
Colonoscopia/métodos , Balão Gástrico , Doenças do Íleo/cirurgia , Obstrução Intestinal , Obesidade Mórbida , Adulto , Feminino , Balão Gástrico/efeitos adversos , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Obesidade Mórbida/cirurgia , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentaçãoRESUMO
BACKGROUND AND AIM: There is no consensus whether a colonoscopy should be recommended for patients under 50 years of age who present with both anal bleeding and benign anal diseases. The aim of this study is to evaluate the effectiveness of colonoscopy to detect neoplastic lesions in this specific group of patients. METHODS: A prospective study analyzing the results of colonoscopies performed in patients younger than 50 years of age who reported a rectal bleeding and also had a diagnosis of benign anal disease at first clinical visit. RESULTS: One hundred and eighty-seven consecutive patients were prospectively included in this study. In 35 patients (18.7%), adenomatous polyps were diagnosed. Thirty-seven percent of those lesions (13 cases) were further classified as either advanced adenomas or serrated adenomas. The prevalence of adenomas was 14.6% among patients under the age of 40 and 20% among those between 40 and 50 years of age. Thirty-one percent of the adenomas (11 cases) were located in the right colon, without any other concomitant lesion in the distal colon. In addition, an unsuspected case of sigmoid carcinoma was diagnosed. CONCLUSION: The performance of colonoscopy in young patients with benign anal diseases and hematochezia resulted in a high rate of detection of neoplastic lesions. The method might be considered as a valid strategy of investigation in this frequent clinical situation.
Assuntos
Pólipos Adenomatosos/patologia , Doenças do Ânus/patologia , Pólipos do Colo/patologia , Colonoscopia , Neoplasias Colorretais/patologia , Hemorragia Gastrointestinal/epidemiologia , Pólipos Adenomatosos/epidemiologia , Adulto , Fatores Etários , Doenças do Ânus/epidemiologia , Brasil/epidemiologia , Tomada de Decisão Clínica , Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de RiscoRESUMO
OBJECTIVE: to evaluate the influence of the splenic flexure mobilization for the main surgical outcomes of patients submitted to resection of sigmoid and rectal cancer. METHODS: we searched the MEDLINE, Cochrane Central Register of Controlled Trials and LILACS, using the terms "splenic flexure mobilization", "colorectal surgery", "rectal cancer", "anterior resection", "sigmoid colon cancer", and "sigmoid resection". The main outcome was anastomotic dehiscence. Other outcomes analyzed were mortality, bleeding, infection and general complications. We estimated the effect sizes by grouping data from six case-control studies (1,433 patients) published until January 2018. RESULTS: our meta-analysis showed that patients undergoing complete mobilization of the splenic flexure had a higher risk of anastomotic dehiscence (RR=2.27, 95%CI: 1.22-4.23) compared with those not submitted to this procedure. There was no difference between the groups in terms of mortality, bleeding, infection and general complications. CONCLUSION: splenic flexure mobilization is associated with a higher risk of anastomotic dehiscence in resections of sigmoid and rectal cancer. This surgical maneuver should be used with caution in the surgical management of sigmoid or rectal cancers.
OBJETIVO: avaliar a influência da mobilização da flexura esplênica nos principais resultados cirúrgicos de pacientes submetidos à ressecção de câncer do cólon sigmoide ou reto. MÉTODOS: os bancos de dados MEDLINE, Cochrane Central Register de Ensaios Controlados e LILACS foram pesquisados usando os termos "mobilização da flexura esplênica", "cirurgia colorretal", "câncer retal", "ressecção anterior", "câncer de cólon sigmoide", "ressecção de sigmoide". O desfecho principal foi a deiscência da anastomose. Outros desfechos analisados foram mortalidade, sangramento, infecção e complicações gerais. Os tamanhos dos efeitos foram estimados por meio do agrupamento dos dados de seis estudos de caso-controle (1.433 pacientes) publicados até janeiro de 2018. RESULTADOS: nossa meta-análise revelou que pacientes submetidos à mobilização completa da flexura esplênica tinham um risco maior de deiscência anastomótica (RR=2,27, IC95%: 1,22-4,23) em comparação àqueles não submetidos a esse procedimento. Nenhuma diferença pôde ser demonstrada entre os grupos em termos de mortalidade, sangramento, infecção e complicações gerais. CONCLUSÃO: a mobilização da flexura esplênica está associada a um maior risco de deiscência anastomótica nas ressecções de câncer de reto ou cólon sigmoide. Esta manobra cirúrgica deve ser utilizada com cautela no manejo cirúrgico dos tumores colorretais.
Assuntos
Colectomia/métodos , Protectomia/métodos , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Colectomia/efeitos adversos , Humanos , Complicações Pós-Operatórias , Protectomia/efeitos adversos , Resultado do TratamentoRESUMO
RESUMO Objetivo: avaliar a influência da mobilização da flexura esplênica nos principais resultados cirúrgicos de pacientes submetidos à ressecção de câncer do cólon sigmoide ou reto. Métodos: os bancos de dados MEDLINE, Cochrane Central Register de Ensaios Controlados e LILACS foram pesquisados usando os termos "mobilização da flexura esplênica", "cirurgia colorretal", "câncer retal", "ressecção anterior", "câncer de cólon sigmoide", "ressecção de sigmoide". O desfecho principal foi a deiscência da anastomose. Outros desfechos analisados foram mortalidade, sangramento, infecção e complicações gerais. Os tamanhos dos efeitos foram estimados por meio do agrupamento dos dados de seis estudos de caso-controle (1.433 pacientes) publicados até janeiro de 2018. Resultados: nossa meta-análise revelou que pacientes submetidos à mobilização completa da flexura esplênica tinham um risco maior de deiscência anastomótica (RR=2,27, IC95%: 1,22-4,23) em comparação àqueles não submetidos a esse procedimento. Nenhuma diferença pôde ser demonstrada entre os grupos em termos de mortalidade, sangramento, infecção e complicações gerais. Conclusão: a mobilização da flexura esplênica está associada a um maior risco de deiscência anastomótica nas ressecções de câncer de reto ou cólon sigmoide. Esta manobra cirúrgica deve ser utilizada com cautela no manejo cirúrgico dos tumores colorretais.
ABSTRACT Objective: to evaluate the influence of the splenic flexure mobilization for the main surgical outcomes of patients submitted to resection of sigmoid and rectal cancer. Methods: we searched the MEDLINE, Cochrane Central Register of Controlled Trials and LILACS, using the terms "splenic flexure mobilization", "colorectal surgery", "rectal cancer", "anterior resection", "sigmoid colon cancer", and "sigmoid resection". The main outcome was anastomotic dehiscence. Other outcomes analyzed were mortality, bleeding, infection and general complications. We estimated the effect sizes by grouping data from six case-control studies (1,433 patients) published until January 2018. Results: our meta-analysis showed that patients undergoing complete mobilization of the splenic flexure had a higher risk of anastomotic dehiscence (RR=2.27, 95%CI: 1.22-4.23) compared with those not submitted to this procedure. There was no difference between the groups in terms of mortality, bleeding, infection and general complications. Conclusion: splenic flexure mobilization is associated with a higher risk of anastomotic dehiscence in resections of sigmoid and rectal cancer. This surgical maneuver should be used with caution in the surgical management of sigmoid or rectal cancers.
Assuntos
Humanos , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Colectomia/métodos , Protectomia/métodos , Complicações Pós-Operatórias , Resultado do Tratamento , Colectomia/efeitos adversos , Protectomia/efeitos adversosRESUMO
BACKGROUND: This study aimed to evaluate the outcomes of 67 patients who underwent revisional bariatric surgeries over a 29-year period in a Brazilian public hospital. METHODS: The records of all patients who underwent revisional bariatric surgery from January 1987 to December of 2016 at our hospital were analyzed for weight loss and complications. Descriptive statistics and paired t tests were computed. RESULTS: Sixty-seven patients were included in the study. The primary surgeries previously performed on these patients were biliopancreatic diversion with duodenal switch (BPD-DS) (37 cases, 55.2%), jejunoileal bypass (JIB) (24 cases, 35.8%), sleeve gastrectomy (4 cases, 5.9%), Roux-en-Y gastric bypass (RYGB) (1 case, 1.5%), and laparoscopic adjustable gastric band (1 case, 1.5%). The indications for revisional surgery were as follows: malnutrition in 29 cases (43.3%), failure to lose weight in 27 cases (40.3%), weight regain in 5 cases (7.5%), and untreatable diarrhea in 6 cases (9.2%). Most revisional surgeries were performed using JIB or BPD-DS. Operative mortality was higher after the revisional procedures compared with that following the primary bariatric surgeries. CONCLUSIONS: Most patients requiring a revisional surgery had undergone a primary BPD-DS or JIB. Severe and untreatable malnutrition and diarrhea were the main indications for the revisional procedures. RYGB produced significant and sustainable weight loss and exhibited a low risk of malnutrition or requiring revisional surgery.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Síndromes de Malabsorção/cirurgia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Desvio Biliopancreático/efeitos adversos , Desvio Biliopancreático/métodos , Desvio Biliopancreático/estatística & dados numéricos , Brasil/epidemiologia , Comorbidade , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Derivação Gástrica/estatística & dados numéricos , Hospitais Públicos , Humanos , Derivação Jejunoileal/efeitos adversos , Derivação Jejunoileal/métodos , Derivação Jejunoileal/estatística & dados numéricos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/etiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Reoperação/métodos , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Redução de PesoRESUMO
BACKGROUND: Bariatric surgery has been investigated as a treatment option for obese patients with nonalcoholic fatty liver disease (NAFLD). Because patients with NAFLD and type 2 diabetes show accelerated progression from liver disease to cirrhosis, it has been suggested that surgery could be indicated for patients with lower degrees of obesity and type 2 diabetes. OBJECTIVE: To analyze the degree of tissue damage in liver biopsies obtained from patients undergoing bariatric surgery, correlating histopathologic findings with their baseline glucose status. SETTING: General hospital in the public health system. METHODS: Intraoperative liver biopsies were obtained from 521 obese patients undergoing bariatric surgery. Patients were divided into 3 study groups according to their preoperative glucose levels: 167 (32.05%) type 2 diabetic, 132 (25.33%) prediabetic, and 222 (42.61%) normoglycemic patients. Tissue samples were classified in accordance with Brunt and Clinical Research Network Nonalcoholic Steatohepatis criteria. RESULTS: Prevalence of NAFLD was 95%. Higher rates of hepatic fibrosis were observed in diabetic patients (56.4%) compared with prediabetic (29.2%), and normoglycemic patients (28.6%) (P<.001). Nonalcoholic steatohepatitis was diagnosed in 59.4% of the diabetics, in 49.2% of the prediabetics, and in 36% of the normoglycemic obese (P<.001). Only 1.5% of the diabetics had no histologic hepatic alterations. CONCLUSION: NAFLD is markedly more severe in diabetic patients. Our data suggest that intraoperative liver biopsy should be considered for diabetic patients undergoing bariatric surgery. Early bariatric surgery should be investigated as a means to prevent progression of NAFLD.