RESUMO
INTRODUCTION: One of the topics that show differences of opinion in the scientific field of nutrition is the recommendation by clinical practice guidelines (CPGs) of an immunomodulatory diet with arginine, nucleotides and omega-3 for individuals diagnosed with cancer undergoing major surgery. The quality of the recommendations is directly related to credibility, transparency and rigour in their development, but also to the quality of the studies published and available for inclusion in the recommendation, such as systematic reviews (SRs) and randomised clinical trials. The aim of this study is to evaluate the methodological quality of the recommendation of perioperative immunomodulatory supplementation for individuals with gastrointestinal and head and neck cancer, the CPGs, and the studies that support the recommendations. METHODS AND ANALYSIS: We will conduct a systematic search for CPGs. Recommendations for nutritional supplementation with immunomodulatory substrates for individuals undergoing major oncological surgery will be analysed using the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence tool. CPGs will be analysed using the Appraisal of Guidelines Research and Evaluation II tool. The SRs cited in the recommendations will be analysed using the A Measurement Tool to Assess Systematic Reviews II tool and additional questions regarding heterogeneity in reviews. The clinical trials cited in the SRs and in the guideline recommendations (when applicable) will be analysed according to questions regarding heterogeneity in trials. The results will be presented in tables or charts using descriptive analyses. ETHICS AND DISSEMINATION: The results of this study will be disseminated through relevant conferences and peer-reviewed journals. PROTOCOL REGISTRATION NUMBER: 10.17605/OSF.IO/X2GYT.
Assuntos
Suplementos Nutricionais , Neoplasias Gastrointestinais , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Humanos , Neoplasias Gastrointestinais/cirurgia , Suplementos Nutricionais/normas , Projetos de Pesquisa/normas , Guias de Prática Clínica como Assunto , Metanálise como Assunto , Assistência Perioperatória/normas , Assistência Perioperatória/métodos , Ácidos Graxos Ômega-3/uso terapêutico , Ácidos Graxos Ômega-3/administração & dosagem , Arginina/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório/normasRESUMO
BACKGROUND: There is a well known relationship between hypoperfusion and postoperative complications like anastomotic leak. No studies have been done addressing this relationship in the context of abdominal trauma surgery. Central venous oxygen saturation is an important hypoperfusion marker of potential use in abdominal trauma surgery for identifying the risk of anastomotic leak development. The purpose of this study was to identify the relationship between low values of central venous oxygen saturation and anastomotic leak of gastrointestinal sutures in the postoperative period in abdominal trauma surgery. METHODS: A cross-sectional prospective study was performed. Patients over 14 years old who required surgical gastrointestinal repair secondary to abdominal trauma were included. Anastomotic leak diagnosis was confirmed through clinical manifestations and diagnostic images or secondary surgery when needed. Central venous oxygen blood saturation was measured at the beginning of surgery through a central catheter. Demographic data, trauma mechanism, anatomic site of trauma, hemoglobin levels, abdominal trauma index, and comorbidities were assessed as secondary variables. RESULTS: Patients who developed anastomotic leak showed lower mean central venous oxygen saturation levels (60.0% ± 2.94%) than those who did not (69.89% ± 7.21%) (p = 0.010). CONCLUSIONS: Central venous oxygen saturation <65% was associated with the development of gastrointestinal leak during postoperative time of patients who underwent surgery secondary to abdominal trauma.
Assuntos
Traumatismos Abdominais/complicações , Fístula Anastomótica/etiologia , Oximetria/estatística & dados numéricos , Traumatismos Abdominais/cirurgia , Adulto , Fístula Anastomótica/cirurgia , Gasometria/métodos , Estudos de Casos e Controles , Cateterismo Venoso Central/métodos , Estudos Transversais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria/métodos , Oxigênio/sangue , Oxigênio/metabolismo , Oxigênio/uso terapêutico , Estudos Prospectivos , Pesquisa Qualitativa , Ferimentos e Lesões/complicações , Ferimentos e Lesões/cirurgiaRESUMO
There is mounting evidence, derived from mechanistic studies, RCTs, and other high-quality studies that there are weight loss independent antidiabetic effects of gastrointestinal surgery. Additionally, there appears to be no relation between the positive metabolic outcomes to baseline BMI. The outdated US National Health Institutes guidelines from 1991 were centered on BMI only criterion and often misleading. The Second Diabetes Surgery Summit held in collaboration with leading diabetes organizations and endorsed by a large group of international Professional Societies developed guidelines that defined eligibility based on the severity and degree of T2D medical control while referring to obesity as a qualifier and not the sole criterion. That is the first time that guidelines are provided to put metabolic surgery into the T2D treatment algorithms.
Assuntos
Cirurgia Bariátrica/normas , Diabetes Mellitus Tipo 2/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/normas , Guias de Prática Clínica como Assunto , Consenso , Diabetes Mellitus Tipo 2/complicações , Humanos , Londres , Obesidade/classificação , Obesidade/complicações , Obesidade/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Sociedades Médicas/organização & administração , Sociedades Médicas/normasRESUMO
Colorectal cancer (CRC) is the most common malignant tumor in Western countries. Despite efforts made to implement screening programmes for early detection and treatment, still half of the patients present or will eventually develop distant metastasis. Management of advanced CRC should be discussed within an experienced multidisciplinary team, to adequately select the most appropriate systemic therapeutic option, as well as the optimal way to integrate it with surgical procedures when indicated. Disease localization and extent, resectability of primary and metastatic disease, tumor biology and dynamics, clinical symptoms, personal preferences and patient's ability to tolerate intensive chemotherapy or extensive surgical procedures are the key factors to properly design a customized treatment plan. The aim of the current manuscript is to provide synthetic practical guidelines regarding therapeutic options for advanced CRC.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Neoplasias Colorretais/diagnóstico , Procedimentos Cirúrgicos do Sistema Digestório/normas , Progressão da Doença , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metástase Neoplásica , Estadiamento de Neoplasias/normasRESUMO
We analyzed the Mexican legal framework, identifying the vectors that characterize quality and control in gastrointestinal surgery. Quality is contemplated in the health protection rights determined according to the Mexican Constitution, established in the general health law and included as a specific goal in the actual National Development Plan and Health Sector Plan. Quality control implies planning, verification and application of corrective measures. Mexico has implemented several quality strategies such as certification of hospitals and regulatory agreements by the General Salubrity Council, creation of the National Health Quality Committee, generation of Clinical Practice Guidelines and the Certification of Medical Specialties, among others. Quality control in gastrointestinal surgery must begin at the time of medical education and continue during professional activities of surgeons, encouraging multidisciplinary teamwork, knowledge, abilities, attitudes, values and skills that promote homogeneous, safe and quality health services for the Mexican population.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Controle de Qualidade , Cirurgia Bariátrica/legislação & jurisprudência , Cirurgia Bariátrica/normas , Certificação/legislação & jurisprudência , Procedimentos Cirúrgicos do Sistema Digestório/normas , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Órgãos Governamentais/organização & administração , Planejamento em Saúde , Hospitais/normas , Humanos , México , Política Pública/legislação & jurisprudênciaRESUMO
Surgery for rectal cancer continues to develop towards improving local control and overall survival, maintaining quality of life and preserving sphincter, genitourinary and sexual function. The multidisciplinary approach integrated in a team of different specialists ensures an individualised treatment for each patient with rectal cancer. Thus, the role of the pathologist has acquired an important relevance, not only in diagnosis, management and evaluation of the surgical specimen, but also for selection of the best adjuvant treatment. Parameters such as macroscopic quality of the mesorectum, status of the circumferential margin and lymph node harvest are considered basic criteria by current guidelines. Additionally, consistency in reporting based on the histologic classification proposed by the World Health Organization (WHO) is mandatory, along with inclusion into the pathologic report of current criteria for tumour node metastasis (TNM) staging, assessment of response to neoadjuvant chemoradiation therapy and clinically relevant molecular studies. Detection of defects in mismatch repair genes and mutational analysis of specific genes should be included as predictive markers for therapy.
Assuntos
Carcinoma , Procedimentos Cirúrgicos do Sistema Digestório/normas , Estadiamento de Neoplasias/normas , Neoplasias Retais , Carcinoma/diagnóstico , Carcinoma/patologia , Carcinoma/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Humanos , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias/tendências , Controle de Qualidade , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Padrões de ReferênciaRESUMO
Since the introduction of the total mesorectal excision by Heald, many changes in the therapeutic management of rectal cancer have been incorporated. The multidisciplinary approach to colorectal cancer, integrated in a team of different specialists, ensures individualised treatment for each patient with rectal cancer. Therefore the role of the pathologist has acquired an important relevance, not only in diagnosing but also managing and evaluating the surgical specimen. The knowledge of preoperative staging, distance between tumour and anal verge or in patients subjected to a neoadjuvant treatment is necessary for the pathologist to make a detailed, accurate and good-quality report. Parameters such as the macroscopic quality of the mesorectum, the status of the circumferential resection margin and the lymph node harvest are considered basic criteria recommended by the current guidelines for the multidisciplinary team audit.
Assuntos
Carcinoma/diagnóstico , Procedimentos Cirúrgicos do Sistema Digestório/normas , Estadiamento de Neoplasias/métodos , Patologia Clínica , Papel Profissional , Neoplasias Retais/diagnóstico , Carcinoma/patologia , Carcinoma/cirurgia , Humanos , Cuidados Pré-Operatórios/métodos , Prognóstico , Controle de Qualidade , Neoplasias Retais/patologia , Neoplasias Retais/cirurgiaRESUMO
CONTEXT AND OBJECTIVE: Most bariatric surgical techniques include essentially non-physiological features like narrowing anastomoses or bands, or digestive segment exclusion, especially the duodenum. This potentially causes symptoms or complications. The aim here was to report on the preliminary results from a new surgical technique for treating morbid obesity that takes a physiological and evolutionary approach. DESIGN AND SETTING: Case series description, in Hospital Israelita Albert Einstein and Hospital da Polícia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná. METHODS: The technique included vertical (sleeve) gastrectomy, omentectomy and enterectomy that retained three meters of small bowel (initial jejunum and most of the ileum), i.e. the lower limit for normal adults. The operations on 100 patients are described. RESULTS: The mean follow-up was nine months (range: one to 29 months). The mean reductions in body mass index were 4.3, 6.1, 8.1, 10.1 and 10.7 kg/m², respectively at 1, 2, 4, 6 and 12 months. All patients reported early satiety. There was major improvement in comorbidities, especially diabetes. Operative complications occurred in 7 percent of patients, all of them resolved without sequelae. There was no mortality. CONCLUSIONS: This procedure creates a proportionally reduced gastrointestinal tract, leaving its basic functions unharmed and producing adaptation of the gastric chamber size to hypercaloric diet. It removes the sources of ghrelin, plasminogen activator inhibitor-1 (PAI-1) and resistin production and leads more nutrients to the distal bowel, with desirable metabolic consequences. Patients do not need nutritional support or drug medication. The procedure is straightforward and safe.
CONTEXTO E OBJETIVO: A maioria das técnicas de cirurgia bariátrica inclui anastomoses ou bandas ou exclusões de segmentos digestivos, principalmente o duodeno, que podem gerar sintomas ou complicações. O objetivo do estudo foi apresentar os resultados dos dois primeiros anos de uso de uma nova técnica no tratamento cirúrgico da obesidade: gastrectomia vertical com omentectomia e enterectomia segmentar. TIPO DE ESTUDO E LOCAL: Descrição de série de casos operados no Hospital Israelita Albert Einstein, Hospital da Polícia Militar, São Paulo, e Hospital Vicentino, Ponta Grossa, Paraná, Brazil. MÉTODO: A técnica utiliza a gastrectomia vertical, omentectomia maior e enterectomia segmentar (incluindo jejuno basicamente) que deixa três metros de intestino delgado (jejuno inicial e a maior parte do íleo), em comprimento no limite inferior do que se considera normal para humanos adultos. Os 100 primeiros pacientes são descritos. RESULTADOS: Com acompanhamento de até 29 meses pós-operatórios (média de oito meses) a redução no índice de massa corpórea foi de 4.3, 6.1, 8.1, 10.1, 10.7 kg/m², respectivamente nos meses 1, 2, 4, 6 e 12 de pós-operatório. Todos os pacientes acusam saciedade precoce. Houve melhora acentuada das doenças associadas em especial a diabetes. Complicações cirúrgicas ocorreram em 7 por cento dos pacientes todas resolvidas sem seqüelas. Não houve óbitos. CONCLUSÕES: O procedimento cria um trato gastrointestinal proporcionalmente reduzido, mas com suas funções digestivas intactas. O procedimento retira fontes de produção de grelina, inibidor do ativador do plasminogênio-1 (PAI-1), resistina e permite que mais nutrientes sejam absorvidos no intestino distal, com as desejáveis conseqüências metabólicas. Os pacientes não precisam de suporte nutricional ou de medicações. O procedimento é fácil e seguro.