Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10–27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial.
The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer.
A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission).
In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors.
This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.
Colon cancer is the third most common malignancy in Colombia, only exceeded by prostate and breast cancers. It is the second most common cancer among females and the third most common among males. The epidemiology of this disease has changed in Colombia, and its peak incidence has now surpassed that of gastric cancer.
We aimed to determine the association between hospital surgical volume and mortality in patients with colon cancer undergoing surgical resection in Colombia.
This was a national retrospective cohort study based on administrative data and included adult patients undergoing surgical resection for colon cancer who were enrolled in Colombia’s contributory health system between 2012 and 2017. We defined exposure as the hospital’s surgical volume where the colon cancer surgery was performed. We classified the patients as exposed to a high surgical volume (above the 90th percentile of the provider distribution) and a low surgical volume (under the 90th percentile). The main outcomes were 30-day and 1-year mortality. Multivariate Poisson regressions were used to identify the association between exposure and mortality rates.
The study included 4,647 patients, of which 4,188 underwent surgery at hospitals with a colectomy volume lower than 33 per year and 459 underwent surgery at institutions with volumes equal to or higher than 33 per year. In the multivariate analysis, after adjusting for observable variables, a lower risk of 30-day mortality was found in patients who underwent surgery at high surgical volume institutions (relative risk - RR 0.57, 95% confidence interval - 95%CI 0.033-0.97). No differences were found in the one-year mortality.
The high surgical volume of a hospital is associated with a 30-day mortality in colon cancer, as described in other studies, but the 1-year mortality did not show this association. Prospective studies are required to establish a causal relationship.
The coronavirus disease 2019 (COVID-19) pandemic was identified in Brazil in February 2020. The first Brazilian case was reported on February 25, 20204, and since then, the number of cases increased dramatically, placing Brazil among the countries with the largest number of infected patients and the largest number of deaths from the new coronavirus (>600,000) (4)
A total of 3,000 patients with moderate or severe COVID-19 were admitted to the Hospital de Clinicas of the School of Medicine of the University of São Paulo for in-hospital treatment. Following the recommendations of its infection committee and the main medical societies, all nononcological elective surgeries were suspended.
From 2008 to 2018, the Cancer Institute performed over 8,500 surgeries for colorectal cancer. In this new scenario, although the number of surgeries was reduced to avoid including contaminated patients, some procedures cannot be canceled or postponed; this is especially the case for procedures performed at the Cancer Institute, given the need for continued oncological treatment in both elective and urgent cases. A contingency plan was, therefore, established to allow us to proceed with surgeries that cannot wait due to the risk of disease progression and worsening of the prognosis.
Three patients with colorectal cancer underwent elective (one patient) or urgent (two patients) surgical treatment in April 2020, and they were diagnosed with COVID-19 only during the postoperative period.
3D-CT angiography has made it possible to reach a qualitatively new level in the determination of treatment tactics for patients with colorectal cancer.
This study aimed to analyze the clinical and radiological aspects that need to be discussed before surgery by a multidisciplinary team in patients with right-sided colon cancer.
This study involved 103 patients with colorectal cancer who underwent preoperative 3D-CT angiography from 2016 to 2021
All patients underwent radical D3 right hemicolectomy. The median quantity of removal lymph nodes were 24.71±10.04. Anastomotic leakage was diagnosed in one patient. We have identified eight most common types of superior mesenteric artery. The ileocolic artery crossed the superior mesenteric vein on the anterior surface in 64 (62.1%) patients and on the posterior surface in 39 (37.9%). In 58 (56.3%) patients, the right colic artery was either absent or was a nonindependent branch of superior mesenteric artery. The distance from the root of the superior mesenteric artery to the root of the middle colic artery was 37.8±12.8 mm and that from the root of the middle colic artery to the root of the ileocolic artery was 29.5±15.7 mm. The trunk of Henle was above the root of the middle colic artery in 66 (64.1%) patients, at the same level with the middle colic artery in 16 (15.5%), and below the middle colic artery in 18 (17.5%) patients.
Preoperative analysis of 3D-CT angiography is a key pattern in assessment of vascular anatomy and can potentially show the complexity of future lymphadenectomy and reduce the risk of anastomotic leakage.
Large number of surgical services use laparoscopy to approach the colon. One of the concerns on the resection using this way is the high rate of cancer relapse at in- and outlet site of the surgical instruments.
To describe a protective device for surgical isolation in laparoscopic colectomy.
The device is made of sterile polyethylene plastic cover used to protect the fiber optic cable in laparoscopic surgery and one 20 Fr. urethral catheter working as a conduit.
The device was used in six laparoscopic colectomies, three for adenocarcinoma of the colon and three for intestinal endometriosis. It was effective to avoid contact of the specimen with the abdominal wall, in order to reduce the risk of implantation of cancer or endometriotic cells and surgical site infection. The device was made intraoperative at all surgeries and allowed good visualization in laparoscopy and maintenance of the pneumoperitoneum. It cost R$ 22,00 (approximately US$ 10), R$14.50 related to the plastic cover and R$7.50, the urethral tube. The production time of the device and its installation in the abdominal cavity was measured in each procedure and was, on average, respectively, of 66 s and 25 s.
The device proved to be feasible, not requiring any special training and can be performed by the surgical team itself, even at institutions with limited resources.
The colorectal neoplasm is the fourth most common malignancy among males and the third among females. In the Western world is estimated that 5% of the population will develop it, making this disease a major public health problem.
To analyze the prevalence of the polymorphism -765G / C region of the COX-2 gene in colorectal cancer patients compared to a control group, analyzing the possible association between this polymorphism and susceptibility to colorectal cancer.
This is a case-control study with 85 participants. Were selected 25 with colorectal cancer (case group) and 60 participants without colorectal neoplasia (control group). The molecular genetic analysis was perform to identify the polymorphism -765G / C COX2 gene with standard literature technique. In addition, patient’s clinical and pathological data were analyzed.
There was a light increase in prevalence between men in the case group, although this difference was not statistically significant. The results showed a high prevalence of GC and CC genotype in individuals with colorectal cancer, demonstrating an association between the presence of the polymorphism in the COX2 gene and susceptibility to colorectal cancer in this pattern (p=0.02). Similarly, there was also difference in allele frequencies in the groups. When patients with cancer were separated by tumor location, there was a higher prevalence of polymorphism in the left colon (p=0.02).
The polymorphism in the COX2 gene is associated with increased susceptibility to colorectal cancer, specially rectosigmoid tumors.
Colorectal cancer is the third most common cancer in the world. In Brazil, it is the leading cause of cancer in the gastrointestinal tract.
To evaluate the preoperative, perioperative, and postoperative risk factors for recurrence and overall survival of patients with left colon cancer operated during a ten-year period.
Patients with left colon cancer surgically treated underwent clinical preoperative workout and cancer staging. The following factors were studied: gender, age, tumor location, T stage, lymph node yield, N stage, M stage, histological type, and tumor differentiation. It was analyzed the influence in five-year overall survival.
A total of 173 patients underwent left colectomy for colon cancer. There was a slight predominance of male gender with 50.9%. The mean age was 60.8 years old. Fifteen (8.7%) tumors were located at splenic flexure, 126 (72.8%) at sigmoid colon, and 32 (18.5%) at descending colon. The median length of hospital stay was seven days. Mean survival was 47.5 months. At 60 months seven patients (4%) lost follow-up, 38 patients (21.9%) deceased and 135 patients (78%) were alive. Overall survival time was 48 months.
Advanced stages (T3-T4, N+ and M+) were the only factors associated with poor long term survival in left colon cancer.
Since 1990 it was proposed that distal and proximal location of colon cancer might follow different biological, epidemiology, pathology and prognosis, probably due to embryologic different development of the two segments of the colon, which may represent two separate disease entities. These differences might have consequences for the treatment of patients with colorectal cancer.
To compare the characteristics between patients with right and left colon cancer, with severity and tumor characteristic that influence in the survival of these patients.
Were evaluated the outcomes of surgical treatment of patients with colon cancer with data collected retrospectively from prospectively collected database.
The tumor’s side did not influence survival time of patients with colon cancer (p=0.112) in the regression model. Only the diseases stage leads to influence on survival time; patients with right colon cancer have more advanced staging (III or IV) and present a risk of death greater in 3.23 times.
This analysis provides evidence that the prognosis of localized left-sided colon cancer is better compared to right-sided colon cancer. Also, the patients with right colon cancer have more advanced stage, mucinous tumor and are older.
Desenvolvido por Surya MKT