The medical residency model, established over a century ago, remains the gold standard for medical education. Given its increasing significance in imparting expertise in medical specialties, understanding the profile of residents and changes over time is crucial.
This study aimed to assess graduates of digestive surgery and coloproctology residency programs at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) regarding their professional, academic, and research activities. It also aimed to analyze changes in resident profiles over the years, the impact of postgraduation on professional activities, and differences between graduates working in São Paulo capital and elsewhere.
A digital survey with 42 questions was sent to graduates who commenced training between 1979 and 2021. Results were analyzed in subgroups based on two eras (Era 1: 1979–2000; Era 2: 2001–2021), the impact of postgraduation, and respondents’ work locations.
The survey was responded by 213 graduates (87.6%). The training significantly impacted all respondents’ professional lives, with 92.5% willing to choose the same specialty again. Graduates from Era 2 showed a higher proportion of females, residents of cities other than São Paulo, and graduates from institutions outside FMUSP. Postgraduate responders were more involved in academic and research activities, publishing more papers, holding societal memberships, and performing more robot-assisted procedures. Those outside São Paulo capital were more involved in endoscopic procedures and associated with medical insurance.
The majority of graduates considered medical residency fundamental for career development. Social and economic changes influenced residents’ profiles and post-program activities.
The laparoscopic approach considerably reduced the morbidity of colorectal surgery when compared to the open approach. Among its benefits, we can highlight less intraoperative bleeding, early oral intake, lower rates of surgical site infection, incisional hernia, and postoperative pain, and earlier hospital discharge.
To compare the perioperative morbidity of right versus left colectomy for cancer and the quality of laparoscopic oncologic resection.
Retrospective analysis of patients submitted to laparoscopic right and left colctomy between 2006 and 2016. Postoperative complications were classified using the Clavien-Dindo scale, 30 days after surgery.
A total of 293 patients were analyzed, 97 right colectomies (33.1%) and 196 left colectomies (66.9%). The averageage was 62.8 years. The groups were comparable in terms of age, comorbidities, body mass index, and the American Society of Anesthesiology (ASA) classification. Preoperative transfusion was higher in the right colectomy group (5.1% versus 0.4%, p=0.004, p<0.05). Overall, 233 patients (79.5%) had no complications. Complications found were grade I and II in 62 patients (21.1%) and grade III to V in 37 (12.6%). Twenty-three patients (7.8%) underwent reoperation. The comparison between left and right colectomy was not statistically different for operative time, conversion, reoperation, severe postoperative complications, and length of stay. The anastomotic leak rate was comparable in both groups(5.6% versus 2.1%, p=0.232, p>0.05). The oncological results were similar in both surgeries. In multiple logistic regression, ASA statistically influenced the worst results (≥ III; p=0.029, p<0.05).
The surgical and oncological results of laparoscopic right and left colectomies are similar, making this the preferred approach for both procedures.
New therapies have revolutionized the treatment of Crohn’s disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied.
The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital.
This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery.
Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6–6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0–1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2–1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73).
The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.
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.
In the surgical treatment of colorectal cancer, a lymphadenectomy is considered adequate when at least 12 lymph nodes are removed.
To evaluate whether videolaparoscopic surgery positively affects the rates of adequate lymphadenectomy.
An observational study was conducted with patients undergoing either open or videolaparoscopic surgery for colorectal cancer between 2008 and 2013. The following variables were collected: gender, age, tumor site, histology, degree of differentiation, tumor stage, number of lymph nodes removed, and number of lymph nodes affected by the disease.
A total of 62 patients with colorectal cancer were included; 42 (67.7%) received open surgery, and 20 (32.3%) laparoscopic surgery. Regarding lymphadenectomy, a mean of 13 lymph nodes (95% CI: 10-16) were removed in the group that received open surgery, while 19 lymph nodes were removed (95% CI: 14-24) in the laparoscopic surgery group (p=0.021). Adequate lymphadenectomy (removal of at least 12 lymph nodes) was achieved in 58.1% of the total cases, in 50.0% of the patients who received open surgery, and in 75% of those who received laparoscopic surgery. Non-elderly patients and those with an advanced disease stage were more likely to receive an adequate lymphadenectomy (p=0.004 and p=0.035, respectively).
Disease stage and patient age were the factors that had the greatest influence on achieving an adequate lymphadenectomy. The type of surgery did not affect the number of lymph nodes removed.
Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis.
To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery.
Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012.
Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis.
Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis.
A total of 16,660 new cases of colon and rectum cancer in men and 17,620 in women are estimated for 2016 in Brazil2. In locally advanced rectum cancer, survival after R0 resection is very good, and exenteration should be offered to patients with advanced primary or recurrent tumor, where resection is necessary in addition to total excision of the conventional mesorectum6. In the case of invasion of the sacrum, excision with free margins greatly increases the morbidity and radicality of the procedure, posing a challenge to the surgeon.
To date, the highest level of evidence for the benefits of the laparoscopic approach in rectal cancer comes from the Corean Trial5 and NCCN6 studies. However, the literature lacks data to justify the use of laparoscopy in locally advanced tumors. In Brazil, there is no report of abdominoperineal resection associated with videolaparoscopic sacrectomy.
The purpose of this report is to present an alternative for the treatment of malignant rectal cancer with posterior invasion involving a combined anterior laparoscopic approach and subsequent tumor resection.
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.
Deep infiltrating colorectal endometriosis may severely affect the quality of life and fertility of patients. Although segmental resection is a therapeutic option that provides positive outcomes in the management of symptoms, its functional effects are still unproven.
Assess the late impact of the laparoscopic approach in treating deep infiltrating endometriosis with segmental colorectal resection.
Prospective case series of 46 patients submitted to laparoscopic treatment of deep infiltrating endometriosis with segmental colorectal resection between 2013 and 2016. Fertility, gynecological and bowel symptoms were assessed at the preoperative period and at three and 12 months (or more) after the procedure.
Preoperative interview assessed the prevalence of infertility (45.6%), gynecological (87%) and intestinal (80.4%) symptoms. At the third month after the procedure a significant reduction in the prevalence of gynecological symptoms (p<0,001), tenesmus (p=0,001) and dysquesia (p=0,002) was observed. After a period of 12 months or more following the procedure a significant reduction in the prevalence persisted for dysmenorrhea (p=0,001), deep dyspareunia (p=0,041), chronic pelvic pain (p=0,011) and dysquesia (p=0,001), as compared to the preoperative period. Total pregnancy rate was 57.1% and spontaneous pregnancy 47.6%.
The treatment of deep infiltrating endometriosis using segmental colorectal resection has provided early and late relief of gynecological and bowel symptoms. The outcomes also indicate a positive impact on the fertility of infertile patients.
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