La correspondencia de Valencia : diario de noticias : eco imparcial de la opinión y de la prensa: Año XXVII Número 9006 - 1904 Enero 11

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 200

Caracterização dos casos de carcinoma colorretal submetidos à laparotomia de urgência durante o período pandêmico no Hospital de Clínicas de Porto Alegre

Introdução: O câncer colorretal (CCR) é uma doença de prevalência, incidência e mortalidade elevadas (1). As principais sociedades de cuidados preventivos defendem o rastreamento de indivíduos assintomáticos a partir dos 45 a 50 anos de idade com vistas ao diagnóstico precoce e à diminuição das taxas de mortalidade (2). Entretanto, a maioria dos CCRs ainda é diagnosticada após o início dos sintomas (3,4). Durante a pandemia da COVID-19, houve um declínio na triagem de neoplasias (5,6), além de um atraso nas cirurgias eletivas, predispondo a casos potencialmente mais severos de CCR (8, 9, 10). O Hospital de Clínicas de Porto Alegre (HCPA) é um dos hospitais de referência para o tratamento do CCR na região Sul e teve papel de extrema importância no tratamento dos pacientes vítimas de COVID-19. Objetivo: Aferir os efeitos da pandemia sobre as cirurgias de urgência de CCR realizadas no HCPA. Métodos: Estudo transversal, retrospectivo, descritivo e com dados secundários, obtidos mediante revisão de prontuários. Resultados: Foram realizadas 53 laparotomias exploradoras de urgência por câncer colorretal de janeiro de 2020 a dezembro de 2021. O tipo histopatológico mais encontrado foi o adenocarcinoma moderadamente diferenciado (71,7%), e o local mais frequente foi o cólon sigmóide (22,64%). A cirurgia mais realizada foi a colectomia esquerda (24,53%) e 67,92% dos pacientes necessitaram de ostomia. O estádio clínico IV foi o mais frequente (49,06%). Quando comparado aos dois anos anteriores à pandemia, houve diferença estatisticamente significativa entre o tempo de sintomas até a procura do serviço de emergência: 13,22±17,49 durante a pandemia versus 3,73±3,04 anteriormente à pandemia (p<0,001). Não houve diferença estatística quanto ao estadiamento ou demais variáveis. Conclusão: Houve um atraso na procura de atendimento médico nos pacientes submetidos à laparotomia exploradora de urgência por CCR no Hospital de Clínicas de Porto Alegre no período da pandemia quando comparado aos dois anos anteriores, mas não houve diferença significativa no estadiamento clínico ou no tempo de internação

Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit.

This is the peer reviewed version of the following article: group, T. E. S. o. C. c. (2018). "Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit." Colorectal Disease 20(S6): 47-57., which has been published in final form at https://doi.org/10.1111/codi.1437. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsINTRODUCTION: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. METHODS: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5). RESULTS: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83-2.79, P = 0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43-11.02, P = 0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur. CONCLUSIONS: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection