Colorectal video-assisted surgery in Uruguay, after 106 cases

Marcelo Viola Malet: Clínica Quirúrgica “B”. Facultad de Medicina. Universidad de la República, Uruguay.-- Marcelo Laurini: Clínica Quirúrgica “3”. Facultad de Medicina. Universidad de la República, Uruguay.-- Justino Zeballos: Clínica Quirúrgica “B”. Facultad de Medicina. Universidad de la República, Uruguay.-- Nicolás Muniz: Clínica Quirúrgica “B”. Facultad de Medicina. Universidad de la República, Uruguay.-- Pablo Rodríguez Goñi: Clínica Quirúrgica “F”. Facultad de Medicina. Universidad de la República, Uruguay.-- Fernando Castelli: . Clínica Quirúrgica “A”. Facultad de Medicina. Universidad de la República, Uruguay.-- Gustavo Sánchez: Clínica Quirúrgica “2”. Facultad de Medicina. Universidad de la República, Uruguay.-- César Canessa: Clínica Quirúrgica “B”. Facultad de Medicina. Universidad de la República, Uruguay.-- Humberto Viola: Departamento de Cirugía, MUCAM, Montevideo, Uruguay. Contacto: Marcelo Viola Malet. E-mail: [email protected] advenimiento de la cirugía laparoscópica ha tenido un gran impacto en la cirugía gastrointestinal en los últimos 20 años. En particular la cirugía laparoscópica colorrectal es sin dudas el desarrollo técnico más importante en la cirugía de colon y recto de los últimos 15 años, y probablemente tendrá un impacto significativo en la formación quirúrgica y en los resultados de esta cirugía. En este trabajo intentamos reflejar nuestra experiencia en la cirugía laparoscópica colorrectal refiriéndonos a los aspectos fundamentalmente técnicos, el instrumental y nuestros resultados a corto y mediano plazo con este tipo de abordaje para la patología colorrectal. Contamos con experiencia en 106 casos de cirugía colorrectal laparoscópica, 63 hombres y 43 mujeres, desde noviembre de 2007 hasta marzo de 2014. En los últimos 4 años se operaron un promedio de 22 pacientes por año. Nuestra serie presentó un índice de falla de sutura del 4.72% y una mortalidad operatoria del 3.7%. El seguimiento promedio de los pacientes fue de 22 meses, con un mínimo de 1 y un máximo de 59 meses. La sobrevida global de la serie fue de 96.9%, con una media de sobrevida de 56.8 meses (IC: 54.3 – 59.2 meses); y una sobrevida libre de enfermedad de 90.7%, con una media de tiempo libre de la enfermedad de 52.2 meses (IC: 48.2 -56.3 meses). La cirugía laparoscópica colorrectal es factible y segura, con cifras de morbimortalidad similares a las presentadas en series a nivel mundial, tanto en cirugía laparoscópica como laparotómica, así como en la radicalidad oncológica de las resecciones.The advent of laparoscopic surgery has had a huge impact on gastrointestinal surgery in the past 20 years. Laparoscopic colorectal surgery is undoubtedly the most important technical development of the past 15 years, and will very likely have a significant impact on surgical training and on the results of this surgery. In recent years, significant events have happened in the history of surgery that have led us to develop new concepts, new terms, and different ways of performing the same techniques. In this paper we try to show our experience in laparoscopic colorectal surgery, mainly referring to the technical aspects, tools and our results in the short and medium term with this type of approach for colorectal disease. We have done 106 laparoscopic colorectal surgeries, 63 men and 43 women were operated since November 2007 to March 2014. In the last 4 years an average of 22 patients were operated per year. Our series presents a suture failure rate of 4.72% and an operative mortality of 3.7%. The average patient follow-up was 22 months, with a minimum of 1 and a maximum of 59 months. Overall survival in the series was 96.9%, with a median survival of 56.7 months (CI: 54.3 to 59.2 months) and disease free survival of 90.7% with a half off due to illness 52.2 months (CI: 48.2 to 56.3 months). Laparoscopic colorectal surgery is feasible and safe, with figures similar to those presented in series worldwide, both in laparotomic and laparoscopic surgery, as well as in cancer morbidity radical resections

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Cirugía correctal videoasistida en Uruguay, luego de 106 casos

El advenimiento de la cirugía laparoscópica ha tenido un gran impacto en la cirugía gastrointestinal en los últimos 20 años. En particular la cirugía laparoscópica colorrectal es sin dudas el desarrollo técnico más importante en la cirugía de colon y recto de los últimos 15 años, y probablemente tendrá un impacto significativo en la formación quirúrgica y en los resultados de esta cirugía. En este trabajo intentamos reflejar nuestra experiencia en la cirugía laparoscópica colorrectal refiriéndonos a los aspectos fundamentalmente técnicos, el instrumental y nuestros resultados a corto y mediano plazo con este tipo de abordaje para la patología colorrectal. Contamos con experiencia en 106 casos de cirugía colorrectal laparoscópica, 63 hombres y 43 mujeres, desde noviembre de 2007 hasta marzo de 2014. En los últimos 4 años se operaron un promedio de 22 pacientes por año. Nuestra serie presentó un índice de falla de sutura del 4.72% y una mortalidad operatoria del 3.7%. El seguimiento promedio de los pacientes fue de 22 meses, con un mínimo de 1 y un máximo de 59 meses. La sobrevida global de la serie fue de 96.9%, con una media de sobrevida de 56.8 meses (IC: 54.3 – 59.2 meses); y una sobrevida libre de enfermedad de 90.7%, con una media de tiempo libre de la enfermedad de 52.2 meses (IC: 48.2 -56.3 meses). La cirugía laparoscópica colorrectal es factible y segura, con cifras de morbimortalidad similares a las presentadas en series a nivel mundial, tanto en cirugía laparoscópica como laparotómica, así como en la radicalidad oncológica de las resecciones

Microsatellite instability in young patients with rectal cancer: molecular findings and treatment response

No abstract available

Impact of microsatellite status in early-onset colonic cancer

Background: The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. Methods: Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I-III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. Results: A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). Conclusion: Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers

Impact of microsatellite status in early-onset colonic cancer

Background: The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. Methods: Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I-III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. Results: A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). Conclusion: Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers

La défense sociale et la nouvelle pénologie comme outils d'analyse de la conception du libéré conditionnel dans la législation belge (1888-2006)

Importance The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Observations Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. Conclusions and Relevance The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes