EFFECTS OF RENAL DYSFUNCTION ON HEALING OF COLONIC ANASTOMOSIS: EXPERIMENTAL STUDY IN WISTAR RATS

Effects of ketorolac on complications and postoperative pancreatic fistula in patients undergoing pancreatectomy

BACKGROUND

There are conflicting data on the risk of postoperative pancreatic fistula (POPF) associated with postoperative NSAID use. The primary objective of this multi-center retrospective study was to assess the relationship between ketorolac use and POPF. The secondary objective was to assess for effect of ketorolac use on overall complication rate.

METHODS

Retrospective chart review of patients undergoing pancreatectomy from January 1, 2005-January 1, 2016 was performed. Data on patient factors (age, sex, comorbidities, previous surgical history etc.), operative factors (surgical procedure, estimated blood loss, pathology etc.), and outcomes (morbidities, mortality, readmission, POPF) were collected. The cohort was compared based on ketorolac use.

RESULTS

The study included 464 patients. Ninety-eight (21%) patients received ketorolac during the study period. Ninety-six (21%) patients were diagnosed with POPF within 30 days. There was a significant association between ketorolac use and clinically relevant POPF (21.4 vs. 12.7%) (p = 0.04, 95% CI [1.76, 1.04-2.97]). There was no significant difference in overall morbidity or mortality between the groups.

DISCUSSION

Though there was no overall increase in morbidity, there was a significant association between POPF and ketorolac use. The use of ketorolac after pancreatectomy should be judicious.

EFFECT OF CHRONIC RENAL DYSFUNCTION ON THE PERMEABILITY OF THE COLON TO WATER AND ELECTROLYTES: EXPERIMENTAL STUDY IN RATS

Background:

Renal insufficiency is a disease that affects several organs by provoking hypervolemia and uremia. The disease reaches more than 500 million people worldwide and few studies bring their influence on the gastrointestinal tract.

Aim:

To evaluate the influence of 5/6 nephrectomy-induced hypervolemia on colonic permeability to water and electrolytes.

Method:

Sixty male Wistar rats weighing between 280-300 g were divided into three groups: 3, 7 and 14 days after nephrectomy, each one having a false-operated/control and partially nephrectomized. For colonic permeability they were submitted to colonic perfusion with a solution of Tyroad containing phenolphthalein. Differences among the concentrations of Na+, K+ and Cl- were used to calculate the rate of colonic permeability for the electrolytes. Phenolphthalein concentrations were used to evaluate the rate of secretion and water absorption.

Results:

The colonic secretion of water and electrolytes occurred expressively in the group seven days after nephrectomy. Hemodynamic and biochemical assessments determined the progression of renal failure in all three groups and polyethylene glycol was shown to be effective in reversing the secretory capacity of the colon.

Conclusion:

Hypervolemia established after 7 days post-nephrectomy 5/6 caused marked colonic secretion for water and electrolytes. The organism presents progressive colonic secretion as the blood volume increases; on the other hand, polyethylene glycol was able to revert this secretory framework of the colon to water and electrolytes by reversing the hypervolemia.

IS SUPERFICIAL COLORECTAL LESIONS WITH LOW AND HIGH GRADES INTRAEPITHELIAL NEOPLASMS MORE PREVALENT IN OLDER ABOVE 65 YEARS?

BACKGROUND

Colorectal cancer has a higher incidence in the rectum and sigmoid. However, with the expansion of the diagnosis of superficial lesions interest in the diagnosis and in the role they play in colorectal carcinogenesis has increased.

AIM

To verify the behavior of superficial lesions of the colon and rectum, comparing the pathological and endoscopic findings, below and above 65 years.

METHODS

Cross-sectional study with prospective evaluation of standard protocol, where 200 patients with colorectal superficial lesions were evaluated; they were submitted to colonoscopy and mucosectomy of these lesions. They were divided in two age groups, below and above 65 years.

RESULTS

One hundred-and-eight were women (54%) and 92 men (46%). Most colon lesions were localized in the right colon (95%) and the remaining (5%) in the rectum. In endoscopy, 77.20% were granular lesions in patients under 65 years and 77.90% above. Colon histology showed low grade intraepithelial neoplasia, being 69.79% in patients under and 73.70% in above 65 years. In rectum, above 65 years the incidence of high-grade intraepithelial neoplasia was higher (66.70%).

CONCLUSION

The superficial colorectal lesions have been more endoscopically diagnosed today, and the highest incidence is the granular type, both in the colon and rectum, regardless of age. Regardless the age, histologically colon lesions were more as low grade intraepithelial neoplasia. In rectum, there was distinction for both age groups, being more frequent high grade intraepithelial neoplasia in patients over 65 years.

FACTORS RELATED TO THE REDUCTION OF THE RISK OF COMPLICATIONS IN COLORECTAL SURGERY WITHIN PERIOPERATIVE CARE RECOMMENDED BY THE ACERTO PROTOCOL

Background:

Perioperative care multimodal protocol significantly improve outcome in surgery.

Aim:

To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol.

Methods:

Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions.

Results:

Two hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml/kg/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting ≤4 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting ≤4 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 30 ml/kg/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day.

Conclusion:

This study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml/kg/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.

IS THERE A DIFFERENCE BETWEEN RIGHT- VERSUS LEFT-SIDED COLON CANCERS? DOES SIDE MAKE ANY DIFFERENCE IN LONG-TERM FOLLOW-UP?

BACKGROUND

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.

AIM

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.

METHOD

Were evaluated the outcomes of surgical treatment of patients with colon cancer with data collected retrospectively from prospectively collected database.

RESULTS

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.

CONCLUSION

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.