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Patrón Uriburu JC, Araujo S, Mario A, Billy J, Méndez R, Rossi G, Rotholtz N, Luis R, Avellaneda N, Melani A. Intracorporeal anastomosis could be associated with a higher lymph node yield in right colon cancer surgery: Results of the ICA-LATAM study, a retrospective, multicentre, comparative analysis in Latin America. Colorectal Dis 2024. [PMID: 38590005 DOI: 10.1111/codi.16962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024]
Abstract
AIM The aim of this work was to compare lymph node (LN) yield in patients operated on for right colon cancer (RCC) using a laparoscopic approach between those receiving an intracorporeal (ICA) or extracorporeal anastomosis (ECA). METHOD This is a retrospective multicentre study involving patients operated on for RCC in nine tertiary referral centres in Latin America during a 2-year period. The main comparative outcome between groups was the number of LNs harvested between groups. RESULTS The study included 416 patients, 261 (62.7%) in the ECA group and 155 (37.3%) in the ICA group. Patients in the ECA group were elderly (66 vs. 61 years, p < 0.001). Patients receiving an ICA achieved a significantly higher LN yield than those receiving an ECA (24 vs. 18, p < 0.001). This group also had a lower percentage of patients achieving a substandard LN yield (<12 LNs) (10% vs. 24.8%, p = 0.001) and more patients achieving a high number of harvested LNs (>32 LNs) (15.5% vs. 8.3%, p = 0.039). In the multivariate analysis, ICA was independently related to the primary outcome (LN yield) (OR 3.28, p = 0.027, 95% CI 1.14-9.38). CONCLUSION In this retrospective study, patients operated on for RCC who received an ICA achieved a higher LN yield. Further studies are needed to reconfirm these findings, and also to find an explanation for these results.
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Affiliation(s)
- Juan C Patrón Uriburu
- Colorectal Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Sergio Araujo
- Colorectal Surgery Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Abedrapo Mario
- Colorectal Surgery Unit, Department of Surgery, Clinical Hospital Univesity of Chile, Santiago de Chile, Chile
| | - Jimenez Billy
- Colorectal Surgery Department, Hospital General de Mexico 'Dr. Eduardo Liceaga', Mexico, Mexico
| | - Ramón Méndez
- Colorectal Surgery Department, Hospital Santa Izabel, Salvador, Brazil
| | - Gustavo Rossi
- Colorectal Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Rotholtz
- Colorectal Surgery Department, Hospital Aleman de Buenos Aires, Buenos Aires, Argentina
| | - Romagnolo Luis
- Colorectal Surgery Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Nicolas Avellaneda
- General Surgery Department, CEMIC University Hospital, Buenos Aires, Argentina
| | - Armando Melani
- Colorectal Surgery Department, Staff Americas Medical Service, Rio de Janeiro, Brazil
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Avellaneda N, Rodrigues Coy CS, Sarubbi Fillmann H, Saad-Hossne R, Muñoz JP, García-Duperly R, Bellolio F, Rotholtz N, Rossi G, Marquez V JR, Cillo M, Lacerda-Filho A, Carrie A, Yuki Maruyama B, Sarubbi Fillmann L, Silvino Craveiro MM, Ferro E, Londoño-Schimmer E, Iglesias A, Bras Harriott C, Campana JP, Londoño Estrada D, Balachandran R, Kotze PG. Risk factors for major complications after surgical treatment of primary ileocecal Crohn's disease. A multicentric Latin American experience. Cir Esp 2023; 101:824-832. [PMID: 37244420 DOI: 10.1016/j.cireng.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Complications after ileocecal resection for Crohn's disease (CD) are frequent. The aim of this study was to analyze risk factors for postoperative complications after these procedures. MATERIALS AND METHODS We conducted a retrospective analysis of patients treated surgically for Crohn's disease limited to the ileocecal region during an 8-year period at 10 medical centers specialized in inflammatory bowel disease (IBD) in Latin America. Patients were allocated into 2 groups: those who presented major postoperative complications (Clavien-Dindo > II), the "postoperative complication" (POC) group; and those who did not, the "no postoperative complication" (NPOC) group. Preoperative characteristics and intraoperative variables were analyzed to identify possible factors for POC. RESULTS In total, 337 patients were included, with 51 (15.13%) in the POC cohort. Smoking was more prevalent among the POC patients (31.37 vs. 17.83; P = .026), who presented more preoperative anemia (33.33 vs. 17.48%; P = .009), required more urgent care (37.25 vs. 22.38; P = .023), and had lower albumin levels. Complicated disease was associated with higher postoperative morbidity. POC patients had a longer operative time (188.77 vs. 143.86 min; P = .005), more intraoperative complications (17.65 vs. 4.55%; P < .001), and lower rates of primary anastomosis. In the multivariate analysis, both smoking and intraoperative complications were independently associated with the occurrence of major postoperative complications. CONCLUSION This study shows that risk factors for complications after primary ileocecal resections for Crohn's disease in Latin America are similar to those reported elsewhere. Future efforts in the region should be aimed at improving these outcomes by controlling some of the identified factors.
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Affiliation(s)
- Nicolás Avellaneda
- General Surgery Department, Hospital Universitario CEMIC, Argentina; Colorectal Surgery Department, Aarhus University Hospital, Denmark.
| | | | | | | | | | | | - Felipe Bellolio
- Coloproctology Unit, Digestive Surgery Department, Pontíficia Universidad Católica de Chile, Chile
| | - Nicolás Rotholtz
- Colorectal Surgery Service, General Surgery Department, Hospital Aleman de Buenos Aires, Argentina
| | - Gustavo Rossi
- Section of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Mariano Cillo
- Colorectal Surgery Department, Hospital Británico de Buenos Aires, Argentina
| | | | - Augusto Carrie
- General Surgery Department, Hospital Universitario CEMIC, Argentina
| | - Beatriz Yuki Maruyama
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | | | | | - Ezequiel Ferro
- Colorectal Surgery Department, Nueva Proctología, Argentina
| | | | - Andrés Iglesias
- Coloproctology Unit, Digestive Surgery Department, Pontíficia Universidad Católica de Chile, Chile
| | - Camila Bras Harriott
- Colorectal Surgery Service, General Surgery Department, Hospital Aleman de Buenos Aires, Argentina
| | - Juan Pablo Campana
- Section of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Nazar ME, Grana F, Alarcon L, Romero GC, Rotholtz N, Eyheremendy EP. What the radiologist needs to know about restaging of rectal carcinoma after chemoradiation therapy. Cancer Imaging 2014. [PMCID: PMC4241996 DOI: 10.1186/1470-7330-14-s1-p16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cimmino DG, Pereyra L, Luna P, Mella JM, Horrisberger G, Lencinas S, Rotholtz N, Peczan C, Pedreira S, Boerr LA. [Surveillance colonoscopy before scheduled: is it worthwhile?]. Acta Gastroenterol Latinoam 2011; 41:17-22. [PMID: 21539064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine de incidence of colonic polyps in colonoscopies performed before scheduled and to identifY the clinical and endoscopic features that predicted this finding. METHODS All patients who underwent at least two complete colonoscopies less than three years apart were retrospectively identified in our computerized database. We excluded patients with high risk of colonic neoplasm requiring a new colonoscopy in less than three years. We analyzed the incidence of polyps before the first and third year after the first study, and the clinical and endoscopic features related to this finding by means of multivariate logistic regression. RESULTS 378 paired colonoscopies fulfilled criteria, 129 were performed less than one year apart (group 1), and 249 less than three years apart (group 2). Regarding surveillance colonoscopies, 19% of patients presented adenomas and 1.5% high grade dysplasia (HGD) in group 1, and 21% presented adenomas and 2% HGD in group 2. In group 1 fair preparation (P = 0.03), and prolonged colonoscopy (P = 0.02) on the first study were independent predictors to find any polyp on the second study before scheduled. In group 2 fair cleansing (P = 0.04), history of sessile polyps (P = 0.01) and 3 or more polyps in the first study (P = 0.01) were independent predictors to find any polyp, while more than 5 polyps in the first study predicate adenomas. CONCLUSION During the first year incident polyps related to difficult procedures (missed polyps?) while at 3 years the history of previous polyps was also important.
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Affiliation(s)
- Daniel G Cimmino
- Servicio de Endoscopia Digestiva, Hospital Alemán, Buenos Aires, Argentina
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Gervaz P, Rotholtz N, Wexner SD, You SY, Saigusa N, Kaplan E, Secic M, Weiss EG, Nogueras JJ, Belin B. Colonic J-pouch function in rectal cancer patients: impact of adjuvant chemoradiotherapy. Dis Colon Rectum 2001; 44:1667-75. [PMID: 11711740 DOI: 10.1007/bf02234388] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The colonic J-pouch technique of reconstruction optimizes functional outcome after proctectomy with coloanal anastomosis. However, the impact of adjuvant chemoradiation therapy on pouch function in rectal cancer patients has not been investigated. METHODS From January 1994 to December 1999, 74 patients with midrectal or low rectal tumors (less than 10 cm from the anal verge) underwent a proctectomy with coloanal anastomosis with colonic J-pouch reconstruction. Chemoradiation was offered in patients with Stage II and III disease. Radiation therapy was administered using a four-field technique including the anal canal, for a total dose of 50.4 Gy (1.8 Gy/fraction/day). Fifteen patients (20 percent) died with metastatic disease, five (6.8 percent) died of other causes without evidence of recurrence, and five (6.8 percent) were lost to follow-up. In addition, two patients had local recurrence (2.7 percent) at the time of follow-up. Forty-five of 47 eligible patients (96 percent) responded to a questionnaire designed to evaluate specifically the degree of continence and pouch evacuation. RESULTS The mean age of patients was 68.9 (range, 42-88) years and the mean duration of follow-up was 28.8 (range, 1-69) months. There were 28 patients in the surgery alone group and 17 patients who received either preoperative (13) or postoperative (4) adjuvant chemoradiation therapy. Patients in the surgery alone group had a significantly better degree of continence (mean +/- standard deviation continence score: 18.1 +/- 2.9 vs. 13.3 +/- 4.1, P < 0.001) and were less likely to experience evacuatory problems (mean +/- standard deviation evacuation score: 21.3 +/- 3.7 vs. 16.4 +/- 3.5, P < 0.001). Use of a pad was more frequent in the chemoradiation therapy than in the surgery alone group (53 vs. 18 percent, P = 0.02). The incidence after functional disorders was also more frequent in the irradiated group of patients: incontinence to gas (76 vs. 43 percent, P = 0.03), to liquid stool (64 vs. 25 percent, P = 0.01), and to solid stool (47 vs. 11 percent, P = 0.01). Moreover, irradiated patients reported more frequent pouch-related specific problems, such as clustering (82 vs. 32 percent, P = 0.001), and sensation of incomplete evacuation (82 vs. 32 percent, P = 0.001). Finally, regression analysis demonstrated that radiation-induced sphincter dysfunction was progressive over time. CONCLUSIONS Both preoperative and postoperative chemoradiation therapy adversely affects continence and evacuation in patients with colonic J-pouch. Because radiation-induced damage to the normal tissues is known to be cumulative over time, long-term progressive dysfunction of the anal sphincter and neorectum are causes of concern. Consideration should be given to excluding the anal canal from the field of irradiation in patients with Stage II and III rectal cancer, whenever a sphincter-preserving procedure is planned.
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Affiliation(s)
- P Gervaz
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston 33331, USA
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Gervaz P, Rotholtz N, Pisano M, Kaplan E, Secic M, Coucke P, Pikarsky A, Efron J, Weiss E, Wexner S. Quantitative short-term study of anal sphincter function after chemoradiation for rectal cancer. Arch Surg 2001; 136:192-6. [PMID: 11177140 DOI: 10.1001/archsurg.136.2.192] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS Pelvic irradiation adversely affects anal sphincter function after proctectomy with coloanal anastomosis for low rectal and middle rectal (<10 cm from the anal verge) tumors. DESIGN Case-control study. SETTING Private, tertiary care referral center. PATIENTS Patients treated for low rectal adenocarcinoma between January 1, 1994, and October 31, 1999. INTERVENTIONS Anal manometric data were prospectively collected at the time of initial diagnosis and before ileostomy closure. MAIN OUTCOME MEASURES Mean and maximum resting pressures (RPs) and squeeze pressures, threshold volume for sensation, and maximal tolerable volume. RESULTS Twenty-three patients in the surgery group and 19 in the chemoradiotherapy group were considered for analysis; 15 patients had preoperative radiotherapy and 4 had postoperative radiotherapy. At the time of ileostomy closure, RPs were significantly lower in the chemoradiotherapy group than in the surgery group (32.7 +/- 17 vs 45.3 +/- 18 mm Hg; P =.03). Squeeze pressures were not significantly different between the surgery and chemoradiotherapy groups (108.7 +/- 56.7 vs 102.0 +/- 52.6 mm Hg; P =.69). The ratios of postresection to preresection RPs were also significantly lower in the chemoradiotherapy group (0.49 +/- 0.29) than in the surgery group (0.76 +/- 0.22) (P =.005). Eight to 12 weeks after proctectomy with coloanal anastomosis, a 24% decrease in RP was noted in the surgery group. The addition of adjuvant pelvic irradiation decreased RP by another 27%. CONCLUSION Adequate shielding of the anal sphincter should be performed for low rectal cancers whenever a sphincter-preserving procedure is considered.
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Affiliation(s)
- P Gervaz
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, 3000 W Cypress Creek Rd, Fort Lauderdale, FL 33309, USA
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