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[PMID]:28453796
[Au] Autor:Kondov S; Rylski B; Kari FA; Wobser R; Leschka S; Siepe M; Beyersdorf F; Czerny M
[Ad] Endereço:Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.
[Ti] Título:Descendo-bifemoral bypass grafting and renal artery revascularization to treat complex obliterative arteriopathy.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):655-658, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Our goal was to describe a new standardized approach in patients with extensive obliterative arteriopathy aimed at distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass grafting and renal artery revascularization. METHODS: Three patients with Leriche's syndrome and either a compromised single kidney or unilateral significant renal artery stenosis were treated with a standardized surgical approach, restoration of distal perfusion via descendo-bifemoral bypass with synchronous ( n = 2) left-sided renal artery revascularization or metachronous ( n = 1) right-sided renal artery revascularization. RESULTS: The intended surgical aim was achieved successfully in all 3 cases. All patients showed a decline in serum creatinine levels. One patient who needed substitution therapy was free from dialysis 3 months after surgery. Additionally, blood pressure management was substantially reduced because uncontrolled peak systolic episodes were no longer observed and pharmacotherapeutic agents could be partially withdrawn. CONCLUSIONS: Distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass and renal artery revascularization is a promising option to treat complex obliterative arteriopathy.
[Mh] Termos MeSH primário: Aorta Abdominal/cirurgia
Implante de Prótese Vascular/métodos
Artéria Femoral/cirurgia
Rim/irrigação sanguínea
Síndrome de Leriche/cirurgia
Obstrução da Artéria Renal/cirurgia
Artéria Renal/cirurgia
[Mh] Termos MeSH secundário: Anastomose Cirúrgica/métodos
Angiografia por Tomografia Computadorizada
Feminino
Seres Humanos
Síndrome de Leriche/complicações
Síndrome de Leriche/diagnóstico
Masculino
Meia-Idade
Obstrução da Artéria Renal/diagnóstico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw388


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[PMID]:28453794
[Au] Autor:Kawahito K; Kimura N; Komiya K; Nakamura M; Misawa Y
[Ad] Endereço:Division of Cardiovascular Surgery, Jichi Medical University, Tochigi, Japan.
[Ti] Título:Blood flow competition after aortic valve bypass: an evaluation using computational fluid dynamics.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):670-676, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Aortic valve bypass (AVB) (apico-aortic conduit) remains an effective surgical alternative for patients in whom surgical aortic valve replacement or transcatheter aortic valve implantation is not feasible. However, specific complications include thrombus formation, possibly caused by stagnation arising from flow competition between the antegrade and retrograde flow, but this has not been fully investigated. The aim of this study was to analyse flow characteristics after AVB and to elucidate mechanisms of intra-aortic thrombus using computational fluid dynamics (CFD). METHODS: Flow simulation was performed on data obtained from a 73-year-old postoperative AVB patient. Three-dimensional cine phase-contrast magnetic resonance imaging at 3 Tesla was used to acquire flow data and to set up the simulation. The vascular geometry was reconstructed using computed tomography angiograms. Flow simulations were implemented at various ratios of the flow rate between the ascending aorta and the graft. Results were visualized by streamline and particle tracing. RESULTS: CFD demonstrated stagnation in the ascending aorta-arch when retrograde flow was dominant, indicating that the risk of thrombus formation exists in the ascending arch in cases with severe aortic stenosis and/or poor left ventricular function. Meanwhile, stagnation was observed in the proximal descending aorta when the antegrade and retrograde flow were equivalent, suggesting that the descending aorta is critical when aortic stenosis is not severe. CONCLUSIONS: Flow stagnation in the aorta which may cause thrombus was observed when retrograde flow was dominant and antegrade/retrograde flows were equivalent. Our results suggest that anticoagulants might be recommended even in patients who receive biological valves.
[Mh] Termos MeSH primário: Aorta Torácica/cirurgia
Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Apêndice Atrial/cirurgia
Velocidade do Fluxo Sanguíneo/fisiologia
Simulação por Computador
Imagem Cinética por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Idoso
Anastomose Cirúrgica/métodos
Aorta Torácica/diagnóstico por imagem
Aorta Torácica/fisiopatologia
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/fisiopatologia
Apêndice Atrial/diagnóstico por imagem
Apêndice Atrial/fisiopatologia
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw428


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[PMID]:29489656
[Au] Autor:Shang Q; Geng Q; Zhang X; Xu H; Guo C
[Ad] Endereço:Department of Pathology, Linyi People's Hospital, Linyi, Shandong province.
[Ti] Título:The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis.
[So] Source:Medicine (Baltimore);97(9):e0045, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study was conducted to assess the clinical advantages of early enteral nutrition (EEN) in pediatric patients who underwent surgery with gastrointestinal (GI) anastomosis.EEN has been associated with clinical benefits in various aspect of surgical intervention, including GI function recovery and postoperative complications reduction. Evaluable data documenting clinical advantages with EEN for pediatric patients after surgery with GI anastomosis are limited.We retrospectively reviewed the medical records of 575 pediatric patients undergoing surgical intervention with GI anastomosis. Among them, 278 cases were managed with EEN and the remaining cases were set as late enteral nutrition (LEN) group. Propensity score (PS) matching was conducted to adjust biases in patient selection. Enteral feeding related complications were evaluated with symptoms, including serum electrolyte abnormalities, abdominal distention, abdominal cramps, and diarrhea. Clinical outcomes, including GI function recovery, postoperative complications, length of hospital stay, and postoperative follow-up, were assessed according to EEN or LEN.Following PS matching, the baseline variables of the 2 groups were more comparable. There were no differences in the incidence of enteral feeding-related complications. EEN was associated with postoperative GI function recovery, including time to first defecation (3.1 ±â€Š1.4 days for EEN vs 3.8 ±â€Š1.0 days for LEN, risk ratio [RR], 0.62; 95% confidence interval [CI] 0.43-1.08, P = .042). A lower total episodes of complication, including infectious complications and major complications were noted in patients with EEN than in patients with LEN (117 [45.9%] vs 137 [53.7%]; OR, 0.73, 95% CI 0.52-1.03, P = .046). Mean postoperative length of stay in the EEN group was 7.4 ±â€Š1.8 days versus 9.2 ±â€Š1.4 days in the LEN group (P = .007). Furthermore, the incidence of adhesive small bowel obstruction was lower for patients with laxative administration compared with control, but no significant difference was attained (P = .092)EEN was safe and associated with clinical benefits, including shorten hospital stay, and reduced overall postoperative complications on pediatric patients undergoing GI anastomosis.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório
Nutrição Enteral
Cuidados Pós-Operatórios
[Mh] Termos MeSH secundário: Anastomose Cirúrgica/efeitos adversos
Pré-Escolar
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Nutrição Enteral/efeitos adversos
Feminino
Seguimentos
Seres Humanos
Perfuração Intestinal/cirurgia
Intestinos/cirurgia
Tempo de Internação
Masculino
Cuidados Pós-Operatórios/efeitos adversos
Complicações Pós-Operatórias
Pontuação de Propensão
Recidiva
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010045


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[PMID]:28466004
[Au] Autor:Zhao Y; Zhang J; Lan Z; Jiang Q; Zhang S; Chu Y; Chen Y; Wang C
[Ad] Endereço:Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
[Ti] Título:Are Internal or External Pancreatic Duct Stents the Preferred Choice for Patients Undergoing Pancreaticoduodenectomy? A Meta-Analysis.
[So] Source:Biomed Res Int;2017:1367238, 2017.
[Is] ISSN:2314-6141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The technique of pancreatic duct stenting during pancreatic anastomosis can markedly reduce the incidence of postoperative pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The method of drainage includes using either an external or an internal stent; the meta-analysis result shows us that there were no differences in the rates of postoperative complications between PD using internal stents and PD using external stents; internal stents may be more favorable during postoperative management of drainage tube. What is more, internal stents could reduce the digestive fluid loss and benefit the digestive function.
[Mh] Termos MeSH primário: Ductos Pancreáticos/cirurgia
Fístula Pancreática/fisiopatologia
Pancreaticoduodenectomia/efeitos adversos
Stents
[Mh] Termos MeSH secundário: Anastomose Cirúrgica/métodos
Drenagem
Seres Humanos
Pâncreas/fisiopatologia
Pâncreas/cirurgia
Pancreatectomia/métodos
Ductos Pancreáticos/fisiopatologia
Fístula Pancreática/cirurgia
Complicações Pós-Operatórias
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1155/2017/1367238


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[PMID]:29381999
[Au] Autor:Zhu Y; Jiang H; Chen Z; Lu B; Wu J
[Ti] Título:Abdominal surgery in patients with essential thrombocythemia: A case report and systematic review of literature.
[So] Source:Medicine (Baltimore);96(47):e8856, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Essential thrombocythemia/thrombocytosis (ET) is characterized by increased bleeding and thrombosis risk during the perioperative period. We report the case of a woman with ET and sigmoid colon cancer, in whom the postoperative course was complicated by anastomotic bleeding. A systematic review was conducted to seek guidance for the management of such patient in the perioperative period. METHODS: A systematic literature review was conducted using EMBASE, Medline, and PubMed databases to detect relevant English language articles. Published studies with full-text articles were included. Two authors independently searched and extracted the data. Any differences were resolved by consensus. Studies on abdominal surgery were manually retrieved. RESULTS: Four case reports (including our case report) that described abdominal surgery in patients with ET were included. All patients were females, with a mean age of 47 years. Laparoscopic surgery was performed in 2 patients, and open surgery was performed in the other 2 patients. Two patients had postoperative bleeding that occurred on the first postoperative day. There was one case of pseudohyperkalemia after surgery and one case of Budd-Chiari syndrome caused by hepatic vein thrombosis. No guidelines for patients with ET undergoing abdominal surgery were found. CONCLUSION: In conclusion, there are currently no definitive guidelines for the perioperative management of patients with ET. Furthermore, there are few reports of ET in patients with malignancy undergoing surgery. Further studies in this unique group of patients are required.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Hemorragia Pós-Operatória/etiologia
Neoplasias do Colo Sigmoide/cirurgia
Trombocitemia Essencial/cirurgia
[Mh] Termos MeSH secundário: Abdome/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Feminino
Seres Humanos
Meia-Idade
Trombocitemia Essencial/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008856


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[PMID]:27778058
[Au] Autor:Michalski CW; Tramelli P; Büchler MW; Hackert T
[Ad] Endereço:Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
[Ti] Título:[Closure of pancreas stump after distal and segmental resection : Suture, stapler, coverage or anastomosis?]
[Ti] Título:Verschluss des Pankreasstumpfes bei Links- und Segmentresektion : Naht, Stapler, Deckung oder Anastomose?.
[So] Source:Chirurg;88(1):25-29, 2017 Jan.
[Is] ISSN:1433-0385
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Postoperative pancreatic fistulas represent the most frequent complication after distal and segmental pancreatectomy and occur with a frequency of up to 50 %. There are many technical variations of pancreatic stump treatment for reduction of fistula rates after distal resection. Most of these techniques have only been analyzed in retrospective studies and the evidence for or against a specific technique is low. Several retrospective trials have been conducted with good results to compare suturing with stapled closure of the remnant and to assess the effect of a vascularized falciform ligament patch in reducing postoperative pancreatic fistula; however, in a recently published randomized trial, which analyzed closure of the remnant with a pancreaticojejunostomy compared to standard closure, these results could not be confirmed. Because stapler resection and closure is the most commonly used technique in laparoscopic distal pancreatectomy, there are a large number of studies which assessed various novel methods of improving stapling. Extended stapler compression time and mesh augmentation of the stapler line can be valid methods to reduce fistula rates. Central pancreatectomy is a relatively rarely used procedure where the right-sided pancreatic remnant is closed in the same fashion as during distal pancreatectomy and the left-sided remnant is connected to the intestines with a pancreaticojejunostomy or pancreaticogastrostomy. In conclusion, postoperative pancreatic fistula rates are still a relevant clinical problem after distal pancreatectomy and further studies on potentially improved novel techniques are required.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/métodos
Pancreatectomia/métodos
Fístula Pancreática/prevenção & controle
Complicações Pós-Operatórias/prevenção & controle
Grampeamento Cirúrgico/métodos
Técnicas de Sutura
[Mh] Termos MeSH secundário: Combinação de Medicamentos
Adesivo Tecidual de Fibrina/administração & dosagem
Fibrinogênio/administração & dosagem
Seres Humanos
Pancreaticojejunostomia/métodos
Fatores de Risco
Ligamento Redondo do Fígado/cirurgia
Telas Cirúrgicas
Trombina/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Drug Combinations); 0 (Fibrin Tissue Adhesive); 0 (TachoSil); 9001-32-5 (Fibrinogen); EC 3.4.21.5 (Thrombin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1007/s00104-016-0301-3


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[PMID]:28468146
[Au] Autor:Jin Y; Hua C; Hu X; Chen H; Ma G; Zou Y; Chen B; Lyu D; Tremp M; Lin X
[Ad] Endereço:*Department of Plastic and Reconstructive Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, China †Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
[Ti] Título:Microsurgical Replantation of Total Avulsed Scalp: Extending the Limits.
[So] Source:J Craniofac Surg;28(3):670-674, 2017 May.
[Is] ISSN:1536-3732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Avulsion of the scalp is a rare but severe trauma and challenging to the reconstructive surgeon. It poses not only physical concussion but also significant persisting psychological distress to the patients. METHODS: Medical records from 5 patients who suffered scalp avulsion were reviewed retrospectively. The following data and methods were assessed: age, number of vessels repaired, method of replantation, vein grafts required, blood transfusion, ischemia time, total operating time, and percentage of scalp survival. RESULTS: In 4 patients, the replantation was performed at the anatomic site. Two arteries and 2 veins were anastomosed in 2 patients; a single artery and a single vein were anastomosed in 2 patients. The middle temporal vein was chosen for anastomosis as a recipient vessel in 2 patients. In the fifth patient with simultaneous cervical fracture that makes primarily replantation technically not possible, the scalp was implanted ectopically in the forearm for the purpose of secondary replantation at the anatomic site. After a mean follow-up of 22.6 months (range 13-29 months), 4 of 5 patients exhibited successful survival of the replanted scalp. CONCLUSIONS: The success of scalp replantation is determined by a comprehensive management of the trauma and well-trained microsurgical technique. The middle temporal vein can be used as a reliable alternative recipient vessel for microvascular anastomosis when replanting the avulsed scalp. In patients in whom primary replantation is not possible, temporary ectopic implantation of the avulsed scalp and anatomic replantation at a second stage is considerable.
[Mh] Termos MeSH primário: Traumatismos Craniocerebrais/cirurgia
Desenluvamentos Cutâneos/cirurgia
Microcirurgia/métodos
Reimplante/métodos
Couro Cabeludo/lesões
Couro Cabeludo/cirurgia
[Mh] Termos MeSH secundário: Adulto
Anastomose Cirúrgica
Artérias/cirurgia
Feminino
Seguimentos
Sobrevivência de Enxerto
Seres Humanos
Masculino
Meia-Idade
Couro Cabeludo/irrigação sanguínea
Veias/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/SCS.0000000000003487


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[PMID]:28467332
[Au] Autor:Cecchini S; Azzoni C; Bottarelli L; Marchesi F; Rubichi F; Silini EM; Roncoroni L
[Ad] Endereço:Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100 Parma Italia.. ste.cecchini79@gmail.com.
[Ti] Título:Surgical treatment of multiple sporadic colorectal carcinoma.
[So] Source:Acta Biomed;88(1):39-44, 2017 Apr 28.
[Is] ISSN:0392-4203
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:AIM: Many aspects of the surgical management of multiple sporadic colorectal cancer syndrome, either synchronous and metachronous, remain to be cleared, in particular the prognostic influence of the extent of surgical resection. METHOD: A retrospective review was performed of patients diagnosed with multiple colorectal cancer from 1982 to May 2010. Clinical and pathologic data were collected and reviewed. Survival analysis was performed. RESULTS: We identified 23 patients with multiple sporadic colorectal cancers, of which 8 had synchronous (SC) and 15 metachronous cancers (MC). Of the MC patients, 2 (13%) had the second cancer within 2 years, 4 (27%) in the time period of 2-5 years and 9 (60%) after 5 years. Twenty-one patients underwent multiple segmental resections; 2 patients underwent subtotal colectomy. The 5-year overall survival rate of SC and MC patients was 100% and 87% (p<0.001) respectively. The 5-year overall survival rate of multiple segmental resection patients and subtotal colectomy was 94% and 75% (p=0.655) respectively. CONCLUSION: Either synchronous and metachronous MSCRC patients showed good prognosis independently from to the extent of resection. Our results support a less aggressive biological behaviour allowing a more conservative management. Multiple segmental colorectal resections seem appropriate from an oncologic point of view in MSCRC patients.
[Mh] Termos MeSH primário: Adenocarcinoma/cirurgia
Neoplasias Colorretais/cirurgia
Neoplasias Primárias Múltiplas/cirurgia
Segunda Neoplasia Primária/cirurgia
[Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade
Adenocarcinoma/patologia
Idoso
Idoso de 80 Anos ou mais
Anastomose Cirúrgica
Colectomia
Neoplasias Colorretais/mortalidade
Neoplasias Colorretais/patologia
Feminino
Seres Humanos
Itália/epidemiologia
Masculino
Meia-Idade
Neoplasias Primárias Múltiplas/mortalidade
Neoplasias Primárias Múltiplas/patologia
Segunda Neoplasia Primária/mortalidade
Segunda Neoplasia Primária/patologia
Prognóstico
Estudos Retrospectivos
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180125
[Lr] Data última revisão:
180125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.23750/abm.v88i1.6031


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[PMID]:28746154
[Au] Autor:Borstlap WAA; Westerduin E; Aukema TS; Bemelman WA; Tanis PJ; Dutch Snapshot Research Group
[Ad] Endereço:Academic Medical Center, Amsterdam, The Netherlands.
[Ti] Título:Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection: Results From a Large Cross-sectional Study.
[So] Source:Ann Surg;266(5):870-877, 2017 11.
[Is] ISSN:1528-1140
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Little is known about late detected anastomotic leakage after low anterior resection for rectal cancer, and the proportion of leakages that develops into a chronic presacral sinus. METHODS: In this collaborative snapshot research project, data from registered rectal cancer resections in the Dutch Surgical Colorectal Audit in 2011 were extended with additional treatment and long-term outcome data. Independent predictors for anastomotic leakage were determined using a binary logistic model. RESULTS: A total of 71 out of the potential 94 hospitals participated. From the 2095 registered patients, 998 underwent a low anterior resection, of whom 88.8% received any form of neoadjuvant therapy. Median follow-up was 43 months (interquartile range 35-47). Anastomotic leakage was diagnosed in 13.4% within 30 days, which increased to 20.0% (200/998) beyond 30 days. Nonhealing of the leakage at 12 months was 48%, resulting in an overall proportion of chronic presacral sinus of 9.5%. Independent predictors for anastomotic leakage at any time during follow-up were neoadjuvant therapy (odds ratio 2.85; 95% confidence interval 1.00-8.11) and a distal (≤3 cm from the anorectal junction on magnetic resonance imaging) tumor location (odds ratio 1.88; 95% confidence interval 1.02-3.46). CONCLUSIONS: This cross-sectional study of low anterior resection for rectal cancer in the Netherlands in 2011, with almost routine use of neoadjuvant radiotherapy, shows that one third of anastomotic leakages is diagnosed beyond 30 days, and almost half of the leakages eventually do not heal. Chronic presacral sinus is a significant clinical problem that deserves more attention.
[Mh] Termos MeSH primário: Fístula Anastomótica/epidemiologia
Neoplasias Retais/cirurgia
Reto/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anastomose Cirúrgica
Fístula Anastomótica/diagnóstico
Fístula Anastomótica/fisiopatologia
Doença Crônica
Auditoria Clínica
Estudos Transversais
Feminino
Seres Humanos
Incidência
Modelos Logísticos
Masculino
Meia-Idade
Terapia Neoadjuvante
Radioterapia Adjuvante
Neoplasias Retais/radioterapia
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1097/SLA.0000000000002429


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[PMID]:29277820
[Au] Autor:Takahashi H; Haraguchi N; Nishimura J; Hata T; Yamamoto H; Matsuda C; Mizushima T; Doki Y; Mori M
[Ad] Endereço:Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Suita, Japan htakahashi@gesurg.med.osaka-u.ac.jp.
[Ti] Título:The Severity of Anastomotic Leakage May Negatively Impact the Long-term Prognosis of Colorectal Cancer.
[So] Source:Anticancer Res;38(1):533-539, 2018 01.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anastomotic leakage is a major critical complication in colorectal resection. Although its relevance to oncological outcome has been widely investigated, the correlation between the severity of anastomotic leakage and oncological outcome is not well understood. PATIENTS AND METHODS: The clinical characteristics of 615 patients who underwent curative resection of colorectal cancer with anastomosis and normal healing were compared with 44 similar patients who experienced anastomotic leakage. RESULTS: Of the 44 patients, seven had grade A anastomotic leakage, 21 had grade B and 16 had grade C. Patients with grade A and B anastomotic leakage were treated conservatively (n=28), and those with grade C (n=16) were treated surgically. Those treated surgically had significantly worse recurrence-free survival and worse cancer-specific survival. CONCLUSION: Anastomotic leakage had a negative prognostic impact on cancer-specific survival that depended on the severity of anastomotic leakage.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Fístula Anastomótica/cirurgia
Neoplasias Colorretais/mortalidade
Neoplasias Colorretais/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Complicações Pós-Operatórias/mortalidade
[Mh] Termos MeSH secundário: Idoso
Neoplasias Colorretais/patologia
Intervalo Livre de Doença
Feminino
Seres Humanos
Inflamação/tratamento farmacológico
Masculino
Meia-Idade
Recidiva Local de Neoplasia/diagnóstico
Recidiva Local de Neoplasia/patologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE



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