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Objective: To present two cases of late anastotomotic breakdown by bevacizumab and compare it with the current literature. Case report: Two patients with metastatic rectal cancer, with neoadjuvant, surgical and adjuvant management including bevacizumab, presenting anastomotic ischemic complications, evidenced with endoscopy, images and directed biopsies, surgically resolved and taking biopsy of perianastomotic sites with ischemic changes. Discussion: There is evidence in the literature reporting late anastomotic ischemia and leaks with the use of bevacizumab. It seems prudent to consider and suspect this complication in a timely manner, especially in patients with risk factors. Conclusions: Ischemic events in surgical territories should be considered when using bevacizumab. Greater emphasis on patients with risk factors such as malnutrition, irradiation or male sex. Anastomotic-directed study prior to initiation of bevacizu)mab should be considered. To highlight bevacizumab suspension and restart times for the evaluation of possible ischemic complications. [ABSTRACT FROM AUTHOR]

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Introduction and aims: Colorectal cancer is among the three most common cancers worldwide. Knowledge and identification of suboptimal outcome-associated factors enable comprehensive patient management. The aim of the present study was to present the results of the surgical management of colorectal cancer at a quaternary care university hospital. Materials and methods: An observational, analytic, cross-sectional study was conducted. Information was collected on a retrospective cohort of patients diagnosed with colorectal cancer from 2013 to 2017 at the Hospital Universitario Mayor Méderi, Bogotá, Colombia. Results: Data on 452 patients, within the study period, were collected. A total of 48.5% of the patients were men, the overall complication rate was 24%, the surgical site infection (SSI) rate was 15.38%, anastomotic dehiscence occurred in 4.18% of the patients, bleeding required reoperation in 1.32%, and the intrahospital mortality rate was 7.47%. Conclusion: Colorectal cancer management at a university hospital was as beneficial as that provided by other types of hospitals, showing a direct association with complete R0 dissections; low complication rates, according to international reports; and reduced overall morbidity. Resumen: Introducción y objetivos: El cáncer colorrectal se encuentra dentro de los 3 primeros cánceres a nivel mundial, el conocimiento e identificación de los factores asociados a los desenlaces no óptimos permiten realizar un manejo integral del paciente. El objetivo de este estudio es presentar los resultados del manejo quirúrgico de enfermedad oncológica colo-rectal en un hospital universitario de cuarto nivel. Materiales y métodos: Se realizó un estudio observacional, analítico de corte transversal, se recolectó la información de una cohorte retrospectiva de pacientes con diagnóstico de cáncer colorrectal entre el año 2013 al año 2017 en el Hospital Universitario Mayor Méderi, Bogotá, Colombia. Resultados: Se recolectaron 452 pacientes durante el periodo de estudio, de estos el 48.5% fueron varones. El porcentaje global de complicaciones fue del 24%, infección del sitio operatorio (ISO) en el 15.38%, dehiscencia de la anastomosis en el 4.18%, sangrado que origina reintervención en el 1.32% y mortalidad intrahospitalaria en el 7.47%. Conclusión: El manejo del cáncer colorrectal en un hospital universitario mostró beneficios y resultados similares y comparables con otros tipos de hospitales con manejo frecuente de esta enfermedad, mostrando una asociación directa en disecciones completas R0, con bajas tasas de complicaciones según lo reportado a nivel mundial y disminución de morbilidad global.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Estudio retrospectivo cuyo objetivo fue investigar el valor de las características de textura de los tumores primarios en la PET/TC con 18F-FDG pretratamiento para la predicción de la respuesta al tratamiento, la progresión y la supervivencia global en pacientes con cáncer de recto que se sometieron a cirugía después de la terapia neoadyuvante (TNA). Se incluyeron en este estudio pacientes con cáncer de recto que se sometieron a estudio PET/TC con 18F-FDG antes del tratamiento y se sometieron a cirugía después de TNA. Se registraron las características clínico-patológicas, la fecha del último seguimiento, la evolución y fallecimiento. Los parámetros de las texturas y los convencionales de PET (Standard Uptake Value-SUVmax, volumen tumoral metabólico-MTV, glucólisis total de la lesión-TLG) se obtuvieron a partir de imágenes PET/TC utilizando el programa LifeX. Los parámetros se agruparon utilizando el índice de Youden en el análisis ROC. Los factores que predicen la respuesta patológica al tratamiento, la progresión y la supervivencia global se determinaron mediante regresión logística y análisis de regresión de Cox. Cuarenta y cuatro pacientes (26-59% hombres, 18-41% mujeres; 60,1 ± 11,4 años) con cáncer de recto fueron incluidos en este estudio. El número de pacientes respondedores y no respondedores a TNA fueron de 15 (34,9%) y 28 (65,1%), respectivamente. La mediana de la duración del seguimiento fue de 29,9 meses. 9 (20,5%) mostraron progresión de la enfermedad y 8 (18,2%) fallecieron durante el período de seguimiento. Los parámetros de entropía GLCM de diferencia y correlación GLCM se encontraron como predictores independientes para la respuesta a TNA. Los parámetros de positividad del margen quirúrgico, rango intercuartílico de intensidad CONV y textura AUC-CSHDISC fueron predictores independientes de progresión, mientras que los parámetros de diferencia inversa normalizada GLCM y LZLGEGLZLM fueron predictores independientes de mortalidad. Los parámetros de textura obtenidos de la PET/TC con 18F-FDG pretratamiento han presentado un valor predictivo más robusto que los parámetros convencionales de la PET en pacientes con cáncer de recto que se sometieron a cirugía después de TNA. This retrospective study aimed to investigate the value of texture features of primary tumors in pretreatment18F-FDG PET/CT in the prediction of response to treatment, progression, and overall survival in patients with rectal cancer who underwent surgery after neoadjuvant therapy (NAT). Patients with rectal cancer who had pretreatment18F-FDG PET/CT, and underwent surgery after NAT were included in this study. Clinicopathologic features, date of last follow-up, progression, and death were recorded. Textural and conventional PET parameters (maximum standardized uptake value-SUVmax, metabolic tumor volume-MTV, total lesion glycolysis-TLG) were obtained from PET/CT images using LifeX program. Parameters were grouped using Youden index in ROC analysis. Factors predicting the pathological response to treatment, progression, and overall survival were determined using logistic regression and Cox regression analyses. Forty-four patients (26(59%) male, 18 (41%) female; 60.1 ± 11.4 years) with rectal cancer were included in this study. The numbers of patients with responders and non-responders to NAT were15(34.9%) and 28(65.1%), respectively. One patient' pathology report did not contain the response status to NAT. The median of follow-up duration was 29.9 months. 9(20.5%) showed disease progression, and 8(18.2%) died during the follow-up period. Difference entropy GLCM and correlation GLCM parameters were found as independent predictors for response to NAT. The positivity of surgical margin, intensity interquartile range CONV and AUC-CSHDISC texture parameters were independent predictors of progression, while normalized inverse difference GLCM and LZLGEGLZLM parameters were independent predictorsof mortality. The texture parameters obtained from pretreatment18F-FDG PET/CT have presented a more robust predictive value than conventional parameters in patients with rectal cancer who underwent surgery after NAT. [ABSTRACT FROM AUTHOR]

Background: One of the mainstays in the treatment of locally advanced rectal cancer is neoadjuvant chemoradiotherapy. Neoadjuvant therapy have demonstrated to decrease local recurrence, also generating tumor downstaging, even leading to a pathological complete response (PCR), the latter related to better overall survival (OS) and disease-free survival (SLE). Aim: To report the anatomo-pathological results of treatment with chemoradiotherapy in rectal cancer, analyzing the relationship with OS and SLE. Material and Method: Prospective cohort study. A database of colorectal surgeries from the Clinical Hospital of the University of Chile between the years 2004-2019, including patients with locally advanced low and middle rectal cancer, who received neoadjuvant and later surgery. Survival analysis was made with the Kaplan-Meier method and the Log-rank test for comparison. A value of p < 0.05 was considered statistically significant. Results: 411 patients underwent surgery for rectal cancer, 143 patients received neoadjuvant therapy, 19% registered PCR. The OS of the group with PCR was 94% (95% CI; 59.79-79.41%) while that of the group without PCR was 71% (95% CI; 66.64-99.20%) (p = 0.018), the SLE in those patients with PCR reached 100%, while in those without PCR it was 74% (95% CI; 64.08-81.28) (p = 0.008). Conclusions: Patients with PCR have better long-term results than those without PCR. PCR could indicate a favorable biological tumor profile, with less tendency to recurrence and improved survival. [ABSTRACT FROM AUTHOR]

Introduction and aim: The value of leakage testing during colorectal resections to identify anastomotic leaks or bleeding has not been established. Our aim was to compare the impact of intraoperative colonoscopy (IOC) versus insufflation with a syringe, as leakage testing in lower anterior resection (LAR) for rectal cancer, with respect to the incidence of postoperative leakage (PL). Materials and methods: A retrospective study utilizing a prospective database of 426 patients with rectal cancer that underwent elective LAR, within the time frame of January 2015 and December 2019, was conducted. The anastomotic leak test was chosen by the surgeon. The incidence of postoperative leakage was compared between patients that underwent IOC and those that had the syringe leak test, utilizing the logistic regression analysis. Propensity score matching was included. Results: There were no significant differences in the clinical characteristics or morbidity and mortality rates between the two groups. Four patients were excluded, leaving a patient total of 422. Seventy patients with IOC were compared with 352 that had the syringe leak test. The incidence of postoperative leakage was 5.7% in the IOC group and 12.2% in the control group (p = 0.001). After propensity score matching (n = 221), balancing the characteristics between the groups, the incidence of postoperative leakage was 5.7% in the IOC group and 13.9% in the syringe leak test group (p = 0.001). Conclusion: IOC was shown to be a safe method for evaluating the integrity of colorectal anastomosis and was associated with a higher percentage of protective stoma use, appearing to reduce the risk for PL. Resumen: Introducción y objetivo: El valor de las pruebas de filtración durante resecciones colorrectales para identificar fuga o sangrado de anastomosis no está establecido. El objetivo es comparar el impacto de la colonoscopia intraoperatoria (CIO) versus insuflación con jeringa como prueba de fuga en resección anterior baja (RAB) para cáncer de recto, con respecto a la incidencia de filtración posoperatoria (FP). Materiales y métodos: Estudio retrospectivo sobre base de datos prospectiva de 426 pacientes con cáncer de recto sometidos a RAB electiva desde enero de 2015 hasta diciembre de 2019. La prueba de fuga anastomótica se realizó a criterio del cirujano. La incidencia de FP se comparó entre pacientes sometidos a CIO y prueba con jeringa, utilizando el análisis de regresión logística, incluido análisis de emparejamiento por puntaje estimado de propensión. Resultados: Las características clínicas y morbimortalidad no mostraron diferencias significativas entre los grupos. Total 422 pacientes, excluidos 4. Se compararon 70 pacientes CIO contra 352 prueba con jeringa. La incidencia de FP fue 5.7% en CIO y 12.2% en grupo control (p = 0.001). Después del emparejamiento por puntaje de propensión (n = 221), equilibrando las características entre los grupos, la incidencia de FP fue 5.7% en CIO y 13.9% en grupo con jeringa (p = 0.001). Conclusión: La CIO es un método seguro para evaluar integridad de anastomosis colorrectal y se asocia con un mayor porcentaje de estoma de protección, lo que parece disminuir el riesgo de FP.

La cirugía del cáncer de recto y ano se ha desarrollado considerablemente en las últimas décadas. En función de dichos avances, se ha observado una disminución en la morbimortalidad operatoria, así como también una mejoría en el pronóstico de estos pacientes. El objetivo del presente estudio es exponer y analizar los resultados del tratamiento quirúrgico del cáncer de recto y ano en un servicio universitario. Se realizó un estudio observacional, descriptivo y retrospectivo de todos los pacientes intervenidos por cáncer de recto y ano en el Hospital Español entre 2016 y 2020. Las variables registradas fueron: variables demográficas, clínico-oncológicas, relacionadas a la morbimortalidad operatoria y a la recidiva locorregional, y la sobrevida a 5 años. El procedimiento más realizado fue la resección anterior de recto (RAR) en 11 intervenciones (58%), mientras que las 8 restantes correspondieron a amputaciones abdominoperineales (AAP) (42%). Se diagnosticaron un total de 6 complicaciones intraoperatorias en 5 pacientes, siendo la perforación del tumor la más frecuente, y un total de 18 complicaciones postoperatorias en 11 pacientes, siendo la más frecuente la infección de la herida quirúrgica abdominal. La morbilidad operatoria mayor fue de 31,6% y la mortalidad operatoria a 90 días fue de 0%. La sobrevida global a 5 años fue de 63,2%. Los resultados quirúrgicos en la presente casuística fueron comparables con los de la bibliografía consultada. Destacamos la nula mortalidad a 90 días, con resultados oncológicos similares a los reportados en la literatura.

Background and objectives: 720,000 new cases of rectal cancer are reported each year. In the locally advanced stage (LARC), multimodal therapy followed by surgery with total mesorectal excision (TME) is the standard of care with potential benefits in acute toxicity, response assessment and resectability. The objective is to describe the clinicopathological characteristics and oncological results in patients treated with neoadjuvant chemoradiation therapy followed by radical surgery. Methods: A descriptive, non-experimental, cross-sectional and retrospective study in which the clinical records of 141 patients diagnosed with LARC defined as cT3T4N0 or cTXN+M0 scheduled for treatment with neoadjuvant chemoradiation therapy at the National Oncology Institute during the period from January 2014 to December 2019 were analyzed. Results: A total of 119 patients completed neoadjuvant chemoradiotherapy followed by radical surgery, resulting in a resectability of 90.1%. The overall rate of postoperative complications was 17.4%. The pCR and downstaging rate was 19.6% and 70.6%, respectively. Preoperative N category was the only variable with a statistically significant impact regarding pCR vs no pCR (p = 0.04). The median follow-up was 39 months, obtaining a 5-year overall survival of 69% and a 5-year disease-free survival of 74.4%. Conclusion: At the National Oncology Institute of Panama, the treatment of LARC with a long course of chemoradiation therapy followed by surgery with curative intent demonstrated high adherence to treatment with a rate of complete pathological response and local control in accordance with international reports. [ABSTRACT FROM AUTHOR]

We present a first in human clinical trial of a new rectoscope that shows, by means of transillumination, the optimal point of transection of the rectum in oncologic surgery. The device was developed together with a team of engineers and was manufactured by 3D printing. Eighteen patients with a mean age of 71 years and a mean distance from the tumor to the anal margin measured by colonoscopy of 10.4 ± 3.9 cm and by MRI of 10 ± 2.4 cm were included in the trial. Transillumination was feasible in all cases, and the use of the rectoscope was safe, as no adverse events due to its use were recorded., (Copyright © 2024 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The watch-and-wait (WW) strategy is an alternative to anterior resection in patients with rectal cancer (RC) that have had a complete clinical response to neoadjuvant treatment. Few reports describe the quality of life and functional anorectal disorders (FADs) in that population. Aim: To analyze and compare the FADs and quality of life in patients with locally advanced adenocarcinoma of the rectum treated with neoadjuvant therapy, divided into two different strategy groups: group 1 (G1), WW; and group 2 (G2), anterior resection. Materials and methods: Thirty patients (G1: n = 20 and G2: n = 10) that had finished neoadjuvant therapy at least 12 months prior were included. Mean patient age was 59.5 years (range: 41-79) and 15 of the patients were men. The FADs were evaluated through: a) clinical history, b) 21-day bowel diary, c) Jorge and Wexner fecal incontinence scale, d) anorectal manometry (ARM), and fecal incontinence quality of life scale (FIQL). Results: Bowel diary: fecal incontinence (40%) and urge to defecate (45%) in G1 vs. fecal incontinence (60%) and urge to defecate (30%) in G2, with no significant differences (p = NS). Fecal incontinence scale: fecal incontinence in G1 was significantly less severe than that in G2 (median 6.5 points vs. 13 points [p = 0.0142]). ARM: no differences between the two groups. Quality of life: significantly different between the two groups (FIQL/G1: 3.7 vs. FIQL/G2: 2.8; p

Presentamos un caso clínico de cáncer de recto avanzado de un paciente de 26 años de edad, que fue sometido a tratamiento con quimioterapia y radioterapia previo a la cirugía, siendo un caso de mal pronóstico por el estadío avanzado del cáncer recta. El cáncer de recto avanzado o recaído comprende los tumores primario de recto considerados por estudios de imágenes y examen físico como “Irresecables”. La presencia en pacientes en menores de 40 años corresponde a Poliposis hereditaria. Aproximadamente 10% son hereditarios; hallándose genes anormales en pacientes con cáncer de recto avanzado. Destacamos además los factores que provocan la escala o nula respuesta al protocolo de tratamiento utilizado por este Instituto en tumores de este tipo.

Comparar la utilidad de la RM y la PET/TC en la estadificación ganglionar (N) de pacientes con cáncer de recto localmente avanzado (CRLA). Estudio retrospectivo de pacientes con CRLA que completaron su estadificación inicial con PET/TC entre enero de 2020 y marzo de 2023. Se valoraron los ganglios locorregionales, determinando N por ambas técnicas según TNM. Se analizó la concordancia entre la RM y la PET/TC. Se calculó la exactitud diagnóstica (ED) de ambas técnicas en aquellos pacientes sometidos a cirugía directa. Se evaluó la afectación ganglionar pélvica no locorregional por ambas modalidades. De 73 pacientes, 48 presentaron finalmente un estadio localmente avanzado; de estos, 39 fueron tratados con neoadyuvancia (quimio-radioterapia) y cirugía, y 9 con cirugía directa. En 25 pacientes, al completar el estudio de extensión mediante PET/TC se encontró enfermedad a distancia, por lo que recibieron tratamiento sistémico. Se obtuvo concordancia débil entre RM y PET/TC para determinar N (k = 0,286; p < 0,005), con 31/73 (42%) concordantes y 42/73 (58%) discordantes. De los discordantes, en 35/42 (83%) la RM supraestadificó en relación con la PET/TC, siendo 17 de estos N+ (RM) y N0 (PET/TC). Valores de ED: 78% para ambas técnicas. S, E, VPP y VPN: del 80%, 75%, 80% y 75% para la RM, y del 60%, 100%, 100% y 67% para la PET/TC. En 8 pacientes la PET/TC identificó adenopatías metastásicas pélvicas no visibles/dudosas por RM. En la estadificación ganglionar inicial del cáncer de recto la RM supraestadifica en relación con la PET/TC. Ambas modalidades son complementarias: la PET/TC ofrece mayor especificidad y la RM, mayor sensibilidad. To compare the usefulness of MRI and PET/CT in nodal staging (N) of patients with locally advanced rectal cancer (LARC). Retrospective study of patients with LARC, who completed their initial staging with PET/CT, between January 2020 and March 2023. Regional nodes were assessed, and N was determined using both techniques according to TNM criteria. Concordance between MRI and PET/CT was analyzed. The accuracy of both techniques was calculated for those patients who underwent direct surgery. Non-regional pelvic lymph nodes were evaluated by both modalities. Among the 73 patients, 48 were ultimately diagnosed with a locally advanced stage. Of these, 39 underwent neoadjuvant treatment (chemoradiotherapy) followed by surgery, and 9 direct surgery. In 25, the PET/CT extension study revealed distant disease, leading to systemic treatment. Weak concordance was observed between MRI and PET/CT in determining N (k = 0.286; P <.005). Out of 73 patients, 31 (42%) exhibited concordance, and 42 (58%) showed discordance. In 83% of the discordant cases, MRI overstaged compared to PET/CT, with 17 cases indicating nodal involvement (N+) by MRI and N0 by PET/CT. Diagnostic accuracy was 78% for both techniques. Sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 75%, 80%, and 75% for MRI, and 60%, 100%, 100%, and 67%, for PET/CT. PET/CT identified pelvic metastatic adenopathies in 8 patients that were not visible/doubtful by MRI. In the initial nodal staging of rectal cancer MRI overstages relative to PET/CT. Both modalities are complementary, PET/CT offers higher specificity and MRI higher sensitivity. [ABSTRACT FROM AUTHOR]

Introduction and aims: Neoadjuvant therapy in rectal cancer is associated with a decrease in tumor size and is the therapeutic indication for patients with T3 or T4 tumors or lymph node involvement. Our aim was to describe the frequency of pathologic response and the survival rate in patients that underwent neoadjuvant therapy for rectal cancer. Materials and methods: A retrospective follow-up study with a survival analysis was conducted. Patients with locally advanced rectal cancer that received neoadjuvant treatment and were operated on at the Instituto de Cancerología Las Américas (Medellín-Colombia) were analyzed. Survival was calculated using the Kaplan-Meier method. Results: A total of 152 patients were included. Mean patient age was 59 years (12.8 SD), 53.9% were men, and 58.6% of the patients were diagnosed with stage IIIB disease. The pathologic complete response (pCR) was achieved in 17% of the patients. A total of 146 (96.1%) patients received the chemoradiotherapy protocol. Fifty-two (34.2%) patients developed metastasis and/or relapse, and one (3.8%) of those patients had presented with pCR. The median follow-up period was 33 months (Q1-Q3: 20-45), with an overall survival rate of 79.5% (95% CI: 70.9-85.8). The 5-year survival rate for the patients that had pCR was 80% (95% CI: 20.3-96.9). Conclusions: The frequency of pCR was similar to that in other published studies and disease recurrence was lower, compared with patients with no response. The 5-year survival rate in patients with pCR was high, albeit lower than that reported in other studies. Resumen: Introducción y objetivos: La terapia neoadyuvante en cáncer de recto se asocia con disminución del tamaño tumoral y es la indicación terapéutica para pacientes con tumores T3, T4 o con compromiso ganglionar. El objetivo fue describir la frecuencia de respuesta patológica y la supervivencia de los pacientes sometidos a neoadyuvancia para cáncer de recto. Materiales y Métodos: Estudio de seguimiento, retrospectivo, con análisis de supervivencia. Se incluyeron los pacientes con cáncer de recto localmente avanzado, que recibieron tratamiento neoadyuvante y se operaron en el Instituto de Cancerología Las Américas (Medellín-Colombia). La supervivencia se estimó por el método Kaplan-Meier. Resultados: Se incluyeron 152 pacientes, promedio de edad 59 años (d.e. 12.8), 53.9% hombres, 58.6% diagnosticados en estadio IIIB. La respuesta patológica completa (pRC) se logró en 17% de los pacientes. El protocolo de quimiorradioterapia se dio a 146 (96.1%) pacientes; presentaron metástasis y/o recaída 52 (34.2%), de los cuales 1 (3.8%) había tenido pRC. La mediana de seguimiento fue 33 meses (Q1-Q3: 20-45) con una supervivencia global de 79.5% (IC95%: 70.9-85.8). Para quienes tuvieron pRC la supervivencia a 5 años fue 80% (IC95%: 20.3-96.9). Conclusiones: La frecuencia de pRC fue similar a otros estudios publicados y su recidiva fue menor con respecto de quienes no tuvieron respuesta. La supervivencia a 5 años de los pacientes con pRC fue alta, aunque inferior a lo publicado en otros estudios.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción. El tratamiento neoadyuvante con radioterapia y quimioterapia radiosensibilizante en el cáncer de recto localmente avanzado (CRLA) disminuye significativamente las tasas de recurrencia local. Por tanto el objetivo de este estudio es analizar la respuesta patológica completa (RPC) y parcial (RPP) tras el tratamiento neoadyuvante con quimioradioterapia en pacientes con CRLA. Material y método. Se realizó un estudio descriptivo, retrospectivo en pacientes con diagnóstico de CRLA desde enero 2016 a diciembre 2018 en el Servicio de Oncología-Radioterápica del Hospital Universitario La Paz. Se incluyeron 140 pacientes. Un grupo de pacientes (92,9%) se trató con radioterapia 3D conformada con una dosis de 45Gy sobre pelvis y una sobreimpresión de 5,4Gy sobre tumor primario y otro grupo (7,1%) se trató con radioterapia con técnica volumétrica y en arcoterapia (VMAT) guiado por imagen (IGRT) con una dosis de 53,7Gy en pelvis con sobreimpresión concurrente al tumor. La dosis de capecitabina oral fue de 850mg/m2 dos veces al día durante el tratamiento. Todos los pacientes fueron reevaluados con resonancia magnética (RM) post-neoadyuvancia. Los pacientes se operaron entre 6-8 semanas tras quimioradioterapia. Resultados. Se obtuvo una RPC de 17,1% y RPP de 80,1% con una tasa global de downstaging de 31,8%. Conclusión. Se concluye que la quimioradioterapia neoadyuvante es un tratamiento seguro con aceptables tasas de control local en los pacientes con CRLA.

Introduction and aim: Surgery for distal rectal cancer (DRC) can be performed with or without sphincter preservation. The aim of the present study was to analyze the outcomes of two surgical techniques in the treatment of DRC patients: low anterior resection (LAR) and abdominoperineal resection (APR). Methods: Patients with advanced DRC that underwent surgical treatment between 2002 and 2012 were evaluated. We compared the outcomes of the type of surgery (APR vs LAR) and analyzed the associations of survival and recurrence with the following factors: age, sex, tumor location, lymph nodes obtained, lymph node involvement, and rectal wall involvement. Patients with distant metastases were excluded. Results: A total of 148 patients were included, 78 of whom were females (52.7%). The mean patient age was 61.2 years. Neoadjuvant chemoradiation therapy was performed in 86.5% of the patients. APR was performed on 86 (58.1%) patients, and LAR on 62 (41.9%) patients. No differences were observed between the two groups regarding clinical and oncologic characteristics. Eighty-seven (62%) patients had pT3-4 disease, and 41 patients (27.7%) had lymph node involvement. In the multivariate analysis, only poorly differentiated tumors (P = .026) and APR (P = .009) correlated with higher recurrence rates. Mean follow-up time was 32 (16-59.9) months. Overall 5-year survival was 58.1%. The 5-year survival rate was worse in patients that underwent APR (46.5%) than in the patients that underwent LAR (74.2%) (P = .009). Conclusions: Patients with locally advanced DRC that underwent APR presented with a lower survival rate and a higher local recurrence rate than patients that underwent LAR. In addition, advanced T/stage, lymph node involvement, and poor tumor differentiation were associated with recurrence and a lower survival rate, regardless of the procedure. Resumen: Introducción y objetivo: La cirugía de cáncer de recto distal (CRD) puede ser llevada a cabo con o sin la preservación de esfínter. El objetivo del presente estudio fue analizar los desenlaces de dos técnicas quirúrgicas en el tratamiento de pacientes con CRD: resección anterior baja (RAB) y resección abdominoperineal (RAP). Métodos: Se evaluó a pacientes con CRD avanzado que se sometieron a tratamiento quirúrgico entre el 2002 y 2012. Comparamos los desenlaces por tipo de cirugía (RAB vs RAP) y analizamos las asociaciones de sobrevida y recurrencia con los siguientes factores: edad, sexo, localización de tumor, ganglios linfáticos afectados y obtenidos, y afectación de la pared rectal. Se excluyó a pacientes con metástasis distantes. Resultados: Se incluyó a un total de 148 pacientes, de los cuales 78 eran mujeres (52.7%). El promedio de edad de los pacientes fue de 62.1. Se realizó radioquimioterapia neoadyuvante en 86.5% de los pacientes. Ochenta y seis pacientes (58.1%) se sometieron a RAP y 62 (41.9%) a RAB. No se observaron diferencias entre los dos grupos respecto a las características clínicas y oncológicas. La enfermedad de 87 pacientes (62%) era pT3-4 y en 41 (27.7%) pacientes existía afectación ganglionar. En el análisis multivariado, solo los tumores con diferenciación pobre (p = 0.026) y la RAP (p = 0.009) estuvieron correlacionados con una tasa más alta de recurrencia. El tiempo promedio de seguimiento fue de 32 meses (16-59.9). La sobrevida de 5 años general fue de 58.1%. La tasa de sobrevida de 5 años fue peor en pacientes que se sometieron a RAP (46.5%) que en pacientes que se sometieron a RAB (74.2%) (p = 0.009). Conclusiones: Los pacientes con CRD localmente avanzado que se sometieron a RAP presentaron una menor tasa de sobrevida y una tasa más alta de recurrencia local que los pacientes que se sometieron a RAB. Además, la etapa T/avanzada, la afectación ganglionar y la diferenciación tumoral pobre estuvieron asociados con mayor recurrencia y tasa más baja de sobrevida, independientemente del procedimiento quirúrgico.

Presentado en sesión de 25 de noviembre de 1953

Aim: To evaluate the clinical outcome of early closure of a protective ileostomy and preoperative stimulation of the efferent limb in a cohort of patients with rectal cancer treated surgically, primarily using the laparoscopic approach., Methods: We performed an observational retrospective cohort study in a prospectively recorded series of patients with rectal cancer who underwent laparoscopic surgery with a protective loop ileostomy between 2017 and 2022. Ileostomy closure was programmed for within 3 months after surgery. All patients underwent stimulation of the efferent limb. Primary outcomes were morbidity and mortality, length of stay (LOS), and re-admission., Results: Between 2017 and 2022, 108 patients underwent resection for rectal cancer and protective ileostomy. The laparoscopic approach was performed in 84.3% of patients (n = 91). Permanent ileostomy was performed in 5 patients (4.6%). Ileostomy closure was thus performed in 95.4% of patients (n = 103). Median time to closure was 74.5 days (range 57-113). In 63.1% (n = 65) of patients, reconstructive surgery was performed within 90 days. Prior to closure, efferent limb stimulation was performed in 77.8% (n = 84) of patients. Global morbidity was 26.2% (n = 27) (85.19%, n = 23 Clavien-Dindo I and 7.41%, n = 2 Clavien-Dindo II). The main causes of morbidity were postoperative ileus (10.7%, n = 11) and rectal bleeding (8.7%, n = 9). Anastomosis leakage occurred in 2 patients. Median hospital stay was 6 days (5-7). Readmission was needed in 6.8% (n = 7) of patients., Conclusion: A previous laparoscopic approach, early closure and stimulation of the efferent limb could be a useful strategy to reduce the morbidity and mortality of temporary ileostomy closure., (Published by Elsevier España, S.L.U.)

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ntroducción: El Cáncer Colorrectal (CCR) es la segunda causa más común de cáncer en los Estados Unidos y es el segundo tumor digestivo más frecuente en Ecuador. La sobrevida de estos pacientes aumenta con el tratamiento adecuado, el cual debe establecerse en función del estadiaje y la localización. El objetivo del presente estudio es describir nuestra experiencia en el tratamiento de los pacientes con cáncer de recto que acudieron al Instituto, en el período 1998-2007. Material y Métodos: El universo comprendió 49 pacientes con cáncer de recto (CR) tratados con fines curativos. Las variables estudiadas fueron edad, sexo, manifestaciones clínicas, etapa clínica y patológica, determinación de antígeno carcinoembrionario (CEA), tipos de tratamiento, metástasis postratamiento, supervivencia y estado actual. Los datos fueron elaborados, tabulados y resumidos mediante tablas y gráficos en el software SPSS v. 15. Para la determinación de supervivencia se utilizó Kaplan Meier. Resultados: El promedio de edad fue 60 años. La frecuencia fue mayor en mujeres. El síntoma más frecuente fue rectorragia (73.5%); el 81.6% no recibió transfusiones sanguíneas; el CEA se mantuvo dentro de los valores de normalidad. La localización tumoral más frecuente fue tercio inferior 53.1%; el 44.9 % perteneció estadío II, 30.6% a III. El grado de diferenciación más frecuente fue el moderado. La supervivencia media global fue de 30.55 meses (72.3 para hombres y 58.8 para mujeres). El promedio de supervivencia libre de enfermedad fue mayor en el sexo masculino, en los que no recibieron transfusiones y en estadío patológico 0 (Tis). Tanto la supervivencia global como libre de enfermedad fue menor en pacientes sometidos a resección anterior baja con margen inferior menor a 2cm. Conclusión: La etapa patológica y los márgenes quirúrgicos amplios (mayores a 2cm) en resecciones anteriores bajas son los principales factores que influyeron en la supervivencia de los pacientes estudiados.

Introduction: colon and rectal cancer is among the leading causes of cancer death worldwide in recent years. Objective: to characterize clinically and epidemiologically colorectal cancer. Method: the bibliographic review was carried out by searching the Medline, Pubmed, Clinical Key, Scielo regional and Scielo Cuba databases, as well as books such as Themes of Internal Medicine, Volume II and the Topics of Surgery, Volume II, both from the Medical Sciences Publishing House. Descriptors were used: colon cancer, rectal cancer, and cancer mortality. A total of 90 papers were reviewed, of which 20 were chosen as bibliographic references. Development: colorectal cancer is a preventable neoplasm and responds satisfactorily to treatment when detected at an early age, so its prognosis depends largely on the degree of progression of the tumor, normally affects the population aged 60 to 80 years, in the that the risk factor that affects the most is aging and currently surgical treatment has proven to be the only one with a chance of cure. Conclusions: colorectal cancer currently occupies one of the first places in morbidity rates worldwide. The clinical manifestations will depend on its location, the right takes the forms: tumor, inflammatory, anemic and dyspeptic, and the left: obstructive, hemorrhagic, inflammatory and tumor and in the final periods mucosanguinolent stools, asthenia, anorexia and loss of blood are added in the final periods. weight, which often lead to cachexia.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Sphincter-sparing surgeries result in the development of a defecatory dysfunction with different degrees, which is known as low anterior resection syndrome (LARS) and is measured with the LARS Score questionnaire. Objective: To determine the association of the EuroQol-5 questionnaire with the different degrees of LARS Score. Materials and Method: Cross-sectional study, applying the LARS Score and EuroQol-5 questionnaire to patients operated with low and middle rectal cancer, during the period 2004-2017. Demographic analysis and type of surgery are performed. Different statistical tests are used to determine associations between variables, considering a significant p value < 0.05. Results: 54 patients were surveyed, 62.16% men, mean age 58.44 years, 37.03% presented Mayor-LARS. The average quality of life indices for Non-LARS patients is 0.75, for Minor-LARS is 0.69 and for Mayor-LARS is 0.61, the difference between indices presents a p value = 0.246. 46.3% present problems in habitual activities. LARS Mayor presents an Odd-Ratio of 3.8 and 4.7 for pain/discomfort and anguish/depression respectively. 70% of patients with LARS Mayor presented SMT and 45% corresponded to those under 65 years of age. Discussion: There is no statistically significant difference between the quality of life indices according to the LARS Score. Mayor-LARS is more likely to develop some degree of Pain/Discomfort and anguish/depression. The percentage of Mayor-LARS is according to what has been published and the TME is one of the factors with the greatest impact on the development of LARS. Conclusion: The LARS Score is non-significantly related to the quality of life index provided by the EuroQol-5D questionnaire, and there is a tendency to decrease quality of life as the LARS worsens. [ABSTRACT FROM AUTHOR]

Introducción: el pronóstico del cáncer de recto depende, entre otros factores, de la calidad oncológica de la resección quirúrgica, entre los que se deben incluir la correcta disección del mesorrecto y un adecuado número de ganglios linfáticos. Objetivos: describir los principales factores que determinan la calidad de la cirugía de resección por cáncer de recto en la Clínica Quirúrgica 2 del Hospital Maciel. Pacientes y método: 36 pacientes operados de coordinación en el período 2012 a 2016. Resultados: la disección mesorrectal fue completa en el 60% de los casos, y en más del 50% se obtuvo un número aceptable de ganglios linfáticos. Discusión: la calidad oncológica de la cirugía por cáncer de recto depende de mútiples factores, entre los que destacamos el volumen anual de cirugías, la experiencia del equipo, factores del paciente (sexo, índice de masa corporal) y de la enfermedad (topografía baja, estadio, respuesta a la neoadyuvancia). Conclusiones: los resultados obtenidos pueden considerarse oncológicamente satisfactorios.

Aim: To analyze the surgical and oncological results of patients with rectal adenocarcinoma (RA) operated with robotic assistance. Materials and Method: Prospective cohort study, consecutive sample of patients between 2014-2017. Inclusion criteria: patients with primary RA, undergoing rectal resection, with robotic assistance with curative intention. Exclusion criteria: histology not adenocarcinoma. Evaluation of clinical-surgical data. Descriptive statistical analysis. Results: 37 patients were included; 20 (54%) were men and average age was 58.7 years. The average distance from the anal margin to the distal edge of the tumor was 6.6 cm (2-12 cm). Chemoradiotherapy (neoadyuvant) was indicated in 26 patients. The most frequent surgery was low anterior resection of the rectum and the average operating time was 266 minutes. Two conversions to laparotomy were performed. One or more complications were observed in 17 (45.9%) patients, 9 of them were Clavien-Dindo III or IV, 5 patients (13%) were reoperated. There were no blood transfusions and no postoperative mortality. The average postoperative hospital stay was 9.6 days (3-34). The average of resected lymph nodes was 15. Surgical margins were negative in all patients. Intestinal transit was restored in 28/32 (87.5%) patients. The average follow-up was 21 months (1-56), the overall and disease-free survival was 100%. Discussion and Conclusion: Proctectomy with robotic assistance has proved to be safe in terms of early surgical results and oncologic indicators of the surgical piece. [ABSTRACT FROM AUTHOR]

During the last decades, advances in surgical techniques, radiotherapy and chemotherapy have significantly increased survival and reduced local recurrence in rectal cancer, avoiding a definitive colostomy. However, this transcendental medical progress has not been accompanied by an improvement in the functional results of patients after sphincter-preserving rectal resection, being the set of defecatory symptoms after rectal resection, known as low anterior resection syndrome (LARS), a practically inevitable sequel, which is usually associated with sexual or urinary dysfunction, chronic pain, high costs and an important alteration in the quality of life. In this article, we will present a complete and updated review of the clinical and alternative characteristics of LARS treatment, ending with a proposal for multidisciplinary and integral management that highlights the importance of prehabilitation, objective evaluation of symptoms, education and adequate information of the patient and his family, in addition to teamwork in units specialized in pelvic floor rehabilitation, a fundamental requirement when properly managing this pathology. [ABSTRACT FROM AUTHOR]

Introduction: Total mesorectal excison and preoperative radiotherapy are important components of multimodal treatment in patients with a low locally advanced rectal cancer. Short-term results of laparoscopic surgery has proven to be safe but oncological results are unclear. Aim: To compare short-term and oncologic outcomes of laparoscopic and open resection of locally advanced rectal cancer operated on in the same period. Materials and Method: A total of 327 patientes with rectal cancer treated by open and laparoscopic curative surgery were retrospectively reviewed. Long-term follow up was compared using Kaplan-Meier curves and survival data were tested by log rank test. Results: Demographic data, levels of carcinoembryonaric antigen, perioperative morbidity and pathologic stages were similar in both groups, except for less inhospital time in laparoscopic group (p = 0.007). Over 90% of middle and low tumors recived preoperative radiotherapy. Local recurrence and overall survival shows no difference between both groups. Low and middle rectal cancer showed worst prognosis than tumors of the high rectum, no matter of type of surgery (p = 0.007). Conclusions: Laparoscopic surgery is non-inferior to open resection for pathological and oncological outcomes. It's not convenient to include on trials lesions located in the high rectum, usually treated with primary surgery as colon cancer. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El cáncer colorrectal es el tercer cáncer en frecuencia a nivel mundial. Aunque su incidencia está aumentando, fundamentalmente en menores de 50 años, su mortalidad ha disminuido un 50% en los países más desarrollados, principalmente debido a la adopción de nuevas prácticas en la prevención, diagnóstico y tratamiento. En particular, las diversas modalidades de diagnóstico por imagen permiten mejorar la toma de decisiones terapéuticas, la evaluación de la respuesta y la eficacia de las nuevas terapias y la detección precoz de la recidiva. La finalidad del presente trabajo es hacer una revisión de la evidencia científica disponible sobre el valor de la tomografía por emisión de positrones con 18F-FDG (18F-FDG PET/TC) en el cáncer colorrectal, haciendo especial hincapié en las indicaciones de las guías y recomendaciones de las principales asociaciones científicas internacionales respecto a esta técnica de imagen. Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under 50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18F-FDG (18F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique. [ABSTRACT FROM AUTHOR]

Introduction: Intersphinteric resection (ISR) allows preserve sphincter function in selected patients with rectal cancer (RC). Notwithstanding, it can produce alterations in defecation. Aim: To analyze the oncological and functional results after an ISR. Materials and Method: Observational, analytical, cross-sectional study, in the period 2007-2016. Inclusion criteria: Patients submitted to ISR by RC with curative intention. All the patients had a follow-up in 2017. Analysis of functional evaluation were performed by Jorge- Wexner, LARS and Kirwan scale. Statistical analysis: Descriptive statistics and Kaplan-Meier method. Results: Of 21 patients; Fourteen (67%) were male, average age: 59 years. Tumor location: 4 cm (2-6 cm) from anal verge. Eighteen (85.7%) patients received neoadjuvant therapy. All distal and radial margins were negative. One patient (4.8%) had distant metastases and there was no locoregional recurrence. With a median follow-up of 76.3 (9.8-126.8) months, the 5-year global and disease-free survival was: 100% and 95% (CI: 90.1-99.9%), respectively. With a median follow-up of 90 months (21.7-124.2); Functional evaluation was performed on 15/21 patients. The Jorge-Wexner score had a median of 13 (4-17) points, the LARS scale of 34 points and in Kirwan scale, four patients (26.7%) showed good function (Kirwan I-II). Conclusion: The oncological results of patients undergoing ISR are satisfactory, however, functional results should be taken into account when proposing this surgical procedure. [ABSTRACT FROM AUTHOR]

In the last 30 years, oncologic outcomes of rectal cancer treatment have been significantly improved due to multimodal management and the introduction of the concept of total mesorectum excision. Although the improvements in oncological treatment and surgical techniques are undeniable, multimodal treatment results in the onset of disorders of the intestinal, sexual and urinary function in a high proportion of these patients. Up to 90% of patients undergoing a low anterior resection refer bowel disorders such as fecal incontinence, urgency, increased frequency and fragmentation of defecation. These elements are included in an entity known as the low anterior resection syndrome and specific assessment tools have been designed recently, evidencing the high incidence and prevalence of this syndrome. In the present review, we update the pathophysiology, risk factors, clinical presentation, evaluation and the alternatives of prevention and treatment of low anterior resection syndrome. [ABSTRACT FROM AUTHOR]

Introduction: The abdominoperineal resection (APR) was the standard treatment of middle-low rectal cancer, in the last 20 years the development of sparing techniques with sphincter preservation with adequate surgical and oncological results has allowed to offer the patient the sphincter apparatus preservation, avoiding the definitive colostomy, however, these techniques may present secondary incontinence to the loss of the rectum. Both surgical options can affect the quality of life of the patient and this element should be considered. Objective: To compare the change in quality of life of patients undergoing APR vs sphincter preserving techniques in patients operated for rectal cancer. Materials and Method: Cross-sectional cohort study with medium-low rectal cancer patients, operated in our hospital from 2009 to 2015. The instrument EuroQuol-5D2, validated in chilean spanish is used. Results: 39 patients were included (11 definitive colostomy and 28 sphincter preservation). In the analysis by domains, significant differences were observed favor to definitive colostomy in the Item of "Habitual Activities" and favor to sphincter preservation in the Item "Sexuality". Conclusions: In patients with middle-low rectal cancer, the choice of surgical technique have a measurable impact on the patient's quality of life. [ABSTRACT FROM AUTHOR]

The diseases of the colorectal area are becoming more frequent for multiple reasons. Of these pathologies, the ones with the highest incidence are colon and rectum cancer. Different studies have reported the importance of scoring systems for the assessment of the patient that will be submitted to surgery. These scoring systems have different factors that are able to interact among themselves, in order to reduce the risk of complications during and after surgery. Some of the risk factors associated with a torpid evolution in colorectal surgery are: age, sex, previous abdominal surgery, value of existing predictive risk scores, obesity, comorbidities and bowel cleansing prior to surgery, which are exposed in the following literature review. [ABSTRACT FROM AUTHOR]

Introducción: el cáncer rectal representa un problema de salud en el mundo y la estadificación clínica constituye la llave para definir la conducta a seguir. Objetivo: determinar la eficacia de la ecoendoscopia en el estadiaje T y N del cáncer rectal. Métodos: se realizó un estudio descriptivo, desde enero del 2014 hasta marzo del 2016, se seleccionaron un total de 33 pacientes que se habían realizado ecoendoscopia y que luego fueron intervenidos quirúrgicamente. Se comparó la estadificación mediante ecoendoscopia con el informe anatomopatológico de la pieza quirúrgica obtenida. Se calculó concordancia global y eficacia diagnóstica en los diferentes estadios del cáncer rectal. Resultados: la concordancia global para la etapa T fue 57,6 % y 87,9 % para N. La precisión diagnóstica en pacientes que recibieron adyuvancia resultó del 47,1 % y 82,4 % para las etapas T y N respectivamente. La eficacia diagnóstica por subetapas T resultó en valores respectivos de sensibilidad y especificidad de 71,43 % (95 % CI 64 %-79 %) y 84,6 % (95 % CI 82 %-86 %) en T1; 76,9 % (95 % CI 73 %-81 %) y 70,0 % (95 % CI 67 %-73 %) en T2; y 42,8 % (95 % CI 35,5 %-50,2 %) y 96,2 % (95 % CI 94,2 %-98,1 %) en T3. Conclusiones: la concordancia global en T resultó inferior a lo reportado en la literatura consultada así como la eficacia diagnóstica de la técnica, debido a que 17 pacientes tuvieron tratamiento adyuvante previo. No hubo resultados significativos en la evaluación de la etapa N.

Introduction: Transanal total mesorectal excision is a hybrid approach that combines the use of a conventional laparoscopic and a transanal platform. Objectives: To conduct an analysis of selected cases with medium and lower rectal cancer, were a combined transanal approach was used and description of the surgical technique. Materials and methods: Prospective series of patients diagnosed with middle and lower third rectal cancer with mesorectal resection assisted by endoanal single port, between October 2012 and December 2015 at University of Chile Clinical Hospital. Descriptive statistics were used for data analysis. Results: A total of 29 patients underwent surgery for middle and lower rectal cancer using a transanal single port. Gender distribution was 22 male and 7 female patients, with a mean age of 55.5 years and a mean BMI of 26.4. The mean distance from the anal margin was 4.8 cm. All patients received neoadjuvant therapy. The surgeries performed were 17 Ta-TME (58.6%) and 12 Ta-TME with intersphincteric approach (41.4%). The colo-anal anastomosis was hand sewn in 15 patients (51.7%), and stapled in 14 (48.3%). The laparoscopic approach was used in 26 patients and the open approach in 3, with 4 conversions (15.4%). The mean operative time was 282 min. The mean hospital stay was 9 days. Conclusion: The endoanal single port appears as a useful tool in total mesorectal dissection for its safety and feasibility. We believe we need randomized prospective studies, where comparison of oncological and functional long-term results is relevant. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Colorectal cancer is among the three most common cancers worldwide. Knowledge and identification of suboptimal outcome-associated factors enable comprehensive patient management. The aim of the present study was to present the results of the surgical management of colorectal cancer at a quaternary care university hospital., Materials and Methods: An observational, analytic, cross-sectional study was conducted. Information was collected on a retrospective cohort of patients diagnosed with colorectal cancer from 2013 to 2017 at the Hospital Universitario Mayor Méderi, Bogotá, Colombia., Results: Data on 452 patients, within the study period, were collected. A total of 48.5% of the patients were men, the overall complication rate was 24%, the surgical site infection (SSI) rate was 15.38%, anastomotic dehiscence occurred in 4.18% of the patients, bleeding required reoperation in 1.32%, and the intrahospital mortality rate was 7.47%., Conclusion: Colorectal cancer management at a university hospital was as beneficial as that provided by other types of hospitals, showing a direct association with complete R0 dissections; low complication rates, according to international reports; and reduced overall morbidity., (Copyright © 2021 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Purpose: This retrospective study aimed to investigate the value of texture features of primary tumors in pretreatment 18 F-FDG PET/CT in the prediction of response to treatment, progression, and overall survival in patients with rectal cancer who underwent surgery after neoadjuvant therapy(NAT)., Methods: Patients with rectal cancer who had pretreatment 18 F-FDG PET/CT, and underwent surgery after NAT were included in this study. Clinicopathologic features, date of last follow-up, progression, and death were recorded. Textural and conventional PET parameters(maximum standardized uptake value-SUVmax, metabolic tumor volume-MTV, total lesion glycolysis-TLG) were obtained from PET/CT images using LifeX program. Parameters were grouped using Youden index in ROC analysis. Factors predicting the pathological response to treatment, progression, and overall survival were determined using logistic regression and Cox regression analyses., Results: Forty-four patients (26(59%) male, 18(41%) female; 60.1±11.4 years) with rectal cancer were included in this study. The numbers of patients with responders and non-responders to NAT were 15(34.9%) and 28(65.1%), respectively. One patient' pathology report did not contain the response status to NAT. The median of follow-up duration was 29.9 months. 9(20.5%) showed disease progression, and 8(18.2%) died during the follow-up period. Difference entropy GLCM and correlation GLCM parameters were found as independent predictors for response to NAT. The positivity of surgical margin, intensity interquartile range CONV and AUC-CSH DISC texture parameters were independent predictors of progression, while normalized inverse difference GLCM and LZLGE GLZLM parameters were independent predictors of mortality., Conclusion: The texture parameters obtained from pretreatment 18 F-FDG PET/CT have presented a more robust predictive value than conventional parameters in patients with rectal cancer who underwent surgery after NAT., (Copyright © 2023 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

La calidad de vida (QOL) es un concepto que ha cobrado cada vez mayor importancia. Cuando hablamos de salud, resulta necesario incluir este tema, debido a que los avances en medicina han permitido alargar la vida considerablemente, lo cual ha repercutido en las expectativas de los pacientes en cuanto a su nivel de actividad, autonomía y estado de salud en general. Más aún, toma especial relevancia el hablar de QOL cuando nos referimos a cáncer de recto, donde los pacientes pueden ser sometidos a terapias altamente invasivas, con cirugías mayores, además de terapias adyuvantes como la quimio y la radioterapia. Posterior a la resección quirúrgica del tumor es frecuente que se requiera confeccionar una ostomía, la cual puede ser permanente o transitoria. Independiente de la temporalidad, podemos distinguir un cambio en la QOL de los pacientes como consecuencia de este tipo de intervención, el cual será revisado en este artículo.

Fournier's Gangrene is the bacterial spread in the perineal and perianal region that compromises deep tissues and occurs in individuals who have some immunomodulation status. It has a high morbidity and mortality rate, and timely treatment affects its prognosis. There are few reported cases associated with rectal perforation due to malignant neoplasia. Two cases of this entity are described in individuals with rectal cancer. Its evolution is described, along with a brief review of the literature. [ABSTRACT FROM AUTHOR]