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DOI: 10.1016/j.jcol.2019.02.001
Critical assessment of the surgical treatment of low rectal adenocarcinoma in a reference hospital in Recife
Análise crítica do tratamento cirúrgico do adenocarcinoma de reto inferior em hospital de referência no Recife
Abstract
Objectives To evaluate the rates of abdominoperineal resection in patients with low rectal adenocarcinoma at the Hospital Barão de Lucena – SES/PE.
Methodology This is a study based on the analysis of medical records of patients with low rectal adenocarcinoma submitted to surgical treatment at the Hospital Barão de Lucena Coloproctology Service between 2013 and 2016.
Results It was observed that 77.5% of patients underwent abdominoperineal resection and 22.5% underwent anal sparing surgery. Most of the patients were male (62.5%), were under 70 years old (72.5%), presented a BMI less than 30 kg/m2 (87.5%), presented American Society of Anesthesiologists (ASA) score I and III (82.5%), Rullier classification from I to III (95%) and TNM different from T1–T3 (95%). In 92.5% of medical records, there was no record of fecal continence before surgery. The most frequent period between the end of the radiotherapy and the surgery was over 11 weeks (57.5%); the most common distance from the tumor to the anal margin was between 3.1 and 4.0 cm (35% of patients).
Conclusion There was a high rate of non-sparing anal sphincter surgeries. The only predictive factor for abdominoperineal resection was the presence of tumors classified as Rullier type III and IV.
Resumo
Objetivos Avaliar a taxa de ressecção abdominoperineal em portadores de adenocarcinoma de reto inferior no Hospital Barão de Lucena – SES/PE.
Metodologia Trata-se de um estudo baseado na análise de prontuários de pacientes com adenocarcinoma de reto inferior submetidos a tratamento cirúrgico no serviço de Coloproctologia do Hospital Barão de Lucena entre 2013 e 2016.
Resultados Observou-se que 77,5% dos pacientes foram submetidos à ressecção abdominoperineal e 22,5% à cirurgia com preservação esfincteriana. A maioria dos pacientes era do sexo masculino (62,5%), tinha menos que 70 anos (72,5%), apresentava IMC menor que 30 kg/m2 (87,5%), apresentava ASA I e II (82,5%), classificação de Rullier de I a III (95%) e TNM diferente de T1-T3 (95%). Em 92,5% dos prontuários, não havia registro sobre a continência fecal antes da cirurgia. O período mais frequente entre o término da radioterapia e a realização da cirurgia foi superior a 11 semanas (57,5%); a distância, mais comum, do tumor à margem anal estava entre 3,1–4,0 cm (35% dos pacientes).
Conclusão Houve uma alta taxa de cirurgias não poupadoras de esfíncter anal. O único fator preditivo para a realização da ressecção abdominoperineal foi a presença de tumores classificados como Rulier tipo III e IV.
Keywords
Adenocarcinoma - Rectal cancer - Colorectal surgery - Colostomy - Magnetic resonance imagingPalavras-chave
Adenocarcinoma - Câncer retal - Cirurgia colorretal - Colostomia - Imagem por ressonância magnéticaPublikationsverlauf
Eingereicht: 11. Januar 2019
Angenommen: 13. Februar 2019
Artikel online veröffentlicht:
08. März 2021
© 2019. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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