Felipe Bellolio

Un índice neutrófilo/linfocito elevado se asocia a peor pronóstico en cáncer de colon etapa II resecado

The neutrophil/lymphocyte ratio is an effective marker of inflammation and can have prognostic value in surgical patients. Aim: To evaluate the effect of an increased neutrophil/lymphocyte ratio (NLR) on perioperative complications ana overall ana disease-free survival in patients undergoing elective resection for stage II colon cancer. Material and Methods: Data was obtained from clinical charts, preoperative blood results and hospital records of all patients undergoing an elective curative resection for colon cancer, between 2000 and 2007. Preoperative NLR was calculated. Follow-up was obtained from a prospectively maintained colorectal cancer database, clinical records and questionnaires. Uni and multivariable analysis were performed to identify associations, and survival analysis was performed using Kaplan-Meier curves. Results: One hundred twenty two patients with a mean age of 69years (52% males), were evaluated. Median follow-up was 73 months, and overall survival for 1 and 5 years was 95% and 68%, respectively. On a multivariable analysis after adjusting for age, sex, tumor depth invasion, use of adjuvant therapies and American Society of Anesthesiology preoperative risk score, an NLR > 5 was associated with an increased perioperative complication rate (odds ratio: 3,06, p = 0,033). Kaplan-Meier survival analysis showed a worse overall and disease-free survival for patients with NLR greater than five. Conclusions: A preoperative NLR of five or more is associated with greater perioperative morbidity and worse oncological outcomes in patients undergoing resection for elective stage II colon cancerBACKGROUND The neutrophil/lymphocyte ratio is an effective marker of inflammation ana can have prognostic value in surgical patients. AIM To evaluate the effect of an increased neutrophil/lymphocyte ratio (NLR) on perioperative complications ana overall ana disease-free survival in patients undergoing elective resection for stage II colon cancer. MATERIAL AND METHODS Data was obtained from clinical charts, preoperative blood results and hospital records of all patients undergoing an elective curative resection for colon cancer, between 2000 and 2007. Preoperative NLR was calculated. Follow-up was obtained from a prospectively maintained colorectal cancer database, clinical records and questionnaires. Uni and multivariable analysis were performed to identify associations, and survival analysis was performed using Kaplan-Meier curves. RESULTS One hundred twenty two patients with a mean age of 69 years (52% males), were evaluated. Median follow-up was 73 months, and overall survival for 1 and 5 years was 95% and 68%, respectively. On a multivariable analysis after adjusting for age, sex, tumor depth invasion, use of adjuvant therapies and American Society of Anesthesiology preoperative risk score, an NLR > 5 was associated with an increased perioperative complication rate (odds ratio: 3.06, p = 0.033). Kaplan-Meier survival analysis showed a worse overall and disease-free survival for patients with NLR greater than five. CONCLUSIONS A preoperative NLR of five or more is associated with greater perioperative morbidity and worse oncological outcomes in patients undergoing resection for elective stage II colon cancer.

Are topical oestrogens useful in faecal incontinence? Double‐blind randomized trial

Background  Histopathological studies have shown the presence of oestrogenic receptors in the anal sphincter, which presumes a role in muscular trophism for circulating oestrogens. This could explain the increase in faecal incontinence (FI) in postmenopausal women.

New treatment for faecal incontinence using zinc–aluminium ointment: a double‐blind randomized trial

Aim  In a randomized double‐blind study the therapeutic effect of a novel zinc–aluminium ointment was compared with placebo in patients with faecal incontinence.

Resultados preliminares de la cirugía laparoscópica del cáncer colorrectal

Resumen es: Han pasado 15 anos desde la primera publicacion de una cirugia laparoscopica por cancer colorrectal (CLCC) y finalmente parece ser que la evidencia la ap...

Abordaje laparoscópico para la reconstrucción de tránsito intestinal post-Hartmann: experiencia de un centro sobre 30 pacientes

INTRODUCTION Intestinal passage reconstruction after Hartmanns (PRH) operation is associated with a high morbidity and mortality of about 1%. Despite the increasing use of laparoscopy as an alternative in PRH, there is a lack of patient series at international level. PATIENTS AND METHODS The prospective series of patients subjected to (PRH) by laparoscopy was analysed using the demographic parameters, ASA classification, reason for primary surgery, time between initial surgery and reconstruction, operation time, conversion to open surgery, bowel rest recovery time, complications, hospital stay and follow up. RESULTS A total of 30 patients with a mean age of 61.5 ± 13 years were operated on using laparoscopy. The ASA classification was 1.8 ± 0.3 the BMI was 26.1 ± 2 Kg/m(2). A total of 63% were admitted due to complicated Hinchley III or IV acute diverticulitis. The interval between initial surgery and the passage reconstruction was 7.1 ± 2 months. Conversion to open surgery was necessary in three cases. The mean intestinal passage recovery was 2.1 ± 1 days and the hospital stay was 5.6 ± 1 days. The long-term complications were one mechanic ileum due to bridles and one case of anastomotic stenosis. CONCLUSIONS The post-Hartmann laparoscopic passage reconstruction is associated with a short intestinal motility recovery time, as well as a less prolonged hospital stay compared to an open surgery series. Randomised studies are needed to determine whether laparoscopic reconstruction is superior to the conventional technique.

Diagnóstico y manejo de colitis ulcerosa grave: Una mirada actualizada

Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.

Diagnóstico y tratamiento de la perforación de colon durante la colonoscopia

Twelve perforations in patients aged 26 to 92 years (six women), wereidentified with a global perforation rate of 0.1%. Five occurred during diagnostic and sevenduring therapeutic procedures. All perforations were confirmed by a plain X ray or CT scan ofthe abdomen. Four patients, without signs of initial diffuse peritoneal irritation, were medicallytreated. One of these, finally required surgery. Among operated patients, a primary suture wasdone in five, a primary excision without colostomy in three and a Hartmann procedure due toa severe peritoneal contamination in one. No patient died.

Mortality trends from colorectal cancer in Chile.

are to be congratulated on the rigorous approach to data collection, analysis and insightful reflection on the potential limitations of the study design while providing important data relevant to a large proportion of colorectal surgical practice. Indeed we also concur with the editor’s commentary indicating that this article raises questions still outstanding in the pursuit of a paradigm shift towards laparoscopic colorectal surgery. The authors demonstrate that patients undergoing laparoscopic surgery have more favourable characteristics including female sex, higher location of rectal tumour and lower Union for International Cancer Control (UICC) stage. Furthermore patients undergoing conversion have greater operative time, intra/postoperative complications and 30-day mortality. Finally the authors conclude that the ‘benefit of laparoscopy seems to be extinguished at the moment of conversion ... [and] is a dramatic phenomenon, when the patients with the most favourable characteristics achieve the poorest results’. We consider this supposition an unfair representation and wish to focus on the analysis of those patients having a laparoscopic operation converted to open surgery which formed 12% of the series. Data on patient and tumour characteristics are not provided for this particular subgroup and it is conceivable that the proportion of converted cases represents the 28.5% and 30.6% of tumours < 6 cm and UICC III respectively. Furthermore the relatively large number of subjects (201) having conversion was not subjected to a multivariate regression analysis. This information would have been of interest in identifying potential predictive factors for conversion. Conversion remains central if the data reporting a negative outcome are to be accepted. We acknowledge that it is hard to dissect out the exact reasons for conversion, but we wish to highlight the potential role of tumour biology in this particular subgroup. We propose that one reason for a poorer short-term (and long-term) outcome in patients undergoing conversion is that the act of conversion may be a marker for poor tumour biology, radicality of surgery and the potential for complications. Indeed the negative impact of postoperative infection and blood transfusion on the cancer-specific outcome continues to receive interest [2–4]. In conclusion clearly the increasing use of laparoscopic surgery in colorectal cancer is inevitable but we feel that for rectal cancer further evidence-based assessment is required. The debate raised by the article would benefit from an additional preoperative analysis of predictive factors for conversion and anthropometric/ three-dimensional reconstruction of pelvic anatomy when considering patients for laparoscopic or open rectal surgery [5,6]. Author contributions

Beneficio de la quimioterapia adyuvante en pacientes con cáncer de colon: cohorte retrospectiva de un hospital clínico universitario

Background: Multiple clinical trials have demonstrated the benefits of adjuvant 5-fluorouracil-based chemotherapy for patients with resectable colon cancer (CC), especially in stage III. Aim: To describe the clinical characteristics of a cohort of CC patients treated at a single university hospital in Chile since 2002, and to investigate if chemotherapy had an effect on survival rates. Material and methods: Review of a tumor registry of the hospital. Medical records of patients with CC treated between 2002 and 2012 were reviewed. Death certificates from the National Identification Service were used to determine mortality. Overall survival was described using the Kaplan-Meier method. A multivariate Cox proportional hazard regression model was also used. Results: A total of 370 patients were treated during the study period (202 in stage II and 168 in stage III). Adjuvant chemotherapy was administered to 22 and 70% of patients in stage II and III respectively. The median follow-up period was 4.6 years. The 5-year survival rate for stage II patients was 79% and there was no benefit observed with adjuvant chemotherapy. For stage III patients, the 5-year survival rate was 81% for patients who received adjuvant chemotherapy, compared to 56% for those who did not receive chemotherapy (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.15–0.56). The benefit of chemotherapy was found to persist after adjustment for other prognostic variables (HR: 0.47; 95% CI: 0.23–0.94). Conclusions: Patients with colon cancer in stage III who received adjuvant chemotherapy had a better overall survival.

Insuficiencia intestinal secundaria a síndrome de intestino corto: resultados de un programa multidisciplinario de rehabilitación intestinal

BACKGROUND In patients suffering intestinal failure due to short bowel, the goal of an Intestinal Rehabilitation Program is to optimize and tailor all aspects of clinical management, and eventually, wean patients off lifelong parenteral nutrition. AIM To report the results of our program in patients suffering intestinal failure. PATIENTS AND METHODS A registry of all patients referred to the Intestinal Failure unit between January 2009 and December 2015 was constructed. Initial work up included prior intestinal surgery, blood tests, endoscopic and imaging studies. Also demographic data, medical and surgical management as well as clinical follow-up, were registered. RESULTS Data from 14 consecutive patients aged 26 to 84 years (13 women) was reviewed. Mean length of remnant small bowel was 100 cm and they were on parenteral nutrition for a median of eight months. Seven of 14 patients had short bowel secondary to mesenteric vascular events (embolism/thrombosis). Medical management and autologous reconstruction of the bowel included jejuno-colic anastomosis in six, enterorraphies in three, entero-rectal anastomosis in two, lengthening procedures in two, ileo-colic anastomosis in one and reversal Roux-Y gastric bypass in one. Thirteen of 14 patients were weaned off parenteral nutrition. CONCLUSIONS Our Multidisciplinary Intestinal Rehabilitation Program, allowed weaning most of the studied patients off parenteral nutrition.Background: In patients suffering intestinal failure due to short bowel, the goal of an Intestinal Rehabilitation Program is to optimize and tailor all aspects of clinical management, and eventually, wean patients off lifelong parenteral nutrition. Aim: To report the results of our program in patients suffering intestinal failure. Patients and methods: A registry of all patients referred to the Intestinal Failure unit between January 2009 and December 2015 was constructed. Initial work up included prior intestinal surgery, blood tests, endoscopic and imaging studies. Also demographic data, medical and surgical management as well as clinical follow-up, were registered. Results: Data from 14 consecutive patients aged 26 to 84 years (13 women) was reviewed. Mean length of remnant small bowel was 100 cm and they were on parenteral nutrition for a median of eight months. Seven of 14 patients had short bowel secondary to mesenteric vascular events (embolism/thrombosis). Medical management and autologous reconstruction of the bowel included jejuno-colic anastomosis in six, enterorraphies in three, entero-rectal anastomosis in two, lengthening procedures in two, ileo-colic anastomosis in one and reversal Roux-Y gastric bypass in one. Thirteen of 14 patients were weaned off parenteral nutrition. Conclusions: Our Multidisciplinary Intestinal Rehabilitation Program, allowed weaning most of the studied patients off parenteral nutrition.