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.

Palavras-chave:
Adenocarcinoma; Câncer retal; Cirurgia colorretal; Colostomia; Imagem por ressonância magnética

Assessed factor	n	%	p-value^a a p-value of the chi-squared test for comparison of proportion (p < 0.05 indicates the proportions found in the levels of the factor evaluated differ).
Gender			0.114
Male	25	62.5
Female	15	37.5
Age			0.004
Less than 70 years	29	72.5
70 or more years	11	27.5
Minimum-maximum	39-88
Mean ± standard deviation	61.4 ± 12.6
BMI			<0.001
Less than 30	35	87.5
30 or more	5	12.5
Minimum-maximum	15.9-32.9
Mean ± standard deviation	25.0 ± 3.8
Incontinence			<0.001
No	37	92.5
Yes	3	7.5
ASA			<0.001
Lower than III	33	82.5
III or more	7	17.5
Rullier			<0.001
Other than IV	38	95.0
Level IV	2	5.0
TNM			<0.001
Other than T4	38	95.0
Level T4	2	5.0
Time after RT			0.343
Less than 11 weeks	17	42.5
11 or more weeks	23	57.5
Minimum-maximum	0.0-100.0
Mean ± standard deviation	15.1 ± 18.4
Distance from AM			0.018
0.0-1.0 cm	2	5.0
1.1-2.0 cm	3	7.5
2.1-3.0 cm	7	17.5
3.1-4.0 cm	14	35.0
4.1-5.0 cm	8	20.0
5.1-6.0 cm	6	15.0
Minimum-maximum	0.0-6.0
Mean ± standard deviation	3.6 ± 1.5
Sparing surgery			0.001
Yes	9	22.5
No	31	77.5

Assessed factor	Sparing surgery		p-value^a a p-value of Fisher's exact test (p < 0.05 indicates that the factor evaluated influences the type of surgery performed).
	Yes	No
Gender			0.117
Male	8 (32%)	17 (68%)
Female	1 (6.7%)	14 (93.3%)
Age			0.399
Less than 70 years	8 (27.6%)	21 (72.4%)
70 or more years	1 (9.1%)	10 (90.9%)
BMI			0.311
Less than 30	7 (20%)	28 (80%)
30 or more	2 (40%)	3 (60%)
Incontinence			1.000
No	9 (24.3%)	28 (75.7%)
Yes	0 (0%)	3 (100%)
ASA			0.175
Lower than III	9 (27.3%)	24 (72.7%)
III or more	0 (0.0%)	2 (100%)
Rullier			1.000
Other than IV	9 (23.7%)	29 (76.3%)
Level IV	0 (0.0%)	2 (100%)
TNM			1.000
Other than T4	9 (23.7%)	29 (76.3%)
Level T4	0 (0.0%)	2 (100%)
Time after RT			0.707
Less than 11 weeks	3 (17.6%)	14 (82.4%)
11 or more weeks	6 (26.1%)	17 (73.9%)
Distance from AM			0.163
0.0-1.0 cm	0 (0.0%)	2 (100%)
1.1-2.0 cm	0 (0.0%)	3 (100%)
2.1-3.0 cm	1 (14.3%)	6 (85.7%)
3.1-4.0 cm	2 (14.3%)	12 (85.7%)
4.1-5.0 cm	2 (25%)	6 (75%)
5.1-6.0 cm	4 (66.7%)	2 (33.3%)

Assessed factor	n	%	p-value^a a p-value of the chi-squared test for comparison of proportion (p < 0.05 indicates the proportions found in the levels of the factor evaluated differ).
Gender			0.577
Male	16	55.2
Female	13	44.8
Age			0.095
Less than 70 years	19	65.5
70 or more years	10	34.5
BMI			<0.001
Less than 30	26	89.7
30 or more	3	10.3
Incontinence			<0.001
No	26	89.7
Yes	3	10.3
ASA			0.002
Lower than III	23	79.3
III or more	6	20.7
Rullier			0.030
I	7	18.4
II	11	28.9
III	20	52.6
TNM
Other than T4	29	100.0
Post-RT time			0.577
Less than 11 weeks	13	44.8
11 or more weeks	16	55.2
Distance from AM			0.033
1.1-2.0 cm	3	10.3
2.1-3.0 cm	6	20.7
3.1-4.0 cm	12	41.4
4.15.0 cm	6	20.7
5.1-6.0 cm	2	6.9

Sociedade Brasileira de Coloproctologia Av. Marechal Câmara, 160/916, 20020-080 Rio de Janeiro/RJ Brasil, Tel.: (55 21) 2240-8927, Fax: (55 21) 2220-5803 - Rio de Janeiro - RJ - Brazil
E-mail: sbcp@sbcp.org.br

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[1] *Corresponding author. E-mail: tagomarques@gmail.com (T.A. Marques).

Brasil

Brasil

Critical assessment of the surgical treatment of low rectal adenocarcinoma in a reference hospital in Recife☆ ☆ Study conducted in the Coloproctology Department of the Hospital Barão de Lucena (HBL), managed by the Pernambuco State Health Department (SES/PE).

RESUMO

Objetivos:

Metodologia:

Resultados:

Conclusão:

Critical assessment of the surgical treatment of low rectal adenocarcinoma in a reference hospital in Recife^☆ ☆ Study conducted in the Coloproctology Department of the Hospital Barão de Lucena (HBL), managed by the Pernambuco State Health Department (SES/PE).