Critical assessment of the surgical treatment of low rectal adenocarcinoma in a reference hospital in Recife

Marques, Thiago Alexandre Martins; Lucena, Maurilio Toscano de; Silva, Mauricio Jose de Matos e; Carvalho, Joaquim Herbenio Costa; Carvalho, Ana Rita Marinho Ribeiro; Barros, Juscielle de Souza

doi:10.1016/j.jcol.2019.02.001

Acessibilidade / Reportar erro

Brasil

Journal of Coloproctology (Rio de Janeiro)

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • J. Coloproctol. (Rio J.) 39 (2) • Apr-Jun 2019 • https://doi.org/10.1016/j.jcol.2019.02.001 copy

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).

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Adenocarcinoma; Rectal cancer; Colorectal surgery; Colostomy; Magnetic resonance imaging

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

Acompanhe os números deste periódico no seu leitor de RSS

[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).

ABSTRACT

Objectives:

Methodology:

Results:

Conclusion:

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).