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Abstract Introduction Colorectal cancer (CRC) ranks among the top three most common cancers in Brazil, and the carcinoembryonic antigen (CEA) is one of the most used and established methods for prognostic evaluation and recurrence monitoring in CRC patients. Objective To analyze the pre- and postneoadjuvant levels of CEA in patients with middle or low rectal adenocarcinoma who underwent elective retossigmoidectomy with total mesorectal excision or abdominoperineal amputation of the rectum and to correlate the differences in pre- and postneoadjuvant CEA levels with the pathological staging. Materials and Methods Retrospective analysis of patients over 18 years old who underwent elective retossigmoidectomy with total mesorectal excision or abdominoperineal resection of the rectum. Data regarding age, sex, type of surgery, absolute CEA values, and differences in pre- and postneoadjuvant CEA levels were evaluated. Results The electronic medical records of 77 patients diagnosed with middle or low rectal adenocarcinoma who underwent surgery were analyzed. The mean pre- and postneoadjuvant levels of CEA were of 15.21(± 26.41) ng/mL and 7.17(± 15.6) ng/mL respectively, indicating a statistically significant decrease (p = 0.00058). The cutoff value for the analysis of neoplastic invasion depth (T) was determined to be 4.9 ng/mL, with a sensitivity of 73%, specificity of 63%, positive predictive value of 81%, and accuracy of 66.7%. For disease stage N, a cutoff value of 16.5 ng/mL was used. In this sample, the CEA test showed that the sensitivity and specificity for identifying patients with positive N disease were 41% and 89%, respectively, with a positive predictive value of 70% and an accuracy of 59.7%. Conclusion Carcinoembryonic antigen levels significantly decreased after neoadjuvant therapy in patients with middle and low rectal cancer. Pretreatment CEA levels were primarily associated with tumor invasion depth.

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Abstract Introduction Despite the advances in pain therapy, postoperative hemorrhoidectomy pain is still common and annoying. The present study aims to minimize post-hemorrhoidectomy pain and improve the quality of life. Materials and Methods The current study is a single-center, prospective, randomized, comparative clinical trial performed in the General Surgery Department from January to October 2024. The study included 150 hemorrhoidectomy patients randomly allocated to five groups: group I – control group; group II – local injection of ketorolac and light bupivacaine; group III – injection of light bupivacaine; group IV – local injection of corticosteroids; and group V – topical diclofenac sodium gel. Results Compared ot the other groups, group IV presented significantly better outcomes (p < 0.001) regarding the need, dose, and frequency of nalufin, postoperative pain score, and time until first ambulation. However, it presented longer healing time than the other groups. Conclusion Local injections of corticosteroids can effectively reduce pain after hemorrhoidectomy.

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Abstract Introduction Colorectal cancer (CRC) ranks third as the most incidental in the world. One of its hereditary forms is Lynch syndrome (LS), characterized by mutations in one of the DNA mismatches repairs (MMR) genes (MLH1, MSH2, MSH6, PMS2, or EPCAM). Current protocols suggest screening with clinical criteria followed by immunohistochemistry (IHC) before next-generation sequencing (NGS) for an early diagnosis. However, using IHC as an isolated screening test may interfere with the diagnosis of LS. Objective To assess the correlation between IHC and NGS to diagnose LS in patients who meet the Amsterdam II clinical criteria. Materials and Methods Observational study comprising 32 patients of both genders, aged between 20 and 64 years at the time of CRC diagnosis. They must meet the Amsterdam II clinical criteria and be registered in the Hereditary Cancer Program of Hospital de Câncer de Pernambuco (HCP). All patients underwent IHC assessment of malignant tumor and blood sample NGS. Results The NGS yielded 11 (34%) positive results for LS. There was a correlation between IHC and NGS in 23 cases. In 8 (35%), there was diagnostic confirmation of IHC by NGS, and in 15 cases (65%) there was diagnostic exclusion of LS by IHC and NGS. In three cases, there was confirmation of a pathogenic variant in MLH1 by NGS. The cases presented the same large deletions, contradicting IHC with proficient MMR. Conclusion A moderate correlation between IHC and NGS has been established, as indicated by the Kappa coefficient of 0.410 utilizing the Amsterdam II clinical criteria.

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Abstract Introduction Urinary and sexual dysfunctions are recognized as serious complications that affect patients' quality of life after mid-rectal cancer surgery; however, studies that focus on the urogenital function after robot-assisted compared to laparoscopic rectal cancer surgery are limited. Objective To compare functional outcomes between patients undergoing robotic and laparoscopic approaches for middle rectal cancer submitted to neoadjuvant chemoradiation. Materials and Methods Patients with mid-rectal cancer were prospectively enrolled in this phase-II randomized trial to robotic or laparoscopic total mesorectal excision (TME). After eligibility was confirmed and chemoradiation therapy was completed, patients underwent randomization in a 2:1 ratio (robotic: laparoscopic TME groups) with stratification according to gender (male or female) and body mass index (BMI) < 35 or ≥ 35. The assessment of urinary function was carried out using complete urodynamic study, urinary symptoms questionnaire (International Consultation on Incontinence Questionnaire – Short Form [ICIQ-SF]), and urinary continence questionnaire (International Prostate Symptom Score [I-PSS]). The complete urodynamic study and the questionnaires were carried out before the start of any treatment and after neoadjuvant therapy (before surgery) and was repeated in the 1st, 3rd, 6th, 12th, 18th and 24th postoperative months. The analysis of male sexual function was carried out using International Index of Erectile Function (IIEF-5) questionnaire. Female sexual function was analyzed using the specific Female Sexual Functiona Index (FSFI) questionnaire, and the Quality-of-Life Questionnaire Core 30 (QLQ-C30) and Quality-of-Life Questionnaire - Colorectal Cancer 29 (QLQ-CR29 were applied to patients at the same time as the sexual and urinary function assessment questionnaires. Results Between 2017 and 2022, 32 patients entered the trial, and 30 were eligible to participate (2 patients were excluded due to screening failure). Among them, only 21 were randomized to robotic or laparoscopic group. Only 9 (42.9%) and 12 patients (57.1%) underwent urodynamic testing at the 3rd and 6th month of postoperative follow-up, respectively. Eighteen (85.7%) and 16 patients (76.2%) completed both the ICIQ-SF and I-PSS questionnaires at the 3rd and 6th month of postoperative follow-up, respectively. Only 7 and 10 patients (33.3% and 47.6%, respectively) completed the IIEF-5 and FSFI at the 3rd month of postoperative follow-up. There was no significant difference in age, BMI, tumor location, neoadjuvant therapy, postoperative pathological results, and adjuvant therapy between the two groups. Our study did not identify any parameter that could suggest lower urinary tract dysfunction in both groups analyzed, either by evaluating maximum flow, postvoid residue and, mainly, by the results of detrusor pressure at maximum flow. On the other hand, the present study demonstrated better sexual function outcomes with robotic surgery in male patients as assessed by the IIEF-5 score. There was a slight advantage to robotic surgery at the 3-month follow-up (median score 18 for robotic versus 17 for laparoscopic). By 6 months, the difference became more pronounced in favor of the robotic group (median score 23 for robotic versus 15 for laparoscopic). Additionally, there was better sexual desire at 3 months in the robotic group according to the QLQ-C29 (median score 66.7 in the robotic group versus 16.6 in the laparoscopic group). Conclusion The robotic approach for TME was associated with potentially better male sexual function than the laparoscopic approach. More randomized studies with a larger number of patients are necessary to confirm our findings.

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Abstract Introduction Colorectal cancer (CRC) is one of the main causes of death by cancer. Patients diagnosed with colon adenocarcinoma and unresectable liver metastases have a poor prognosis, with a median overall survival (OS) of 24 months. Case Presentation We herein report the case of a 7-year sustained complete response (CR) with 2 cycles of modified 5-fluorouracil plus oxaliplatin (mFLOX) in a metastatic setting. The patient is a White Brazilian male aged 59 years. Conclusion There is scarce evidence on the clinical evolution of non-operable patients with metastasis to establish a definitive cure only with a chemotherapy regimen, without complimentary liver resection. The patient herein reported achieved CR with only two cycles of treatment, which is not usual in this scenario. He was deemed non-operable because of the number and position of the lesions detected before the start of chemotherapy.