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Abstract(s)
Introdução: A resseção e anastomose do colon esquerdo pode ser realizada por três vias de abordagem (aberta, laparoscópica e laparoscópica com extração da peça por orifícios naturais). O objetivo do estudo é avaliar a diferença dos valores em pós-operatório da PCR de acordo com a via de abordagem, a sua variação com as complicações sépticas e o seu valor preditivo nestas complicações.
Métodos: Efetuou-se a analise de uma base de dados prospetiva de doentes submetidos a cirurgia oncológica de resseção do colon esquerdo, com anastomose primária, entre Janeiro de 2010 a Setembro de 2012, avaliando o valor da PCR nas primeiras 48 e 72 horas de pós-operatório e das complicações séticas. A análise estatística foi efetuada com recurso ao programa IBM SPSS Statistics 19® utilizando os testes qui-quadrado, teste t studant, teste exato de Fisher, ANOVA e curva ROC.
Resultados: Foram analisados 91 pacientes, 35 (38,5%) foram intervencionados por via aberta, 35 (38,5%) por via laparoscópica e 21 (23%) por via NOSE. Às 48h de pós-operatório, a média dos valores de PCR foi inferior na cirurgia laparoscópica em relação à cirurgia aberta (p=0,013). Não existe diferença significativa no valor de PCR até às 48 horas, quando se comparam os grupos com complicações e sem complicações. No grupo submetido a laparoscopia, verificou-se uma diferença significativa no valor de PCR nas primeiras 72 horas entre os doentes com complicações e os doentes sem complicações (p=0,028). Nos doentes submetidos a cirurgia aberta e NOSE verificou-se apenas uma tendência (p=0,172 e p=0,115 respetivamente). Para as complicações séticas foi estabelecido um valor cut-off da PCR de 149 mg/L na amostragem da totalidade dos doente. O valor de cut-off variou consoante a via de abordagem, sendo 142 mg/L na via aberta, 122,2 mg/L na via laparoscopia e 245,2 mg/L na via NOSE, com valores preditivos negativos variaram entre 81,8% e 100%.
Conclusão: Nas 72 horas de pós-operatório a PCR é um bom preditor de complicações séticas nas três vias cirúrgicas em estudo. Perante uma boa evolução clínica, um valor de PCR inferior ao cut-off estabelecido para a via de abordagem tem um VPN elevado, permitindo uma alta hospitalar com um grau considerável de segurança.
Introduction: Resection and anastomosis of the left colon can be performed by three different surgical techniques (open, laparoscopic and laparoscopic with natural orifice specimen extraction). The objective of the study is to evaluate the difference of CRP postoperative values according to the surgical approach, its variation with septic complications and its predictive value in this complications. Methods: Performed the analysis of a prospective database of patients undergoing oncologic resection of the left colon with primary anastomosis between January 2010 and September 2012, analyzing CRP value at the first 48 and 72 hours of post-operative period and septic complications. Statistic analysis was performed in the IBM SPSS Statistics program, using the chi-squared test, Fisher’s exact test, t-student test, ANOVA and ROC curve. Results: Ninety-one patients were analyzed. Of this, 35 (38,5%) underwent open surgery, 35 (38,5%) laparoscopic surgery and 21 (23%) laparoscopic surgery by NOSE technique. In the first 48h after surgery, the mean values of CRP were lower in the laparoscopic surgery than those of open surgery (p=0,013). There was no statistical difference between those with or without septic complications in this time period, but, in the first 72 hours that difference was statistical significant in the laparoscopic group (p=0,028). In the patients who underwent laparoscopy by NOSE technique and by open surgery only a tendency was seen (p=0,172 and p=0,115 respectively). For septic complications were established a CRP cut-off of 149 mg/L for the entire study population. The cut-off value changed with the surgery approach (142 mg/L in open surgery, 122,2 mg/L in laparoscopy and 245,5 mg/L in laparoscopy by NOSE). NPV varied between 81,8% and 100%. Conclusion: In the first 72 hours of postoperative period, CRP is a good predictor of septic complications in the three surgical approaches analyzed. A good clinical evolution, a CRP lower than the cut-off established for the surgical approach has high negative predictive value allowing us to give a safe discharge from hospital.
Introduction: Resection and anastomosis of the left colon can be performed by three different surgical techniques (open, laparoscopic and laparoscopic with natural orifice specimen extraction). The objective of the study is to evaluate the difference of CRP postoperative values according to the surgical approach, its variation with septic complications and its predictive value in this complications. Methods: Performed the analysis of a prospective database of patients undergoing oncologic resection of the left colon with primary anastomosis between January 2010 and September 2012, analyzing CRP value at the first 48 and 72 hours of post-operative period and septic complications. Statistic analysis was performed in the IBM SPSS Statistics program, using the chi-squared test, Fisher’s exact test, t-student test, ANOVA and ROC curve. Results: Ninety-one patients were analyzed. Of this, 35 (38,5%) underwent open surgery, 35 (38,5%) laparoscopic surgery and 21 (23%) laparoscopic surgery by NOSE technique. In the first 48h after surgery, the mean values of CRP were lower in the laparoscopic surgery than those of open surgery (p=0,013). There was no statistical difference between those with or without septic complications in this time period, but, in the first 72 hours that difference was statistical significant in the laparoscopic group (p=0,028). In the patients who underwent laparoscopy by NOSE technique and by open surgery only a tendency was seen (p=0,172 and p=0,115 respectively). For septic complications were established a CRP cut-off of 149 mg/L for the entire study population. The cut-off value changed with the surgery approach (142 mg/L in open surgery, 122,2 mg/L in laparoscopy and 245,5 mg/L in laparoscopy by NOSE). NPV varied between 81,8% and 100%. Conclusion: In the first 72 hours of postoperative period, CRP is a good predictor of septic complications in the three surgical approaches analyzed. A good clinical evolution, a CRP lower than the cut-off established for the surgical approach has high negative predictive value allowing us to give a safe discharge from hospital.
Description
Keywords
Hemicolectomia esquerda Complicações sépticas Pós-operatório Proteína c reativa