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Cirurgia colorretal oncológica: um protocolo de recuperação cirúrgica otimizada
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Authors
Abstract(s)
Introdução: O carcinoma colorretal(CCR) é uma doença multifatorial, sendo o terceiro
cancro mais prevalente e a segunda maior causa de morte relacionada com o cancro no
mundo. A cirurgia curativa ainda é um dos tratamentos de primeira linha mais utilizados
no tratamento de doentes com CCR. Nos últimos anos surgiram programas e protocolos
de recuperação cirúrgica otimizada, como o criado pela ERAS Society, ajudando os
profissionais de saúde a sistematizar os cuidados e a orientar a sua prática. No entanto,
a maioria dos protocolos como o ERAS foram desenhados para cirurgia colorretal como
um todo, e não especificamente para cirurgias colorretais oncológicas, apesar de serem
recorrentemente utilizados para esse efeito.
Objetivos: Esta dissertação surge com o principal objetivo de desenhar e propor um
novo protocolo de otimização cirúrgica para cirurgia colorretal oncológica, a aplicar nos
períodos pré-admissão hospitalar, pré-operatório, intraoperatório e pós-operatório. Visa
ainda realizar uma revisão da bibliografia recente, no que concerne à otimização
cirúrgica de pacientes submetidos a cirurgia colorretal oncológica, comparar o protocolo
desenhado com o protocolo ERAS para cirurgia colorretal e justificar, ou não, a criação
de protocolos de otimização cirúrgica específicos para cirurgia colorretal oncológica.
Materiais e métodos: Para a realização desta dissertação foi efetuada uma pesquisa
nas plataformas PubMed® e B-On®, de artigos lançados após 2018, dando prioridade a
revisões sistemáticas, revisões de literatura e meta-análises, resultando numa base de
dados final de 72 artigos extraídos destas plataformas. Adicionalmente foram incluídos
33 artigos extra equação de pesquisa, dada a sua relevância e atualidade.
Resultados: Foi criado um protocolo com 30 tópicos, divididos em quatro tempos: préadmissão hospitalar, pré-operatório, intraoperatório e pós-operatório. Destes tópicos 14
não se encontravam mencionados no protocolo ERAS. Dos pontos coincidentes entre
ambos os protocolos, apenas um se encontrava em discordância, sendo esse o ponto
acerca da preparação mecânica intestinal (PMI).
Conclusões: A otimização cirúrgica é uma etapa crucial no tratamento dos doentes
com CCR, permitindo não só melhorar o outcome cirúrgico, como diminuir as
complicações da intervenção. A patologia colorretal é variada e não inclui apenas o
carcinoma colorretal, no entanto, considera-se que, poderia ser relevante existir um
protocolo que funda o protocolo ERAS para cirurgia colorretal com o protocolo aqui
proposto.
Introduction: Colorectal carcinoma (CRC) is a multifactorial disease, ranking as the third most prevalent cancer and the second leading cause of cancer-related deaths worldwide. Curative surgery remains one of the most used first-line treatments for CRC patients. In recent years, enhanced recovery after surgery (ERAS) programs and protocols have emerged, helping healthcare professionals to systematize care and guide their practice. However, most protocols, such as ERAS, were designed for colorectal surgery as a whole and not specifically for oncological colorectal surgeries, despite being frequently used for this purpose. Objectives: This study aims to design and propose a new surgical optimization protocol for oncological colorectal surgery, to be applied during the pre-hospital admission, preoperative, intraoperative, and postoperative periods. It also seeks to conduct a review of recent literature on the surgical optimization of patients undergoing oncological colorectal surgery, compare the proposed protocol with the ERAS protocol for colorectal surgery, and assess the need for specific optimization protocols tailored to oncological colorectal surgery. Materials and Methods: To carry out this investigation, a search was conducted on the PubMed® and B-On® platforms for articles published after 2018, prioritizing systematic reviews, literature reviews, and meta-analyses, resulting in a final database of 72 articles extracted from these platforms. Additionally, 33 articles outside the search equation were included due to their relevance and timeliness. Results: A protocol consisting of 30 topics was created, divided into four stages: prehospital admission, preoperative, intraoperative, and postoperative. Of these topics, 14 were not mentioned in the ERAS protocol. Among the overlapping points between the two protocols, only one showed disagreement, which was related to mechanical bowel preparation. Conclusions: Surgical optimization is a crucial step in the treatment of CRC patients, improving surgical outcomes and reducing complications associated with the procedure. Colorectal pathology is diverse and includes more than colorectal carcinoma; however, it is considered relevant to have a protocol that combines the ERAS protocol for colorectal surgery with the protocol proposed here.
Introduction: Colorectal carcinoma (CRC) is a multifactorial disease, ranking as the third most prevalent cancer and the second leading cause of cancer-related deaths worldwide. Curative surgery remains one of the most used first-line treatments for CRC patients. In recent years, enhanced recovery after surgery (ERAS) programs and protocols have emerged, helping healthcare professionals to systematize care and guide their practice. However, most protocols, such as ERAS, were designed for colorectal surgery as a whole and not specifically for oncological colorectal surgeries, despite being frequently used for this purpose. Objectives: This study aims to design and propose a new surgical optimization protocol for oncological colorectal surgery, to be applied during the pre-hospital admission, preoperative, intraoperative, and postoperative periods. It also seeks to conduct a review of recent literature on the surgical optimization of patients undergoing oncological colorectal surgery, compare the proposed protocol with the ERAS protocol for colorectal surgery, and assess the need for specific optimization protocols tailored to oncological colorectal surgery. Materials and Methods: To carry out this investigation, a search was conducted on the PubMed® and B-On® platforms for articles published after 2018, prioritizing systematic reviews, literature reviews, and meta-analyses, resulting in a final database of 72 articles extracted from these platforms. Additionally, 33 articles outside the search equation were included due to their relevance and timeliness. Results: A protocol consisting of 30 topics was created, divided into four stages: prehospital admission, preoperative, intraoperative, and postoperative. Of these topics, 14 were not mentioned in the ERAS protocol. Among the overlapping points between the two protocols, only one showed disagreement, which was related to mechanical bowel preparation. Conclusions: Surgical optimization is a crucial step in the treatment of CRC patients, improving surgical outcomes and reducing complications associated with the procedure. Colorectal pathology is diverse and includes more than colorectal carcinoma; however, it is considered relevant to have a protocol that combines the ERAS protocol for colorectal surgery with the protocol proposed here.
Description
Keywords
Carcinoma Colorretal Carcinoma do Colon e Reto Cirurgia Colorretal Fast Track Oncologia Otimização Otimização Cirúgica Pré-Habilitação Proctologia