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Abstract(s)
Introdução: Segundo a Organização Mundial de Saúde, o cancro colorretal é a
terceira neoplasia com maior incidência no mundo, sendo responsável por cerca de
10% das mortes de causa oncológica. O desenvolvimento das abordagens laparoscópica
e robótica em muito contribuíram para a diminuição da morbilidade associada à
cirurgia, tendo-se, por isso, assistido durante as últimas décadas a uma transição para
abordagens minimamente invasivas no que diz respeito ao tratamento desta patologia.
Objetivo: Avaliar a existência de superioridade de uma das abordagens, laparoscópica
ou laparotómica, tendo em consideração as complicações desenvolvidas nos primeiros
30 dias após a intervenção cirúrgica. Adicionalmente, comparar as taxas de incidência e
mortalidade destas complicações relatadas noutros países com as do Centro Hospitalar
Universitário da Cova da Beira, às relatadas noutros países.
Métodos: Estudo observacional e retrospetivo que incluiu pacientes submetidos a
cirurgia como tratamento do cancro colorretal, entre janeiro de 2016 e dezembro de
2022 no Centro Hospitalar e Universitário Cova da Beira. Foram excluídos todos os
pacientes com idade inferior a 18 anos, que não tenham realizado a cirurgia de forma
eletiva ou cuja abordagem cirúrgica não tenha sido laparotómica, laparoscópica ou
conversão entre estas duas abordagens.
Resultados: De uma amostra inicial de 483 pacientes, foram excluídos 82, obtendo-se
uma amostra final de 401 cirurgias realizadas. Destas, 51,9% foram por via
laparotómica, 43,6% por abordagem laparoscópica, com uma taxa de conversão de
cerca de 8,0%. No que concerne às complicações, a cirurgia laparoscópica convertida
está associada a um maior número de complicações na amostra estudada (pvalue=0,003<0,05), nomeadamente com maior risco de infeção (pvalue=0,039<0,05), deiscência da ferida operatória (p-value=0,022<0,05),
evisceração (p-value<0,001<0,05), e necessidade de reintervenção (pvalue=0,012<0,05), mas apenas o número de complicações se associa a uma
mortalidade aumentada aos 30 dias (p-value<0,001<0,05). Quando comparadas
apenas as via laparoscópica e laparotómica, a cirurgia por via aberta está associada a
maior taxa de infeção (p-value=0,036<0,05) e deiscência da ferida operatória (pvalue=0,036<0,05), a internamentos mais prolongados (p-value=0,000<0,05) e, no
geral, a um maior número de complicações (p-value=0,014<0,05). Em doentes com
idades superiores a 75 anos, existe uma maior tendência para a preferência pela abordagem laparotómica (p-value=0,029<0,05), contudo, foi nos pacientes
submetidos a cirurgia laparoscópica, que se encontrou uma associação entre idades
superiores a 75 anos e internamentos mais longos (p-value=0,002<0,05) e com uma
incidência maior de outras complicações (p-value=0,025<0,05), nomeadamente
pneumonia e infeção do trato urinário. Nas cirurgias convertidas, idades mais
avançadas associaram-se à ocorrência de infeção da ferida operatória (pvalue=0,043<0,05) e a um maior número de complicações desenvolvidas no primeiro
mês pós-cirurgia (p-value<0,001<0,05). O sexo do paciente não demonstrou qualquer
associação com as várias variáveis quando estudada cada abordagem individualmente
(p-value>0,05). Pacientes que realizaram terapia neoadjuvante apresentaram uma
média de dias de internamento maior (p-value<0,001<0,05) e mais complicações (pvalue=0,017<0,05) nas abordagens laparoscópicas.
Conclusão: A abordagem laparoscópica é uma opção viável e superior em termos de
complicações no primeiro mês para o tratamento cirúrgico do cancro colorretal no
Centro Hospitalar Universitário Cova da Beira, e, possivelmente, em todo o país.
Relativamente às taxas de incidência das várias complicações da cirurgia colorretal, a
mortalidade aos 30 dias e a taxa de conversão entre abordagens, encontram-se
próximas do limite inferior dos intervalos de valores registados em estudos
internacionais ou mesmo abaixo destes.
Introduction: According to the World Health Organization, colorectal cancer is the third most common cancer in the world and is responsible for around 10% of cancerrelated deaths. The development of laparoscopic and robotic approaches has greatly contributed to reducing the morbidity associated with the surgery, and over the last few decades there has been a transition to minimally invasive approaches in the treatment of this disease. Aim: Assess the superiority of one of the approaches, laparoscopic or laparotomic, taking into account the complications that develop in the first 30 days after surgery. In addition, it aims to compare the incidence and mortality rates of these complications reported in other countries with those of the Centro Hospitalar Universitário da Cova da Beira. Methods: Observational and retrospective study that included patients who underwent surgery to treat colorectal cancer between January 2016 and December 2022 at the Centro Hospitalar e Universitário Cova da Beira. All patients under the age of 18, who did not undergo elective surgery or whose surgical approach was not laparotomic, laparoscopic or conversion between these two approaches were excluded. Results: From an initial sample of 483 patients, 82 were excluded, resulting in a final sample of 401 surgeries. Of these, 51.9% were laparotomic, 43.6% laparoscopic, with a conversion rate of around 8.0%. Concerning the complications, converted laparoscopic surgery is associated with a greater number of complications in the studied sample (pvalue=0.003<0.05), namely with a greater risk of infection (p-value=0.039<0.05), surgical wound dehiscence (p-value=0.022<0.05), evisceration (p-value<0.001<0.05), and the need for reintervention (p-value=0.012<0.05), but only the number of complications is associated with increased mortality at 30 days (p-value<0.001<0.05). When only the two main techniques are compared, open surgery is associated with a higher rate of infection (p-value=0,036<0,05) and surgical wound dehiscence (pvalue=0,036<0,05), longer hospital stays (p-value=0,000<0,05) and, overall, a greater number of complications (p-value=0,014<0,05). In patients aged over 75, there was a greater tendency to prefer the laparotomic approach (p-value=0.029<0.05), however, it was in patients undergoing laparoscopic surgery that an association was found between ages over 75 and longer hospital stays (p-value=0.002<0.05) and with a higher incidence of other complications (p-value=0.025<0.05), namely pneumonia and urinary tract infection. In converted surgeries, older age was associated with the occurrence of surgical wound infection (p-value=0.043<0.05) and with a greater number of complications developing in the first month after surgery (pvalue<0.001<0.05). The sex of the patient showed no association with the various variables when each approach was studied individually (p-value>0.05). Patients who underwent neoadjuvant therapy had a longer average hospital stay (pvalue<0.001<0.05) and more complications (p-value=0.017<0.05) in laparoscopic approaches. Conclusion: The laparoscopic approach is a viable and superior option in terms of complications in the first month in the surgical treatment of colorectal cancer at Centro Hospitalar Universitário Cova da Beira, and, possibly, throughout the country. When speaking of the incidence rates of the various colorectal surgery complications, mortality at 30 days and conversion between approaches, these are close to or even below the lower limit of the ranges of values recorded in international studies.
Introduction: According to the World Health Organization, colorectal cancer is the third most common cancer in the world and is responsible for around 10% of cancerrelated deaths. The development of laparoscopic and robotic approaches has greatly contributed to reducing the morbidity associated with the surgery, and over the last few decades there has been a transition to minimally invasive approaches in the treatment of this disease. Aim: Assess the superiority of one of the approaches, laparoscopic or laparotomic, taking into account the complications that develop in the first 30 days after surgery. In addition, it aims to compare the incidence and mortality rates of these complications reported in other countries with those of the Centro Hospitalar Universitário da Cova da Beira. Methods: Observational and retrospective study that included patients who underwent surgery to treat colorectal cancer between January 2016 and December 2022 at the Centro Hospitalar e Universitário Cova da Beira. All patients under the age of 18, who did not undergo elective surgery or whose surgical approach was not laparotomic, laparoscopic or conversion between these two approaches were excluded. Results: From an initial sample of 483 patients, 82 were excluded, resulting in a final sample of 401 surgeries. Of these, 51.9% were laparotomic, 43.6% laparoscopic, with a conversion rate of around 8.0%. Concerning the complications, converted laparoscopic surgery is associated with a greater number of complications in the studied sample (pvalue=0.003<0.05), namely with a greater risk of infection (p-value=0.039<0.05), surgical wound dehiscence (p-value=0.022<0.05), evisceration (p-value<0.001<0.05), and the need for reintervention (p-value=0.012<0.05), but only the number of complications is associated with increased mortality at 30 days (p-value<0.001<0.05). When only the two main techniques are compared, open surgery is associated with a higher rate of infection (p-value=0,036<0,05) and surgical wound dehiscence (pvalue=0,036<0,05), longer hospital stays (p-value=0,000<0,05) and, overall, a greater number of complications (p-value=0,014<0,05). In patients aged over 75, there was a greater tendency to prefer the laparotomic approach (p-value=0.029<0.05), however, it was in patients undergoing laparoscopic surgery that an association was found between ages over 75 and longer hospital stays (p-value=0.002<0.05) and with a higher incidence of other complications (p-value=0.025<0.05), namely pneumonia and urinary tract infection. In converted surgeries, older age was associated with the occurrence of surgical wound infection (p-value=0.043<0.05) and with a greater number of complications developing in the first month after surgery (pvalue<0.001<0.05). The sex of the patient showed no association with the various variables when each approach was studied individually (p-value>0.05). Patients who underwent neoadjuvant therapy had a longer average hospital stay (pvalue<0.001<0.05) and more complications (p-value=0.017<0.05) in laparoscopic approaches. Conclusion: The laparoscopic approach is a viable and superior option in terms of complications in the first month in the surgical treatment of colorectal cancer at Centro Hospitalar Universitário Cova da Beira, and, possibly, throughout the country. When speaking of the incidence rates of the various colorectal surgery complications, mortality at 30 days and conversion between approaches, these are close to or even below the lower limit of the ranges of values recorded in international studies.
Description
Keywords
Cancro Colorretal Laparoscopia Laparotomia Tratamento Cirúrgico