Search

Background: The aim of the study was to determine the socioeconomic and demographic factors associated with advanced colorectal cancer (CRC) presentation at our institution., Methods: From January 2009 to January 2018, patients that underwent CRC surgery at our institution were included and retrospectively analyzed. Univariate and multivariate logistic regression were used to determine independent risk factors for presenting with advanced CRC., Results: A total of 277 patients were included, 53.5% presented with advanced CRC. The multivariate analysis identified that living in a rural area (odds ratio [OR] = 5.25; 95% confidence interval [95% CI]: 2.27-12-10; p < 0.001), weight loss (OR = 2.33; 95% CI: 1.35-4.09; p = 0.002), needing emergency surgery (OR = 4.68; 95% CI: 1.25-17.49; p = 0.022), location in the rectum in comparison with colon (OR = 2.66; 95% CI: 1.44-4.91; p = 0.002), and location in the mid rectum (OR = 6.10; 95% CI: 2.31-16.12; p < 0.001) were associated with higher odds of advanced CRC stage at presentation., Conclusions: Patients with lower socioeconomic status, with symptoms, and needing emergency surgery were associated with advanced CRC stage at presentation. Special interventions to improve access to care in this population should be planned to enhance CRC outcomes., (Copyright: © 2023 Permanyer.)

Background: Diagnosis of colorectal cancer (CRC) after emergency presentation is associated with a worse prognosis., Aim: The aim of the study was to determine the sociodemographic factors related with emergency CRC surgery at our institution., Methods: From January 2009 to December 2017, patients that underwent CRC surgery at our institution were included in the study. Univariate and multivariate logistic regression were used to determine the effect of the potential risk factors on the rate of emergency surgery., Results: A total of 247 patients underwent CRC surgery at our institution. The rate of emergency surgery was 7.7%. On univariate analysis, patients without a family history of cancer (odds ratio [OR]: 4.95), living in a rural area (OR: 3.7), and late clinical cancer stage (OR: 5.06) were associated with emergent surgery. Mid-income status was a protective factor for emergency surgery (OR: 0.14, p = 0.003). On multivariate analysis, late clinical cancer stage (OR: 4.41, 95% CI 1.21-16.05, p = 0.024) and mid-income economic status (OR: 0.41, 95% CI 0.04-0.55, p = 0.004) were identified as independent risk factors for emergency surgery., Conclusion: Social, economic, and demographic factors were identified as predictors for emergent CRC surgery., (Copyright: © 2021 Permanyer.)

Background: The implementation of quality-of-care indicators aiming to improve colorectal cancer (CRC) outcomes has been previously described by Cancer Care Ontario. The aim of this study was to assess the quality-of-care indicators in CRC at a referral centre in a developing country and to determine whether improvement occurred over time., Methods: We performed a retrospective study of our prospectively collected database of patients after CRC surgery from 2001 to 2016. We excluded patients who underwent local transanal excision, pelvic exenteration or palliative procedures. We evaluated trends over time using the Cochran-Armitage test for trend., Results: A total of 343 patients underwent surgical resection of CRC over the study period. There was improvement of the following indicators over time: the proportion of patients detected by screening ( p = 0.03), the proportion of patients with preoperative liver imaging ( p = 0.001), the proportion of patients with stage II or III rectal cancer who received neoadjuvant chemotherapy ( p = 0.03), the proportion of patients with pathology reports that indicated the number of lymph nodes examined and the number of positive nodes ( p = 0.001), and the proportion of patients with pathology reports describing the details on margin status ( p = 0.001)., Conclusion: This study showed the feasibility of applying the Cancer Care Ontario indicators for evaluating outcomes in CRC treatment at a single centre in a developing country. Although there was an improvement of some of the quality-of-care indicators over time, policies and interventions must be implemented to improve the fulfillment of all indicators.

Rectal affection accounts for 30% of colorectal cancer. The standard of treatment is surgical resection, which often is curative. For superior and middle-rectal involvement, low anterior resection (LAR) is the preferred procedure. For tumors involving the lower portion of the rectum, abdominoperineal resection (APR) or LAR are the options of treatment, depending on sphincter involvement. The main surgical objective is to achieve a R0 resection with an appropriated total mesorrectal excision, greater number of lymph nodes and negative distal and radial margins. These surgical parameters have been used as quality indicators and have prognostic implications in terms of overall and disease-free survival. Total mesorectal excision with preservation of hypogastric nerves has shown a reduction in rates of sexual and bladder dysfunction as well as lower local recurrence. At specialized centers such procedures are performed by minimal invasive surgery; however the number of meta-analysis is scarce.

Background: The liver is the organ in which often metastasize primary tumors. Knowledge of the etiology and forms of presentation of metastatic disease is key to deciding on the different treatment options., Objective: Describe the surgical management of liver metastases in colorectal cancer and factors that affect the survival of patients., Patients and Methods: We reviewed 43 cases of patients with metastatic liver cancer of the colon or rectum, who underwent liver surgery, attended January 1990 to December 2007. We analyzed demographic variables and perioperative associated with the survival of patients. There was the course and type of postoperative complications as well as the direct causes of mortality., Results: Were conducted mostly metastasectomies (n = 25), followed by right hepatectomy (n = 9),and left hepatectomy (n = 9). Surgical mortality was 4.6% (n = 2). The survival rate at 1, 3 and 5 year were 45% (18 patients), 42.5% (18 patients)and 12.5% (5 patients), respectively. The presence of a single metastatic lesion (p = 0.006), size of the lesion larger than 5 cm (p = 0.003), positive lymph nodes (p = 0.002), synchronous tumor (p = 0.04),presence of extra hepatic disease (p = 0.01), positive margin (p = 0.001) and blood loss >2000 mL were significantly associated with a lower survival rate., Conclusion: After hepatic resection for metastatic colorectal cancer the presence of more than one tumor, > of 5 cm, with presence of synchronous tumor, nodes and positive margins, extra hepatic disease, as well blood loss > 2000 mL are factors associated with a worse survival.