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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2022.tde-03012023-103010
Document
Author
Full name
Bárbara Bianca Linhares Mota
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2022
Supervisor
Committee
Feres, Omar (President)
Feitosa, Marley Ribeiro
Netinho, João Gomes
Sobrado Junior, Carlos Walter
Title in Portuguese
Análise dos resultados cirúrgicos e oncológicos em operações videolaparoscópicas eletivas realizadas por residentes de coloproctologia
Keywords in Portuguese
Cirurgia colorretal
Educação médica
Videolaparoscopia
Abstract in Portuguese
INTRODUÇÃO: Com o aperfeiçoamento e a ampla aceitação da via laparoscópica nas operações colorretais, houve a necessidade de treinamento específico dos cirurgiões em formação. Existem poucos estudos avaliando os resultados cirúrgicos e oncológicos das colectomias videolaparoscópicas, realizadas exclusivamente por médicos residentes e seu real impacto na segurança do paciente. OBJETIVO: analisar os resultados cirúrgicos e oncológicos das colectomias videolaparoscópicas realizadas por residentes de coloproctologia e comparar com os resultados observados na literatura. METODOLOGIA: trata-se de uma análise retrospectiva de pacientes submetidos a cirurgias colorretais por via videolaparoscópica, realizadas por médicos residentes do HCFMRP-USP, entre 2014 e 2018. Foram estudadas as características clínicas dos pacientes e os principais aspectos cirúrgicos e oncológicos durante período de um ano. RESULTADOS: Foram analisadas 191 operações, sendo que a principal indicação cirúrgica foi a neoplasia maligna. Destes, 67% eram adenocarcinomas estágio III, a maioria T3/T4 e menores que 5 cm. Fatores de mau prognóstico (indiferenciação tumoral, desmoplasia e diferenciação mucinosa) foram encontrados em 12% dos casos, e invasões perineural e angiolinfática em 46%. A duração média das cirurgias foi de 210±58 minutos. Houve necessidade de estoma em 21,5% dos pacientes, principalmente colostomia em alça. A taxa de conversão chegou a 23%, sendo 79,5% por dificuldades técnicas e os demais casos convertidos por acidentes intraoperatórios. A mediana do tempo de internação foi de 6 dias. Anemia pré operatória associou-se a uma maior taxa de complicações (11,5%) e reoperações (12%). Houve comprometimento das margens de ressecção cirúrgica em 8,6% dos casos. A taxa de subestadiamento linfonodal foi de 43%. A taxa de recidiva em um ano foi de 3,2% e a taxa de mortalidade, 6,2%. CONCLUSÃO: a videocirurgia colorretal realizada por médicos residentes apresentou eficácia e segurança semelhante aos dados encontrados na literatura. Palavras-chave: Cirurgia colorretal, videolaparoscopia, educação médica.
Title in English
Analysis of surgical and oncological results in elective laparoscopic operations performed by coloproctology residents
Keywords in English
Colorectal surgery
Medical education
Videolaparoscopy
Abstract in English
INTRODUCTION: With the improvement and wide acceptance of the laparoscopic approach in colorectal operations, there was a need for specific training of surgeons. There are few studies evaluating the surgical and oncological results of laparoscopic colectomy performed exclusively by resident physicians and their real impact on patient safety. OBJECTIVES: to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with the results observed in the literature. METHODOLOGY: this is a retrospective analysis of patients undergoing colorectal surgery by videolaparoscopic route, performed by resident physicians at the HCFMRP-USP, between 2014 and 2018. The clinical characteristics of the patients, as well as the main surgical and oncological aspects in a one-year follow-up period. RESULTS: 191 operations were analyzed. The main surgical indication was malignant neoplasm. Of these, 67% were stage III adenocarcinomas, most T3/T4 and smaller than 5 cm. Poor prognostic factors (tumor dedifferentiation, desmoplasia and mucinous differentiation) were found in 12% of cases, and perineural and angiolymphatic invasions, in 46%. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate reached 23%, 79,5% of which were due to technical difficulties, and the remaining cases were converted due to intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a high rate of complications (11,5%) and reoperations (12%). Surgical resection margins were compromised in 8,6% of cases. The lymph node substaging rate was 43%. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%. CONCLUSION: laparoscopy colorectal surgery performed by resident physicians showed efficacy and safety similar to data found in the literature.
 
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Publishing Date
2023-01-12
 
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