Browsing by Author "Fernandes, D"
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- Acute Treatment of Malignant Colorectal Occlusion: Real Life PracticePublication . Fernandes, D; Domingues, S; Gonçalves, BM; Bastos, P; Ferreira, A; Rodrigues, A; Gonçalves, R; Lopes, L; Rolanda, CINTRODUCTION: Colorectal cancer presents itself as acute bowel occlusion in 10-40% of patients. There are two main therapeutic approaches: urgent surgery and endoluminal placement self-expandable metallic stents (SEMS). AIMS AND METHODS: This study intended to better clarify the risk/benefit ratio of the above-mentioned approaches. We conducted a retrospective longitudinal multicenter study, including 189 patients with acute malignant colorectal occlusion, diagnosed between January 2005 and March 2013. RESULTS: Globally (85 patients - 35 bridge-to-surgery and 50 palliative), SEMS's technical success was of 94%. Palliative SEMS had limited clinical success (60%) and were associated with 40% of complications. SEMS occlusion (19%) was the most frequent complication, followed by migration (9%) and bowel perforation (7%). Elective surgery after stenting was associated with a higher frequency of primary anastomosis (94% vs. 76%; p = 0.038), and a lower rate of colostomy (26% vs. 55%; p = 0.004) and overall mortality (31% vs. 57%; p = 0.02). However, no significant differences were identified concerning postoperative complications. Regarding palliative treatment, no difference was found in the complications rate and overall mortality between SEMS and decompressive colostomy/ileostomy. In this SEMS subgroup, we found a higher rate of reinterventions (40% vs. 5%; p = 0.004) and a longer hospital stay (14, nine vs. seven, three days; p = 0.004). CONCLUSION: SEMS placement as a bridge-to-surgery should be considered in the acute treatment of colorectal malignant occlusion, since it displays advantages regarding primary anastomosis, colostomy rate and overall mortality. In contrast, in this study, palliative SEMS did not appear to present significant advantages when compared to decompressive colostomy.
- Gastric Mixed Adenoneuroendocrine CarcinomaPublication . Fernandes, D; Soares, JB; Rolanda, C
- Operação de Wertheim-Meigs em carcinoma do colo do útero e tratamento complementar: análise crítica de cinco anosPublication . Freitas, D; Rodrigues, F; Fernandes, D; Petiz, AOBJECTIVES: Review and critical analysis of the Wertheim-Meigs Operations performed at our institution in the context of cervical cancer and to assess the proportion who underwent treatment with adjuvant radiotherapy (with or without chemotherapy) and the main indications. MATERIAL AND METHODS: Retrospective review of Wertheim-Meigs operations, conducted in the context of carcinoma of the cervix, between 01.01.2005 and 31.12.2010, through consultation with clinical processes. It was later performed a descriptive statistical analysis of the cases. RESULTS: During this period 119 Wertheim-Meigs Operations were performed. Four were excluded: two, for primary indication for adjuvant therapy due to histological subtype; two for the inability to exclude invasive disease preoperatively and the invasion was not confirmed after surgery. A total of 115 cases were reviewed and analyzed, and of these 50 (43.5%) underwent complementary therapy, the main indication being the presence of lymphovascular invasion in 21 cases (42% of cases submitted to complementary therapy ). CONCLUSIONS: The mean age of patients undergoing radical surgery is 49 years, with stage IB1 most often determining its performance. Complementary therapy was performed in 43.5% of cases, the main indication being lymphovascular invasion (42%) followed by lymph node invasion (16%). Internal audit to the Service is satisfactory, with 16.5% surgical complication rate and high technical performance.