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Colorectal cancer risk in hamartomatous polyposis syndromes

World Journal of Gastrointestinal Surgery 2015年第3期7卷 25-32页

作者： Fábio Guilherme Campos marleny novaes figueiredo Carlos Augusto Real Martinez Surgery at University of São Paulo Medical SchoolSão Paulo SP 01411-000Brazil Colorectal Surgery Division Gastroenterology DepartmentHospital das ClínicasUniversity of São PauloMedical SchoolSão Paulo SP 01411-000Brazil Colorectal Surgery Division University of São PauloMedical SchoolSão Paulo SP 01411-000Brazil Surgery at University of Campinas Medical School(UNICAMP)São Paulo 01411-000Brazil Colorectal Surgery Division Gastrocentro HospitalUniversity of CampinasMedical SchoolSão Paulo 01411-000Brazil

Colorectal cancer(CRC) is a major cause of morbidity and mortality around the world, and approximately 5% of them develop in a context of inherited mutations leading to some form of familial colon cancer syndromes. Recognition and characterization of these patients have contributed to elucidate the genetic basis of CRC. Polyposis Syndromes may be categorized by the predominant histological structure found within the polyps. The aim of the present paper is to review the most important clinical features of the Hamartomatous Polyposis Syndromes, a rare group of genetic disorders formed by the peutz-Jeghers syndrome, juvenil polyposis syndrome and PTEN Hamartoma Tumor Syndrome(Bannayan-Riley-Ruvalacaba and Cowden Syndromes). A literature search was performed in order to retrieve the most recent and important papers(articles, reviews, clinical cases and clinical guidelines) regarding the studied subject. We searched for terms such as "hamartomatous polyposis syndromes", "Peutz-Jeghers syndrome", "juvenile polyposis syndrome", "juvenile polyp", and "PTEN hamartoma tumour syndrome"(Cowden syndrome, Bananyan-Riley-Ruvalcaba). The present article reports the wide spectrum of disease severity and extraintestinal manifestations, with a special focus on their potential to develop colorectal and other neoplasia. In the literature, the reported colorectal cancer risk for Juvenile Polyposis, Peutz-Jeghers and PTEN Hamartoma Tumor Syndromes are 39%-68%, 39%-57% and 18%, respectively. A review regarding cancer surveillance recommendations is also presented.

关键词： Hereditary GI cancer syndromes Peutz-Jeghers Juvenile polyposis Cowden syndrome PTENtumor

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Short-term outcomes after laparoscopic colorectal surgery in patients with previous abdominal surgery: A systematic review

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World Journal of Gastrointestinal Surgery 2016年第7期8卷 533-540页

作者： marleny novaes figueiredo Fabio Guilherme Campos Luiz Augusto D'Albuquerque Sergio Carlos Nahas Ivan Cecconello Yves Panis Department of Gastroenterology University of S?o Paulo Medical School Division of Colorectal Surgery Department of Gastroenterology Hospital das Clínicas University of S?o Paulo Medical School Department of Gastroenterology Hospital das Clínicas University of S?o Paulo Medical School Department of Colorectal Surgery P?le des Maladies de l’Appareil Digestif (PMAD)

AIM: To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS: A broad literature search was performed with the terms "colorectal", "colectomy", "PAOS", "previous surgery" and "PAOS". Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS, whether descriptive or comparative. Endpoints of interest were conversion rates, inadvertent enterotomy and morbidity. Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and ***: From a total of 394 citations, 13 full-texts achieved selection criteria to be included in the study. Twelve of them compared patients with and without PAOS. All studies were retrospective and comparative and two were case-matched. The selected studies comprised a total of 5005 patients, 1865 with PAOS. Among the later, only 294(16%) had history of a midline incision for previous gastrointestinal surgery. Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopywas more prevalent in 3 of 5 studies that disclosed this event. Morbidity was similar in the majority of studies. A quantitative analysis(meta-analysis) could not be performed due to heterogeneity of the studies. CONCLUSION: Conversion rates were slightly higher in PAOS groups, although not statistical significant in most studies. History of PAOS did not implicate in higher morbidity rates.

关键词： Previous abdominal surgery Laparoscopic surgery Colorectal surgery Previous abdominal surgery Laparoscopy

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Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: Technical evolution and outcomes after 20 years

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World Journal of Gastrointestinal Surgery 2016年第3期8卷 232-237页

作者： marleny novaes figueiredo Fábio Guilherme Campos Department of Gastroenterology University of S?o Paulo Medical School Department of Gastroenterology Hospital das Clínicas University of S?o Paulo Medical School

In the setting of Hemorrhoidal Disease treatment, the option of conventional hemorrhoidectomy is highly effective, but it is still associated with postoperative pain and discomfort. For this reason, technical alternatives have been developed in order to reduce complications and to provide better postoperative recovery. To accomplish this aim, non-excisional techniques such as stapled hemorrhoidectomy and Doppler-guided hemorrhoidal ligation have been introduced into clinical practice with high expectations. The aim of this article is to revise the literature about transanal hemorrhoidal dearterialization technique in the treatment of hemorrhoidal disease, looking into its evolution, results and possible benefits over other modalities of surgical treatment. The literature review showed that Dopplerguided hemorrhoidal dearterialization is a safe and effective method to treat grades II to IV hemorrhoidal disease. Outcomes in patients presenting prolapse are satisfactory and the association of anopexy is an important aspect of this operation. Anal physiology disturbances are rarely observed and mainly transitory. This technique is an excellent option for every patient, especially in those with previous anal surgeries and in patients with previous alterations of fecal continence, when an additional procedure might represent a risk of definitive incontinence.

关键词： Doppler-guided hemorrhoidal dearterialization Hemorrhoids Transanal hemorrhoidal dearterialization

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