Abstract Survival in rectal cancer has been related mainly to clinical and pathological staging. Recurrence is the most challenging issue when surgical treatment of rectal cancer is concerned. This study aims to establish a recurrence pattern for rectal adenocarcinoma submitted to surgical treatment between June 2003 and July 2021. After applying the exclusion criteria to 305 patients, 166 patients were analyzed. Global recurrence was found in 18.7% of them, while 7.8% have had local recurrence. Recurrences were diagnosed from 5 to 92 months after the surgical procedure, with a median of 32.5 months. Follow-up varied from 6 to 115 months. Recurrence, in literature, is usually between 3 and 35% in 5 years and shows a 5-year survival rate of only 5%. In around 50% of cases, recurrence is local, confined to the pelvis. This study was consonant with the literature in most aspects evaluated, although a high rate of local recurrence remains a challenge in seeking better surgical outcomes.

Dispositivos cirúrgicos de porta única descartáveis têm sido utilizados para a Cirurgia Trans-anal Minimamente Invasiva (CTAMI) com benefícios, quando comparados com ressecção local e microcirurgia endoscópica trans-anal (MET). Objetivo: Apresentar os desfechos e detalhes da técnica. Método: Uma série de pacientes com indicação para ressecção local de tumores retais foi tratada cirurgicamente pela plataforma CTAMI. Resultados: Onze pacientes foram tratados por CTAMI. A distância a contar da margem anal variou de 1,5 até 8 cm, e o diâmetro máximo do tumor foi 6 cm. Um diagnóstico inicial de adenoma foi a indicação mais frequente para a ressecção. A única complicação ocorrida foi uma deiscência parcial. Mínimo tempo para preparação, baixo custo e a possibilidade do uso de instrumentos laparoscópicos convencionais fazem de CTAMI uma boa opção para a ressecção trans-anal. Os resultados dessa técnica são animadores, no que diz respeito à exeqüibilidade, manobrabilidade, custos iniciais, tempo de preparação, ressectabilidade e percentual de complicações. Graças à sua simplicidade e semelhança com a cirurgia laparoscópica convencional, CTAMI tem uma fácil curva de aprendizado. Embora atualmente ainda seja motivo de discussão o uso apropriado da excisão local, CTAMI é uma técnica que ainda provavelmente ainda crescerá muito–e há muito a ser aprendido.

Disposable single-port surgery devices have been used for transanal minimally invasive surgery (TAMIS) with benefits, when compared to local resection and transanal endoscopic microsurgery (TEM). Objective: To show outcomes and details of the technique. Method: A series of patients with indication for local resection of rectal tumors were submitted to surgery using the TAMIS platform. Results: Eleven patients have been submitted to TAMIS. Distance from anal verge was from 1.5 to 8 cm and maximum tumor diameter was 6 cm. Initial diagnosis of adenoma was the most frequent indication for resection. One partial dehiscence was the only complication seen. Minimal setup time, low cost and the possibility of using regular laparoscopic instruments make TAMIS a good option for transanal resection. The results of this technique are encouraging, concerning the feasibility, maneuverability, upfront cost, setup time, resectability and complication rate. Because of its simplicity and similarity with conventional laparoscopic surgery, it can be learned easily. Although at the present time the appropriate use of local excision is still under debate, TAMIS is a technique that still expects a lot of growing and much remains to be learned.

OBJETIVO: Relatar um caso raro de adenocarcinoma de pâncreas que se apresentou como tumores colorretais sincrônicos. Paciente masculino, 76 anos, apresentava dor abdominal difusa de forte intensidade, diarréia e vômitos há sete dias. Tratava de gastrite há dois anos e nos últimos quatro meses apresentava hiporexia e perda de peso. Estava emagrecido, desidratado e desnutrido, com distensão abdominal importante, ruídos hidroaéreos ausentes e dor difusa à palpação abdominal. Exames evidenciaram hiperglicemia, distensão importante do intestino delgado ao raio x, ultra-som de abdome com colecistolitíase e endoscopia digestiva alta com pangastrite, bulboduodenite e papila normal. Tomografia abdominal confirmou colecistolitíase. A colonoscopia mostrou três lesões, em reto médio, cólon transverso e na válvula íleocecal. As biópsias revelaram apenas reação inflamatória. Persistiram os sintomas e decidiu-se submetê-lo a colecistectomia onde foram vistas lesões planas em diafragma cujas biópsias evidenciaram adenocarcinoma. No quinto dia de pós-operatório o paciente apresentava quadro obstrutivo e foi submetido à nova laparotomia com colectomia direita, ileostomia terminal dupla e biópsia pancreática. Esta mostrou adenocarcinoma e o estudo imunoistoquímico positivo para tumor primário do pâncreas. O paciente evoluiu para óbito um mês após. CONCLUSÃO: o exame de imagem normal não descarta a hipótese diagnóstica e quando a origem do tumor primário não está definida é essencial o exame imunoistoquímico para firmar o diagnóstico.

OBJECTIVE: Report a case of a rare pancreatic adenocarcinoma presented as synchronic colorectal tumor. CASE REPORT: Seventy six year old man with high intensity and diffuse abdominal pain, diarrhea and vomiting during seven days. At that moment he had been in treatment for gastritis for 2 years and in the last four months he presented hyporexia and weight loss. He was dehydrated and malnourished, with abdominal distention and diffuse abdominal pain on clinical examination. Laboratorial exams showed hyperglycemia, x-ray revealed intense abdominal distention, abdominal ultrasound revealed cholecystolithiasis and upper digestive endoscopy showed pangastritis. The computed tomography just confirmed the cholecystolithiasis. A colonoscopy was performed and revealed three tumors located in the rectum, transverse colon and ileocecal valve that were biopsed and just showed inflammatory cells. As the symptoms persist he underwent laparoscopic cholecystectomy that was converted to the open technique when it was observed white flat lesions in the diaphragm peritoneum, the biopsies revealed adenocarcinoma. In the fifth postoperatory day the patient developed obstructive symptoms and underwent right colectomy with double terminal colostomy and pancreas biopsy that showed adenocarcinoma with immunohistochemical profile proving the pancreas as the source. The patient died within one month. CONCLUSION: The normal findings in radiological exams do not dismiss a diagnostic hypothesis and when the source of a tumor is not well established the clinical patterns should be considered and the immunohistochemical profile is essential to confirm the diagnosis.