This research presents the design, fabrication and controller development of a robotic retractor which driven by a robotic manipulator for laparoscopic colorectal surgery. The system consists of a dual-head fan retractor and a manipulator. The dual-head fan retractor comprises two fan devices, retractor wrist, tubular element and handle. The fan device is facilitated with a fan end-effector, an expansion mechanism and a clutchspring mechanism. Two fan devices have been used in the system to provide an anthropoid hand-holding shape which is specifically advanced for surgical purpose because intestine tends to slip when subject to disturbance and the anthropoid handholding shape can effectively halt that. One of the two fan devices is rotatable which makes the anthropoid hand-holding shape achievable. The retractor wrist possesses a triggering device, based on clutch-spring mechanism, for rotating the rotatable fan device. The clutch-spring mechanism has an impact on rotating the palms of the fan devices. In front of the handle, it is the so called front body which includes two fan devices, retractor wrist and tubular element. The front body can be controlled and is motorised using two motors fixed to the tubular element. The dual-head fan retractor is modelled in SolidWorks, and stress analysis of the retractor has been carried out by SolidWorks Simulation. Then, the mathematical model of the fan blades is developed. A 3-joint manipulator is modelled and controlled by a computed torque PD control approach as part of an investigative study to fit such a system to the retractor for robotic manipulation. Based on this investigation, the retractor is attached to a 2-joint robotic manipulator which has one rotational joint and a prismatic joint. This manipulator is mathematically modelled, and the dynamic equations are obtained. Control methods from Azenha and Khatib are simulated and compared. Azenha & Machado's method has fewer input parameters and less oscillation when utilising the same control gains. Timeoptimal control is then successfully developed for the above 2-joint manipulator. This study clearly indicates that a retractor to be used for laparoscopic surgery can be effectively controlled using a multi-joints and multi degrees of freedom robotic manipulator.

Orientadores: Wu Feng Chung, Huei Diana Lee / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T05:29:12Z (GMT). No. of bitstreams: 1 Espindola_Bianca_M.pdf: 2713191 bytes, checksum: 789ce5a7fa04c538dd3cc79742af1522 (MD5) Previous issue date: 2014 / Resumo: A manometria anorretal (MA) é um exame de especial interesse na área da Coloproctologia, pois, permite a avaliação de diversos parâmetros relacionados à fisiologia anorretal como a pressão máxima de contração voluntária (PMCV) e a capacidade de sustentação da pressão de contração voluntária (CS). Entretanto, apesar desses atributos serem amplamente utilizados, ainda persistem dúvidas em relação à melhor maneira de se avaliar a função de continência fecal, pois, diversos pacientes avaliados por meio desses parâmetros podem ser portadores de distúrbios funcionais relacionados ao ato de evacuação e apresentar resultados manométricos normais. Sob esse escopo, neste trabalho, analisou-se um novo parâmetro de avaliação da função anorretal, a área média resultante (AMR) sob as curvas pressão versus tempo do exame MA em comparação com os atributos biomecânicos PMCV e média da capacidade de sustentação (MCS). Foram incluídos no estudo 64 exames de MA, sendo 12 pertencentes a pacientes em condição de continência fecal (Controle), quatro representativos de indivíduos portadores de IF grau I (IF GI), 20 provenientes de pessoas com característica de IF grau II (IF GII) e 28 representaram o conjunto de sujeitos com IF grau III (IF GIII). Para o delineamento dos gráficos de manometria e cálculo da PMCV, MCS e AMR de cada exame, foi utilizado um aplicativo computacional desenvolvido por meio das linguagens de programação R e Java. As médias da PMCV (mmHg) encontradas nos grupos Controle, IF GII e IF GIII foram 247,58 mmHg, 142,40 mmHg e 153,36 mmHg, respectivamente (p = 0,0001), enquanto na MCS (segundos), 37,44 segundos, 35,97 segundos e 37,31 segundos, respectivamente (p = 0,1155) e, por final, na AMR (mmHg x segundos) 3934,32 mmHg x segundo, 2031,49 mmHg x segundo e 1855,60 mmHg x segundo, respectivamente (p = 0,0001). Nas comparações entre pares, a PMCV mostrou-se adequada para diferenciar pacientes continentes de incontinentes GII e de GIII (p < 0,001), no entanto, não ocorreu diferença estatística significativa após a comparação feita entre o grupo IF GII e o IF GIII (p > 0,05). De modo semelhante, a AMR foi eficiente para distinguir o Grupo Controle do IF GII e do GIII, todavia, não se mostrou adequada para diferenciar os dois últimos grupos entre si. A MCS não se mostrou adequada para diferenciar pacientes continentes de incontinentes fecal grau II e grau III. Por meio desses resultados, a PMCV e a AMR podem auxiliar no diagnóstico de pacientes com incontinência fecal. Todavia, novos estudos precisam ser realizados com a finalidade de aumentar a compreensão da fisiopatogenia dessa condição patológica / Abstract: The anorectal manometry (AM) is an exam of special interest in the area of Coloproctology, because it permits the evaluation of several parameters related to the anorectal¿s physiology, such as the maximum voluntary contraction pressure (MVCP) and the support¿s capacity of voluntary squeeze pressure (SCVSP). However, despite the fact that these parameters are widely used, questions related to the best way to evaluate the fecal continence function still remain. This is due to the fact that several of the evaluated patients possibly have functional disorders related with the defecation act and yet have normal manometrics¿ results. Under this scope, in this work a new anorectal function evaluation¿s parameter has been analysed: the average resulting area (ARA) obtained from anorectal manometry exam¿s curves "Pressure versus Time" compared with the biomechanics attributes MVCP and average support¿s capacity (ASC). During the research 64 manometric exams were included, of which 12 of patients with fecal continence (Control), 4 representing individuals with FI degree I (FI DI), 20 with characteristics of FI degree II (FI DII) and 28 representing a group of patients with FI degree III (FI DIII). For the manometric graphics¿ delineation and for calculating the MVCP, SCVSP and ARA of each exam, a computational application developed using Java and R languages was used. The average values of MVCP (in mmHg) found on the groups Control, FI DII and FI DIII were respectively 247.58 mmHg, 142.40 mmHg and 153.36 mmHg (p = 0.0001). The SCVSP results (in seconds) were respectively 37.44 seconds, 35.97 seconds and 37.31 seconds (p = 0.1155). Finally, the ARA results (in mmHg x seconds) were correspondingly 3934.32 mmHg x second, 2031.49 mmHg x second and 1855.60 mmHg x second (p = 0.0001). In the comparison between pairs, the MVCP parameter has demonstrated to be appropriate to distinguish continent from incontinent patients DII and DIII (p > 0.001). However, there was no significant statistic difference when the comparison was made between the group FI DII and FI DIII (p > 0.05). In a similar way, the ARA parameter was efficient to differentiate the Control group from the groups FI DII and FI DIII, although it was not adequate to distinguish the last two ones between themselves. There was no evidence that SCVSP was adequate to differentiate continent patients from fecal incontinent patients degree II and degree III. According to these results, the MVCP and the ARA parameters have shown to be able to assist the patient¿s diagnosis with fecal incontinence. However, new researches need to be developed to better understand the pathogenesis of different degrees of this illness / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

Class of 2017 Abstract / Objectives: To determine if the addition of oral alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive enhanced recovery after surgery (ERAS) program decreases length of stay, recovery time and narcotic/acetaminophen use without affecting colorectal surgery patient outcomes. Methods: Patients were compared before and after the implementation of alvimopan, liposomal bupivacaine and intravenous acetaminophen with an ERAS program. The primary outcome was hospital length of stay (measured in hours). Secondary outcomes included change in time to first meal, bowel sounds, and bowel movement (measured in hours), pain scores (visual analog scale 0-10), opioid use (measured in morphine equivalent milligrams), and acetaminophen use (measured in mg). Results: Thirty-seven individuals were included in the pre implementation population and fifty one patients were included in the post implementation population. The mean length of stay decreased from 124.3 hours to 100.2 hours (P equals 0.13) with the addition of the ERAS program with the three medications. The 24 hour morphine equivalent intervals for seventy-two hours following surgery decreased from 125.8 mg (day 1), 81.9 mg (day 2) and 44.5 mg (day 3) to 44.3 mg (day 1), 22.8 mg (day 2) and 13.2 mg (day 3) (P less than 0.005 for each one). Conclusions: The addition of alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive ERAS program decreased length of stay but not significantly. However, the addition of these three medications with the ERAS program changes was associated with a statistically significant decrease in opioid use.

Class of 2017 Abstract / Objectives: To determine if the addition of oral alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive enhanced recovery after surgery (ERAS) program decreases length of stay, recovery time and narcotic/acetaminophen use without affecting colorectal surgery patient outcomes. Methods: Patients were compared before and after the implementation of alvimopan, liposomal bupivacaine and intravenous acetaminophen with an ERAS program. The primary outcome was hospital length of stay (measured in hours). Secondary outcomes included change in time to first meal, bowel sounds, and bowel movement (measured in hours), pain scores (visual analog scale 0-10), opioid use (measured in morphine equivalent milligrams), and acetaminophen use (measured in mg). Results: Thirty-seven individuals were included in the pre implementation population and fifty one patients were included in the post implementation population. The mean length of stay decreased from 124.3 hours to 100.2 hours (P equals 0.13) with the addition of the ERAS program with the three medications. The 24 hour morphine equivalent intervals for seventy-two hours following surgery decreased from 125.8 mg (day 1), 81.9 mg (day 2) and 44.5 mg (day 3) to 44.3 mg (day 1), 22.8 mg (day 2) and 13.2 mg (day 3) (P less than 0.005 for each one). Conclusions: The addition of alvimopan, liposomal bupivacaine and intravenous acetaminophen as part of a comprehensive ERAS program decreased length of stay but not significantly. However, the addition of these three medications with the ERAS program changes was associated with a statistically significant decrease in opioid use.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Esse estudo avaliou as anastomoses colo-cÃlicas sem preparo intestinal comparando com anastomoses realizadas com preparo intestinal prÃvio. Foram utilizados 42 animais (Canis familiares) fÃmeas, pesando entre 8,4 a 16,9 Kg, clinicamente sadios, oriundos do Canil da Prefeitura Municipal de Teresina, PiauÃ. Foram distribuÃdos em 2 grupos de 21 animais: grupo I (controle) â animais submetidos ao preparo intestinal com soluÃÃo glicerinada a 12% via retal 24hs antes do procedimento e grupo II (estudo) â animais submetidos ao procedimento sem preparo intestinal prÃvio. Todos os animais de ambos os grupos foram submetidos à laparotomia com secÃÃo do cÃlon descendente e anastomose primÃria com fio de polipropileno e acompanhados no trans e pÃs-operatÃrio por um mÃdico veterinÃrio, sendo a dieta instituÃda quando ocorreu a primeira evacuaÃÃo. Esses animais foram submetidos à eutanÃsia no 21 dia de pÃs-operatÃrio apÃs anestesia venosa com cloridrato de cetamina e aplicaÃÃo de cloreto de potÃssio a 20% endovenosa; realizou-se nova laparotomia e avaliaÃÃo da anastomose colo-cÃlica. Avaliou-se a evoluÃÃo clÃnica, o grau de aderÃncias intestinais e a pressÃo de ruptura da anastomose. Utilizou-se o teste T para amostras nÃo pareadas para dados paramÃtricos e Mann-Whitney test para dados nÃo paramÃtricos. Ocorreu um (4,5%) Ãbito em cada grupo sendo o do grupo I (controle) no 7 dia pÃs-operatÃrio devido à deiscÃncia da anastomose colo-cÃlica e outro no 10 dia de pÃs-operatÃrio no grupo II(estudo) devido à infecÃÃo de sÃtio cirÃrgico incisional profunda com deiscÃncia total da parede abdominal. NÃo foi observado diferenÃa estatisticamente significante no grau de aderÃncias intestinais entre os grupos. Durante a realizaÃÃo do teste de pressÃo de ruptura ocorreu ruptura da anastomose de um animal em cada grupo e nÃo houve diferenÃa estatisticamente significante entre os grupos (p>0,05). A anastomose colo-cÃlica sem preparo intestinal apresentou a mesma seguranÃa e eficÃcia da anastomose realizada com preparo prÃvio. / Esse estudo avaliou as anastomoses colo-cÃlicas sem preparo intestinal comparando com anastomoses realizadas com preparo intestinal prÃvio. Foram utilizados 42 animais (Canis familiares) fÃmeas, pesando entre 8,4 a 16,9 Kg, clinicamente sadios, oriundos do Canil da Prefeitura Municipal de Teresina, PiauÃ. Foram distribuÃdos em 2 grupos de 21 animais: grupo I (controle) â animais submetidos ao preparo intestinal com soluÃÃo glicerinada a 12% via retal 24hs antes do procedimento e grupo II (estudo) â animais submetidos ao procedimento sem preparo intestinal prÃvio. Todos os animais de ambos os grupos foram submetidos à laparotomia com secÃÃo do cÃlon descendente e anastomose primÃria com fio de polipropileno e acompanhados no trans e pÃs-operatÃrio por um mÃdico veterinÃrio, sendo a dieta instituÃda quando ocorreu a primeira evacuaÃÃo. Esses animais foram submetidos à eutanÃsia no 21 dia de pÃs-operatÃrio apÃs anestesia venosa com cloridrato de cetamina e aplicaÃÃo de cloreto de potÃssio a 20% endovenosa; realizou-se nova laparotomia e avaliaÃÃo da anastomose colo-cÃlica. Avaliou-se a evoluÃÃo clÃnica, o grau de aderÃncias intestinais e a pressÃo de ruptura da anastomose. Utilizou-se o teste T para amostras nÃo pareadas para dados paramÃtricos e Mann-Whitney test para dados nÃo paramÃtricos. Ocorreu um (4,5%) Ãbito em cada grupo sendo o do grupo I (controle) no 7 dia pÃs-operatÃrio devido à deiscÃncia da anastomose colo-cÃlica e outro no 10 dia de pÃs-operatÃrio no grupo II(estudo) devido à infecÃÃo de sÃtio cirÃrgico incisional profunda com deiscÃncia total da parede abdominal. NÃo foi observado diferenÃa estatisticamente significante no grau de aderÃncias intestinais entre os grupos. Durante a realizaÃÃo do teste de pressÃo de ruptura ocorreu ruptura da anastomose de um animal em cada grupo e nÃo houve diferenÃa estatisticamente significante entre os grupos (p>0,05). A anastomose colo-cÃlica sem preparo intestinal apresentou a mesma seguranÃa e eficÃcia da anastomose realizada com preparo prÃvio. / The objective of this study was to evaluate the efficacy of colo-colonic anastomosis in dogs with and without preoperative bowel preparation. The experiment included 42 healthy female mongrel dogs (Canis familiaris) weighing 8.4-16.9 Kg, supplied by the municipal dog pound of Teresina, PiauÃ. The animals were distributed at random in two groups of 21 animals each: Group I (control) = submitted to bowel preparation with rectal administration of 12% glycerin solution one day before the procedure, and Group II (study) = without previous bowel preparation. All animals were submitted to laparotomy with sectioning of the descending colon and primary anastomosis using polypropylene thread under the peri and postoperative supervision of a veterinary physician. The animals were allowed access ad libitum to water and standard feed following the first evacuation. On the 21st postoperative day (POD 21), the dogs were euthanized with ketamine i.v. followed by 20% potassium chloride i.v., and a second laparotomy was performed through the same incision in order to evaluate the anstomosis. In addition, the abdominal cavity was evaluated for adhesions and the burst pressure of the anastomosis was tested. The unpaired samples were compared with Student&#700;s t test for parametric data and with the Mann-Whitney test for non-parametric data. One animal in each group (4.5%) died. The death in Group I (control) occurred on POD 7 due to anastomotic dehiscence. The death in Group II (study) occurred on POD 10 due to deep incisional infection at the surgical site and complete dehiscence of the abdominal wall. The groups did not differ significantly with regard to adhesion grade or anastomotic burst pressure (one specimen burst in each group) (p>0.05). In conclusion, the level of safety and efficacy was the same for colo-colonic anastomosis with and without previous bowel preparation. / The objective of this study was to evaluate the efficacy of colo-colonic anastomosis in dogs with and without preoperative bowel preparation. The experiment included 42 healthy female mongrel dogs (Canis familiaris) weighing 8.4-16.9 Kg, supplied by the municipal dog pound of Teresina, PiauÃ. The animals were distributed at random in two groups of 21 animals each: Group I (control) = submitted to bowel preparation with rectal administration of 12% glycerin solution one day before the procedure, and Group II (study) = without previous bowel preparation. All animals were submitted to laparotomy with sectioning of the descending colon and primary anastomosis using polypropylene thread under the peri and postoperative supervision of a veterinary physician. The animals were allowed access ad libitum to water and standard feed following the first evacuation. On the 21st postoperative day (POD 21), the dogs were euthanized with ketamine i.v. followed by 20% potassium chloride i.v., and a second laparotomy was performed through the same incision in order to evaluate the anstomosis. In addition, the abdominal cavity was evaluated for adhesions and the burst pressure of the anastomosis was tested. The unpaired samples were compared with Student&#700;s t test for parametric data and with the Mann-Whitney test for non-parametric data. One animal in each group (4.5%) died. The death in Group I (control) occurred on POD 7 due to anastomotic dehiscence. The death in Group II (study) occurred on POD 10 due to deep incisional infection at the surgical site and complete dehiscence of the abdominal wall. The groups did not differ significantly with regard to adhesion grade or anastomotic burst pressure (one specimen burst in each group) (p>0.05). In conclusion, the level of safety and efficacy was the same for colo-colonic anastomosis with and without previous bowel preparation.

In this thesis, I chose to identify and evaluate different monitoring methods on surgeon specific outcomes in colorectal surgery. An initial literature search identified different methods that were applied to a cohort of colorectal patients operated on by general surgeons using an electronic hospital database. Surgeon specific complications were validated with a chart review. General surgeons at The Ottawa Hospital were surveyed on their opinions regarding monitoring outcomes. We can conclude that different methods may be needed as they are dependent heavily on specified target limits. With our derived cohort, we had adequate risk adjustment using a modified Escobar model for 30 day mortality and morbidity. These complications were derived from electronic algorithms and had excellent specificity and sensitivity. General surgeons at The Ottawa Hospital have different opinions regarding monitoring their outcomes and surgeon engagement is necessary to make monitoring fruitful for patients, public, hospital administration, and surgeons.

In this thesis, I chose to identify and evaluate different monitoring methods on surgeon specific outcomes in colorectal surgery. An initial literature search identified different methods that were applied to a cohort of colorectal patients operated on by general surgeons using an electronic hospital database. Surgeon specific complications were validated with a chart review. General surgeons at The Ottawa Hospital were surveyed on their opinions regarding monitoring outcomes. We can conclude that different methods may be needed as they are dependent heavily on specified target limits. With our derived cohort, we had adequate risk adjustment using a modified Escobar model for 30 day mortality and morbidity. These complications were derived from electronic algorithms and had excellent specificity and sensitivity. General surgeons at The Ottawa Hospital have different opinions regarding monitoring their outcomes and surgeon engagement is necessary to make monitoring fruitful for patients, public, hospital administration, and surgeons.

Management of very low rectal cancer is one of the most challenging issues faced by colorectal surgeons. For tumors in the mid and upper rectum, procedures can be done to resect the cancer while maintaining continence, a major determinant of post-operative quality of life. In the low rectum, however, to optimize oncologic outcomes, many surgeons feel compelled to pursue abdominoperineal (APR) over low anterior resection (LAR), a sphincter-preserving procedure. It was hypothesized that after robust adjustment, procedure choice will not be associated with a difference in disease-free survival in the resection of tumors in the low rectum. To analyze this, the US Rectal Cancer Collaborative Database, a comprehensive, multi-center dataset obtained from six institutions between 2010 and 2016, was queried. Patients undergoing TME resection for Stage I-III very low rectal cancers (involvement) were selected for this study. Patients were categorized by procedure- LAR vs APR. Primary outcome was five-year disease-free survival. Secondary outcomes included overall survival, recurrence, length of stay, and complications. An adjusted analysis was performed to account for all known potential confounders. 431 patients with very low rectal cancer treated by either APR or LAR were identified. 154 (35.7%) underwent APR. The overall recurrence rate was 19.6%. Median follow-up time was 42.5 months. An analysis adjusted for age, gender, BMI, ASA class, and pathologic stage observed no difference in disease free survival between operative types (HR=0.90, 95% CI [0.53-1.52], p=0.70). Similarly, secondary outcomes demonstrated no significant difference between operation types, including length of stay (Beta: 0.04, Std. error = 0.25, p = 0.54), overall survival (HR=1.29, 95% CI [0.71-2.32], p=0.39), or complications (OR = 1.53, 95% CI [0.94 - 2.50], p=0.09). In this analysis, no significant difference in disease-free survival or overall survival was observed between patients undergoing APR or LAR for very low rectal cancer. This comprehensive study supports the treatment of very low rectal cancer, less than 5cm from the anorectal ring with no sphincter involvement, by either abdominal perineal or low anterior resection. Further studies may focus on patient-reported and quality of life outcomes which may influence decision-making.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24832号 / 医博第5000号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤, 学, 教授 今中, 雄一, 教授 阪上, 優 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-29T17:01:35Z No. of bitstreams: 1 CarlaMariaMoraes_dissert.pdf: 4345886 bytes, checksum: 7c2b7d3028309208358698339e534111 (MD5) / Made available in DSpace on 2018-10-29T17:01:35Z (GMT). No. of bitstreams: 1 CarlaMariaMoraes_dissert.pdf: 4345886 bytes, checksum: 7c2b7d3028309208358698339e534111 (MD5) Previous issue date: 2017-07-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Colorectal cancer (CRC) is a prevalent disease in Brazil and worldwide. It is treated with surgical indication, neoadjuvant therapies such as Chemotherapy and / or Radiotherapy. Thus in elective surgeries, the approach of the multidisciplinary team to improve the clinical condition of surgical patients is required. Nutritional impairments to the side effects of cancer treatment prior to surgery are permanent. Therefore, the preoperative nutritional assessment, therapy and post-surgical nutritional monitoring are fundamental, since this nutritional impairment contributes to the increase of postoperative morbidity and mortality. Objective: To identify the status and preoperative nutritional risk of patients eligible for colorectal surgery. Methods: We studied from February, 2014 to August, 2015, 22 patients (11 men and 11 women; 59.6± 12.4 years) hospitalized in the Coloproctology Department of Hospital de Base/ FAMERP candidates to the elective major abdominal surgery. Preoperative evaluation was performed by a protocol that comprised subjective global assessment (SGA), objective nutritional assessment (ONA), anthropometric parameters (weight, height, BMI, measures of circumferences and triceps skinfold), biochemical (hematocrit, hemoglobin and serum albumin) and dietary recall of the usual intake. Nutritional risk was calculated according to criteria combined according to the Nutritional Guidelines Nutritional Therapy (DITEN) and the Second National Consensus Oncology Nutrition (CNNO) based on parameters such as: weight loss (pp)>10% in 6 months, severe malnutrition according to SGA, BMI <18.5kg/m2 (adults) or 22 kg/m2 (elderly) and serum albumin <3.0g/dL. Results: In the study, 18 (81.8%) patients had cancer (50.0% colon cancer and 31.8% rectal cancer). All patients had major surgery indication, 8 (27.3%) reported having gastrointestinal symptoms, 20 (90.9%) reported no impairment in functional capacity and 8 (36.4%) showed depletion of adipose tissue and lean mass. Nine (40.9%) patients were considered malnourished or at nutritional risk according to SGA, and only 2 (9.1%) according to BMI (P=0.0339). Thirteen (59.1%) of them were overweighed according to BMI, 7 (31.8%) and 11 (50%) were classified with malnutrition / nutritional risk and overweight according to ONA, respectively. Regarding the anthropometric profile, the group of men towards women; higher weight median (77.8kg x 60.0 kg, P=0.0126), CMB (26.4 cm x 22.2 cm P=0.0372), DC (100 cm x 80 cm; P=0.0301) and WHR (0.99 x 0.88, P=0.0010) were observed. Regarding the PCT, there was a higher median in the female group compared to the group of men (23.0 mm x 10.0 mm; P=0.0065). In 10 (45.5%) patients and in 11 (50%) of them, the ingestion of calories and protein was smaller than 75% of the required. Only 2 (9.1%) patients had serum albumin levels between 3.5 and 3.0 g/dL. Thus, 4 (18.2%) patients were considered to have severe nutritional risk according to DITEN and II CNNO. Conclusions: Considering the results found in the study, it is concluded that the impaired nutritional status, either by depletion of lean body mass, as the overweight is a common finding in patients undergoing surgery for colorectal cancer. Severe nutritional risk is present in these patients, so the Preoperative Nutritional Therapy is fundamental and can provide better results in the elective surgeries. / O câncer colorretal (CCR), doença prevalente no Brasil e no mundo, a qual é tratada com cirúrgia, terapias neoadjuvantes e adjuvantes, como quimioterapia e/ou radioterapia vem ganhando mais atenção devido ao aumento da incidência. Assim, em cirurgias eletivas, a atuação da equipe multidisciplinar pode contribuir decisivamente para melhorar as condições clínicas dos pacientes cirúrgicos e o resultado do tratamento. Prejuízos nutricionais devido aos efeitos colaterais do tratamento oncológico anterior à cirurgia são evidentes. Portanto, a avaliação nutricional pré-cirúrgica, a terapia e o acompanhamento nutricional pós-cirúrgico são fundamentais, uma vez que o comprometimento nutricional contribui para o aumento da morbimortalidade pós-operatória. Objetivo: Identificar o estado e o risco nutricional pré-operatório de pacientes candidatos à cirurgia colorretal. Casuística e Método: Foram estudados, de Fevereiro/2014 à Agosto∕2015, 22 pacientes (11 homens e 11 mulheres; 59,6+ 12,4 anos), internados nas enfermarias da Disciplina de Coloproctologia do Hospital de Base/FAMERP, candidatos à cirurgia abdominal eletiva de grande porte. A avaliação pré-operatória foi realizada por protocolo composto de avaliação nutricional subjetiva global (ANSG), avaliação nutricional objetiva (ANO), parâmetros antropométricos (peso, altura, IMC, medidas de circunferências e prega cutânea do tríceps), bioquímicos (hematócrito, hemoglobina e albumina sérica) e recordatório alimentar da ingestão habitual. O risco nutricional foi calculado de acordo com critérios combinados segundo as Diretrizes Nutricionais de Terapia Nutricional (DITEN) e o II Consenso Nacional de Nutrição Oncológica (CNNO), baseado em parâmetros como: perda de peso (pp)>10% em 06 meses, desnutrição grave de acordo com ANSG, IMC<18,5Kg/m2 (adultos) ou 22Kg/m2 (idosos) e albumina sérica <3,0g/dL. Resultados: Na casuística, 18(81,8%) eram portadores de câncer (50,0%câncer de cólon e 31,8% câncer de reto) e 18,2 outras doenças do intestino. Todos os pacientes tinham indicação de cirurgia de grande porte, sendo que 6(27,3%) relataram apresentar sintomas gastrointestinais, 20(90,9%) referiram ausência de disfunção na capacidade funcional e 8(36,4%) apresentaram depleção de tecido adiposo e de massa magra. Nove (40,9%) pacientes foram considerados desnutridos ou de risco nutricional segundo a ANSG, e apenas 2(9,1%) segundo o IMC (P=0,0339). Treze (59,1%) deles tinham excesso de peso de acordo com o IMC, 7(31,8%) e 11(50%) classificaram-se com desnutrição/risco nutricional e com excesso de peso segundo a ANO, respectivamente. Em relação ao perfil antropométrico, no grupo dos homens em relação às mulheres, observaram-se maiores medianas de peso (77,8kg x 60,0kg; P=0,0126), CMB (26,4cm x 22,2cm; P=0,0372), CC (100 cm x 80 cm; P=0,0301) e RCQ (0,99 x 0,88; P=0,0010). Em relação ao PCT, verificou-se maior mediana no grupo das mulheres comparado ao grupo dos homens (23,0mm x 10,0mm; P=0,0065). Em 10(45,5%) pacientes e em 11(50%) deles, a ingestão de calorias e proteínas foi considerada menor que 75% das necessidades. Apenas 2(9,1%) pacientes apresentaram níveis séricos de albumina entre 3,5 a 3,0 g/dL. Sendo assim, 4 (18,2%) pacientes foram considerados com risco nutricional grave segundo o DITEN e o II CNNO. Conclusões: Considerando-se os resultados encontrados na casuística, conclui-se que o estado nutricional comprometido, tanto pela depleção de massa magra, como pelo excesso de peso, é um achado frequente em pacientes que realizam a cirurgia do câncer colorretal. O risco nutricional grave está presente nestes pacientes, de tal modo que a Terapia Nutricional pré-operatória, é fundamental, pois pode influenciar os melhores resultados em cirurgias eletivas.