Arquivos Brasileiros De Cirurgia Digestiva[JOURNAL]
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200 papers
Histological response of gastric adenocarcinomas after chemotherapy in the Tunisian population.
Bacha D, Mallek I, Ben-Rejeb S … +4 more , Attia M, Gharbi L, Lahmar A, Ben-Slama S
Arq Bras Cir Dig · 2025 · PMID 41036938 · Full text
BACKGROUND: Gastric cancer is the fifth most common and a leading cause of cancer death. Since 2005, perioperative chemotherapy (CT) has been the standard for non-metastatic gastric adenocarcinomas. Tumor response relies...
BACKGROUND: Gastric cancer is the fifth most common and a leading cause of cancer death. Since 2005, perioperative chemotherapy (CT) has been the standard for non-metastatic gastric adenocarcinomas. Tumor response relies essentially on histological criteria. AIMS: The aim of the study was to evaluate tumor regression grade (TRG) after neoadjuvant CT and compare the Mandard and Becker scoring systems. METHODS: This 15-year retrospective study included patients with gastric adenocarcinoma treated with neoadjuvant CT and surgery. The TRG was assessed using Mandard and Becker scores, evaluated by area under the curve (AUC) for homogeneity, monotonicity, and discrimination. Tumors were staged by the American Joint Committee on Cancer and classified as the World Health Organization. RESULTS: Forty patients (mean age 62 years; M:F ratio 2.6) were included. Tubular adenocarcinoma was the most common (48%), and 20% were stage IV. Mandard TRG1 and TRG5 each accounted for 15%, with median survivals of 48 and 30.5 months, respectively. For Becker TRG, they were 25.15 months (TRG 1), 24 months (TRG 2), and 54 months (TRG 3). The mean survival was 49.2 months for TRG1 and 39.2 months for TRG5 (Mandard), 50.3 months for TRG1 and 42.2 months for TRG3 (Becker). The positive predictive values for Mandard and Becker were 1.116 and 0.418 at 1 year and 5.719 and 1.820 at 5 years. The linearity values for Mandard and Becker were 0.6 and 0.3 at 1 year and 2.5 and 2.2 at 5 years. The AUC values at 1 year were 0.568 (Mandard), and 0.545 (Becker), and 0.606 for both at 5 years. CONCLUSIONS: TRG is an independent survival predictor in gastric cancer, with similar performance between Mandard and Becker scores. Combined with ypTNM staging, it may enhance prognostic accuracy. BACKGROUND: This 15-year retrospective study compares the prognostic performance of the Mandard and Becker tumor regression grading systems in gastric adenocarcinoma. BACKGROUND: Both tumor regression grade systems showed moderate and comparable predictive value for 1- and 5-year overall survival. BACKGROUND: The Mandard score showed slightly better linearity and positive predictive value, but no clear superiority was observed. BACKGROUND: Combining tumor regression grade classification with ypTNM staging may improve prognostic accuracy in gastric cancer patients treated with neoadjuvant chemotherapy. CENTRAL MESSAGE: Gastric cancer is the 5th most common cancer globally and the 4th leading cause of cancer-related deaths. Since 2005, perioperative chemotherapy has been the standard for non-metastatic gastric adenocarcinomas. Tumor response relies essentially on histological criteria, with many scoring systems, the most used of which are Mandard and Becker, but without consensus. PERSPECTIVES: This study confirms that the tumor regression classification is an independent prognostic factor in gastric cancer, particularly when combined with ypTNM staging. While Mandard shows slightly better performance, both Mandard and Becker scores demonstrate moderate and comparable predictive value, with no clear superiority. These findings highlight the need for a standardized system integrating nodal response and other key histological features to improve prognostic accuracy.
ANGELITA HABR-GAMA. TRIBUTE TO A REMARKABLE WOMAN AND BRAZILIAN ICON OF GLOBAL COLORECTAL SURGERY. FORMER PRESIDENT OF THE BRAZILIAN COLLEGE OF DIGESTIVE SURGERY (2007-2008).
Marques CFS, Campos FG, Sobrado CW
Arq Bras Cir Dig · 2025 · PMID 40960753 · Full text
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Artificial intelligence-assisted colonoscopy for colorectal lesion detection: a case-control study on diagnostic accuracy and histopathological agreement.
Facanali Junior MR, Sousa Junior AHDS, Marques CFS … +1 more , Safatle-Ribeiro AV
Arq Bras Cir Dig · 2025 · PMID 40929467 · Full text
BACKGROUND: Artificial intelligence (AI)-assisted colonoscopy has emerged as a tool to enhance adenoma detection rates (ADRs) and improve lesion characterization. However, its performance in real-world settings, especial...
BACKGROUND: Artificial intelligence (AI)-assisted colonoscopy has emerged as a tool to enhance adenoma detection rates (ADRs) and improve lesion characterization. However, its performance in real-world settings, especially in developing countries, remains uncertain. AIMS: The aim of this study was to evaluate the impact of AI on ADRs and its concordance with histopathological diagnosis. METHODS: A matched case-control study was conducted at a colorectal cancer (CRC) referral center, including 146 patients aged 45-75 years who underwent colonoscopy for CRC screening or surveillance. Patients were allocated into two groups: AI-assisted colonoscopy (n=74) and high-definition conventional colonoscopy (n=72). The primary outcome was ADR, and the secondary outcome was the agreement between AI-based lesion characterization and histopathology. Statistical analysis was performed with a significance level of p<0.05. RESULTS: ADR was higher in the AI group (60%) than in the control group (50%), but this difference was not statistically significant (p>0.05). AI-assisted lesion characterization showed substantial agreement with histopathology (kappa=0.692). No significant difference was found in withdrawal time (29 min vs. 27 min; p>0.05), indicating that AI did not delay the procedure. CONCLUSIONS: Although AI did not significantly increase ADR compared to conventional colonoscopy, it demonstrated strong histopathological concordance, supporting its reliability in lesion characterization. AI may reduce interobserver variability and optimize real-time decision-making, reinforcing its clinical utility in CRC screening.
Pancreatoduodenectomy and surgical treatment of groove pancreatitis.
Apodaca-Torrez FR, Zotti OR, Apodaca-Rueda M … +3 more , Santos MA, Fuziy RA, Lobo EJ
Arq Bras Cir Dig · 2025 · PMID 40900574 · Full text
BACKGROUND: Groove pancreatitis is an unusual form of chronic pancreatitis that can be mistaken for a pancreatic head neoplasm. BACKGROUND: Once the diagnosis is confirmed, clinical management follows the standard recomm...
BACKGROUND: Groove pancreatitis is an unusual form of chronic pancreatitis that can be mistaken for a pancreatic head neoplasm. BACKGROUND: Once the diagnosis is confirmed, clinical management follows the standard recommendations for chronic pancreatitis. BACKGROUND: Surgery is indicated when clinical treatment fails or when there is diagnostic uncertainty regarding pancreatic neoplasia. BACKGROUND: Pancreatoduodenectomy is an effective treatment option when performed in high-volume referral centers. BACKGROUND: Groove pancreatitis (GP) is a rare, segmental form of chronic pancreatitis that primarily affects individuals between 40 and 50 years of age. It has been referred to by various other names, such as paraduodenal pancreatitis, cystic dystrophy of heterotopic pancreas, duodenal dystrophy, duodenal pancreatic hamartoma, paraduodenal wall cyst, and myoadenomatosis. This distinct and sporadic form of pancreatitis (GP) can be classified, depending on the affected segment, into a segmental form - affecting the entire pancreatic head - and a pure form limited to the pancreaticoduodenal groove, with preservation of the remaining pancreatic parenchyma. Its true incidence, as well as its pathophysiological mechanisms, remains unknown. BACKGROUND: Groove pancreatitis is a rare, segmental form of chronic pancreatitis that, in some cases, may be mistaken for pancreatic head neoplasia, with imaging modalities including endoscopic ultrasound currently playing a key role in its diagnosis. A review of the medical papers indicates that initial treatment should be multidisciplinary, similar to the management of classic chronic pancreatitis. When there is little or no response to conservative and/or endoscopic treatment, surgical intervention is indicated, and pancreatoduodenectomy is a good option, provided it is performed in centers with extensive experience in pancreatobiliary surgery. BACKGROUND: Groove pancreatitis (GP) is a rare and segmental form of chronic pancreatitis that affects the pancreaticoduodenal sulcus. Its pathophysiology is still not well known, and several etiological factors have been attributed, with chronic alcohol consumption being the most common association. Its treatment still generates controversy. The initial clinical approach followed by endoscopic therapies prevails. Surgery is indicated when these treatment options fail. AIMS: The aim of this study was to analyze the clinical, imaging, and surgical treatment data of a series of patients diagnosed with GP. METHODS: The clinical, radiological, surgical, and postoperative follow-up data were analyzed, in addition to the histopathological results of chronic pancreatitis, in patients undergoing pancreaticoduodenectomy. RESULTS: A total of eight patients were included, of whom six were male, and their mean age was 45 years. The main symptom presented was long-standing abdominal pain with the use of analgesics and weight loss; all patients were chronic alcoholics. Imaging methods defined the diagnosis of GP in the preoperative period in five patients. In three patients, the preoperative diagnosis was neoplasia of the head of the pancreas. All patients underwent pancreaticoduodenectomy and one patient developed pancreatic fistula. There was a regression of pain in all patients. CONCLUSIONS: For patients with GP who do not respond to the clinical approach, or in the face of diagnostic doubt, pancreaticoduodenectomy constitutes a good therapeutic option.
Liver transplantation in patients over 70 years old.
Genzini T, Rodrigues MG, Almeida TN … +7 more , Danziere FR, Fonseca LEPD, Genzini MC, Lerner FK, Coelho AIM, Grochoski KCV, Perosa M
Arq Bras Cir Dig · 2025 · PMID 40900573 · Full text
BACKGROUND: Liver transplantation (LT) in patients aged ≥70 years is feasible with selected donors. BACKGROUND: Short-term outcomes were comparable to those in younger recipients. BACKGROUND: Elderly patients had higher...
BACKGROUND: Liver transplantation (LT) in patients aged ≥70 years is feasible with selected donors. BACKGROUND: Short-term outcomes were comparable to those in younger recipients. BACKGROUND: Elderly patients had higher intensive care unit (ICU) stay and transfusion needs. BACKGROUND: Advanced age should not be a contraindication for LT when carefully evaluated. BACKGROUND: A retrospective analysis of liver transplants was performed, comparing patients over and under 70 years of age. The elderly group was transplanted with careful donor selection and obtained results comparable to those of the younger group. BACKGROUND: This study aims to show that elderly patients over 70 years of age can have good results after liver transplantation, comparable to patients under 70 years of age, with good donor selection and perhaps additional points to favor their position on the waiting list. BACKGROUND: Liver transplantation (LT) is increasingly recognized as a treatment option for various diseases affecting a growing elderly population. However, its use in patients over 70 years of age remains controversial in centers with suboptimal outcomes or high waitlist mortality. AIM: The aim of this study was to evaluate the effectiveness of LT as a treatment option for elderly patients aged 70 years or older, in comparison with younger recipients. METHODS: This retrospective study was conducted based on medical record data from 309 liver transplant recipients treated by the same surgical team across three hospitals - two located in São Paulo, São Paulo state (SP) and one in Rio Branco, Acre state (AC). Patients were divided into two groups for comparison: those aged up to 69 years (Group I) and those aged 70 years or older (Group II). RESULTS: Donor characteristics were similar between the two groups, except for a higher norepinephrine dose in Group I (p<0.05). Group II showed greater transfusion requirements and longer intensive care unit (ICU) stays (p<0.05), as well as higher rates of malnutrition and comorbidities. Notably, 90-day survival was comparable between the groups. CONCLUSIONS: Patients aged 70 years or older can achieve outcomes comparable to those of younger recipients, provided they receive grafts from carefully selected donors. This population should not be excluded from transplant waitlists, and specific allocation policies or scoring adjustments should be considered to ensure equitable access.
Implementation of the recommendations of the II Brazilian Consensus On Gastric Cancer in clinical practice: a multicenter study of the Brazilian Gastric Cancer Association.
Ramos MFKP, Pereira MA, Albuquerque AF … +18 more , Viana EF, Costa Junior WL, Sanches SRA, Silva AM, Ribeiro Junior U, Oliveira APRA, Victer FC, Targa GZ, Assumpção PP, Weston AC, Ribeiro Neto JP, Moreira LF, Mrue F, Lopes LR, Kassab P, Pinto JOG, Barchi LC, Forones NM
Arq Bras Cir Dig · 2025 · PMID 40900504 · Full text
BACKGROUND: Gastric cancer (GC) remains a major global health problem. Despite a decline in its incidence, GC is still the third most lethal cancer worldwide. BACKGROUND: Multimodal treatment approaches are employed, inc...
BACKGROUND: Gastric cancer (GC) remains a major global health problem. Despite a decline in its incidence, GC is still the third most lethal cancer worldwide. BACKGROUND: Multimodal treatment approaches are employed, including chemotherapy (CMT), radiotherapy (RDT), surgery, expanded criteria for endoscopic resection, and increased use of minimally invasive surgery. BACKGROUND: The development of clinical guidelines and consensus recommendations to update and guide healthcare professionals involved in GC treatment has gained increasing prominence. BACKGROUND: Preoperative nutritional therapy, indication of D2 lymphadenectomy, and the use of minimally invasive surgery for distal EGC, was notably strong. BACKGROUND: Greater attention is warranted regarding the broader implementation of diagnostic laparoscopy and ensuring the retrieval of an adequate number of lymph nodes during D2 lymphadenectomy to optimize staging and outcomes. BACKGROUND: The development of consensus statements and clinical guidelines supports decision-making in clinical practice. However, recommendations formulated by experts may not always reflect real-world clinical practice. In this study, 21 key statements from the 2nd Brazilian Consensus on Gastric Cancer were evaluated across multiple cancer reference centers. It was found that, in 10 of these statements, current clinical practice diverged from the consensus recommendations. BACKGROUND: Some consensus statements may be revised in future editions to better reflect the realities of clinical practice in the national context. To enhance adherence to the recommendations, broad dissemination of the study results is essential, alongside the implementation of educational initiatives and institutional policies aimed at promoting guideline compliance. These measures may contribute to closing the gap between consensus recommendations and everyday clinical practice, ultimately improving patient outcomes. BACKGROUND: The management of gastric cancer has become increasingly complex, highlighting the importance of clinical guidelines to ensure standardized care. The Second Brazilian Consensus on Gastric Cancer was developed to guide clinical practice across the country. AIMS: The aim of this study was to evaluate the degree of implementation of the 2nd Brazilian Consensus recommendations in cancer reference centers in Brazil. METHODS: This multicenter study involved 18 cancer centers that prospectively collected data over a one-year period. Notably, 21 key statements from the Consensus were assessed. Adherence was defined as following the recommendation in more than 80% of applicable cases. RESULTS: Of the 21 statements, 11 (52.4%) met the predefined adherence threshold. The selective use of endoscopic ultrasound and PET-CT was consistent with the recommendations. However, diagnostic laparoscopy was underutilized, performed in only 24.7% of patients. Preoperative nutritional therapy, another key recommendation, was provided in just 42% of cases. D2 lymphadenectomy was performed in 79.8% of surgeries, but only 63.3% of specimens included ≥25 lymph nodes, the recommended minimum for adequate staging. Minimally invasive surgery (MIS) was performed in approximately 25% of early distal tumors but was rarely used in advanced proximal tumors. Despite not being recommended for early stage tumors, omentectomy and bursectomy were still performed in a significant number of T1/T2 cases. Preoperative chemotherapy was used in 35.4% of distal tumors ≥IB and 54.3% of proximal tumors, showing partial adherence to this recommendation. CONCLUSIONS: Just over half of the II Brazilian Consensus recommendations were implemented in routine practice. There was strong adherence to D2 lymphadenectomy and MIS for early distal tumors. However, there is still room for improvement in areas such as diagnostic laparoscopy, nutritional support, adequate lymph node retrieval, and using more neoadjuvant chemotherapy to enhance care and follow national guidelines.
Inflammatory bowel diseases in Brazil: journey of doctors who care for patients. What is the importance?
Craveiro MMS, Sassaki LY, Vilela EG … +1 more , Hossne RS
Arq Bras Cir Dig · 2025 · PMID 40834209 · Full text
BACKGROUND: Inflammatory bowel diseases (IBDs), represented by Crohn's disease and ulcerative colitis, are conditions whose epidemiological rates are increasing worldwide. BACKGROUND: The study of IBDs and the treatment...
BACKGROUND: Inflammatory bowel diseases (IBDs), represented by Crohn's disease and ulcerative colitis, are conditions whose epidemiological rates are increasing worldwide. BACKGROUND: The study of IBDs and the treatment of patients with these conditions are a daily challenge for specialist doctors. BACKGROUND: Understanding the profile of the doctors who treat these patients and their difficulties during treatment is essential. BACKGROUND: Many adversities are related to health policies, such as access to medications and complementary tests, which compromises the adequate treatment of these patients. BACKGROUND: Inflammatory bowel diseases are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide. It is known that early diagnosis and short start of the correct indicated treatment alter the natural history of the disease, preventing complications; hence, it is necessary to know the profile of the doctors who treat these patients in Brazil and especially to understand the difficulties in care and evaluate them in relation to other variables. BACKGROUND: This study showed the profile of physicians who treat inflammatory bowel disease (IBD) patients, through their registration in the Brazilian Inflammatory Bowel Disease Study Group. In addition to analyzing the physician's profile and their difficulties, the main aspects that hinder both the diagnosis and treatment of the disease, attributed to external factors, were listed. Therefore, more effective public health policies should be planned and expanded, aiming at growth and adaptation focused on IBDs. BACKGROUND: Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide. AIMS: The aim of this study was to profile the doctors who treat patients with IBDs in Brazil and to understand and analyze the journey and importance of this care. METHODS: This is a cross-sectional study that descriptively and inferentially analyzed the pre-existing database of the Brazilian Inflammatory Bowel Disease Study Group and through this observed the reality of care for Crohn's disease and ulcerative colitis, in the country. RESULTS: In the descriptive analysis, we found results regarding the physicians' profile such as specialty, number of patients treated with these diseases and their difficulties in accessing medications, complementary exams, and multidisciplinary team. In the statistical analysis regarding the Human Development Index of the states, the significant results were related to workplace, difficulty in accessing medications, and referral to other specialists. Regarding the association of variables with medical demographics, the results were significant in relation to workplace, difficulty in accessing medications, and complementary exams. CONCLUSIONS: The study showed a profile of the doctors who treat patients with IBDs and who participated in this survey. In addition to analyzing and describing the doctor's profile and their difficulties, we listed the main aspects that hinder both diagnosis and treatment, attributed to external factors, regardless of their reality and competence.
Preventive correction of fibrinolysis with epsilon aminocaproic acid detected by thromboelastometry during liver transplantation.
Nascimento JCR, Freitas LH, Pinto DV … +4 more , Souza AL, Aquino CC, Santos DT, Nunes RR
Arq Bras Cir Dig · 2025 · PMID 40834208 · Full text
BACKGROUND: Orthotopic liver transplantation (OLT) is a highly complex procedure. BACKGROUND: OLT can be difficult to control intraoperative bleeding in patients with coagulopathies. BACKGROUND: OLT may result in a high...
BACKGROUND: Orthotopic liver transplantation (OLT) is a highly complex procedure. BACKGROUND: OLT can be difficult to control intraoperative bleeding in patients with coagulopathies. BACKGROUND: OLT may result in a high need for transfusion of blood products. BACKGROUND: Epsilon aminocaproic acid (EACA) can reduce the need for transfusion of Hood products. BACKGROUND: EACA can be safe with regard to complications such as thrombosis. BACKGROUND: A total of 105 patients were assessed for eligibility, and 55 were excluded. The remaining 50 patients were randomized, of which 24 patients were allocated to the intervention group and the other 26 to the saline placebo group. In the analysis of the fibrinolytic and hemostatic coagulation profile by rotational thromboelastometry, fibrinolysis was significantly less frequent in patients treated with epsilon aminocaproic acid (p<0.001) compared to those in the placebo group during the anhepatic phase. In the other analyses using thromboelastometry assays such as extrinsic pathway thromboelastometry (EXTEM) (clotting time [CT], clot formation time, alpha angle, amplitude of clot firmness 10 min after CT [A10], and maximum clot firmness [MCF]) and fibrinogen-specific thromboelastometry (FIBTEM) (A10 and MCF), there was no significant difference nor postoperative complications in both groups. BACKGROUND: Some studies have shown that epsilon aminocaproic acid (EACA) inhibits the binding of plasminogen to lysine residues on the surface of fibrin and prevents conversion of plasminogen to plasmin and the degradation of glycoprotein Ib receptors, thus preserving platelet function. Although EACA did not reduce blood product transfusion, the drug effectively treated all cases and was not associated with any complications of increased risk of hepatic artery and vein thrombosis or mortality within 3 months after orthotopic liver transplantation (OLT). These results support the safety of EACA as the antifibrinolytic drug of choice in OLT. However, future studies involving larger randomized clinical trials and higher doses are needed to further investigate the results. BACKGROUND: Orthotopic liver transplantation (OLT) is a highly complex procedure, which can be difficult to control intraoperatively in patients with coagulopathies. AIMS: The aim of this study was to evaluate the prophylactic administration of epsilon aminocaproic acid (EACA) to reduce the need for transfusion of blood products and its relevance for thrombosis. METHODS: Patients were randomized into two groups: one group received EACA (20 mg/kg/h) before surgical incision until the end of OLT and a control group received a similar volume of 0.9% saline solution. Blood was collected to analyze fibrinolysis and coagulation disorders using rotational thromboelastometry (ROTEM®). RESULTS: A total of 24 patients received EACA and 26 patients received saline solution. In the analysis of the fibrinolytic and hemostatic coagulation profile by ROTEM®, fibrinolysis was significantly less frequent in the group of patients treated with EACA (p<0.001) in the anhepatic phase. There were no significant differences in the other extrinsic pathway thromboelastometry and fibrinogen-specific thromboelastometry analyses. In addition, there were no significant differences between both groups regarding the average and percentage transfusion of blood products, postoperative complications, patients who were discharged from the hospital, and those who died within 3 months after liver transplantation. CONCLUSIONS: Although the administration of EACA did not reduce the transfusion of blood products, this drug effectively treated fibrinolysis and was not associated with any complications with increased risk of vein and hepatic artery thrombosis or mortality within 3 months after liver transplantation.
Pancreatoduodenectomy with vascular reconstruction versus chemotherapy alone in patients with locally advanced pancreatic cancer: a systematic review.
Costa ACD, Duarte VA, Santa Cruz F … +5 more , Chaouch MA, Kumar J, Reccia I, Ferraz ÁAB, Habib N
Arq Bras Cir Dig · 2025 · PMID 40767666 · Full text
BACKGROUND: Pancreatic cancer is still a terrifying condition that has a high mortality rate due to its rapid progression and treatment complexity. However, there is still no consensus on what the gold standard of treatm...
BACKGROUND: Pancreatic cancer is still a terrifying condition that has a high mortality rate due to its rapid progression and treatment complexity. However, there is still no consensus on what the gold standard of treatment for locally advanced pancreatic cancer (LAPC) is. AIMS: The aim of this study was to review the current evidence-based data on treatment strategies for LAPC, comparing pancreatoduodenectomy with vascular reconstruction (PDVR) and chemotherapy alone (CA). METHODS: This systematic review was performed according to the PRISMA 2020 guidelines. Overall survival (OS) was the primary endpoint, while progression-free survival (PFS) was the secondary endpoint. The included studies were published between 2013 and 2023. RESULTS: A total of 16 relevant papers were found in the literature search. The median PFS duration for CA varied from 3.22 to 11.7 months, whereas the median overall survival (mOS) varied from 5.95 to 23.0 months. The mOS ranged from 12.7 to 24.9 months and the median PFS time ranged from 8.5 to 22.5 months for patients submitted to neoadjuvant therapy followed by PDVR. CONCLUSIONS: LAPC presents worse outcomes when patients are submitted to CA with gemcitabine only, or when patients undergo upfront PDVR.
Variables related to locoregional and distant recurrence in esophageal cancer.
Fonseca S, Ramos IGS, Maegawa FAB … +2 more , Uson Junior PLS, Tustumi F
Arq Bras Cir Dig · 2025 · PMID 40767665 · Full text
BACKGROUND: Esophageal cancer remains one of the most aggressive malignancies of the gastrointestinal tract, with high rates of recurrence and mortality despite curative-intent surgery and adjuvant therapies. Identifying...
BACKGROUND: Esophageal cancer remains one of the most aggressive malignancies of the gastrointestinal tract, with high rates of recurrence and mortality despite curative-intent surgery and adjuvant therapies. Identifying factors associated with recurrence is crucial for improving outcomes and guiding personalized treatment. AIMS: The aim of this study was to evaluate pretreatment and treatment-related variables associated with recurrence in patients with esophageal cancer undergoing surgical resection. METHODS: This retrospective study analyzed data from patients with stage I-III esophageal carcinoma who underwent esophagectomy between 2000 and 2025, using the Fundação Oncocentro de São Paulo (FOSP) database. Clinical, histological, and treatment-related variables were evaluated. Disease-free survival and recurrence patterns were assessed using Cox proportional hazards models and Fine-Gray subdistribution hazard models. RESULTS: A total of 2,057 patients were included, with a mean follow-up of 36.5 months (±44.8). In the multivariate analysis, advanced tumor stage (stage II: HR 1.68, 95%CI 1.21-2.33; stage III: HR 3.23, 95%CI 2.29-4.56; both p<0.01), location (middle esophagus: HR 1.31, 95%CI 1.11-1.54; p=0.001; upper esophagus: HR 1.54, 95%CI 1.21-1.96; p<0.001), and histological subtype (rare histologies: HR 2.17, 95%CI 1.35-3.49; p=0.001) were associated with worse disease-free survival. Multimodal therapy improved disease-free survival (HR 0.40, 95%CI 0.24-0.66) in stage III tumors. Squamous cell carcinoma was independently associated with locoregional recurrence (SHR 1.52, 95%CI 1.05-2.20; p=0.027). For distant recurrence, squamous cell carcinoma showed a protective effect (SHR 0.52, 95%CI 0.31-0.88; p=0.015), while high tumor grade (grade II: SHR 3.65, 95%CI 1.98-6.72; p<0.001) was associated with an increased risk. Multimodal treatments influenced recurrence patterns but did not independently predict outcomes after adjustment. CONCLUSIONS: Tumor stage, location, and histology were strong predictors of disease-free survival after surgery for esophageal cancer. Histological subtypes significantly influenced recurrence patterns. Squamous cell carcinoma was associated with a higher risk of locoregional recurrence but a lower risk of distant metastasis compared to adenocarcinoma. Multimodal therapy demonstrated a protective effect in stage III disease.
Siewert II esophagogastric junction cancer: total gastrectomy or esophagectomy?
Wohnrath DR, Silva ROE, Araujo RLC
Arq Bras Cir Dig · 2025 · PMID 40767664 · Full text
BACKGROUND: The surgical approach for esophagogastric junction cancers (EJC), Siewert II, has been controversial regarding margin control, reconstruction, and lymphadenectomy extension. Therefore, predicting the need for...
BACKGROUND: The surgical approach for esophagogastric junction cancers (EJC), Siewert II, has been controversial regarding margin control, reconstruction, and lymphadenectomy extension. Therefore, predicting the need for total/subtotal esophagectomy and proximal gastrectomy (TEPG) or total gastrectomy with distal esophagectomy (TGDE) can be challenging, with each direction usually excluding the other. Historically, complication rates for TEPG are higher, affecting further systemic treatment and long-term outcomes. AIMS: The aim of this study was to describe a surgical strategy for approaching tumors such as Siewert II EGJ, with the intraoperative decision to perform total gastrectomy with lymphadenectomy D2 or esophagectomy with lymphadenectomy based on intraoperative frozen sections. METHODS: All patients underwent laparotomy, beginning with greater curvature detachment while preserving the right gastroepiploic, right and left gastric arteries; dissection of the esophageal hiatus for node harvesting; and transection of the distal esophagus and its frozen section. TGDE was preferred if the proximal margin of the distal esophagus was negative; TEPG and gastric tube reconstruction were performed through transhiatal access if the margin was positive. RESULTS: Among 38 Siewert II patients, 26 (69%) underwent TGDE and 12 (31%) underwent TEPG, regardless of the trend toward higher complication rates, positive margins, and shorter overall survival in the TEPG group, no statistically significant differences were detected. CONCLUSIONS: Although no significant differences in morbidity between the two procedures were noted, type II errors could be a possible cause. This study suggests that unnecessary esophagectomies can be avoided without jeopardizing surgical or oncologic outcomes by opting for a less morbid procedure.
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Arq Bras Cir Dig · 2025 Jun · PMID 40608603 · Full text
[This corrects the article doi: 10.1590/0102-67202025000010e1879].
[This corrects the article doi: 10.1590/0102-67202025000010e1879].
Retrospective longitudinal and comparative observational study between gastric bypass surgery and sleeve gastrectomy: 5-year post-operative follow-up.
Concon Filho A, Damous SHB, Otoch JP … +5 more , Coronado MB, Zotarelli Filho IJ, Galvão Neto MP, Brunaldi VO, Artifon ELA
Arq Bras Cir Dig · 2025 · PMID 40608602 · Full text
BACKGROUND: Among the 2.0 billion overweight individuals in the world, Brazil ranks fifth in the number of obese people, therefore requiring treatment options for obesity. AIM: The aim of this study was to compare the pe...
BACKGROUND: Among the 2.0 billion overweight individuals in the world, Brazil ranks fifth in the number of obese people, therefore requiring treatment options for obesity. AIM: The aim of this study was to compare the percentage of total body weight loss (%TWL), change in body mass index (BMI), percentage of excess weight loss (%EWL), incidence of reflux esophagitis, and occurrence of Barrett's esophagus in obese patients undergoing gastric bypass (Roux-en-Y gastric bypass [RYGB]) and sleeve gastrectomy (SG), both techniques by videolaparoscopy. METHODS: The study included 100 consecutive patients who underwent RYGB and SG techniques, totaling 200 patients, and were followed up for 60 months, from June 2013 to July 2018. RESULTS: The frequency of gastroesophageal reflux disease (GERD) was lower in RYGB patients (p<0.05). At 60 months, the %EWL was 77.4±13.3 kg (RYGB) versus 80.5±17.5 kg (SG) (p<0.05). The BMI data were statistically significantly different between groups after 5 years (28.5±3.9 kg/m2 in RYGB and 31.9±5.3 kg/m2 in SG groups, p<0.05). During the follow-up, the RYGB showed higher %EWL compared to the SG (at 60 months, 80.1% vs. 59.1%, respectively, p<0.05). The %TWL was 30% for the RYGB and 19.7% for the SG (p<0.05). The RYGB had a lower frequency of reflux esophagitis and Barrett's esophagus. CONCLUSIONS: The RYGB technique showed greater absolute weight loss, %TWL, BMI reduction, and %EWL in higher obesity classes compared to the SG technique. Additionally, RYGB had a lower frequency of reflux esophagitis and Barrett's esophagus.
The use of surgical glue and sutures in the aponeurosis synthesis of the abdominal wall in Wistar rats.
Utrabo CAL, Busato CR, Koga AY … +5 more , Machozeki J, Guimarães M, Beltrame D, Machinski E, Lipinski LC
Arq Bras Cir Dig · 2025 · PMID 40608601 · Full text
BACKGROUND: Adequate closure of the abdominal wall determines the success of the surgery. AIMS: The aim of this study was to study the healing of the abdominal wall of rats by comparing the use of surgical glue (2-octyl...
BACKGROUND: Adequate closure of the abdominal wall determines the success of the surgery. AIMS: The aim of this study was to study the healing of the abdominal wall of rats by comparing the use of surgical glue (2-octyl cyanoacrylate) with polypropylene 3.0 thread and poliglecaprone 3.0 thread. METHODS: A total of 60 Wistar rats were divided into two groups: Group 30 and Group 90. Each group was subdivided into three subgroups, surgical glue subgroup (C1), polypropylene subgroup (C2), and poliglecaprone subgroup (C3). An incision was made in the aponeurosis of the abdominal wall while maintaining the integrity of the parietal peritoneum. The 3 subgroups of 10 animals were euthanized on the 30th and 90th postoperative days. The abdominal wall fragments were submitted to macroscopic, histological, and tensiometric analysis. RESULTS: Macroscopic analysis did not show any abnormality. Tensiometry on the 30th postoperative day showed a mean rupture tension of 30.98N in subgroup C1, 27.90N in subgroup C2, and 23.90N in subgroup C3. On the 90th postoperative day, the mean rupture tension was 30.05N in subgroup C1, 44.42N in subgroup C2, and 34.78N in subgroup C3. CONCLUSIONS: The synthesis of the abdominal aponeurosis performed with surgical glue (2-octyl cyanoacrylate) showed adequate resistance to rupture tension to maintain its integrity when compared with the synthesis with polypropylene thread or poliglecaprone thread, with both methods being equally effective.
ASSOCIATION BETWEEN AFFECTIVE TEMPERAMENT AND MORBID OBESITY IN BARIATRIC SURGERY CANDIDATES: A CASE-CONTROL STUDY.
Mousfi AKJ, Mauer S, Nassif PAN … +3 more , Sigwalt MF, Cuenca RM, Torres OJM
Arq Bras Cir Dig · 2025 · PMID 40435019 · Full text
BACKGROUND: Affective temperaments are part of the spectrum of mood disorders and comprise the concepts of hyperthymia, dysthymia and cyclothymia. Numerous studies have demonstrated a strong relationship between obesity...
BACKGROUND: Affective temperaments are part of the spectrum of mood disorders and comprise the concepts of hyperthymia, dysthymia and cyclothymia. Numerous studies have demonstrated a strong relationship between obesity and mood disorders. AIMS: The objective of the present study was to evaluate the frequency of affective temperaments in morbidly obese individuals and controls and to establish a possible association between affective temperaments and morbid obesity. METHODS: The study evaluated 106 cases (morbidly obese) and one hundred controls (non-obese). To assess affective temperaments, the Temperament Evaluation in Memphis Pisa and San Diego - Rio de Janeiro TEMPS-Rio de Janeiro scale was applied. Depressive symptoms were assessed using the Hamilton Depression Rating Scale, anxiety symptoms using the Hamilton Anxiety Rating Scale and manic symptoms using the Young Mania Rating Scale. For univariate and multivariate analysis, logistic regression models were adjusted. RESULTS: The presence of at least one affective temperament was 74.5% in the morbidly obese group and 63% in the non-obese group. When comparing the two groups, the statistical analysis of the age subgroup of individuals aged 50 years or over showed an odds ratio of 2.56 (1.07-6.09) for hyperthymic temperament. CONCLUSIONS: In the age group of 50 years or more, cases of morbid obesity are significantly more likely (2.56 times) to occur in individuals with a hyperthymic temperament. Among the three types of affective temperaments evaluated, only hyperthymia could be a risk factor for morbid obesity.
IMPACT OF SLEEVE GASTRECTOMY ON THE NEUTROPHIL-TO-LYMPHOCYTE RATIO AND THE PLATELET-TO-LYMPHOCYTE RATIO AND ITS RELATIONSHIP WITH POSTOPERATIVE WEIGHT LOSS.
Iwanaga TC, Santa-Cruz F, Ferraz ÁAB … +1 more , Kreimer F
Arq Bras Cir Dig · 2025 · PMID 40435018 · Full text
BACKGROUND: Obesity represents a chronic pro-inflammatory status that contributes to accelerated atherosclerosis and cell aging. Besides the widely used C-reactive protein and ferritin, other inflammatory markers have ga...
BACKGROUND: Obesity represents a chronic pro-inflammatory status that contributes to accelerated atherosclerosis and cell aging. Besides the widely used C-reactive protein and ferritin, other inflammatory markers have gained attention, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), which are related with the degree of inflammation in various pathological conditions, including obesity and its comorbidities. AIMS: To compare and monitor the levels of NLR and PLR before and after sleeve gastrectomy (SG). METHODS: Retrospective study that included a total of 622 patients with obesity who underwent SG as primer bariatric surgery in our center. Data regarding the presence of comorbidities, including type 2 diabetes (T2D), high blood pressure (HBP) and non-alcoholic fatty liver disease (NAFLD), variations in body weight and body mass index (BMI), and biochemical markers of inflammation, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) were gathered. Values of NLR and PLR were correlated with weight loss and prognosis of comorbidities within the postoperative period. RESULTS: The sample was predominantly female (79.3%) with average age 36.91±10.04 years, with comorbidities including HBP (25.1%), T2D (8.0%), and NAFLD (80.1%). Patients with HBP showed reduced NLR and CRP post-intervention, while those with T2D experienced decreased CRP but increased PLR. Correlation analysis found no significant correlation between BMI/weight changes and NLR but significant correlation with PLR. Post-surgery, NLR decreased for previously NAFLD patients, and PLR increased. CONCLUSIONS: According to the results, patients with obesity present a significant decrease in NLR and an increase in PLR after SG.
ANATOMIC VARIATIONS OF THE CYSTIC ARTERY DURING CHOLECYSTECTOMIES: IS IT IMPORTANT FOR THE SURGEON TO KNOW?
Schiewe JA, Miranda LHG, Romano RM … +1 more , Romano MA
Arq Bras Cir Dig · 2025 · PMID 40366990 · Full text
BACKGROUND: Knowledge of the cystic artery and its variations is essential to perform safe cholecystectomies. The cystic artery originates from the right hepatic artery, passing posterior to the common hepatic duct, ante...
BACKGROUND: Knowledge of the cystic artery and its variations is essential to perform safe cholecystectomies. The cystic artery originates from the right hepatic artery, passing posterior to the common hepatic duct, anterior to the cystic duct, and branching into two branches at the neck of the gallbladder. However, variations in position, size, and relationship with adjacent structures are common. AIMS: This article presents a literature review regarding cystic artery variations and their frequency during cholecystectomies. METHODS: The articles selected for this review were chosen from the PubMed and SciELO databases. The standardized descriptors used were anatomic variation and cholecystectomy. These were chosen using the "Medical Subject Headings" and combined with the Boolean operator AND and the non-standard descriptor cystic artery. RESULTS: It was found in 54.5% of the studies that the anatomical pattern of the cystic artery was the most frequent type. A different origin from the standard was cited in 63.6% of the articles. Double irrigation of the gallbladder was found in 59.1%. In 36.4%, the cystic artery was anterior to the common hepatic duct or the cystic duct. Cystic arteries outside Calot's triangle were found in 36.4%. Short cystic arteries were found in 13.6%. The absence or non-identification of the artery was reported in 9.1%. CONCLUSIONS: Variations of the cystic artery are common and are frequently reported. One aspect of a safe cholecystectomy is anatomical knowledge and its possible variations. Thus, surgeons must be familiar with this point in order to reduce vascular and biliary injuries.
POSTOPERATIVE OUTCOME OF PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT AFTER ELECTIVE AND EMERGENCY LAPAROTOMY.
Valverde Filho MT, Aragão GVP, Castro ILV … +5 more , Santana JO, Codes L, Zollinger CC, Andraus W, Bittencourt PL
Arq Bras Cir Dig · 2025 · PMID 40298658 · Full text
BACKGROUND: Surgery is associated with a high risk for morbidity and mortality, particularly when performed in critical patients requiring intensive care unit (ICU) admission. AIM: The aim of this study was to investigat...
BACKGROUND: Surgery is associated with a high risk for morbidity and mortality, particularly when performed in critical patients requiring intensive care unit (ICU) admission. AIM: The aim of this study was to investigate risk factors associated with adverse outcomes in a large cohort of patients admitted to a single-center ICU after abdominal surgery. METHODS: All patients admitted to a surgical ICU for postoperative care, from January 2016 to December 2022, were retrospectively evaluated. Data concerning demographics and clinical and perioperative variables were compared to in-hospital mortality. RESULTS: A total of 1,717 patients (1,096 women, mean age: 61±17 years) were evaluated. Most of the patients underwent colorectal (n=499), pancreatic (n=148), biliary tract (n=147), and gastric surgeries (n=145); liver resection (n=131); and several gynecological or obstetric procedures (n=250). Only 52.3% of these surgical procedures were elective. The mean Charlson Comorbidity Index (CCI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were 4.4±2.8 and 10.1±5.6, respectively. Mortality was observed in 158 (9.2%) patients. Age (70.4±14.3 vs. 60.6±17.1 years in survivors, p=0.002), CCI (6.1±2.5 vs. 4.3±2.8 in survivors, p=0.005), type of surgery (13.6% in emergent/urgent vs. 5.5% in elective surgeries, p<0.001), and APACHE II score (16.7±8.4 vs. 9.4±4.7 in survivors, p<0.0001) were associated with mortality on univariate analysis, but only CCI, type of surgery, and APACHE II score were independently correlated with a higher risk of death on multivariate analysis. CONCLUSIONS: Mortality after abdominal surgery in patients requiring postoperative ICU support is less than 10% nowadays, and it is independently associated with urgent or emergent surgeries, disease severity, and comorbidity.
IMPACT OF THE COVID-19 QUARANTINE ON THE MENTAL AND EMOTIONAL HEALTH OF POST-BARIATRIC SURGERY WOMEN: A QUALITATIVE STUDY.
Lima AP, Marques IG, Goessler KF … +5 more , De Cleva R, Santo MA, Roschel H, Gualano B, Benatti FB
Arq Bras Cir Dig · 2025 · PMID 40243880 · Full text
BACKGROUND: The coronavirus disease 2019 (COVID-19) greatly impacted patients undergoing bariatric surgery due to prolonged quarantine and lockdown measures. AIMS: The aim of this study was to qualitatively investigate t...
BACKGROUND: The coronavirus disease 2019 (COVID-19) greatly impacted patients undergoing bariatric surgery due to prolonged quarantine and lockdown measures. AIMS: The aim of this study was to qualitatively investigate the impact of the COVID-19 quarantine and lockdown measures on the mental and emotional health of post-bariatric surgery women. METHODS: A qualitative study was carried out, with individual interviews conducted via video calls using a video-communication service (Google Meet®). The moderator guide inquired about three pre-established topics based on the literature: mental and emotional health, social relationship, and the use of health technology. RESULTS: A total of 12 women participated in this study, with an average age of 43±9.83 years, a body mass of 82.33±13.83 kg, a height of 1.62±0.06 m, a body mass index of 26.32±2.97 kg/m2, and post-surgery time of 12.83±4.37 months. The interviews had an average duration of 50.71±7.26 min. Our results suggested a negative impact of the COVID-19 pandemic on aspects of mental and emotional health, such as increased anxiety, depressive symptoms, fear, stress, and anguish, which were somehow diminished in patients who were closer to family members. Bariatric surgery was mentioned as a positive aspect by the patients for coping with clinical risk conditions. CONCLUSIONS: The study showed a negative impact of the COVID-19 pandemic on aspects of mental and emotional health mostly due to lockdown measures, which led to social isolation and an increased burden with household chores.
RISK FACTORS FOR POSTOPERATIVE PANCREATIC FISTULA FOLLOWING PANCREATICODUODENECTOMY: TUNISIAN CENTER EXPERIENCE.
Khedhiri N, Zaafouri H, Boujelbene W … +5 more , Cherif M, Helal I, Mesbahi M, Haddad D, Ben-Maamer A
Arq Bras Cir Dig · 2025 · PMID 40243879 · Full text
BACKGROUND: Pancreaticoduodenectomy (PD) is a major intervention in digestive surgery. Although its mortality is currently low in experienced centers, morbidity remains high, dominated by a pancreatic fistula. AIMS: The...
BACKGROUND: Pancreaticoduodenectomy (PD) is a major intervention in digestive surgery. Although its mortality is currently low in experienced centers, morbidity remains high, dominated by a pancreatic fistula. AIMS: The aim of this study was to analyze the risk factors for postoperative pancreatic fistula (POPF) after PD. METHODS: A retrospective study was conducted at the General Surgery Department of Habib Thameur University Hospital in Tunis for 12 years (2010-2021). All patients who underwent PD were included regardless of indications. RESULTS: Our series comprised 50 patients, consisting of 27 men and 23 women. The rate of a pancreatic fistula was 32% (16 patients) with an average time of onset of 5 days (1-12 days). It was observed as a biochemical leak (grade A) in 1 patient (2%), pancreatic fistula grade B in 5 patients (10%), and pancreatic fistula grade C in 10 patients (20%). Pancreatic fistula was responsible for 10% of postoperative mortality (five patients). Univariate analysis showed a statistically significant correlation between POPF and the following factors: diameter of the main pancreatic duct ≤3 mm (p=0.036, p<0.05), soft texture of the pancreas (p=0.025, p<0.05), pancreaticojejunostomy by two semi-overlapping sutures (p=0.049, p<0.05), and fasting blood glucose level ≤8 mmol/l (p=0.025, p<0.05). Multivariate analysis showed that soft pancreatic texture was the only independent risk factor for POPF (p=0.02, p<0.05). CONCLUSION: The soft texture of the pancreas is the only independent risk factor for POPF. Prospective randomized studies are still needed to accurately determine the true risk factors for a pancreatic fistula after PD.
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