Arq Bras Cir Dig
· 2025 · PMID 40197973
·
Full text
BACKGROUND: Biliary fistula is one of the most common complications after liver resection and is associated with significant morbidity and mortality. One of the methods used to evaluate biliary fistulas is the White test...BACKGROUND: Biliary fistula is one of the most common complications after liver resection and is associated with significant morbidity and mortality. One of the methods used to evaluate biliary fistulas is the White test, which consists of injecting a lipid emulsion into the bile duct. However, no standard technique for performing the White test has been published. AIMS: The aim of this study was to standardize the technique for performing the White test in patients undergoing hepatectomies, with and without previous cholecystectomy, and to assess the preliminary results. METHODS: Patients over 18 years of age who were submitted to open hepatectomy were included in the study. The primary outcome was the rate of biliary fistula. Secondary outcomes were the incidence of acute pancreatitis and overall morbidity, measured by the Clavien-Dindo classification. RESULTS: The standard technique for the White test was performed on 17 patients. In total, three patients had previous cholecystectomy, and two had low insertion of the cystic duct, requiring cannulation of the hepatocholedochal duct. None of the patients developed clinically significant biliary leaks. Acute pancreatitis did not occur in any patient. One patient developed pneumonia requiring mechanical ventilation (Clavien-Dindo IV). All others had minor or no complications. CONCLUSIONS: The standardized technique for performing the White test suggests an appropriate strategy to maximize the detection of intraoperative biliary leaks.
Arq Bras Cir Dig
· 2025 · PMID 40197972
·
Full text
BACKGROUND: Microscopic analysis of tumor budding (TB) may be an essential predictive tool for regional lymph node metastases in colorectal cancer, especially among patients in intermediate stages, who exhibit considerab...BACKGROUND: Microscopic analysis of tumor budding (TB) may be an essential predictive tool for regional lymph node metastases in colorectal cancer, especially among patients in intermediate stages, who exhibit considerable prognostic variability. AIMS: The aim of this study was to assess the predictive power of BT regarding the presence of lymph node metastases and its association with other characteristics related to colorectal carcinoma progression. METHODS: This is a cross-sectional, retrospective study with a quantitative approach, focusing on the review of medical records and histopathological reports of patients who underwent oncologic surgery for colorectal cancer. RESULTS: A total of 153 patient records were examined, with a predominance of the 61-70 age group and a male majority (50.98%). Adenocarcinoma not otherwise specified was the most common histological type (60.78%), with the majority exhibiting moderate differentiation (87.58%). From the total sample, 97 cases (63.39%) exhibited TB, with 51.55% classified as a high budding score. Invasion of adipose tissue/subserosa was the most prevalent, occurring in 46.41% of cases. Regional lymph node metastases and angiolymphatic invasion were observed in 66 and 101 patients, respectively. Cross-tabulation analysis showed a statistically significant association between TB and lymph node metastasis (p<0.05). CONCLUSIONS: The relationship between TB and lymph node metastasis highlights the significance of this histological factor in the risk stratification and prognosis of patients with colorectal cancer, complementing TNM staging. Therefore, the assessment of tumor budding is crucial in histopathological reports, potentially influencing additional therapeutic decisions.
Oliveira CVC, Santana RC, Coimbra FJF
… +7 more, Kow A, Pawlik TM, Adam R, Soubrane O, Herman P, Cotta-Pereira RL, International Hepato-Pancreato-Biliary Association
Arq Bras Cir Dig
· 2025 · PMID 40197971
·
Full text
Deaths related to colorectal cancer are generally associated with its metastases that affect the liver (50%) through the hematogenous route. Approximately 20-25% of these patients already have synchronous metastases in t...Deaths related to colorectal cancer are generally associated with its metastases that affect the liver (50%) through the hematogenous route. Approximately 20-25% of these patients already have synchronous metastases in the liver at the time of primary tumor diagnosis. In others, liver metastases will occur during the course of the disease and are called metachronous. Metachronous metastases are believed to have a better prognosis; however, 20-25% of metastatic cases can be resected during the course of the disease. There is a lack of consensus on the diagnostic time interval for metastases to be considered metachronous in the consulted literature. Surgical treatment of metastases and lymph nodes is indicated, and extrahepatic neoplastic disease must be carefully evaluated. Liver transplantation can benefit the patient, should be evaluated, and is indicated in some special situations.
Arq Bras Cir Dig
· 2025 · PMID 40105628
·
Full text
BACKGROUND: Colonoscopy is a widely used endoscopic procedure to investigate diseases of the colon and rectum. Colonoscopy procedure has difficulties for the patient and endoscopist. AIMS: To investigate whether the use...BACKGROUND: Colonoscopy is a widely used endoscopic procedure to investigate diseases of the colon and rectum. Colonoscopy procedure has difficulties for the patient and endoscopist. AIMS: To investigate whether the use of an abdominal corset can make the colonoscopy procedure easier and faster. METHODS: This is a prospective randomised controlled study. Patients over 18 years of age who underwent elective colonoscopy in our clinic were evaluated. Patients were divided into two groups according to the use of the corset. Variables were compared between the groups. RESULTS: A total of 204 patients were included in the study. Corsets were used in 97 patients and not used in 107 patients. The need for manual compression was found to be decreased in the corset use group. There was no effect of corset use on cecal intubation time in the general population. It was found that cecal intubation time decreased with corset use in patients with body mass index - BMI<30 and male gender. CONCLUSIONS: The need for manual compression can be reduced by the use of an abdominal corset during colonoscopy. The use of an abdominal corset may make the colonoscopy procedure faster and easier for the endoscopist and the patient.
Arq Bras Cir Dig
· 2025 · PMID 40105627
·
Full text
BACKGROUND: Research indicates that patients undergoing bariatric surgery face a six to seven times higher risk of developing alcohol use disorder (AUD) compared with the population of obese individuals not undergoing su...BACKGROUND: Research indicates that patients undergoing bariatric surgery face a six to seven times higher risk of developing alcohol use disorder (AUD) compared with the population of obese individuals not undergoing surgical intervention. Studies suggest that problematic alcohol consumption encompassing depression escalates gradually after surgery. AIMS: The purpose of this study was to evaluate the impact of bariatric surgery on the incidence of AUD and depression during the postoperative period. METHODS: Prospective study that evaluated 68 patients who underwent either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). The presence of AUD and depression was assessed both pre- and post-operatively. AUD assessment utilized the AUD identification test-C score, whereas depression assessment employed the Beck Depression Inventory (BDI). RESULTS: The average age of the sample was 42.81±9.28 years, with 85.3% being female. The mean follow-up was 16.54±7.41 months. In the preoperative assessment, 92.6% of the sample fell into the low-risk category for AUD. No significant difference was observed between the RYGB and SG groups. Postoperatively, 89.7% of the sample was classified as low risk for AUD, with no significant differences compared with the preoperative assessment. Regarding depression, there was no significant difference between pre- and post-operative periods for all patients. However, a notable trend toward a reduction in "severe depression" was observed in the postoperative period for patients undergoing SG (pre: 14.0% vs. post: 7.0%, p=0.013). CONCLUSIONS: There is no significant difference in the presence of AUD and depression between pre- and post-operative assessments in patients who have undergone bariatric surgery.
Arq Bras Cir Dig
· 2025 · PMID 40052996
·
Full text
BACKGROUND: Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), lacks a known etiology. Although clinical symptoms, imaging, and colonoscopy are common diagnostic tools, fecal c...BACKGROUND: Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), lacks a known etiology. Although clinical symptoms, imaging, and colonoscopy are common diagnostic tools, fecal calprotectin (FC) serves as a widely used biomarker to track disease activity. Metabolomics, within the omics sciences, holds promise for identifying disease progression biomarkers. This approach involves studying metabolites in biological media to uncover pathological factors. AIMS: The purpose of this study was to explore fecal metabolomics in IBD patients, evaluate its potential in differentiating subtypes, and assess disease activity using FC. METHODS: Cross-sectional study including IBD patients, clinical data, and FC measurements (=200 μg/g as an indicator of active disease). RESULTS: Fecal metabolomics utilized chromatography mass spectrometry/solid phase microextraction with MetaboAnalyst 5.0 software for analysis. Of 52 patients (29 UC, 23 CD), 36 (69.2%) exhibited inflammatory activity. We identified 56 fecal metabolites, with hexadecanoic acid, squalene, and octadecanoic acid notably distinguishing CD from UC. For UC, octadecanoic and hexadecanoic acids correlated with disease activity, whereas octadecanoic acid was most relevant in CD. CONCLUSIONS: These findings highlight the potential of metabolomics as a noninvasive complement for evaluating IBD, aiding diagnosis, and assessing disease activity.
Arq Bras Cir Dig
· 2025 · PMID 40052993
·
Full text
BACKGROUND: Differences in skin color have socioeconomic and health implications; however, gaps persist in understanding health-related quality of life (HRQoL) perception. AIMS: To examine whether skin color differences...BACKGROUND: Differences in skin color have socioeconomic and health implications; however, gaps persist in understanding health-related quality of life (HRQoL) perception. AIMS: To examine whether skin color differences influence HRQoL in obese patients undergoing Roux-en-Y gastric bypass surgery. METHODS: Cross-sectional study with participants of both genders, aged 18 to 60, and three to six months postoperatively. Data were collected from October 2018 to July 2019 at a bariatric clinic in Salvador, Bahia. Skin color, Moorehead-Ardelt II Quality of Life Questionnaire (MAQOL-II) scores, anthropometric measurements, socioeconomic status, physical activity, and body image perceptions were recorded. RESULTS: Of 196 patients, 67.35% were Black. "Self-esteem" in MAQOL-II demonstrated the most significant post-surgical improvement, with 62.8% reporting "much better" outcomes. Adjusted residuals associated "much better" and "unchanged" responses with skin color. The overall MAQOL-II score indicated lower HRQoL scores (M=1.65; standard deviation - SD=0.98) for individuals with black skin compared to those with white skin. Analyzing questionnaire responses, both racial groups exhibited equal percentages (45.3%) reporting "much better" and "better" post-surgery progress. However, no statistically significant differences in HRQoL were observed when comparing skin color. CONCLUSIONS: Skin color appears not to significantly impact the HRQoL of obese patients undergoing Roux-en-Y gastric bypass.
Silva MPME, Sabbaga J, Najman HL
… +5 more, Nascimento CDC, Cotta-Pereira RL, Nicoluzzi JEL, Braghiroli MI, International Hepato-Pancreato-Biliary Association
Arq Bras Cir Dig
· 2025 · PMID 39936820
·
Full text
Colorectal cancer (CRC) is a common disease, with incidence in Brazil of 45,630 new cases per 100,000 inhabitants between 2023-2025. Risk factors for CRC can be evaluated between environmental and hereditary and their mo...Colorectal cancer (CRC) is a common disease, with incidence in Brazil of 45,630 new cases per 100,000 inhabitants between 2023-2025. Risk factors for CRC can be evaluated between environmental and hereditary and their mode of presentation are classified as sporadic, inherited and familial. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. The percentage of patients with a true hereditary genetic predisposition is less than 10%, and these are related to the presence or absence of colonic polyps as an important manifestation of the disease. Non-polyposis diseases are known as hereditary non-polypomatous colorectal cancer (HNPCC) or Lynch syndrome, and polyposis diseases are familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), and hamartomatous polyposis syndromes (e.g., Peutz-Jeghers, juvenile polyposis, phosphatase and tensin homologue - PTEN, Cowden syndrome). These diseases are linked to a high risk of developing cancer. With the development of treatments in metastatic disease and the use of targeted therapies and their biomarkers, it was possible to evaluate them within clinical studies both in the primary tumor and in the correspondence of metastases.
Arq Bras Cir Dig
· 2025 · PMID 39936819
·
Full text
BACKGROUND: The carcinogenesis of colorectal cancer is well understood. Adenomas are the precursor lesions in about 70% of cases, highlighting the importance of screening programs. AIMS: The aim of this study was to anal...BACKGROUND: The carcinogenesis of colorectal cancer is well understood. Adenomas are the precursor lesions in about 70% of cases, highlighting the importance of screening programs. AIMS: The aim of this study was to analyze the effectiveness of colonoscopy examinations performed in a private tertiary service by calculating the polyp detection rate (PDR) and adenoma detection rate (ADR) and comparing these rates with literature data. METHODS: This retrospective observational study evaluated colonoscopies performed at Hospital Centro Médico de Campinas between 2018 and 2020. It assessed the indications and complications of colonoscopy, sex, age group, bowel preparation, cecal intubation rate, ADR, PDR, and advanced adenoma detection rate (AADR). RESULTS: During the period, 3,686 colonoscopies were performed, and 3,076 were included in the analysis. The mean patient age was 57.2 years, and most patients were female (53.5%). Complications occurred in 39 colonoscopies (1.3%), with bleeding in six cases and perforation in one case. Tubular adenoma was the most prevalent histological subtype found in 20% of tests and in 62.7% of those with positive findings. The PDR was 23% and significantly increased with advancing age (p<0.01). The ADR was 20% and also significantly increased with age (p<0.001). This rate was higher in men (27%). The AADR was 4%. CONCLUSIONS: Colonoscopy is an effective polyp detection method, and the PDR was higher in men and significantly increased with age. The ADR and AADR were comparable to the literature data.
BACKGROUND: Patients undergoing Crohn's disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients. AIMS: The aim of this study was to investigate factors determining POC in p...BACKGROUND: Patients undergoing Crohn's disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients. AIMS: The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy. METHODS: This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher's exact) test, Student's t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used. RESULTS: There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50). CONCLUSIONS: Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.
Arneiro AJ, Pereira MA, Dias AR
… +2 more, Ribeiro Junior U, Ramos MFKP
Arq Bras Cir Dig
· 2025 · PMID 39879512
·
Full text
BACKGROUND: The COVID-19 pandemic has overloaded healthcare systems worldwide. Other diseases, such as neoplasms, including gastric cancer, remained prevalent and had their treatment compromised. AIMS: The aim of this st...BACKGROUND: The COVID-19 pandemic has overloaded healthcare systems worldwide. Other diseases, such as neoplasms, including gastric cancer, remained prevalent and had their treatment compromised. AIMS: The aim of this study was to evaluate the impact of the COVID-19 pandemic on the treatment of gastric cancer and adherence to the recommended preoperative COVID-19 screening protocol. METHODS: A retrospective study evaluated patients diagnosed with gastric adenocarcinoma who underwent surgical treatment between 2015 and 2023. RESULTS: A total of 769 patients with gastric cancer were evaluated and organized into two groups: (i) pre-COVID group and (ii) COVID group. The pre-COVID group consisted of 527 patients operated on between 2015 and 2019, and the COVID group consisted of 242 patients from 2020 to 2023. The average number of surgical procedures per year in the pre-COVID group was 105 and 81 in the COVID group. There was a statistically significant difference between ASA classification (p=0.002) and clinical staging (p=0.015), which were worse in the COVID group. We observed an increase in diagnostic surgeries (p=0.026), with an increase in the minimally invasive route (p<0.001). In patients undergoing curative surgery, there was a greater indication for postoperative ICU (p=0.022) and neoadjuvant chemotherapy (p<0.001). There was no difference in 30- and 90-day mortality. CONCLUSIONS: The surgical and oncological outcomes for patients operated on during the pandemic remained uncompromised, even though many presented with more advanced initial stages and poorer clinical performance. High adherence to protocols and a low rate of complications related to coronavirus indicate that surgeries were performed safely during this period.
Lucchese AM, Kalil AN, Diniz AL
… +7 more, Oldhafer KJ, Pawlik TM, Adam R, Soubrane O, Braghiroli MI, Cotta-Pereira RL, International Hepato-Pancreato-Biliary Association
Arq Bras Cir Dig
· 2025 · PMID 39879511
·
Full text
Liver metastases from melanomas, sarcomas, and renal tumors are less frequent. Treatment and prognosis will depend on whether they are isolated or multiple, size and location, the presence or absence of extrahepatic neop...Liver metastases from melanomas, sarcomas, and renal tumors are less frequent. Treatment and prognosis will depend on whether they are isolated or multiple, size and location, the presence or absence of extrahepatic neoplastic disease, age, stage of the initial disease, initial treatments instituted, time of evolution, and clinical condition of the patient. Recently, a high number of oncological therapies including monotherapy or in combination, neoadjuvants or adjuvants, and immuno-oncological treatments have been developed and tested, increasing disease-free time and survival.
Cardia L, Gadducci AV, Pajecki D
… +2 more, Santo MA, DE Cleva R
Arq Bras Cir Dig
· 2025 · PMID 39879510
·
Full text
BACKGROUND: Obesity is a predisposing factor for serious comorbidities, particularly those related to elevated cardiovascular mortality. The atherogenic index of plasma (AIP) has been shown to be a useful indicator of pa...BACKGROUND: Obesity is a predisposing factor for serious comorbidities, particularly those related to elevated cardiovascular mortality. The atherogenic index of plasma (AIP) has been shown to be a useful indicator of patients with insulin resistance. AIMS: The aim of this study was to assess cardiovascular risk before and after surgical treatment of obesity. METHODS: A total of 615 patients undergoing bariatric surgery between 2007 and 2012 were evaluated using the analysis of electronic records (triglyceride/high-density lipoprotein cholesterol) before and after surgery. The AIP levels >3.5 mg/dL for men and >2.5 mg/dL for women were insulin-resistant and predisposed to cardiovascular events. RESULTS: A total of 117 men had an AIP >3.5 mg/dL during the preoperative period, 13.5% during the early postoperative period, 14.3% during the intermediate period, and 18.2% during the late postoperative period. Among 498 women, 56.2% had an AIP >2.5 mg/dL before surgery, 17.9% in early postoperative period, 13.5% in the intermediate period, and 11.4% in the late period. CONCLUSIONS: Bariatric surgery resulted in a significant effect on the AIP, insulin resistance, metabolic syndrome, and therefore, the risk of cardiovascular diseases.
Ben-Slama S, Mallek I, Ghorbeli E
… +5 more, Hajri M, Labidi T, Mestiri H, Lahmar A, Bacha D
Arq Bras Cir Dig
· 2025 · PMID 39841766
·
Full text
BACKGROUND: Hepatocellular carcinoma (HCC) encompasses rare variants like chromophobe hepatocellular carcinoma (CHCC) characterized by distinct histological features and molecular profiles. CASE REPORT: A 56-year-old mal...BACKGROUND: Hepatocellular carcinoma (HCC) encompasses rare variants like chromophobe hepatocellular carcinoma (CHCC) characterized by distinct histological features and molecular profiles. CASE REPORT: A 56-year-old male with chronic hepatitis C, presenting pain in the right hypochondrium. Imaging revealed a solitary liver lesion, subsequently resected and histologically diagnosed as HCC. Macroscopic examination found a 4×4 cm encapsulated liver nodule with necrotic areas, surrounded by numerous smaller satellite nodules in Segment 6. The liver was in micronodular cirrhosis. Histologically, the tumor had focal trabecular or pseudoglandular patterns within a vascularized stroma. The cells were large, with clear to eosinophilic cytoplasm and hyperchromatic and pleomorphic nuclei with focal anaplastic features. No vascular invasion was noted in adjacent cirrhotic liver tissue. RESULTS: The final diagnosis was CHCC. Due to its rarity and overlapping characteristics with other hepatic tumors, CHCC poses diagnostic challenges. Accurate diagnosis necessitates thorough histopathological assessment and molecular testing. The identification of the alternative lengthening of telomeres phenotype may distinguish CHCC from conventional HCC and hold potential implications for targeted therapeutic approaches. CONCLUSIONS: Recognition of HCC variants is critical for effective management and underscores the need for continued research into its clinical behavior and therapeutic responses.
Tejeda-Herrera D, Caballero-Alvarado J, Zavaleta-Corvera C
Arq Bras Cir Dig
· 2025 · PMID 39841765
·
Full text
BACKGROUND: Laparoscopic cholecystectomy is considered safe; however, it is not free from complications, such as bile duct injuries, bleeding, and infection of the surgical site. AIMS: The aim of this study was to determ...BACKGROUND: Laparoscopic cholecystectomy is considered safe; however, it is not free from complications, such as bile duct injuries, bleeding, and infection of the surgical site. AIMS: The aim of this study was to determine the effectiveness of two prediction tools, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) calculator and the surgical Apgar, in predicting post-cholecystectomy complications. METHODS: A cross-sectional, analytical, and comparative study was conducted on patients over 18 years old diagnosed with acute cholecystitis who underwent open or laparoscopic cholecystectomy at the Regional Teaching Hospital of Trujillo between 2015 and 2019. A chi-square test was used for bivariate analysis, and the receiver operating characteristic (ROC) curve analysis was employed to determine the discriminative capacity of the ACS-NSQIP and surgical Apgar calculators in predicting severe complications. RESULTS: A total of 227 patients were included in the study. The analysis revealed that the mean age of patients who experienced severe complications was 75.32±4.58 years. Additionally, 52.6% of these patients were male. Regarding the prediction analysis based on the ROC curve, the ACS-NSQIP calculator showed an area under the curve of 0.895 (95%CI 0.819-0.971; p=0.01), whereas the surgical Apgar calculator showed an area under the curve of 0.611 (95%CI 0.488-0.735; p=0.11). CONCLUSIONS: The obtained results indicate that the ACS-NSQIP calculator is effective in predicting severe complications in patients undergoing cholecystectomy due to acute cholecystitis. These findings may have important implications for clinical practice and medical decision-making, focusing on the appropriate use of prediction tools to improve outcomes in this type of surgical procedure.
Torres OJM, Torzilli G, Enne M
… +7 more, Gonçalves R, Santibanes E, Pawlik T, Adam R, Soubrane O, Herman P, Cotta-Pereira RL
Arq Bras Cir Dig
· 2025 · PMID 39841764
·
Full text
The development of surgical techniques, chemotherapy, biological agents, and multidisciplinary approaches have made patients with unresectable colorectal liver metastases eligible for surgery. Many strategies have been d...The development of surgical techniques, chemotherapy, biological agents, and multidisciplinary approaches have made patients with unresectable colorectal liver metastases eligible for surgery. Many strategies have been developed to allow patients for surgical resection (percutaneous portal vein embolization, liver venous deprivation, parenchyma-sparing liver surgery, reverse strategy, associating liver partition and portal vein ligation for staged hepatectomy, and liver transplantation), the only form of disease control and curative treatment.
Ramos EJB, Marques HP, Palavecino M
… +5 more, Pawlik T, Adam R, Soubrane O, Herman P, Cotta-Pereira RL
Arq Bras Cir Dig
· 2025 · PMID 39841763
·
Full text
In patients with synchronic liver colorectal metastasis, resection of the primary tumor and liver metastases is the only potentially curative strategy. In such cases, there is no consensus on whether resection of the pri...In patients with synchronic liver colorectal metastasis, resection of the primary tumor and liver metastases is the only potentially curative strategy. In such cases, there is no consensus on whether resection of the primary tumor and metastases should be performed simultaneously or whether a staged approach should be performed (resection of the primary tumor and after, hepatectomy, or hepatectomy first). Patients with no bowel occlusion and with extensive liver disease are advised neoadjuvant oncological therapy. Similarly, various strategies such as portal vein embolization, liver deprivation, two-staged hepatectomy, and associating liver partition and portal vein ligation are available for patients who do not have a sufficient future liver remnant (generally 30-40% of the total). Therefore, a multidisciplinary approach is required for the treatment of these patients.
Figueira ERR, Montagnini AL, Okubo J
… +5 more, Fernandes AGV, Pereira MA, Ribeiro Junior U, Herman P, Jukemura J
Arq Bras Cir Dig
· 2025 · PMID 39841762
·
Full text
BACKGROUND: Pancreatic neuroendocrine tumors (PNETs) are uncommon and heterogeneous neoplasms, often exhibiting indolent biological behavior. Their incidence is rising, largely due to the widespread use of high-resolutio...BACKGROUND: Pancreatic neuroendocrine tumors (PNETs) are uncommon and heterogeneous neoplasms, often exhibiting indolent biological behavior. Their incidence is rising, largely due to the widespread use of high-resolution imaging techniques, particularly influencing the diagnosis of sporadic non-functioning tumors, which account for up to 80% of cases. While surgical resection remains the only curative option, the impact of factors such as tumor grade, size, and type on prognosis and recurrence is still unclear. AIMS: To investigate prognostic risk factors and outcomes in patients with sporadic PNETs treated surgically. METHODS: A retrospective analysis was conducted on patients with sporadic PNETs who underwent pancreatic resection. Data were collected from medical records. RESULTS: A total of 113 patients were included: 32 with non-functioning tumors (NF-PNETs), 70 with insulinomas, and 11 with other functioning tumors (OF-PNETs). Patients with insulinoma were significantly younger, had a higher BMI, lower prevalence of comorbidities and ASA scores, and underwent significantly more pancreatic enucleations compared to patients with OF-PNET and NF-PNET. The insulinoma group had more grade I tumors, smaller tumor diameter, lower TNM staging, and lower disease recurrence rates. In univariate analysis, age, tumor type, tumor size, and TNM staging were identified as potential risk factors for tumor recurrence. In multivariate analysis, only the NF-PNET type was identified as an independent prognostic factor for disease recurrence. CONCLUSIONS: NF-PNETs are an independent prognostic risk factor for disease recurrence. This finding supports the need for closer follow-up of patients with small tumors who are selected for conservative management.
Quireze Junior C, Coelho FF, Lima AS
… +7 more, Marques HP, Palavecino M, Pawlik T, Adam R, Soubrane O, Herman P, Cotta-Pereira RL
Arq Bras Cir Dig
· 2025 · PMID 39841761
·
Full text
Complete removal of metastatic disease and maintenance of an adequate liver remnant remains the only treatment option with curative intent concerning colorectal liver metastases. Surgery impacts on the long-term prognosi...Complete removal of metastatic disease and maintenance of an adequate liver remnant remains the only treatment option with curative intent concerning colorectal liver metastases. Surgery impacts on the long-term prognosis and complications adversely affect oncological results. The actual morbidity involving this scenario is debatable and estimated to be ranging from 15% to 50%. Postoperative complications eventually lead to an increase in both mortality rates and tumor recurrence. Biliary fistula and liver failure are the leading complications following liver resection to metastatic colorectal cancer. Prophylactic drainage does not prevent fistulas or hemorrhage. Drainage along with endoscopic intervention and/or surgery may be necessary for grade B and C fistulas. Liver failure is a potentially lethal complication with few therapeutic options. Patient selection and preoperative care are crucial for its prevention.