Frizon E, Aguilar-Nascimento JE, Zanini JC
… +4 more, Roux MS, Schemberg BCL, Tonello PL, Dock-Nascimento DB
Arq Bras Cir Dig
· 2025 · PMID 39841760
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BACKGROUND: Multimodal protocols such as Acceleration of Total Postoperative Recovery and Enhanced Recovery After Surgery propose a set of pre- and post-operative care to accelerate the recovery of surgical patients. How...BACKGROUND: Multimodal protocols such as Acceleration of Total Postoperative Recovery and Enhanced Recovery After Surgery propose a set of pre- and post-operative care to accelerate the recovery of surgical patients. However, in clinical practice, simple care such as early refeeding and use of drains are often neglected by multidisciplinary teams. AIMS: Investigate whether early postoperative refeeding determines benefits in colorectal oncological surgery; whether the patients' clinical conditions preoperatively and the use of a nasogastric tube and abdominal drain delay their recovery. METHODS: Retrospective cohort carried out at the Cascavel Uopeccan Cancer Hospital, including adult cancer patients (age ≥18 years), from the Unified Health System (SUS), who underwent colorectal surgeries from January 2018 to December 2021. RESULTS: 275 patients were evaluated. Of these, 199 (75.4%) were refed early. Late refeeding (odds ratio - OR=2.1; p=0.024), the use of nasogastric tube (OR=2.72; p=0.038) and intra-abdominal drain (OR=1.95; p=0.054) increased the chance of infectious complication. Multivariate analysis showed that receiving a late postoperative diet is an independent risk factor for infectious complications. Late refeeding (p=0.006) after the operation and the placement of an intra-abdominal drain (p=0.007) are independent risk factors for remaining hospitalized for more than five days postoperatively. CONCLUSIONS: Refeeding early in the postoperative period reduces the risk of infectious complications. Using abdominal drains and refeeding late (>48h) for cancer patients undergoing colorectal surgery are risk factors for hospital stays longer than five days.
Severo RR, Santa-Cruz F, Kreimer F
… +2 more, Sena AB, Ferraz ÁAB
Arq Bras Cir Dig
· 2025 · PMID 39841759
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BACKGROUND: Preoperative hospitalization with the purpose to obtain more effective weight loss provides intensive care for patients who have a higher body mass index (BMI) and associated diseases that involve a greater r...BACKGROUND: Preoperative hospitalization with the purpose to obtain more effective weight loss provides intensive care for patients who have a higher body mass index (BMI) and associated diseases that involve a greater risk of peri- and postoperative complications. It is a therapeutic strategy that can make it possible to overcome obstacles related to the difficulty of adhering to obesity treatment. AIMS: To analyze the implementation of a preoperative hospitalization strategy for weight loss in patients eligible for bariatric surgery. METHODS: Retrospective study that included 194 patients with a BMI=50 kg/m2. They were grouped according to preoperative preparation strategies: inpatient (n=32) and outpatient (n=162), who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2020. The groups were compared regarding preoperative weight loss before and after the strategies and postoperative up to two years after surgery. RESULTS: Most patients were female and there were significant differences in age group (an average of 42.94 years in the preoperative hospitalization strategy group and 37.73 in the outpatient strategy group). The mean BMI in the hospitalized group was 63.01±8.72 kg/m2, and in the outpatient group it was 54.95±4.31 kg/m2. There was a significant difference only between initial and preoperative weight in the hospitalized group. Furthermore, the difference between initial weight and last recorded weight up to two years after surgery was significant in each group. The occurrence of associated diseases was higher in the outpatient group. CONCLUSIONS: Patients following the preoperative hospitalization strategy experienced significant weight loss before surgery.
Arq Bras Cir Dig
· 2025 · PMID 39813557
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BACKGROUND: Blood loss during liver transplantation (LT) remains a major concern associated with increased morbidity and reduced patient and graft survival. The high complexity of the procedure associated with the multif...BACKGROUND: Blood loss during liver transplantation (LT) remains a major concern associated with increased morbidity and reduced patient and graft survival. The high complexity of the procedure associated with the multifaceted origin of the bleeding urges early identification of high-risk patients and proper monitoring of hemostasis disorders in order to improve results. The accuracy of international normalized ratio (INR) and activated partial thromboplastin time (aPTT) to evaluate coagulation status in cirrhotic patients has been doubted. AIMS: The aim of this study was to investigate the applicability of these coagulation tests to indicate fresh frozen plasma transfusion in LT. METHODS: This retrospective cohort study analyzed 297 cirrhotic patients submitted to LT. INR and aPTT were measured preoperatively and in each surgical phase. Hemostatic blood components were transfused only for coagulopathy indication. Patients were divided according to intraoperative plasma transfusion into transfused and non-transfused groups. The accuracy of INR and aPTT to predict plasma transfusions was investigated. The alert values of INR and aPTT unassociated with coagulopathy in each phase of surgery were identified. RESULTS: Multivariate analysis showed that preoperative hematocrit (odds ratio [OR]=0.90, p<0.001), preoperative fibrinogen (OR=0.99, p<0.001), and absence of hepatocellular carcinoma (OR=3.57, p=0.004) were significant predictors of plasma transfusions. CONCLUSIONS: INR and aPTT demonstrated poor accuracy in predicting plasma transfusions, irrespective of the cutoff adopted, highlighting the need for a more comprehensive approach to guide hemostatic therapy in LT to improve the outcome.
Fonseca GM, DA Costa LH, Meira Junior JD
… +4 more, Dell'aquilla Junior NF, Ribeiro Junior U, Herman P, D'Albuquerque LAC
Arq Bras Cir Dig
· 2025 · PMID 39813556
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BACKGROUND: The medical residency model, established over a century ago, remains the gold standard for medical education. Given its increasing significance in imparting expertise in medical specialties, understanding the...BACKGROUND: The medical residency model, established over a century ago, remains the gold standard for medical education. Given its increasing significance in imparting expertise in medical specialties, understanding the profile of residents and changes over time is crucial. AIMS: This study aimed to assess graduates of digestive surgery and coloproctology residency programs at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) regarding their professional, academic, and research activities. It also aimed to analyze changes in resident profiles over the years, the impact of postgraduation on professional activities, and differences between graduates working in São Paulo capital and elsewhere. METHODS: A digital survey with 42 questions was sent to graduates who commenced training between 1979 and 2021. Results were analyzed in subgroups based on two eras (Era 1: 1979-2000; Era 2: 2001-2021), the impact of postgraduation, and respondents' work locations. RESULTS: The survey was responded by 213 graduates (87.6%). The training significantly impacted all respondents' professional lives, with 92.5% willing to choose the same specialty again. Graduates from Era 2 showed a higher proportion of females, residents of cities other than São Paulo, and graduates from institutions outside FMUSP. Postgraduate responders were more involved in academic and research activities, publishing more papers, holding societal memberships, and performing more robot-assisted procedures. Those outside São Paulo capital were more involved in endoscopic procedures and associated with medical insurance. CONCLUSIONS: The majority of graduates considered medical residency fundamental for career development. Social and economic changes influenced residents' profiles and post-program activities.
Bertinatti JPP, Marçal JMB, Cambruzzi E
… +1 more, Leão DE Alencar DE
Arq Bras Cir Dig
· 2025 · PMID 39813555
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BACKGROUND: Cholangiocarcinoma (CCA) is a rare neoplasm, with high mortality, originating in the bile ducts. Its incidence is higher in Eastern countries due to the endemic prevalence of liver parasites. Factors such as...BACKGROUND: Cholangiocarcinoma (CCA) is a rare neoplasm, with high mortality, originating in the bile ducts. Its incidence is higher in Eastern countries due to the endemic prevalence of liver parasites. Factors such as metabolic syndrome, smoking, and pro-inflammatory conditions are also linked to the disease. Clinical features include asthenia, abdominal pain, cholestasis, and increased serum levels of CEA and CA19-9. AIMS: The aim of this study was to evaluate CCA prevalence, survival, and potential prognostic and therapeutic implications in a patient cohort and assess correlations with clinical laboratory data and possible associated risk factors. METHODS: This is a retrospective study of the clinical and histological data of patients diagnosed with CCA at Santa Casa de Misericórdia in Porto Alegre, Brazil, between 2016 and 2021. RESULTS: There was a 56% prevalence of CCA in women, with intrahepatic localization in 55.4% of cases and unifocality in 85.6% of patients. The mean age of the patients was 63 years (26-89 years), with a mean tumor size of 5.5 cm. The median survival time was 7 months (0 to >50). CA19-9 was altered in 81% of patients, whereas GOT/GPT was altered in 62.5% and gamma-glutamyl transferase/alkaline phosphatase/bilirubin in 69.1% of patients. Mortality was higher among patients with extrahepatic CCA. CONCLUSION: Risk factors such as smoking, cholecystectomy, cirrhosis, intrahepatic lithiasis, and transplantation should be considered individually by the attending physician for radiological monitoring and incidental discovery of the neoplasm. Lack of timely identification by the attending physician can delay diagnosis, increasing mortality.
Drizlionoks E, Tercioti Junior V, Coelho Neto JS
… +2 more, Andreollo NA, Lopes LR
Arq Bras Cir Dig
· 2025 · PMID 39813554
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BACKGROUND: Gastric stump neoplasia is defined as a neoplasia that arises in the gastric remnant after at least 5 years of interval from the first gastric resection. AIMS: The aim of this study was to analyze 51 patients...BACKGROUND: Gastric stump neoplasia is defined as a neoplasia that arises in the gastric remnant after at least 5 years of interval from the first gastric resection. AIMS: The aim of this study was to analyze 51 patients who underwent total and subtotal gastrectomy and multi-visceral resections in patients with gastric stump cancer. METHODS: The hospital records of 51 patients surgically treated for gastric stump cancer between 1989 and 2019 were reviewed. The following data were analyzed: sex, age group, the interval between the first surgery and the diagnosis of gastric stump cancer, location of the ulcer that motivated the gastrectomy, type of reconstruction, tumor resectability, surgery performed, reconstruction of the digestive tract, associated surgical procedures, postoperative complications using the Clavien-Dindo classification, disease staging, and survival. RESULTS: There were 43 (83.3%) men, with a mean age of 66.9 years. The mean interval between the initial gastrectomy and surgery for the treatment of gastric stump neoplasia was 34.7 years. All had previously undergone Billroth II reconstruction. Most patients underwent total gastrectomy (35 cases - 68.6%), followed by subtotal gastrectomy (6 cases - 11.8%), and the remainder were considered unresectable (10 patients - 19.6%), undergoing jejunostomy for nutritional support. Multi-visceral resections consisted of splenectomies, cholecystectomies, hepatectomies, partial colectomies, pancreatectomies, enterectomies, and nephrectomies. Among the patients who had the lesion resected, the mean follow-up time was 34.2 months (standard deviation: 47.6 months), the overall survival at 3 years was 43.6%, and the survival at 5 years was 29.7%. CONCLUSION: The treatment of gastric stump neoplasia is still challenging and difficult, and personalized follow-up strategies should be focused on high-risk patients, offering opportunities for early intervention, better clinical outcomes, and long-term survival.
Gaete MI, Meira Junior JD, Loyola S
… +5 more, Meneses L, Dreyse J, Hevia J, Briceño E, Martinez J
Arq Bras Cir Dig
· 2025 · PMID 39813553
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BACKGROUND: Perihilar cholangiocarcinoma presents unique challenges in perioperative management, requiring a comprehensive approach to optimize patient outcomes. AIMS: This case study focuses on the multidisciplinary man...BACKGROUND: Perihilar cholangiocarcinoma presents unique challenges in perioperative management, requiring a comprehensive approach to optimize patient outcomes. AIMS: This case study focuses on the multidisciplinary management and innovative interventions performed in the perioperative care of a patient with hilar cholangiocarcinoma. METHODS: A comprehensive assessment and treatment strategy involving neoadjuvant therapy and interventional radiology techniques were implemented. Neoadjuvant chemotherapy was administered to reduce tumor size and improve resectability. The crucial role of interventional radiology in managing postoperative complications is highlighted, particularly in the case of massive pulmonary embolism. RESULTS: The neoadjuvant therapy successfully reduced tumor size, enabling an R0 surgical resection. Additionally, interventional radiology interventions, such as percutaneous pharmaco-mechanical thrombectomy, effectively addressed the life-threatening complication of massive pulmonary embolism. CONCLUSIONS: This article highlights the importance of a collaborative, multidisciplinary approach in managing complex oncological surgeries, especially regarding the hospital's rescue capacity for severe postoperative complications. Emergent management with interventional radiology had a central role in resolving life-threatening complications.
Martins BC, Martins E Silva AARS, Soares AABDS
… +1 more, Ribeiro Junior U
Arq Bras Cir Dig
· 2024 · PMID 39699383
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BACKGROUND: The use of mesh in the repair of large hiatal hernias is still controversial. One of the most feared adverse events related to the use of mesh is erosion into the esophageal and gastric walls. AIMS: To record...BACKGROUND: The use of mesh in the repair of large hiatal hernias is still controversial. One of the most feared adverse events related to the use of mesh is erosion into the esophageal and gastric walls. AIMS: To record the endoscopic treatment of mesh that has migrated into the gastric lumen after surgical treatment of hiatal hernia. METHODS: The technical option was to wait for the progressive migration of the mesh into the gastric lumen, monitoring with upper digestive endoscopy, with removal by traction at the best time, with the aid of foreign body forceps. RESULTS: The mesh was completely removed, and the evolution was satisfactory, without complications. CONCLUSIONS: In patients with mesh migration into the stomach who are oligosymptomatic and do not show signs of complications, endoscopic surveillance and subsequent removal of the foreign body can be successfully performed when the mesh is not adhered to the gastric wall, avoiding surgical procedures with high morbidity and mortality.
Ramos MFKP, Pereira MA, Luizaga CTM
… +5 more, Lombardo V, Leite VB, Peres SV, Pinheiro RN, Ribeiro Junior U
Arq Bras Cir Dig
· 2024 · PMID 39699382
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BACKGROUND: The hospitals' volume, specialization, availability of all oncological services, and experience in performing complex surgeries have a favorable impact on gastric cancer (GC) treatment. AIMS: The aim of this...BACKGROUND: The hospitals' volume, specialization, availability of all oncological services, and experience in performing complex surgeries have a favorable impact on gastric cancer (GC) treatment. AIMS: The aim of this study was to compare the results of GC treatment according to the type of oncological hospital in the State of São Paulo. METHODS: Patients diagnosed with GC between 2000 and 2022 in qualified hospitals for cancer treatment were evaluated by data extracted from the hospital cancer registry. Patients were assessed according to the type of hospital for cancer treatment: Oncology High Complexity Assistance Unit (UNACON) and Oncology High Complexity Care Center (CACON), which has greater complexity. RESULTS: Among the 33,774 patients, 23,387 (69.2%) were treated at CACONs and 10,387 (30.8%) in UNACONs. CACON patients were younger, had a higher level of education, and had a more advanced cTNM stage compared to UNACON (all p<0.001, p<0.05). The time from diagnosis to treatment was over 60 days in 49.8% of CACON's patients and 39.4% of UNACON's (p<0.001, p<0.05). Surgical treatment was performed in 18,314 (54.2%) patients. The frequency pN0 (40.3 vs 32.4%) and pTNM stage I (23 vs 19.5%) were higher in CACON. There was no difference in overall survival (OS) between all adenocarcinoma cases treated at CACON and UNACON (9.3 vs 10.3 months, p=0.462, p>0.05). However, considering only patients who underwent curative surgery, the OS of patients treated at CACON was better (24.4 vs 18 months, p<0.001). CONCLUSIONS: Patients with GC who underwent gastrectomy at CACONs had better survival outcomes, suggesting that the centralization of complex cancer surgery may be beneficial.
Arq Bras Cir Dig
· 2024 · PMID 39699381
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BACKGROUND: Hepatectomy is historically associated with higher morbidity and mortality, related to intraoperative blood loss and biliary fistulas. Technological advances and improvements in surgical and anesthetic techni...BACKGROUND: Hepatectomy is historically associated with higher morbidity and mortality, related to intraoperative blood loss and biliary fistulas. Technological advances and improvements in surgical and anesthetic techniques have led to greater safety in performing these surgeries. AIMS: The aim of this study was to analyze morbidity and mortality in patients undergoing hepatectomy. METHODS: Retrospective cohort study of patients undergoing liver resections. The type of hepatectomy, indications, need for intraoperative blood transfusion, hospital stay, complications, and postoperative mortality were analyzed. RESULTS: A total of 48 hepatectomies were performed during the studied period, the most common being 26 (54.16%) major hepatectomies, distributed among 13 (50%) left hepatectomies, 11 (42.30%) right hepatectomies, and 2 (7.70%) others. In total, 24 (45.84%) minor hepatectomies were performed, 11 (50%) mono segmentectomies, and 5 (22.72%) left lateral hepatectomies. The main indications for resection in benign diseases were 6 (12.50%) neotropical hepatic hydatidosis, five (10.41%) intrahepatic lithiasis, and in primary malignancies, 9 (18.75%) hepatocarcinomas. There was no need for an intraoperative blood transfusion. Hospital stays after surgery ranged from 2 to 40 days (average=7 days), and 41 (85.42%) patients went to the ICU in the first 72 h after surgery. In total, 9 (18.75%) patients developed postoperative complications. Overall mortality was 2.08%. CONCLUSIONS: Hepatocellular carcinoma and neotropical hydatidosis were the main diseases with surgical indication, and major hepatectomies were the most performed procedures. Morbidity and mortality were in line with results from major global centers.
Norero E, Ceroni M, Martinez C
… +5 more, Muñoz R, Mejia R, Morales E, Obaid I, Gonzalez P
Arq Bras Cir Dig
· 2024 · PMID 39699380
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BACKGROUND: Laparoscopic gastrectomy offers advantages in the postoperative period compared to the open approach. Most studies have been performed on distal gastrectomies; however, laparoscopic total gastrectomy (LTG) is...BACKGROUND: Laparoscopic gastrectomy offers advantages in the postoperative period compared to the open approach. Most studies have been performed on distal gastrectomies; however, laparoscopic total gastrectomy (LTG) is not universally accepted. AIM: The aim of this study was to assess the results of LTG, on postoperative morbidity outcomes and long-term survival. METHODS: This is a retrospective cohort study from a prospective database of patients who underwent LTG, from 2005 to 2022, due to early and advanced gastric cancer. A totally laparoscopic technique was utilized, and the Roux-en-Y reconstruction was performed in all cases. Postoperative complications and long-term survival were evaluated. RESULTS: A total of 100 patients were included (men 57, age 64 years, and body mass index 26). A D2 lymphadenectomy was performed in 68 cases. The postoperative hospitalization period was 8 days (6-62 days). Postoperative complications occurred in 26%, with 7% esophago-jejunal anastomosis leak, 4% abdominal collections, and 2% gastrointestinal bleeding. In 7% of cases, the complication was considered Clavien 3 or greater. Operative mortality was 1%. The pathology findings confirmed advanced gastric cancer in 50 cases. The median lymph node count was 38, and surgery was considered R0 in 99%. The median follow-up was 50 months. Overall 5-year survival was 74%. Survival in T1 cases was 95% at 5 years. For stage I, survival was 95%, and for stages II and III, it was 52% and 43%, at 5 years, respectively. CONCLUSIONS: These results support the feasibility and oncological adequacy of minimally invasive total gastrectomy. Postoperative morbidity has an acceptable rate. Long-term survival was in accordance with the disease stage.
Ferrarin DD, Malafaia O, Czeczko NG
… +5 more, Kubrusly LF, Sigwalt MF, Sousa EL, Repka JCD, Caron PHL
Arq Bras Cir Dig
· 2024 · PMID 39699379
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BACKGROUND: Nowdays, more relevant applications of perinatal derivatives, such as amniotic membrane (AM), are emerging in our environment as a source of biomaterials for use in different healing processes. The study of a...BACKGROUND: Nowdays, more relevant applications of perinatal derivatives, such as amniotic membrane (AM), are emerging in our environment as a source of biomaterials for use in different healing processes. The study of anastomosis healing associated with antimetabolic drugs such as 5-fluorouracil (5-FU) is a potential target of AM. AIMS: To evaluate the healing effects of AM in rats treated with 5-FU at a dose of 20 mg/kg on the seventh day of postoperative evolution, regarding the parameters percentage of type I collagen (mature), cell viability, microvascular density and formation of granulation tissue. METHODS: Thirty-two Wistar rats were used, submitted to colotomy and colorraphy, separated into four groups of eight, which received different treatments daily, intraperitoneally, until the day of sacrifice: saline solution (C), 20 mg/kg 5-FU, 20 mg/kg 5-FU and AM. RESULTS: Treatment with 20 mg/kg of 5-FU, on the seventh postoperative day, induced adverse effects on the anastomotic healing process, evidenced by a decrease in the percentage of type I (mature) collagen, cell viability, microvascular density, fibrin-leukocyte scab formation and angiofibroblast proliferation; the use of AM under these conditions induced an improvement in the percentage of type I (mature) collagen. CONCLUSIONS: Treatment with 20 mg/kg of 5-FU on the seventh postoperative day induced adverse effects on the anastomotic healing process, and the use of AM under these conditions induced an improvement in the percentage of type I (mature) collagen.
Arq Bras Cir Dig
· 2024 · PMID 39699378
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BACKGROUND: The relationship between thrombosis and cancer is based on evidence that cancer promotes prothrombotic changes in the host hemostatic system. The activation of blood coagulation is closely linked to tumor gro...BACKGROUND: The relationship between thrombosis and cancer is based on evidence that cancer promotes prothrombotic changes in the host hemostatic system. The activation of blood coagulation is closely linked to tumor growth and dissemination. AIMS: To evaluate whether quantifications of plasma circulation tumor deoxyribonucleic acid (DNA) and thrombin-antithrombin complex could act as predictors for thrombotic events and death in patients with gastric or colorectal adenocarcinomas, while also evaluating the Karnofsky Performance Status. METHODS: Eighty-two patients were included in the study and divided into three groups: controls (n=20), gastric adenocarcinomas (n=21), and colorectal adenocarcinomas (n=41). In order to calculate the Karnofsky index, information was collected to measure the patient's ability to perform common daily tasks. The following serum measurements were conducted: complete blood count, platelet count, extracellular deoxyribonucleic acid, and thrombin-antithrombin complex. RESULTS: Ten patients (16%) experienced thrombosis during treatment. Patients with thrombin-antithrombin complex levels greater than 0.53 had a five-times higher risk of thrombosis. Lower Karnofsky Performance Status was also a risk factor for the event in this population. Neither thrombin-antithrombin complex nor plasma circulation tumor DNA were predictors of death after multivariate adjustment. Thus, Karnofsky index signaled a better overall survival prognosis for colorectal and gastric adenocarcinoma patients. CONCLUSIONS: Thrombin-antithrombin complex acts as a marker for thrombosis in patients with colorectal and gastric adenocarcinomas. We recommend prophylactic anticoagulation when the Karnofsky value is low and/or the thrombin-antithrombin complex concentration is greater than 0.53 ng/ml.
Arq Bras Cir Dig
· 2024 · PMID 39630843
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BACKGROUND: There is recent evidence showing that obesity is associated with gastroesophageal reflux disease and esophageal dysmotility, although symptoms are not always present. AIMS: This is a prospective study based o...BACKGROUND: There is recent evidence showing that obesity is associated with gastroesophageal reflux disease and esophageal dysmotility, although symptoms are not always present. AIMS: This is a prospective study based on high-resolution manometry findings in bariatric surgery candidates and their correlation with postoperative dysphagia. METHODS: Manometric evaluation was performed on candidates for bariatric surgery from 2022 to 2024. The examination was conducted according to the protocol of the fourth version of the Chicago Classification, including different positions and provocative maneuvers to confirm the diagnosis of dysmotility. Patients were followed for 90 days after surgery to verify the occurrence of dysphagia or difficulty adapting to the diet. RESULTS: High-resolution manometry was performed on 46 candidates for bariatric surgery with a mean body mass index of 46.5 kg/m2. Esophagogastric junction outflow obstruction was diagnosed in 16 (34.8%) patients, and ineffective esophageal motility was diagnosed in 8 (17.4%) patients. None of the subjects reported symptoms during the preoperative period. Out of the 46 individuals initially included, 44 underwent bariatric surgery, 23 (52.3%) underwent Roux-en-Y gastric bypass, and 21 (47.7%) underwent sleeve gastrectomy. One patient with esophagogastric junction outflow obstruction reported dysphagia after Roux-en-Y bypass, but symptoms spontaneously resolved during the 90-day follow-up period. CONCLUSIONS: Although patients with severe obesity have a high prevalence of esophageal motility disorders, no clinical repercussions were observed after bariatric surgery during the study period.
Arq Bras Cir Dig
· 2024 · PMID 39630841
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Mixed neuroendocrine-non-neuroendocrine tumors (MiNEN) are a rare type of tumor formed by two components, a non-neuroendocrine component that is most often an adenocarcinoma and a neuroendocrine tumor, and each of these...Mixed neuroendocrine-non-neuroendocrine tumors (MiNEN) are a rare type of tumor formed by two components, a non-neuroendocrine component that is most often an adenocarcinoma and a neuroendocrine tumor, and each of these components must represent at least 30% of the tumor. The origin of this tumor on the ampulla of Vater or periampullary region is more infrequent. Usually, the lesions are highly aggressive and quickly metastasizing, and their biological behavior is dictated by the high grade of the neuroendocrine component. This is the first report of a patient with ampullary MiNEN treated employing a robotic pancreaticoduodenectomy. Although being submitted to aggressive treatment with complete surgical resection followed by systemic therapy, the patient developed early recurrence with hepatic metastatic disease, demonstrating the hostile nature of these tumors.
Fernandes ESM, Mello FPT, Andrade RO
… +10 more, Girão CL, Cesar C, Pimentel LS, Coelho HSM, Basto ST, Siqueira M, Brito A, Sousa CCT, Genzini T, Torres OJM
Arq Bras Cir Dig
· 2024 · PMID 39630840
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BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA) was considered a contraindication for liver transplantation. However, recent studies have shown that highly selected cases of patients with a good response to neoadjuvan...BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA) was considered a contraindication for liver transplantation. However, recent studies have shown that highly selected cases of patients with a good response to neoadjuvant therapy may achieve acceptable survival rates when following liver transplantation. AIMS: To present two cases of patients with iCCA, without extrahepatic disease, who underwent living donor liver transplantation after receiving neoadjuvant chemotherapy. METHODS: Two cases of patients with histopathological diagnosis of locally advanced iCCA, ineligible for resection and without evidence of extrahepatic disease, are presented. RESULTS: These patients underwent at least nine sessions of neoadjuvant chemotherapy, including Gemcitabine and Cisplatin, with or without the addition of immunobiological agents, resulting in a radiological tumor response. They subsequently underwent living donor liver transplantation. The average follow-up time was 15 months, with no clinical or radiological signs of disease. CONCLUSIONS: In well-selected patients without extrahepatic disease, living donor liver transplantation represents a potential therapeutic option for iCCA.
Kassab P, Ferraz ÁAB, Mitidieri ACH
… +11 more, Berti LV, Santo MA, Szego T, Zanon CC, Castro OAP, Freitas Junior WR, Ilias EJ, Malheiros CA, Valez AC, Campos ACL, Brazilian College of Digestive Surgery (CBCD) and Brazilian Society of Bariatric and
Metabolic Surgery (SBCBM).
Arq Bras Cir Dig
· 2024 · PMID 39630839
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Obesity is recognized as a significant risk factor for various types of cancer. Although the incidence of some types of cancer across various primary sites is decreasing due to specific prevention measures (screening pro...Obesity is recognized as a significant risk factor for various types of cancer. Although the incidence of some types of cancer across various primary sites is decreasing due to specific prevention measures (screening programs, smoking cessation), the incidence of neoplasms in the young population shows a significant increase associated with obesity. There is sufficient evidence to say that bariatric surgery has been shown to significantly lower the risk of developing obesity-associated cancers, which are linked to metabolic dysregulation, chronic low-grade systemic inflammation, and hormonal alterations such as elevated levels of insulin and sex hormones.
Arq Bras Cir Dig
· 2024 · PMID 39630838
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BACKGROUND: Many free radicals result in an inflammatory process due to complications caused by gallstones. These free radicals are inactivated by various reactions and participate in different reactions. Molecules are o...BACKGROUND: Many free radicals result in an inflammatory process due to complications caused by gallstones. These free radicals are inactivated by various reactions and participate in different reactions. Molecules are oxidants and antioxidants that take an active role in almost every event that takes place in the body. AIMS: To analyse the changes in total antioxidant level (TAL) and total oxidant level (TOL) in the follow-up of patients hospitalized for cholelithiasis or its complications, showing the active oxidative stress, and to test the usability of these parameters in the evaluation of treatment success. METHODS: Forty-five patients took part in the study. Blood samples were taken twice, previous to surgery and 6 hours after surgery. Tissue samples were also obtained from patients who were operated. Then, the samples were sent to a laboratory to measure the total oxidant and antioxidant status of patients. RESULTS: The median for the TAL_before (pre-operation or hospitalization in non-operational) variable was 2.40 (interquartile range - IQR=0.50), and the median for the TAL_after variable was 2.20 (IQR=0.33). The median of the tissue-derived TAL variable was 0.32 (IQR=0.13), and the median of the TOL variable was 0.43 (IQR=0.52). The median value of the TAL_before variable for men was 2.50 (IQR=0.50), while the median value for the TAL_before variable for women was 2.30 (IQR=0.50). TAL_before variable values did not show a statistically significant difference according to gender (Z=1.446; p=0.154, p>0.05). Similarly, the median values of TOL_before variable by gender were similar (Z=0.614; p=0.545, p>0.05). CONCLUSIONS: Cholelithiasis and its complications cause many inflammatory responses, ending with free radical formation. During follow-up, its level decreases due to consumption or success of the treatment.