Abstract Introduction. The objective of this study was to compare the short-term outcomes of laparoscopic gastrectomy in adults vs. older patients with locally advanced gastric cancer from a Western country cohort. Methods. Prospective cohort study in patients undergoing laparoscopic gastrectomy for locally advanced gastric cancer at the Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, between November 2014 and December 2018. Descriptive, group comparison and bivariate analysis was performed. Results. Of a total of 116 patients, 51 patients (44%) were 65 years or older and 63 patients (54%) were men. No statistically significant difference was found when comparing patients under 65 years of age with those 65 years of age or older. The median operating time was 240 minutes in both groups (p>0.05), the median macroscopic resection margins were 6 cm vs. 5 cm (p>0.05), the median number of lymph nodes dissected was 25 vs. 19 (p>0.05), the median number of positive lymph nodes was 4 vs. 3 (p>0.05), the median stay was 7 days in both groups (p>0.05). The overall rate of postoperative complications did not differ significantly between adults (7%) and older adults (11%) (p>0.05) and no significant differences were observed in the rates of minor (Clavien-Dindo grade II; 3-5% vs. 6-12%; p>0.05) and severe complications (Clavien-Dindo ≥ IIIa; 3-5% vs. 4-8%; p>0.05). Conclusions. No statistically differences were found in short-term outcomes between adult and older patients with locally advanced gastric cancer treated with laparoscopic gastrectomy. This technique is safe in the elderly.

Resumen Introducción. El objetivo de este estudio fue comparar los desenlaces a corto plazo de la gastrectomía laparoscópica en adultos vs. adultos mayores con cáncer gástrico localmente avanzado en una cohorte de un país occidental. Métodos. Estudio de cohorte prospectivo en pacientes sometidos a gastrectomía laparoscópica por cáncer gástrico localmente avanzado, en el Hospital Universitario Erasmo Meoz, de Cúcuta, Colombia, entre noviembre de 2014 y diciembre de 2018. Se realizó análisis descriptivo, de comparación de grupos y bivariado. Resultados. De un total de 116 pacientes, 51 pacientes (44 %) tenían 65 años o más y 63 pacientes (54 %) eran hombres. No se encontró diferencia estadísticamente significativa al comparar los pacientes menores de 65 años con los de 65 años o más. La mediana del tiempo operatorio fue de 240 minutos en ambos grupos (p>0,05), la mediana de los márgenes de resección macroscópica fue 6 cm vs. 5 cm (p>0,05), la mediana de los ganglios linfáticos disecados fue 25 vs. 19 (p>0,05), la mediana de ganglios linfáticos positivos fue 4 vs. 3 (p>0,05), la mediana de estancia fue de 7 días en ambos grupos (p>0,05). La tasa general de complicaciones posoperatorias no difirió significativamente entre adultos (7%) y adultos mayores (11 %) (p>0,05) y no se observaron diferencias significativas en las tasas de complicaciones menores (Clavien-Dindo grado II; 3-5 % vs. 6-12 %; p>0,05) y graves (Clavien-Dindo ≥ IIIa; 3-5 % vs. 4-8 %; p>0,05). Conclusiones. No se encontraron diferencias estadísticamente significativas en los resultados a corto plazo entre los pacientes adultos y adultos mayores con cáncer gástrico localmente avanzado tratados con gastrectomía laparoscópica. Esta técnica es segura en ancianos.

ABSTRACT Objective: To evaluate sensitivity and specificity of the G8 test in screening older adults with cancer who may benefit from a Comprehensive Geriatric Assessment (CGA). Material and methods: This observational retrospective study was carried out in the Geriatrics Service of the Guillermo Almenara Hospital in Lima, Peru. CGA reports were reviewed in the electronic medical records of older adults (> 60 years) with cancer, both outpatients and inpatients, between November 2022 and July 2023. Patients were classified according to the SIOG-1 (International Society of Geriatric Oncology) criteria into two groups: fit and non-fit patients (vulnerable + frail + too sick). Sensitivity, specificity, and positive predictive value, area under the receiver operating characteristic curve (AUC), were estimated for the G8 test. Results: 201 patients entered the study, 91 women (45.3%) and 110 (54.7%) men; their mean age was 76.2 ± 7.4 years. The most frequent neoplasms were colorectal, stomach, prostate, and bile ducts. The prevalence of eligible and unfit patients was 23.4% and 76.6%, respectively. When the G8 test score was ≤11, sensitivity, specificity, positive predictive value, and AUC were 73.4% (95% Confidence Interval: 65.7- 80.2%), 91.5% (79.6%-97.6%), 96.6% (91.7-98.6%), and 89% (84-93%), respectively. Conclusions: The G8 test with a score ≤11 would have high sensitivity and specificity for identifying vulnerable or frail patients with cancer who could benefit from the CGA.

RESUMEN Objetivo: evaluar la sensibilidad y especificidad del test G8 en el tamizaje de adultos mayores con cáncer para la realización de la valoración geriátrica integral (VGI). Materiales y métodos: el presente estudio observacional y retrospectivo se realizó en el Servicio de Geriatría del Hospital Almenara de Lima, Perú. Se revisaron los informes de VGI en las historias clínicas electrónicos de adultos mayores (> 60 años) con cáncer, ambulatorios y hospitalizados, durante noviembre de 2022 y julio de 2023. Los pacientes se clasificaron según los criterios SIOG-1 (Sociedad Internacional de Oncología Geriátrica), formando dos grupos: pacientes aptos y pacientes no aptos o unfit (vulnerables + frágiles + muy enfermos). Del test G8 se estimó la sensibilidad, especificidad y valor predictivo positivo, área bajo la curva característica operativa del receptor (AUC). Resultados: ingresaron al estudio 201 pacientes, 91 mujeres (45,3%) y 110 (54,7%) varones, la media de la edad fue de 76,2 ± 7,4 años. Las neoplasias más frecuentes fueron colorrectal, estómago, próstata y vías biliares. La prevalencia de pacientes aptos y no aptos (unfit) fue del 23,4 y 76,6%, respectivamente. Cuando el puntaje de la prueba G8 fue ≤11, la sensibilidad, especificidad, valor predictivo positivo y AUC fueron 73,4% (intervalo de confianza al 95%: 65,7-80,2%), 91,5% (79,6%-97,6%), 96,6% (91,7-98,6%) y 89% (84-93%), respectivamente. Conclusiones: el test G8 con puntaje ≤11 tendría una alta sensibilidad y especificidad, para identificar adultos con cáncer vulnerables o frágiles, que podrían beneficiarse de la VGI.

RESUMO A medicina molecular abriu novos horizontes na compreensão dos mecanismos das doenças e na descoberta de intervenções alvo. A maior disponibilidade de sequenciação de DNA e RNA, análise imuno-histoquímica, proteômica e outros testes moleculares mudou a forma como os médicos conduzem as doenças. A classificação molecular do câncer gástrico proposta pelo Atlas do Genoma do Câncer divide os adenocarcinomas gástricos em quatro subtipos. No entanto, os alvos disponíveis e/ou imunoterapias aprovadas para uso clínico parecem estar dissociados desses subtipos moleculares. Até que seja apresentada uma interpretação mais confiável da estupenda quantidade de dados fornecidos pelas classificações moleculares, as diretrizes clínicas irão se basear nos alvos acionáveis disponíveis e nas terapias aprovadas para orientar os médicos na condução da gestão do câncer na era das terapias moleculares. alvo RNA imunohistoquímica, imunohistoquímica imuno histoquímica, histoquímica imuno-histoquímica entanto eou ou

ABSTRACT Molecular medicine opened new horizons in understanding disease mechanisms and discovering target interventions. The wider availability of DNA and RNA sequencing, immunohistochemical analysis, proteomics, and other molecular tests changed how physicians manage diseases. The gastric cancer molecular classification proposed by The Cancer Genome Atlas Program divides gastric adenocarcinomas into four subtypes. However, the available targets and/or immunotherapies approved for clinical use seem to be dissociated from these molecular subtypes. Until a more reliable interpretation of the stupendous amount of data provided by the molecular classifications is presented, the clinical guidelines will rely on available actionable targets and approved therapies to guide clinicians in conducting cancer management in the era of molecular therapies. interventions sequencing analysis proteomics diseases subtypes However andor or presented

RESUMO Introdução: O câncer gástrico segue como terceira causa de mortalidade mundial por neoplasias malignas. Seus índices prognósticos ainda não foram bem definidos para intervenção cirúrgica quanto à estratificação da intensidade da inflamação crônica. Os Critérios Prognósticos de Glasgow (CPG) e os índices de O-POSSUM e PPOSSUM podem constituir essas padronizações e foram testados para avaliar a associação entre eles e o prognóstico após gastrectomia curativa. Método: Estudo retrospectivo, analisando prontuários de pacientes com adenocarcinoma gástrico e submetidos à gastrectomia, no período de 2015 até 2021, em dois hospitais no Rio de Janeiro. Foram observados a extensão cirúrgica, os dados clínicos e laboratoriais pré, peri e pós-operatórios, até 30 dias após a cirurgia. Os pacientes foram estratificados pelos CPG e comparados segundo classificação de ClavienDindo (CD). Regressão logística foi realizada para testar associação entre o desfecho e variáveis independentes. Resultados: Dos 48 doentes, 56,25% eram do sexo feminino. Houve diferença entre os grupos quanto à extensão cirúrgica e CPG (ambos com p<0,001), enquanto O-POSSUM, P-POSSUM e idade não apresentaram diferença. Fatores associados com complicação CD ≥ III-a na análise univariada foram CPG (OR: 85,261; IC: 24,909-291,831) e P-POSSUM (OR: 1,211; IC: 1,044-1,404). Na análise multivariada, os fatores independentes associados ao CD ≥ III-a foram CPG (OR: 114,865; IC: 15,430-855,086), P-POSSUM (OR: 1,133; IC: 1,086-1,181) e O-POSSUM (OR: 2,238; IC: 1,790-2,797). Conclusão: Neste modelo, CPG, P-POSSUM e O-POSSUM previram complicações cirúrgicas graves. Há necessidade de estudos mais aprofundados para instituir estratégias de forma a minimizar a resposta inflamatória no período pré-operatório. Introdução malignas crônica (CPG OPOSSUM POSSUM curativa Método retrospectivo 201 2021 Janeiro pré pósoperatórios, pósoperatórios pós operatórios, operatórios pós-operatórios 3 cirurgia CD. . (CD) Resultados 4 doentes 5625 56 25 56,25 feminino ambos p<0,001, p0001 p p<0,001 , 0 001 p<0,001) OPOSSUM, POSSUM, P IIIa III OR (OR 85,261 85261 85 261 IC 24,909291,831 24909291831 24,909 291,831 24 909 291 831 24,909-291,831 1,211 1211 1 211 1,0441,404. 10441404 1,044 1,404 044 404 1,044-1,404) multivariada 114,865 114865 114 865 15,430855,086, 15430855086 15,430 855,086 15 430 855 086 15,430-855,086) 1,133 1133 133 1,0861,181 10861181 1,086 1,181 181 1,086-1,181 2,238 2238 2 238 1,7902,797. 17902797 1,790 2,797 790 797 1,790-2,797) Conclusão modelo graves préoperatório. préoperatório operatório. operatório pré-operatório 20 202 (CD 562 5 56,2 p000 p<0,00 00 85,26 8526 8 26 909291 24,909291,83 2490929183 24909 24,90 291831 291,83 90 29 83 24,909-291,83 1,21 121 21 0441 1,0441,404 1044140 1044 1,04 1404 1,40 04 40 1,044-1,404 114,86 11486 11 86 430855 15,430855,086 1543085508 15430 15,43 855086 855,08 43 08 15,430-855,086 1,13 113 13 0861 1,0861,18 1086118 1086 1,08 1181 1,18 18 1,086-1,18 2,23 223 23 7902 1,7902,797 1790279 1790 1,79 2797 2,79 79 1,790-2,797 56, p00 p<0,0 85,2 852 90929 24,909291,8 249092918 2490 24,9 29183 291,8 9 24,909-291,8 1,2 12 1,0441,40 104414 104 1,0 140 1,4 1,044-1,40 114,8 1148 43085 15,430855,08 154308550 1543 15,4 85508 855,0 15,430-855,08 1,1 1,0861,1 108611 108 118 1,086-1,1 2,2 22 1,7902,79 179027 179 1,7 279 2,7 7 1,790-2,79 p0 p<0, 85, 9092 24,909291, 24909291 249 24, 2918 291, 24,909-291, 1, 1,0441,4 10441 10 14 1,044-1,4 114, 4308 15,430855,0 15430855 154 15, 8550 855, 15,430-855,0 1,0861, 10861 1,086-1, 2, 1,7902,7 17902 17 27 1,790-2,7 p<0 24,909291 2490929 24,909-291 1,0441, 1,044-1, 15,430855, 1543085 15,430-855, 1,0861 1,086-1 1,7902, 1,790-2, p< 24,90929 249092 24,909-29 1,0441 1,044-1 15,430855 154308 15,430-855 1,086- 1,7902 1,790-2 24,9092 24,909-2 1,044- 15,43085 15,430-85 1,790- 24,909- 15,4308 15,430-8 15,430-

ABSTRACT Introduction: Gastric cancer is still the third cause of death worldwide due to malignant neoplasms. Its prognostic indices have not yet been well defined for surgical intervention in terms of stratifying the intensity of chronic inflammation. The Glasgow Prognostic Score (GPS) and O-POSSUM and P-POSSUM Indices may constitute these standardizations and were tested to assess the association between them and the prognosis after curative gastrectomy. Method: Retrospective observational study, analysing medical records of patients with gastric adenocarcinoma who underwent gastrectomy, from 2015 to 2021, in two hospitals in Rio de Janeiro. Surgical extension, pre, peri and postoperative clinical and laboratory data were observed, up to 30 days after surgery. Patients were layered by GPS and compared according to the Clavien-Dindo (CD) classification. Logistic regression was performed to test the association between the outcome and independent variables. Results: Of the 48 patients, 56.25% were female. There was difference between the groups regarding surgical extension and GPS (both with p<0.001), while O-POSSUM, P-POSSUM and age showed no difference. Factors associated with CD ≥ III-a complication in the univariate analysis were GPS (OR: 85,261; CI: 24,909- 291,831) and P-POSSUM (OR: 1,211; CI:1,044-1,404). In the multivariate analysis, the independent factors associated with CD ≥ III-a were GPS (OR:114,865; CI: 15,430-855,086), P-POSSUM (OR: 1,133; CI: 1,086-1,181) and O-POSSUM (OR: 2,238; CI: 1,790-2,797). Conclusion: In this model, GPS, P-POSSUM and O-POSSUM predicted serious surgical complications. There is a need for further studies to establish strategies to minimize the inflammatory response in the preoperative period. Introduction neoplasms inflammation (GPS OPOSSUM O POSSUM PPOSSUM P gastrectomy Method study 201 2021 Janeiro pre observed 3 surgery ClavienDindo Clavien Dindo (CD classification variables Results 4 5625 56 25 56.25 female both p<0.001, p0001 p p<0.001 , 0 001 p<0.001) OPOSSUM, POSSUM, IIIa III OR (OR 85,261 85261 85 261 CI 24,909 24909 24 909 291,831 291831 291 831 1,211 1211 1 211 CI1,0441,404. CI10441404 1,044 1,404 . 044 404 CI:1,044-1,404) OR114,865 OR114865 114,865 114 865 (OR:114,865 15,430855,086, 15430855086 15,430 855,086 15 430 855 086 15,430-855,086) 1,133 1133 133 1,0861,181 10861181 1,086 1,181 181 1,086-1,181 2,238 2238 2 238 1,7902,797. 17902797 1,790 2,797 790 797 1,790-2,797) Conclusion model complications period 20 202 562 5 56.2 p000 p<0.00 00 85,26 8526 8 26 24,90 2490 90 291,83 29183 29 83 1,21 121 21 CI1 0441 CI1,0441,404 CI1044140 1044 1,04 1404 1,40 04 40 CI:1,044-1,404 OR114 OR114,86 OR11486 114865 114,86 11 86 (OR:114,86 430855 15,430855,086 1543085508 15430 15,43 855086 855,08 43 08 15,430-855,086 1,13 113 13 0861 1,0861,18 1086118 1086 1,08 1181 1,18 18 1,086-1,18 2,23 223 23 7902 1,7902,797 1790279 1790 1,79 2797 2,79 79 1,790-2,797 56. p00 p<0.0 85,2 852 24,9 249 9 291,8 2918 1,2 12 CI1,0441,40 CI104414 104 1,0 140 1,4 CI:1,044-1,40 OR11 OR114,8 OR1148 11486 114,8 (OR:114,8 43085 15,430855,08 154308550 1543 15,4 85508 855,0 15,430-855,08 1,1 1,0861,1 108611 108 118 1,086-1,1 2,2 22 1,7902,79 179027 179 1,7 279 2,7 7 1,790-2,79 p0 p<0. 85, 24, 291, 1, CI1,0441,4 CI10441 10 14 CI:1,044-1,4 OR1 OR114, 1148 114, (OR:114, 4308 15,430855,0 15430855 154 15, 8550 855, 15,430-855,0 1,0861, 10861 1,086-1, 2, 1,7902,7 17902 17 27 1,790-2,7 p<0 CI1,0441, CI1044 CI:1,044-1, (OR:114 15,430855, 1543085 15,430-855, 1,0861 1,086-1 1,7902, 1,790-2, p< CI1,0441 CI104 CI:1,044-1 (OR:11 15,430855 154308 15,430-855 1,086- 1,7902 1,790-2 CI1,044 CI10 CI:1,044- (OR:1 15,43085 15,430-85 1,790- CI1,04 CI:1,044 15,4308 15,430-8 CI1,0 CI:1,04 15,430- CI1, CI:1,0 CI:1, CI:1

ABSTRACT BACKGROUND: Predicting short- and long-term outcomes of oncological therapies is crucial for developing effective treatment strategies. Malnutrition and the host immune status significantly affect outcomes in major surgeries. AIMS: To assess the value of preoperative prognostic nutritional index (PNI) in predicting outcomes in gastric cancer patients. METHODS: A retrospective cohort analysis was conducted on patients undergoing curative-intent surgery for gastric adenocarcinoma between 2009 and 2020. PNI was calculated as follows: PNI=(10 x albumin [g/dL])+(0.005 x lymphocytes [nº/mm3]). The optimal cutoff value was determined by the receiver operating characteristic curve (PNI cutoff=52), and patients were grouped into low and high PNI. RESULTS: Of the 529 patients included, 315 (59.5%) were classified as a low-PNI group (PNI<52) and 214 (40.5%) as a high-PNI group (PNI≥52). Older age (p=0.050), male sex (p=0.003), American Society of Anesthesiologists score (ASA) III/IV (p=0.001), lower hemoglobin level (p<0.001), lower body mass index (p=0.001), higher neutrophil-lymphocyte ratio (p<0.001), D1 lymphadenectomy, advanced pT stage, pN+ and more advanced pTNM stage were related to low-PNI patient. Furthermore, 30-day (1.4 vs. 4.8%; p=0.036) and 90-day (3.3 vs. 10.5%; p=0.002) mortality rates were higher in low-PNI compared to high-PNI group. Disease-free and overall survival were worse in low-PNI patients compared to high-PNI (p<0.001 for both). ASA III/IV score, low-PNI, pT3/T4, and pN+ were independent risk factors for worse survival. CONCLUSIONS: Preoperative PNI can predict short- and long-term outcomes of patients with gastric cancer after curative gastrectomy. Low PNI is an independent factor related to worse disease-free and overall survival. BACKGROUND short longterm long term strategies surgeries AIMS METHODS curativeintent intent 200 2020 follows PNI=10 PNI10 PNI= 10 PNI=(1 g/dL+0.005 gdL0005 gdL g/dL + 0.005 g dL 0 005 [g/dL])+(0.00 nº/mm3. nºmm3 nºmm nº/mm3 . nº mm3 mm [nº/mm3]) cutoff=52, cutoff52 cutoff=52 , 52 cutoff=52) RESULTS included 31 59.5% 595 59 5 (59.5% lowPNI PNI<52 PNI52 (PNI<52 21 40.5% 405 40 (40.5% highPNI PNI≥52. PNI≥52 (PNI≥52) p=0.050, p0050 p p=0.050 050 (p=0.050) p=0.003, p0003 p=0.003 003 (p=0.003) (ASA IIIIV III IV p=0.001, p0001 p=0.001 001 (p=0.001) p<0.001, p<0.001 (p<0.001) neutrophillymphocyte neutrophil lymphocyte D lymphadenectomy pN patient Furthermore 30day day 30 1.4 14 1 4 (1. vs 4.8% 48 8 p=0.036 p0036 036 90day 90 3.3 33 3 (3. 10.5% 105 p=0.002 p0002 002 Diseasefree Disease free (p<0.00 both. both both) lowPNI, PNI, pT3T4 pTT pT3 T4 T pT3/T4 CONCLUSIONS gastrectomy diseasefree disease 20 202 PNI=1 PNI1 PNI=( g/dL+0.00 gdL000 0005 0.00 00 [g/dL])+(0.0 nº/mm [nº/mm3] cutoff5 cutoff=5 59.5 (59.5 PNI<5 PNI5 (PNI<5 2 40.5 (40.5 PNI≥5 (PNI≥52 p005 p=0.05 05 (p=0.050 p000 p=0.00 (p=0.003 (p=0.001 p<0.00 1. (1 4.8 p=0.03 p003 03 9 3. (3 10.5 (p<0.0 pT3T pT3/T g/dL+0.0 gdL00 000 0.0 [g/dL])+(0. [nº/mm3 cutoff= 59. (59. PNI< (PNI< 40. (40. PNI≥ (PNI≥5 p00 p=0.0 (p=0.05 (p=0.00 p<0.0 ( 4. 10. (p<0. g/dL+0. gdL0 0. [g/dL])+(0 [nº/mm (59 (40 (PNI≥ p0 p=0. (p=0.0 p<0. (p<0 g/dL+0 [g/dL])+( (5 (4 p=0 (p=0. p<0 (p< g/dL+ [g/dL])+ p= (p=0 p< (p [g/dL]) (p= [g/dL] [g/dL

RESUMO RACIONAL: Estimar os desfechos de curto e longo prazo das terapias contra o câncer é crucial para o desenvolvimento de estratégias de tratamento eficazes. A desnutrição e o estado imunológico do hospedeiro afetam significativamente os desfechos em cirurgias de grande porte. OBJETIVOS: Avaliar o valor do índice nutricional prognóstico pré-operatório (INP) na predição de desfechos em pacientes com câncer gástrico. MÉTODOS: Foi realizada uma análise de coorte retrospectiva de pacientes submetidos à cirurgia com intenção curativa para adenocarcinoma gástrico entre 2009 e 2020. O INP foi calculado da seguinte forma: INP=(10 x albumina [g/dL])+(0.005 x linfócitos [nº/mm3]). O valor de corte ideal foi determinado pela curva característica de operação do receptor (ponto de corte do INP=52), e os pacientes foram agrupados em INP baixo ou alto. RESULTADOS: Dos 529 pacientes incluídos, 315 (59,5%) foram classificados como grupo de baixo INP (INP<52) e 214 (40,5%) como grupo de alto INP (INP>52). Idade mais avançada (p=0,050), sexo masculino (p=0,003), escore da Sociedade Americana de Anestesiologistas (ASA) III/IV (p=0,001), menor nível de hemoglobina (p<0,001), menor índice de massa corpórea (p=0,001), maior relação neutrófilos-linfócitos (p<0,001), linfadenectomia D1, estágio pT avançado, pN+ e estágio pTNM mais avançado foram relacionados ao paciente com baixo INP. Além disso, as taxas de mortalidade em 30 dias (1,4 vs. 4,8%; p=0,036) e em 90 dias (3,3 vs. 10,5%; p=0,002) foram maiores no grupo com baixo PNI em comparação ao grupo com alto INP. A sobrevida livre de doença e a sobrevida global foram piores em pacientes com baixo INP em comparação com pacientes com alto INP (p<0,001 para ambos). Escore ASA III/IV, baixo INP, pT3/T4 e pN+ foram fatores de risco independentes para pior sobrevida. CONCLUSÕES: O INP pré-operatório pode predizer desfechos de curto e longo prazo de pacientes com câncer gástrico após gastrectomia curativa. Baixo INP é um fator independente relacionado a piores sobrevida livre de doença e sobrevida global. RACIONAL eficazes porte OBJETIVOS préoperatório pré operatório (INP MÉTODOS 200 2020 forma INP=10 INP10 INP= 10 INP=(1 g/dL+0.005 gdL0005 gdL g/dL + 0.005 g dL 0 005 [g/dL])+(0.00 nº/mm3. nºmm3 nºmm nº/mm3 . nº mm3 mm [nº/mm3]) ponto INP=52, INP52 INP=52 , 52 INP=52) RESULTADOS incluídos 31 59,5% 595 59 5 (59,5% INP<52 (INP<52 21 40,5% 405 40 (40,5% INP>52. INP>52 (INP>52) p=0,050, p0050 p p=0,050 050 (p=0,050) p=0,003, p0003 p=0,003 003 (p=0,003) (ASA IIIIV III IV p=0,001, p0001 p=0,001 001 (p=0,001) p<0,001, p<0,001 (p<0,001) neutrófiloslinfócitos neutrófilos D1 D pN disso 3 1,4 14 1 4 (1, vs 4,8% 48 8 p=0,036 p0036 036 9 3,3 33 (3, 10,5% 105 p=0,002 p0002 002 (p<0,00 ambos. ambos ambos) pT3T4 pTT pT3 T4 T pT3/T CONCLUSÕES 20 202 INP=1 INP1 INP=( g/dL+0.00 gdL000 0005 0.00 00 [g/dL])+(0.0 nº/mm [nº/mm3] INP5 INP=5 59,5 (59,5 INP<5 (INP<5 2 40,5 (40,5 INP>5 (INP>52 p005 p=0,05 05 (p=0,050 p000 p=0,00 (p=0,003 (p=0,001 p<0,00 1, (1 4,8 p=0,03 p003 03 3, (3 10,5 (p<0,0 pT3T g/dL+0.0 gdL00 000 0.0 [g/dL])+(0. [nº/mm3 59, (59, INP< (INP< 40, (40, INP> (INP>5 p00 p=0,0 (p=0,05 (p=0,00 p<0,0 ( 4, 10, (p<0, g/dL+0. gdL0 0. [g/dL])+(0 [nº/mm (59 (40 (INP> p0 p=0, (p=0,0 p<0, (p<0 g/dL+0 [g/dL])+( (5 (4 p=0 (p=0, p<0 (p< g/dL+ [g/dL])+ p= (p=0 p< (p [g/dL]) (p= [g/dL] [g/dL

ABSTRACT Introduction: Malignant tumors are the second cause of death worldwide, as well as in the province of Matanzas. Malignant neoplasms of the digestive tract are located in different sites, which, in addition to being a health problem, has a significant economic impact on the health system. Objectives: To determine the mortality caused by malignant tumors of digestive location in the municipality of Colón in the last decade. Methods: A retrospective and descriptive study of mortality due to digestive cancer was carried out in the municipality of Colón, Matanzas, from January 1, 2011 to December 31, 2020, based on the record of deceased of the municipality. The used independent variables were sex, age and primary cause of death. The data were analyzed using descriptive statistics. Results: A total of 459 persons had, as primary cause of death, malignant tumors located in the digestive system, while an increasing trend was observed. Colon cancer accounted for the highest number of patients who died (52 %). There was an increasing mortality trend for colon, liver and stomach cancers, and a decreasing trend for esophageal and pancreatic cancers. Mortality was higher in the male sex (249) and over 60 years of age (369). Conclusions: There was a high and increasing mortality due to malignant tumors of digestive location in the last decade in the municipality of Colon, with a greater and notable contribution of colorectal cancer to the burden of this mortality.

RESUMEN Introducción: Los tumores malignos constituyen la segunda causa de muerte a nivel mundial, también en la provincia de Matanzas. Las neoplasias malignas de vías digestivas se sitúan en diferentes escaños, lo cual, además de ser un problema de salud, tiene un impacto económico de peso en el sistema de salud. Objetivos: Determinar la mortalidad causada por tumores malignos de localización digestiva en el municipio matancero de Colón en el último decenio. Métodos: Se realizó un estudio descriptivo retrospectivo de la mortalidad por cáncer digestivo en el municipio de Colón, Matanzas, desde el 1 de enero de 2011 hasta el 31 de diciembre de 2020 según el registro de fallecidos del municipio. Las variables independientes utilizadas fueron: sexo, edad y causa primaria de muerte. Los datos fueron analizados aplicando estadística descriptiva. Resultados: Un total de 459 personas tuvieron como causa primaria de muerte tumores malignos localizados en el sistema digestivo y se observó una tendencia creciente. El cáncer de colon aportó el mayor número de pacientes fallecidos (52 %). Existió una tendencia de mortalidad creciente para los cánceres de colon, hígado y estómago y decreciente para el cáncer de esófago y páncreas. La mortalidad fue mayor en el sexo masculino (249) y a partir de los 60 años de edad (369). Conclusiones: Existió una alta y creciente mortalidad por tumores malignos de localización digestiva en el último decenio en el municipio de Colón, con un mayor y notable aporte del cáncer colorrectal a la carga de esta mortalidad.

ABSTRACT BACKGROUND: Lymph node status is vital for gastric cancer (GC) prognosis, but the conventional pN stage may be limited by variations in lymphadenectomy and stage migration. The N-Ratio, which assesses the ratio of metastatic to resected lymph nodes, emerges as a promising prognostic tool. AIMS: To assess N-Ratios prognostic value in GC, particularly in patients with <25 resected lymph nodes. METHODS: Patients who underwent gastrectomy with curative intent for GC were retrospectively evaluated. The N-Ratio categories were determined using the ROC curve method, and the area under the curve (AUC) was used as a measure of performance in predicting recurrence/death. RESULTS: A total of 561 GC patients were included in the study, 57% had pN+ status, and 17.5% had <25 resected lymph nodes. N-Ratio, with a mean of 0.12, predicted survival with 74% accuracy (AUC=0.74; 95%CI 0.70–0.78, p<0.001). N-Ratio categories included: N-Ratio 0 (43%); N-Ratio 1 (12.3%); N-Ratio 2 (31.6%); and N-Ratio 3 (13.2%). Disease-free survival (DFS) varied among all N-Ratio groups, with N-Ratio 3 showing worse survival than pN3 cases (DFS=21.8 vs. 11 months, p=0.022, p<0.05). In cases with <25 resected lymph nodes, DFS was not significantly worse in N-Ratio 0 (68.8 vs. 81.9%, p=0.061, p>0.05) and N-Ratio 1 (66.2 vs. 50%, p=0.504, p>0.05) groups. The DFS of N-Ratio-0 cases with <25 lymph nodes was similar to N-Ratio 1 cases. CONCLUSIONS: N-Ratio influenced survival in GC patients, especially in advanced lymph node disease (N-Ratio 3). Considering that N-Ratio does not impact pN0 cases, individualized prognosis assessment is essential for patients with <25 resected lymph nodes. BACKGROUND (GC migration NRatio, NRatio N Ratio, Ratio tool AIMS NRatios Ratios 25 <2 METHODS evaluated method AUC (AUC recurrencedeath recurrence death recurrence/death RESULTS 56 study 57 175 17 5 17.5 012 12 0.12 74 AUC=0.74 AUC074 (AUC=0.74 95CI CI 95 070078 70 78 0.70–0.78 p<0.001. p0001 p p<0.001 . 001 p<0.001) 43% 43 (43%) 12.3% 123 (12.3%) 31.6% 316 31 6 (31.6%) 13.2%. 132 13.2% 13 (13.2%) Diseasefree Disease free (DFS groups DFS=21.8 DFS218 21 8 (DFS=21. vs months p0022 022 p=0.022 p<0.05. p005 p<0.05 05 p<0.05) 68.8 688 68 (68. 819 81 9 81.9% p0061 061 p=0.061 p>0.05 66.2 662 66 (66. 50 50% p0504 504 p=0.504 NRatio0 N-Ratio- CONCLUSIONS 3. 3) < 17. 01 0.1 7 AUC=0.7 AUC07 (AUC=0.7 07007 0.70–0.7 p000 p<0.00 00 4 (43% 12.3 (12.3% 31.6 (31.6% 13.2 (13.2% DFS=21. DFS21 (DFS=21 p002 02 p=0.02 p00 p<0.0 68. (68 81.9 p006 06 p=0.06 p>0.0 66. (66 p050 p=0.50 0. AUC=0. AUC0 (AUC=0. 0700 0.70–0. (43 12. (12.3 31. (31.6 13. (13.2 DFS=21 DFS2 (DFS=2 p=0.0 p0 p<0. (6 81. p>0. p05 p=0.5 AUC=0 (AUC=0 070 0.70–0 (4 (12. (31. (13. DFS=2 (DFS= p=0. p<0 ( p>0 AUC= (AUC= 07 0.70– (12 (31 (13 DFS= p=0 p< p> 0.70 (1 (3 p= 0.7

RESUMO RACIONAL: O status linfonodal é vital para o prognóstico do câncer gástrico (CG), mas o estágio pN convencional pode ser limitado por variações na linfadenectomia e migração do estágio. O N-Ratio, que avalia a proporção entre linfonodos metastáticos e linfonodos ressecados, surge como uma ferramenta prognóstica promissora. OBJETIVOS: Avaliar o valor prognóstico do N-Ratio no CG, particularmente em pacientes com <25 linfonodos ressecados. MÉTODOS: Foram analisados, retrospectivamente, pacientes submetidos à gastrectomia com intenção curativa para CG. As categorias do N-Ratio foram determinadas pelo método da curva ROC, e a área sob a curva (AUC) foi utilizada como medida de desempenho na previsão de recorrência/óbito. RESULTADOS: Foram incluídos no estudo 561 pacientes com CG, 57% tinham status pN+ e 17,5% tinham <25 linfonodos ressecados. O N-Ratio, com média de 0,12, previu a sobrevida com precisão de 74% (AUC=0,74; IC95% 0,70–0,78, p<0,001). As categorias N-Ratio incluíram: N-Ratio 0 (43%); N-Ratio 1 (12,3%); N-Ratio 2 (31,6%); e N-Ratio 3 (13,2%). A sobrevida livre de doença (SLD) variou entre todos os grupos N-Ratio, com o N-Ratio 3 apresentando pior sobrevida do que os casos pN3 (SLD=21,8 vs.11 meses, p=0,022, p<0,05). Nos casos com <25 linfonodos ressecados, a SLD não foi significativamente pior nos grupos N-Ratio 0 (68,8 vs. 81,9%, p=0,061, p>0,05) e N-Ratio 1 (66,2 vs. 50%, p=0,504, p>0,05). A SLD dos casos de N-Ratio 0 com <25 linfonodos foi semelhante aos casos de N-Ratio 1. CONCLUSÕES: O N-Ratio influenciou a sobrevida em pacientes com CG, especialmente na doença linfonodal avançada (N-Ratio 3). Considerando que a proporção N não afeta os casos pN0, a avaliação prognóstica individualizada é essencial para pacientes com <25 linfonodos ressecados. RACIONAL CG , (CG) NRatio, NRatio Ratio, Ratio ressecados promissora OBJETIVOS 25 <2 MÉTODOS analisados retrospectivamente ROC AUC (AUC recorrênciaóbito recorrência óbito recorrência/óbito RESULTADOS 56 57 175 17 5 17,5 012 12 0,12 74 AUC=0,74 AUC074 (AUC=0,74 IC95 IC 070078 70 78 0,70–0,78 p<0,001. p0001 p p<0,001 . 001 p<0,001) incluíram 43% 43 (43%) 12,3% 123 (12,3%) 31,6% 316 31 6 (31,6%) 13,2%. 132 13,2% 13 (13,2%) (SLD SLD=21,8 SLD218 21 8 (SLD=21, vs11 vs 11 vs.1 meses p0022 022 p=0,022 p<0,05. p005 p<0,05 05 p<0,05) 68,8 688 68 (68, 819 81 9 81,9% p0061 061 p=0,061 p>0,05 66,2 662 66 (66, 50 50% p0504 504 p=0,504 p>0,05. CONCLUSÕES 3. 3) pN0 (CG < 17, 01 0,1 7 AUC=0,7 AUC07 (AUC=0,7 IC9 07007 0,70–0,7 p000 p<0,00 00 4 (43% 12,3 (12,3% 31,6 (31,6% 13,2 (13,2% SLD=21, SLD21 (SLD=21 vs1 p002 02 p=0,02 p00 p<0,0 68, (68 81,9 p006 06 p=0,06 p>0,0 66, (66 p050 p=0,50 0, AUC=0, AUC0 (AUC=0, 0700 0,70–0, (43 12, (12,3 31, (31,6 13, (13,2 SLD=21 SLD2 (SLD=2 p=0,0 p0 p<0, (6 81, p>0, p05 p=0,5 AUC=0 (AUC=0 070 0,70–0 (4 (12, (31, (13, SLD=2 (SLD= p=0, p<0 ( p>0 AUC= (AUC= 07 0,70– (12 (31 (13 SLD= p=0 p< p> 0,70 (1 (3 p= 0,7

RESUMO Objetivo Correlacionar a performance funcional e impacto da disfagia na qualidade de vida de pacientes oncológicos em cuidados paliativos. Método Estudo transversal e quantitativo realizado no ambulatório e enfermaria de oncologia de um hospital universitário. Os critérios de inclusão exigiram que os pacientes respondessem positivamente à pergunta: “você tem dificuldade ou problema para engolir?”. Foram excluídos os pacientes que tivessem diagnóstico de câncer de cabeça e pescoço, incapacidade de responder questionários devido a estarem em processo ativo de morte, estado de sonolência, dor extrema e instabilidade sistêmica, bem como os instrumentos de coleta que não foram concluídos. Foram aplicados dois instrumentos em suas versões para o português brasileiro: a Palliative Performance Scale (PPS) e M. D. Anderson Dysphagia Inventory (MDADI). A análise das variáveis foi realizada com base na estatística descritiva e inferencial, por meio da correlação de Pearson, em nível de significância de 5%. Resultados A amostra foi composta por 39 participantes, com média de 65,3 anos, dos quais 24 (61,5%) eram mulheres. As localizações mais frequentes de neoplasia foram: pâncreas e estômago. O resultado da PPS indicou que a média dos pacientes apresentou deambulação reduzida, incapacidade para trabalhar, porém com independência no autocuidado, nível de ingesta e consciência completos e o MDADI obteve grau médio de limitação. Pacientes ambulatoriais apresentaram correlação moderada entre o resultado do MDADI e nível de funcionalidade pela PPS. Conclusão Pacientes oncológicos do ambulatório de cuidados paliativos apresentaram correlação entre performance funcional e o impacto da disfagia na qualidade de vida. universitário pergunta você engolir. engolir . engolir?” pescoço morte sonolência sistêmica concluídos brasileiro (PPS M D MDADI. (MDADI) inferencial Pearson 5 5% 3 participantes 653 65 65, anos 2 61,5% 615 61 (61,5% mulheres estômago reduzida trabalhar autocuidado limitação engolir? (MDADI 6 61,5 (61,5 61, (61, (61 (6 (

ABSTRACT Purpose To correlate the functional performance and impact of dysphagia on the quality of life of cancer patients in palliative care. Methods This cross-sectional, quantitative study was conducted at the outpatient clinic and oncology ward of a university hospital. Inclusion criteria required patients to respond positively to the question: “Do you have difficulty or problems swallowing?”. Patients were excluded if they had been diagnosed with head and neck cancer, were unable to answer questionnaires due to actively dying status, were in a state of drowsiness, experienced extreme pain and systemic instability, or if data collection instruments were incomplete. Two instruments were used in their Brazilian Portuguese versions: the Palliative Performance Scale (PPS) and the M. D. Anderson Dysphagia Inventory (MDADI). The variables were analyzed using descriptive and inferential statistics, with Pearson's correlation used at a 5% significance level. Results The sample consisted of 39 participants, with an average age of 65.3 years, of whom 24 (61.5%) were women. The most frequent neoplasm sites were the pancreas and stomach. The results of the PPS indicated that the average patient had reduced ambulation and inability to work, but maintained independence in self-care, with a complete level of swallowing and consciousness. The MDADI showed an average degree of limitation. Outpatients exhibited a moderate correlation between the MDADI result and the level of functionality according to the PPS. Conclusion Cancer patients at the palliative care outpatient clinic demonstrated a correlation between functional performance and the impact of dysphagia on quality of life. crosssectional, crosssectional cross sectional, sectional cross-sectional hospital question Do swallowing. . swallowing?” status drowsiness instability incomplete versions (PPS M D MDADI. (MDADI) statistics Pearsons Pearson s 5 3 participants 653 65 65. years 2 61.5% 615 61 (61.5% women stomach work selfcare, selfcare self care, self-care consciousness limitation swallowing? (MDADI 6 61.5 (61.5 61. (61. (61 (6 (

ABSTRACT Purpose: This study evaluated the prevalence of complications in the postoperative period of esophagogastric oncological surgeries. Methods: We conducted a retrospective cross-sectional study, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The study size implied 163 patients who underwent surgical treatment for esophageal and gastric cancer and experienced postoperative complications between January 2018 and December 2022. These patients were treated at the Liga Norte Riograndense Contra o Câncer, a high-complexity oncology center and a reference for cancer treatment in Northeast Brazil. Results: The prevalence found was 88.3%. The most prevalent complications were Clavien-Dindo I and II, and infection was the most common. According to our statistics analysis, hypoalbuminemia showed a positive correspondence with the occurrence of postoperative complications (odds ratio = 8.60; 95% confidence interval 1.35–54.64, p = 0.0358). Conclusions: Postoperative complications of gastroesophageal surgeries increase patient morbidity and mortality. Purpose Methods crosssectional cross sectional STROBE (STROBE guidelines 16 201 2022 Câncer highcomplexity high complexity Brazil Results 883 88 3 88.3% ClavienDindo Clavien Dindo II common analysis odds 8.60 860 8 60 95 1355464 1 35 54 64 1.35–54.64 0.0358. 00358 0.0358 . 0 0358 0.0358) Conclusions mortality 20 202 88.3 8.6 86 6 9 135546 5 1.35–54.6 0035 0.035 035 2 88. 8. 13554 1.35–54. 003 0.03 03 1355 1.35–54 00 0.0 135 1.35–5 0. 13 1.35– 1.35 1.3 1.

ABSTRACT Glomus tumors (GTs) are benign vascular neoplasms of soft tissues that occur in peripheral acral areas. Most intra-abdominal GTs develop in the stomach; the incidence of intestinal presentation is very low, We report the case of a 26-year-old female patient with chronic mild pain in the umbilical region with no other symptoms or signs. The imaging tests demonstrated a heterogeneous abdominopelvic mass with a solid vascularized component, and a cystic component with papillary projections. The pathology examination of the surgical specimen reported the diagnosis of GT of the small bowel (SB). We conducted a review of the literature and found their low incidence, affecting both men and women between 26 and 88 years without a predominant geographic distribution. Glomus tumors should be considered as a rare differential diagnosis in the presence of small SB tumors.

RESUMEN Los tumores glómicos (TG) son neoplasias vasculares benignas de tejidos blandos en zonas acrales periféricas. La mayoría de los TG intraabdominales se producen en el estómago; su presentación intestinal es de muy baja incidencia. Se presenta el caso de una mujer de 26 años, que consultó por dolor abdominal crónico de baja intensidad en región umbilical sin otra signo sintomatología. Se completó su estudio imagenológico y se detectó una lesión abdominopélvica heterogénea con componente sólido vascularizado, y líquido con proyecciones papilares. El informe de la patología de la pieza quirúrgica arrojó el diagnóstico de TG de intestino delgado. Se realizó una consulta que demuestra su baja incidencia: afecta a personas entre 26 y 88 años de ambos sexos en igual proporción, sin una distribución geográfica predominante. Los TG deben considerarse como un raro diagnóstico diferencial ante tumores del intestino delgado (ID).

Resumen Introducción: El riesgo de desarrollar cáncer gástrico varía entre continentes, países y regiones. A pesar de que existe una alta prevalencia de Helicobacter pylori su rol como patógeno o mutualista define el riesgo de cáncer gástrico en las regiones de Colombia. Objetivo: Discutir el rol de Helicobacter pylori en el riesgo de cáncer gástrico en Colombia. Materiales y métodos: Revisión de literatura mediante la búsqueda, en las bases de datos LILACS, SciELO, PubMed. Resultados: La coevolución del humano y de Helicobacter pylori; la virulencia de genes cagA, vacA; el tipo de respuesta inmune inflamatoria a Helicobacter pylori (Th1) o antinflamatoria (Th2) y la susceptibilidad humana a cáncer gástrico (IL1β, IL10), junto a la dieta y factores ambientales explican el papel de Helicobacter pylori como patógeno o mutualista asociado al riesgo de cáncer gástrico en Colombia. Conclusiones: Helicobacter pylori tiene un rol mutualista principalmente en poblaciones de bajo riesgo de cáncer gástrico (costas), no obstante, en poblaciones con alto riesgo de cáncer gástrico (andes), su papel como patógeno amerita la erradicación; única estrategia para mitigar la alta incidencia de este cáncer en Colombia.

Abstract Introduction: The risk to develop gastric cancer varies between continents, countries and regions. Although there is a high prevalence of Helicobater pylori, its role as either pathogen or mutualistic bacteria defines the risk of gastric cancer in Colombian regions. Objective: To discuss the role of Helicobacter pylori in the risk of gastric cancer in Colombia. Materials and methods: A literature review based on searching LILACS, SciELO, and PubMed databases. Results: Helicobacter pylori role as either a pathogen or mutualistic microorganism associated with gastric cancer risk in Colombia can be explained by analyzing elements such as: human and Helicobacter pylori coevolution; cagA and vacA gene virulence; inflammatory (Th1) or anti-inflammatory (Th2) responses induced by Helicobacter pylori; human susceptibility to gastric cancer (IL1β, IL10); diet; and environmental factors. Conclusions: Even though Helicobacter pylori has a mutualistic role in populations at low gastric cancer risk (coastal regions), its role as a pathogen in populations at higher risk (Andean regions) justifies its eradication as a key strategy to mitigate the incidence of this cancer in Colombia.

Resumo Introdução: O risco de desenvolver câncer gástrico varia entre continentes, países e regiões. Embora haja uma alta prevalência de Helicobacter pylori, seu papel como patógeno ou mutualista define o risco de câncer gástrico nas regiões da Colômbia. Objetivo: Discutir o papel do Helicobacter pylori no risco de câncer gástrico na Colômbia. Materiais e métodos: Revisão da literatura por meio da busca, nas bases de dados LILACS, SciELO e PubMed. Resultados: A coevolução de humanos e Helicobacter pylori; a virulência dos genes cagA, vacA; o tipo de resposta imune inflamatória ao Helicobacter pylori (Th1) ou anti-inflamatório (Th2) e a suscetibilidade humana ao câncer gástrico (IL1β, IL10), juntamente com a dieta e fatores ambientais explicam o papel do Helicobacter pylori como patógeno ou mutualista associado ao risco de câncer gástrico na Colômbia. Conclusões: Helicobacter pylori tem um papel mutualista principalmente em populações de baixo risco de câncer gástrico (litoral), porém, em populações com alto risco de câncer gástrico (andes), seu papel como patógeno justifica a erradicação; única estratégia para mitigar a alta incidência deste câncer na Colômbia.

ABSTRACT Introduction: Primary gastric choriocarcinoma (PGC) is a rare and highly aggressive neoplasm that represents less than 0.1% of all gastric cancers. This neoplasm is often confused with gastric adenocarcinoma because it shares clinical, epidemiological and histopathological characteristics, so it is important to maintain a high suspicion of this entity. Case of report: A case of a 64-year-old woman who came to the hospital with non-specific gastrointestinal symptoms that arose anemia, fatigue and early fullness is presented. The endoscopic biopsy of the lesion revealed the presence of PGC in clinical stage IV that presented a partial response after 4 cycles of chemotherapy with the EMA/EP regimen (Etoposide 140 mg, Methotrexate 440 mg, Actinomycin D 0.5 mg/ Etoposide 220 mg, cisplatin 110 mg). Conclusion: To emphasize the poor prognosis of extragonadal choriocarcinomas in contrast to gonadal choriocarcinomas, which usually have a better prognosis.

RESUMEN Introducción: El coriocarcinoma gástrico primario (CGP) es una neoplasia infrecuente y altamente agresiva que representa menos de 0.1% de todos los cánceres gástricos. Esta neoplasia suele ser frecuentemente confundida con adenocarcinoma gástrico debido a que comparte características clínicas, epidemiológicas e histopatológicas similares, por lo que es importante mantener una alta sospecha de esta entidad. Reporte de caso: Se presenta el caso de una paciente mujer de 64 años que acudió al hospital con síntomas gastrointestinales inespecíficos que incluían anemia, fatiga y llenura precoz. La biopsia endoscópica de la lesión reveló la presencia de CGP en estadio clínico IV que presentó una respuesta parcial luego de 4 ciclos de quimioterapia con el esquema EMA/EP (Etoposido 140 mg, Metotrexate 440 mg, Actinomicina D 0.5 mg/ Etoposido 220 mg, cisplatino 110 mg). Conclusión: Enfatizar el mal pronóstico de los coriocarcinomas extragonadales en contraste con los coriocarcinomas gonadales, los cuales suelen tener un mejor pronóstico.

Abstract Aim: The main objective of this study is to determine the response to the firstline treatment regimen with triple standard therapy (amoxicillin, clarithromycin, omeprazole), to eradicate Helicobacter pylori in a certain population. The goal is to determine if the proposed regimen in international guidelines services is still a suitable option for patients in a certain region of Costa Rica. Methods: The study took place in San Francisco de Asís Hospital, Grecia, Alajuela, Costa Rica. All patients with a Helicobacter pylori infection that were given first- line treatment with triple therapy (amoxicillin, clarithromycin and omeprazole) for its eradication for 14 days, in the period between February of 2017 and February of 2019, were included in the study. Results: A total of 369 cases were identified. The diagnosis was made with biopsy in 96.4% of patients. Response to first-line treatment was achieved in 90.5% corroborated by fecal antigen in 92.1% of all cases. Conclusions: This study shows that triple therapy with amoxicillin, clarithromycin and omeprazole for 14 days maintains an adequate level of efficacy. However, it must be considered that these results are from a specific area and may not reflect the reality of the entire country.

Resumen Objetivo: Este estudio tiene como objetivo principal determinar la respuesta al esquema de tratamiento de primera línea con triple terapia estándar (amoxicilina, claritromicina, omeprazol), para erradicación de Helicobacter pylori en una determinada población, para determinar si este esquema propuesto en guías internacionales es aún una opción adecuada para pacientes en una determinada región de Costa Rica. Métodos: Se realizó una búsqueda en el servicio de gastroenterología del Hospital San Francisco de Asís, Grecia, Alajuela, Costa Rica; de todos los pacientes con infección por Helicobacter pylori y que recibieron tratamiento de primera línea con triple terapia (amoxicilina, claritromicina y omeprazol) por 14 días, en el periodo comprendido entre febrero 2017 a febrero 2019, incluyendo para el análisis solamente en los que se contaba con una prueba confirmatoria posterior a tratamiento, ya fuera por antígeno fecal de H. pylori o biopsia convencional. Resultados: Se identificaron un total de 369 casos. El diagnóstico se realizó con biopsia en el 96,4% de los pacientes. La respuesta al tratamiento de primera línea se alcanzó en un 90.5% corroborada por antígeno fecal en el 92.1% de los casos. Conclusiones: Este estudio muestra que la terapia triple con amoxicilina, claritromicina e Inhibidor de bomba de protones por 14 días mantiene un adecuado nivel de eficacia. Sin embargo, hay que tomar en cuenta que estos datos son únicamente de un área de atracción determinada y puede que no reflejen la realidad de todo el país.

Background: The effect of the duodenal exclusion in glycemic regulation has yet to benbsp;defined. Individuals with type 2 Diabetes Mellitus (T2DM) operated for other reasons thannbsp;obesity, represent an adequate model to analyze clinical outcomes of duodenal exclusion.nbsp;nbsp; Objective: To analyze the changes in glycemia and pharmacotherapy for T2DM in patients undergoing gastrectomy with Roux-in-Y derivation for gastric cancer.nbsp; Methods: An observational study was conducted in 2018 on patients who were submitted to surgery from 2001 to 2016. Medical records of 129 patients’ cohort operated in two public hospitals were analyzed retrospectively before the surgery (T0) and one year after (T1). The researchnbsp;protocol was approved by the ethics committee. The final sample was mainly represented bynbsp;women (50.5%) with a mean age of 65.5 years, and a mean body mass index of 26.5 kg/m2 SD 4.30.nbsp;nbsp; Results: One year later, mean glucose levels of the entire sample decreased (p=0.046), but 70% of patients with glycemiagt; 100 at T0, remained with the same value in T1. Glycated hemoglobin had no significant change (p=0.988). Regarding the pharmacotherapy for T2DM,nbsp;60.7% of the sample had no change. However, 6.7% had discontinuation of the medication with the improvement of T2DM. The multivariate model by classification and decision tree method (CART) found as predictors of change innbsp;DM2 medication, age (lt;62.5 years) and a body mass index (gt; 30.2 kg/m2) with a predictive value ofnbsp;71.4%.nbsp; Conclusion: There was no improvement of glycemia and pharmacotherapy in patients withnbsp;T2DM who underwent gastrectomy with Roux-en-Y reconstruction, with a body mass index below 30nbsp;kg/m2

Antecedentes: Aún no se ha definido el efecto de la exclusión duodenal en la regulación glucémica. Individuos con Diabetes Mellitus tipo 2 (DM2) operados por otras razones distintas a la obesidad, representan un modelo adecuado para analizar los resultados clínicos de la exclusión duodenal. Objetivo: Analizar los cambios en la glucemia y la farmacoterapia para la DM2 en pacientes sometidos a gastrectomía con derivación en Y de Roux por cáncer gástrico. Métodos: se realizó un estudio observacional en 2018 en pacientes que fueron sometidos a cirugía entre 2001 y 2016. Se analizaron retrospectivamente las historias clínicas de una cohorte de 129 pacientes operados en dos hospitales públicos antes de la cirugía (T0) y un año después (T1). El protocolo de investigación fue aprobado por el comité de ética. La muestra final estuvo representada mayoritariamente por mujeres (50,5 %) con una edad media de 65,5 años y un índice de masa corporal medio de 26,5 kg/m2 SD 4,30. Resultados: Un año después, los niveles medios de glucosa de toda la muestra disminuyeron (p=0,046), pero el 70% de los pacientes con glucemia gt; 100 en T0, permanecieron con el mismo valor en T1. La hemoglobina glicosilada no tuvo cambios significativos (p=0,988). En cuanto a la farmacoterapia para la DM2, el 60,7% de la muestra no presentó cambios. Sin embargo, el 6,7% tuvo suspensión de la medicación con la mejoría de la DM2. El modelo multivariante por método de clasificación y árbol de decisión (CART) encontró como predictores de cambio de medicación en DM2 la edad (lt; 62,5 años) y el índice de masa corporal (gt; 30,2 kg/m2) con un valor predictivo del 71,4%. Conclusión: No hubo mejoría de la glucemia y la farmacoterapia en pacientes con DM2 que se sometieron a gastrectomía con reconstrucción en Y de Roux, con un índice de masa corporal por debajo de 30 kg/m2

Contexto: O efeito da exclusão duodenal na regulação glicêmica ainda não foi definido. Indivíduos com Diabetes Mellitus tipo 2 (T2DM) operados por outros motivos que não obesidade, representam um modelo adequado para analisar os resultados clínicos da exclusão duodenal. Objetivo: Analisar as alterações da glicemia e da farmacoterapia para DM2 em pacientes submetidos à gastrectomia com derivação em Y de Roux para câncer gástrico. Métodos: Foi realizado um estudo observacional em 2018 em pacientes operados de 2001 a 2016. Os prontuários de uma coorte de 129 pacientes operados em dois hospitais públicos foram analisados ​​retrospectivamente antes da cirurgia (T0) e um ano após (T1). O protocolo de pesquisa foi aprovado pelo comitê de ética. A amostra final foi representada principalmente por mulheres (50,5%) com idade média de 65,5 anos e índice de massa corporal médio de 26,5 kg/m2 SD 4,30. Resultados: Um ano depois, os níveis médios de glicose de toda a amostra diminuíram (p=0,046), mas 70% dos pacientes com glicemia gt; 100 em T0, permaneceram com o mesmo valor em T1. A hemoglobina glicada não apresentou alteração significativa (p=0,988). Em relação à farmacoterapia para DM2, 60,7% da amostra não apresentou alteração. No entanto, 6,7% tiveram descontinuação da medicação com melhora do DM2. O modelo multivariado pelo método de classificação e árvore de decisão (CART) encontrou como preditores de mudança na medicação para DM2, idade (lt;62,5 anos) e índice de massa corporal (gt; 30,2 kg/m2) com valor preditivo de 71,4%. Conclusão: Não houve melhora da glicemia e farmacoterapia em pacientes com DM2 submetidos à gastrectomia com reconstrução em Y de Roux, com índice de massa corporal abaixo de 30 kg/m2

ABSTRACT The objective was to evaluate the association between octogenarian age and the rate of postoperative morbidity and mortality and 5-year survival in older adults at the National Institute of Neoplastic Diseases (INEN) during the period 2000-2013. We developed an observational, retrospective, analytical, paired cohort study. It includes patients with gastric adenocarcinoma as diagnosis, treated by R0 D2 gastrectomy at INEN during the period 2000 to 2013. One group included all octogenarian patients who met the inclusion criteria (92) and the other group made up of non-octogenarian patients, aged between 50 to 70 years because it is the age peak for this pathology (276). In a 1:3 ratio, paired according to sex, tumor stage, and type of gastrectomy, which are the main factors that could influence survival in this population. Octogenarians had lower albumin level (p<0.002), lower preoperative hemoglobin (p<0.001) and higher ASA classification (p<0.001). 30 days mortality rate was higher in octogenarians but not statistically significant (4.1% vs 1.4%; p=0.099). The 5-year cumulative survival probability was 56% for octogenarians and 58% for non- octogenarians (p=0.763). Clinical stage ≥ III and postoperative complication grade ≥ 3 by Clavien Dindo scale were predictors of survival. In conclusion, octogenarians have a higher rate of postoperative morbidity, mainly for respiratory causes. Postoperative mortality and overall survival rates do not differ between octogenarians and non-octogenarians with stomach cancer treated by R0 D2 gastrectomy.

RESUMEN El objetivo de la presente investigación es evaluar la asociación entre la edad octogenaria y la tasa de morbimortalidad posoperatoria y supervivencia a los 5 años en adultos mayores tratados mediante gastrectomía R0 D2 en el Instituto Nacional de Enfermedades Neoplásicas (INEN) durante el periodo 2000-2013. Se realizó un estudio observacional, retrospectivo, analítico de cohorte pareado, que incluye pacientes con diagnóstico de adenocarcinoma gástrico tratados mediante gastrectomía R0 D2 en el INEN durante los años 2000 a 2013. Un grupo compuesto por todos los pacientes octogenarios que cumplieron los criterios de inclusión (92) y otro grupo compuesto por pacientes no octogenarios, con edades entre 50 a 70 años por ser el pico de presentación para esta patología (276). En una proporción 1:3, pareados según sexo, estadio tumoral y tipo de gastrectomía, los cuales constituyen los principales factores que podrían influir en la sobrevida de esta población. Los octogenarios presentaron menor albúmina (p<0,002), menor hemoglobina preoperatoria (p<0,001) y mayor clase ASA (p<0,001). La tasa de mortalidad a 30 días fue mayor en los octogenarios, pero no estadísticamente significativa (4,1% vs 1,4%; p=0,099). La probabilidad acumulada de supervivencia a 5 años fue 56% para octogenarios y 58% para los controles (p=0,763). El estadio clínico ≥ III y complicación posoperatoria grado ≥3 por Clavien Dindo fueron factores asociados de supervivencia. En conclusión, los octogenarios presentan mayor tasa de morbilidad posoperatoria, principalmente de causa respiratoria. Las tasas de mortalidad posoperatoria y supervivencia global no difieren entre octogenarios y no octogenarios con cáncer de estómago tratados mediante gastrectomía R0 D2.