Abstract Prognostic factors for local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision. Background: The standard curative treatment for locally advanced rectal cancer of the middle and lower thirds is long-course chemoradiotherapy followed by total mesorectal excision. Purpose: To evaluate the prognostic factors associated with local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision. Methods: Retrospective study including patients with rectal cancer T3–4N0M0 or T (any)N + M0 located within 10 cm from the anal border, or patients with T2N0M0 located within 5 cm, treated by long course chemoradio-therapy followed by total mesorectal excision with curative intent. Clinical, demographic, radiologic, surgical, and anatomopathological data were collected. Local recurrence was estimated using the Kaplan-Meier function, and risk was estimated according to each characteristic using univariate and multivariate analyses. Results: 270 patients were included, 57.8% male and mean age 61.7 (30‒88) years. At initial staging, 6.7% of patients were stage I, 21.5% stage II, and 71.8% stage III. Open surgery was performed in 65.2%, with sphincter preservation in 78.1%. Mortality within 30 postoperative days was 0.7%. After 49.4 (0.5‒86.1) months of median follow-up, overall and local recurrences were 26.3% and 5.9%. On multivariate analyses, local recurrence was associated with involvement of the mesorectal fascia on restaging MRI (HR = 9.11, p = 0.001) and with pathologic involvement of radial surgical margin (HR = 8.19, p < 0.001). Conclusion: Local recurrence of rectal cancer treated with long-course chemoradiation and total mesorectal excision is low and is associated with pathologic involvement of the radial surgical margin and can be predicted on restaging MRI. Background longcourse Purpose Methods T34N0M0 TNM T3 4N0M0 N M T3–4N0M anyN any 1 border T2N0M chemoradio therapy intent Clinical demographic radiologic collected KaplanMeier Kaplan Meier function analyses Results 27 included 578 57 8 57.8 617 61 7 61. 30‒88 3088 88 (30‒88 years staging 67 6 6.7 I 215 21 21.5 II 718 71 71.8 III 652 65 2 65.2% 781 78 78.1% 3 07 0 0.7% 494 49 4 49. 0.5‒86.1 05861 86 (0.5‒86.1 followup, followup follow up, up follow-up 263 26 26.3 59 9 5.9% HR 911 11 9.11 0.001 0001 001 819 19 8.19 0.001. . Conclusion T34N0M NM 4N0M 57. 30‒8 308 (30‒8 6. 21. 71. 65.2 78.1 0.7 0.5‒86. 0586 (0.5‒86. 26. 5.9 91 9.1 0.00 000 00 81 8.1 30‒ (30‒ 65. 78. 0. 0.5‒86 058 (0.5‒86 5. 9. 0.0 8. (30 0.5‒8 05 (0.5‒8 (3 0.5‒ (0.5‒ ( 0.5 (0.5 (0. (0

Abstract Introduction: Crohn’s disease (CD) has been related to an increased prevalence of psychiatric disorders and suicide risk (SR). However, the nature of their relationship still deserves clarification. The aim of this study is to assess the prevalence of major depressive disorder (MDD) in patients with CD, and to investigate the relationship between MDD and CD outcomes. Methods: A cross-sectional study involving CD patients was performed. CD activity was evaluated by the Harvey-Bradshaw index and CD phenotype by the Montreal classification. The presence of MDD was assessed by the Patient Health Questionnaire score-9 (PHQ-9). Sociodemographic data and other characteristics were retrieved from electronic medical records. Results: 283 patients with CD were included. The prevalence of MDD was 41.7%. Females had a risk of MDD 5.3 times greater than males. CD disease duration was inversely correlated with MDD severity. Individuals with active CD were more likely to have MDD (OR = 796.0; 95% CI 133.7‒4738.8) than individuals with CD remission. MDD was more prevalent in inflammatory behavior (45.5%) and there were no statistical differences regarding the disease location. 19.8% of the sample scored positive for SR. Conclusion: The present results support data showing an increased prevalence of MDD in individuals with CD. Additionally, it indicates that MDD in CD might be related to the activity of CD. Prospective studies are warranted to confirm these results and to address whether MDD leads to CD activity, CD activity leads to MDD or both ways are existent. Introduction Crohns Crohn s (CD SR . (SR) However clarification (MDD outcomes Methods crosssectional cross sectional performed HarveyBradshaw Harvey Bradshaw classification score9 score 9 score- PHQ9. PHQ9 PHQ (PHQ-9) records Results 28 included 417 41 7 41.7% 53 5 3 5. males severity OR 796.0 7960 796 0 95 133.7‒4738.8 133747388 133 4738 8 remission 45.5% 455 45 (45.5% location 198 19 19.8 Conclusion Additionally existent (SR (PHQ-9 2 4 41.7 796. 79 133.7‒4738. 13374738 13 473 45.5 (45.5 1 19. (PHQ- 41. 133.7‒4738 1337473 47 45. (45. (PHQ 133.7‒473 133747 (45 133.7‒47 13374 (4 133.7‒4 1337 ( 133.7‒ 133.7 133.

Abstract Background & Aims Perianal fistulizing Crohn's disease is the main risk factor for anal cancer in patients with inflammatory bowel disease. Whether this occurs due to a higher frequency of human papillomavirus remains unclear. The authors aimed to evaluate the prevalence of HPV and high-risk HPV in patients with perianal Crohn's disease, compared with a control group. Methods The authors conducted a two-center cross-sectional study in which perianal fistulizing Crohn's disease patients were matched for age and sex with patients with anorectal fistula without Crohn's disease. Biopsy specimens were obtained from fistulous tracts during examination under anesthesia for both groups. The samples were sent for HPV detection and genotyping using the INNO-LiPA test. Results A total of 108 subjects (54 in each group) were recruited. The perianal fistulizing Crohn's disease group showed a statistically higher frequency of HPV in the fistulous tract than the control group (33.3% vs. 16.7%; p = 0.046). Separate analyses on high-risk types demonstrated that there was a numerically higher frequency of HPV in the perianal fistulizing Crohn's disease group. In multiple logistic regression, patients with perianal fistulizing Crohn's disease were found to have a chance of HPV 3.29 times higher than patients without Crohn's disease (OR = 3.29; 95% CI 1.20‒9.01), regardless of other variables. The types most frequently identified in the perianal fistulizing Crohn's disease group were HPV 11 (12.96%) and HPV 16 (9.26%). Conclusion Perianal fistulizing Crohn's disease is associated with a higher prevalence of HPV than in patients with anorectal fistula without Crohn's disease. Crohns Crohn s unclear highrisk high twocenter two center crosssectional cross sectional groups INNOLiPA INNO LiPA test 10 54 (5 recruited 33.3% 333 33 3 (33.3 vs 16.7% 167 7 0.046. 0046 0.046 . 0 046 0.046) regression 329 29 3.2 OR 95 1.20‒9.01, 120901 1.20‒9.01 , 1 20 9 01 1.20‒9.01) variables 12.96% 1296 12 96 (12.96% 9.26%. 926 9.26% 26 (9.26%) 5 ( 33.3 (33. 16.7 004 0.04 04 32 2 3. 12090 1.20‒9.0 12.96 129 (12.96 92 9.26 (9.26% 33. (33 16. 00 0.0 1209 1.20‒9. 12.9 (12.9 9.2 (9.26 (3 0. 120 1.20‒9 12. (12. 9. (9.2 1.20‒ (12 (9. 1.20 (1 (9 1.2 1.

ABSTRACT BACKGROUND: Minimally invasive distal pancreatectomy (MIDP) is associated with less blood loss and faster functional recovery. However, the benefits of robotic assisted distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) are unknown. AIMS: To compare RDP versus LDP for surgical treatment of benign lesions, pre-malignant and borderline malignant pancreatic neoplasias. METHODS: This is a retrospective study comparing LDP with RDP. Main outcomes were overall morbidity and overall costs. Secondary outcomes were pancreatic fistula (PF), infectious complications, readmission, operative time (OT) and length of hospital stay (LOS). RESULTS: Thirty patients submitted to LDP and 29 submitted to RDP were included in the study. There was no difference regarding preoperative characteristics. There was no difference regarding overall complications (RDP – 72,4% versus LDP – 80%, p=0,49). Costs were superior for patients submitted to RDP (RDP=US$ 6,688 versus LDP=US$ 6,149, p=0,02), mostly due to higher costs of surgical materials (RDP=US$ 2,364 versus LDP=1,421, p=0,00005). Twenty-one patients submitted to RDP and 24 to LDP developed pancreatic fistula (PF), but only 4 RDP and 7 LDP experienced infectious complications associated with PF. OT (RDP=224 min. versus LDP=213 min., p=0.36) was similar, as well as conversion to open procedure (1 RDP and 2 LDP). CONCLUSIONS: The postoperative morbidity of robotic distal pancreatectomy is comparable to laparoscopic distal pancreatectomy. However, the costs of robotic distal pancreatectomy are slightly higher. BACKGROUND MIDP (MIDP recovery However (LDP unknown AIMS lesions premalignant pre neoplasias METHODS PF, PF , (PF) readmission (OT LOS. LOS . (LOS) RESULTS characteristics 724 72 72,4 80 80% p=0,49. p049 p p=0,49 0 49 p=0,49) RDP=US$ RDPUS US (RDP=US 6688 6 688 6,68 LDPUS LDP=US 6149 149 6,149 p=0,02, p002 p=0,02 02 p=0,02) 2364 364 2,36 LDP1421 1 421 LDP=1,421 p=0,00005. p000005 p=0,00005 00005 p=0,00005) Twentyone Twenty one RDP=224 RDP224 224 (RDP=22 min LDP213 213 LDP=21 p=0.36 p036 36 similar ( LDP. LDP) CONCLUSIONS (PF (LOS 72, 8 p04 p=0,4 RDP=US 668 68 6,6 614 14 6,14 p00 p=0,0 236 2,3 LDP142 42 LDP=1,42 p00000 p=0,0000 0000 RDP=22 RDP22 22 (RDP=2 LDP21 21 LDP=2 p=0.3 p03 3 p0 p=0, 66 6, 61 6,1 23 2, LDP14 LDP=1,4 p0000 p=0,000 000 RDP=2 RDP2 (RDP= LDP2 LDP= p=0. p=0 LDP1 LDP=1, p000 p=0,00 00 RDP= p= LDP=1

RESUMO RACIONAL: A pancreatectomia distal minimamente invasiva (PDMI) está associada a menos perda sanguínea e recuperação funcional mais rápida, no entanto, os benefícios da pancreatectomia distal robótica (PDR) são desconhecidos quando comparada a pancreatectomia distal laparoscópica (PDL). OBJETIVOS: Comparar PDR versus PDL no tratamento cirúrgico de lesões benignas, neoplasias pancreáticas malignas, pré-malignas e limítrofes. MÉTODOS: Estudo retrospectivo comparando PDL com PDR. Os desfechos primários avaliados foram morbidade e custos hospitalares. Os desfechos secundários foram fístula pancreática (FP), complicações infecciosas, readmissão, tempo cirúrgico e tempo de internação hospitalar (TIH). RESULTADOS: Trinta pacientes submetidos a PDL e 29 submetidos a PDR foram incluídos no estudo. Não houve diferença em relação às características pré-operatórias. Não houve diferença em relação às complicações gerais (PDL – 72,4% versus PRD – 80%, p=0,49). Os custos foram superiores para PDR (PDR=US$ 6688 versus PDL=US$ 6149, p=0,02), principalmente devido aos custos mais elevados de materiais cirúrgicos (PDR=US$ 2364 versus PDL=1421, p=0,00005). Vinte e um pacientes submetidos a PDR e 24 submetidos a PDL desenvolveram fístula pancreática (PF), no entanto, apenas 4 submetidos PDR e 7 a PDL apresentaram complicações infecciosas associadas a FP. O tempo cirúrgico (PDR=224 min. versus PDL=213 min., p=0,36) e a conversão para cirurgia aberta (1 PDR e 2 PDL) não tiveram diferença estatística. CONCLUSÕES: A morbidade pós operatória da pancreatectomia distal robótica é comparável à pancreatectomia distal laparoscópica. Entretando, os custos da pancreatectomia distal robótica são mais elevados. RACIONAL PDMI (PDMI rápida entanto (PDR PDL. . (PDL) OBJETIVOS benignas malignas prémalignas pré limítrofes MÉTODOS hospitalares FP, FP , (FP) readmissão TIH. TIH (TIH) RESULTADOS estudo préoperatórias. préoperatórias operatórias. operatórias pré-operatórias 724 72 72,4 80 80% p=0,49. p049 p p=0,49 0 49 p=0,49) PDR=US$ PDRUS US (PDR=US 668 PDLUS PDL=US 6149 p=0,02, p002 p=0,02 02 p=0,02) 236 PDL1421 1421 PDL=1421 p=0,00005. p000005 p=0,00005 00005 p=0,00005) PF, PF (PF) PDR=224 PDR224 224 (PDR=22 min PDL213 213 PDL=21 p=0,36 p036 36 1 ( estatística CONCLUSÕES Entretando (FP (TIH 72, 8 p04 p=0,4 PDR=US 66 614 p00 p=0,0 23 PDL142 142 PDL=142 p00000 p=0,0000 0000 (PF PDR=22 PDR22 22 (PDR=2 PDL21 21 PDL=2 p=0,3 p03 3 p0 p=0, 6 61 PDL14 14 PDL=14 p0000 p=0,000 000 PDR=2 PDR2 (PDR= PDL2 PDL= p=0 PDL1 PDL=1 p000 p=0,00 00 PDR= p=

Resumo Objetivo: Avaliar os valores máximo e médio de captação padronizada, o valor metabólico do tumor e a glicólise total da lesão do local do tumor primário, medidos no estudo de 18F-FDG-PET/CT realizado antes e depois da quimiorradioterapia neoadjuvante (nQRT) em pacientes com câncer de esôfago, como preditores de doença residual (DR). Materiais e Métodos: Os valores máximo e médio de captação padronizada e os parâmetros volumétricos (valor metabólico do tumor e glicólise total da lesão) da 18F-FDG-PET/CT realizada em 39 pacientes antes e após a nQRT para carcinoma de esôfago foram avaliados para RD. Usamos curvas receiver operating characteristic (ROC) para analisar o desempenho diagnóstico dos parâmetros 18F-FDG-PET/CT na definição de RD. O estudo anatomopatológico foi utilizado como padrão ouro. Resultados: Dezoito pacientes (46%) apresentaram DR após a nQRT. Áreas estatisticamente significativas sob a curva ROC para predizer DR foram obtidas para as quatro variáveis nos estudos realizados após a nQRT, com áreas sob a curva ROC semelhantes em torno de 0,72. Considerando a presença de captação visualmente detectável (captação maior que o background) no local da lesão primária após a nQRT como resultado positivo, teríamos uma sensibilidade de 94% e uma especificidade de 48% para detecção de DR. Conclusão: A 18F-FDG-PET/CT pode ser útil para detectar a presença de doença neoplásica residual no câncer de esôfago após a nQRT.

Abstract Objective: To evaluate the maximum and mean standardized uptake values, together with the metabolic tumor value and the total lesion glycolysis, at the primary tumor site, as determined by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT), performed before and after neoadjuvant chemoradiotherapy (nCRT), as predictors of residual disease (RD) in patients with esophageal cancer. Materials and Methods: The standardized uptake values and the volumetric parameters (metabolic tumor value and total lesion glycolysis) were determined by 18F-FDG-PET/CT to identify RD in 39 patients before and after nCRT for esophageal carcinoma. We used receiver operating characteristic curves to analyze the diagnostic performance of 18F-FDG-PET/CT parameters in the definition of RD. The standard of reference was histopathological analysis of the surgical specimen. Results: Eighteen patients (46%) presented RD after nCRT. Statistically significant areas under the curve (approximately 0.72) for predicting RD were obtained for all four of the variables evaluated after nCRT. Considering the presence of visually detectable uptake (higher than the background level) at the primary tumor site after nCRT as a positive result, we achieved a sensitivity of 94% and a specificity of 48% for the detection of RD. Conclusion: The use of 18F-FDG-PET/CT can facilitate the detection of RD after nCRT in patients with esophageal cancer.

RESUMO RACIONAL: A enzima metilenotetrahidrofolato redutase está envolvida na síntese de DNA através do metabolismo do folato. A inibição da sua atividade aumenta a suscetibilidade a mutações, danos e metilação aberrante do DNA, o que altera a expressão gênica de supressores tumorais e proto-oncogenes, potenciais fatores de risco para câncer de esôfago. OBJETIVOS: Investigar a associação entre os polimorfismos metilenotetrahidrofolato redutase 677C>T e metilenotetrahidrofolato redutase 1298A>C e a suscetibilidade ao câncer de esôfago, avaliando a distribuição de genótipos e haplótipos entre casos e controles, bem como investigar a associação de polimorfismos com características clínicas, epidemiológicas e sobrevida. MÉTODOS: Avaliaram-se 109 pacientes com câncer de esôfago submetidos à esofagectomia, enquanto 102 indivíduos constituaram o grupo controle. O DNA genômico do sangue periférico foi isolado e submetido à amplificação por reação em cadeia da polimerase em tempo real. A associação entre os polimorfismos e o risco de desenvolver câncer de esôfago foi avaliada por regressão logística. RESULTADOS: Não houve associação dos polimorfismos e haplótipos metilenotetrahidrofolato redutase 677C>T e metilenotetrahidrofolato redutase 1298A>C com a suscetibilidade ao câncer de esôfago. Pacientes com câncer de esôfago portadores do polimorfismo metilenotetrahidrofolato redutase 677TT apresentaram maior risco de morte pela doença. Para o genótipo TT homozigoto polimórfico, o risco de morte aumentou significativamente em comparação com os casos do genótipo selvagem metilenotetrahidrofolato redutase 677CC (referência) (p=0,045; RR=2,22, IC95% 1,02–4,83). CONCLUSÕES: Não houve associação entre os polimorfismos metilenotetrahidrofolato redutase 677C>T e metilenotetrahidrofolato redutase 1298A>C e o risco de suscetibilidade ao câncer de esôfago. O genótipo homozigoto polimórfico metilenotetrahidrofolato redutase 677TT associou-se a um maior risco de óbito após tratamento cirúrgico para câncer de esôfago.

ABSTRACT BACKGROUND: The enzyme methylenetetrahydrofolate reductase is engaged in DNA synthesis through folate metabolism. Inhibiting the activity of this enzyme increases the susceptibility to mutations, and damage and aberrant DNA methylation, which alters the gene expression of tumor suppressors and proto-oncogenes, potential risk factors for esophageal cancer. AIMS: This study aimed to investigate the association between methylenetetrahydrofolate reductase 677C>T and methylenetetrahydrofolate reductase 1298A>C polymorphisms and susceptibility to esophageal cancer, by assessing the distribution of genotypes and haplotypes between cases and controls, as well as to investigate the association of polymorphisms with clinical and epidemiological characteristics and survival. METHODS: A total of 109 esophageal cancer patients who underwent esophagectomy were evaluated, while 102 subjects constitute the control group. Genomic DNA was isolated from the peripheral blood buffy coat followed by amplification by polymerase chain reaction and real-time analysis. Logistic regression was used to assess associations between polymorphisms and the risk of developing esophageal cancer. RESULTS: There was no association for methylenetetrahydrofolate reductase 677C>T and methylenetetrahydrofolate reductase 1298A>C polymorphisms and haplotypes, with esophageal cancer susceptibility. Esophageal cancer patients carrying methylenetetrahydrofolate reductase 677TT polymorphism had higher risk of death from the disease. For polymorphic homozygote TT genotype, the risk of death significantly increased compared to wild-type genotype methylenetetrahydrofolate reductase 677CC (reference) cases (p=0.045; RR=2.22, 95%CI 1.02–4.83). CONCLUSIONS: There was no association between methylenetetrahydrofolate reductase 677C>T and methylenetetrahydrofolate reductase 1298A>C polymorphisms and esophageal cancer susceptibility risk. Polymorphic homozygote genotype methylenetetrahydrofolate reductase 677TT was associated with higher risk of death after surgical treatment for esophageal cancer.

ABSTRACT BACKGROUND: Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias. AIMS: This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. METHODS: This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$). RESULTS: A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91±644.79; LVIHR: 1,989.67±763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57±211.51; LVIHR: 84.55±252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43±894.97; LVIHR: 2,120.16±663.78; p<0.001), material resources (RVIHR: 3,204.32±351.55; LVIHR: 736.51±972.32; p<0.001), and medications (RVIHR: 823.40±175.47; LVIHR: 288.50±352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24±3,520.82; LVIHR: 10,295.95±3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes. CONCLUSION: Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs. BACKGROUND Roboticassisted assisted debated strategies AIMS institution METHODS ReBEC (ReBEC RBR5s6mnrf. RBR5s6mnrf RBRsmnrf RBR 5s6mnrf . s mnrf RBR-5s6mnrf) (LVIHR (RVIHR) R$. R R$ (R$) RESULTS 1 (RVIHR 2,447.91±644.79 24479164479 2 447 91 644 79 1,989.67±763.00 19896776300 989 67 763 00 p=0.030, p0030 p p=0.030 , 0 030 p=0.030) 270.57±211.51 2705721151 270 57 211 51 84.55±252.34 845525234 84 55 252 34 p=0.023, p0023 p=0.023 023 p=0.023) 3,164.43±894.97 31644389497 3 164 43 894 97 2,120.16±663.78 21201666378 120 16 663 78 p<0.001, p0001 p<0.001 001 3,204.32±351.55 32043235155 204 32 351 736.51±972.32 7365197232 736 972 823.40±175.47 8234017547 823 40 175 47 288.50±352.55 2885035255 288 50 352 14,712.24±3,520.82 1471224352082 14 712 24 520 82 10,295.95±3,453.59 1029595345359 10 295 95 453 59 p<0.001. stay ward tests meshes CONCLUSION smnrf RBR-5s6mnrf (R$ 2,447.91±644.7 2447916447 44 9 64 7 1,989.67±763.0 1989677630 98 6 76 p003 p=0.03 03 270.57±211.5 270572115 27 5 21 84.55±252.3 84552523 8 25 p002 p=0.02 02 3,164.43±894.9 3164438949 4 89 2,120.16±663.7 2120166637 12 66 p000 p<0.00 3,204.32±351.5 3204323515 20 35 736.51±972.3 736519723 73 823.40±175.4 823401754 17 288.50±352.5 288503525 28 14,712.24±3,520.8 147122435208 71 52 10,295.95±3,453.5 102959534535 29 45 (R 2,447.91±644. 244791644 1,989.67±763. 198967763 p00 p=0.0 270.57±211. 27057211 84.55±252. 8455252 3,164.43±894. 316443894 2,120.16±663. 212016663 p<0.0 3,204.32±351. 320432351 736.51±972. 73651972 823.40±175. 82340175 288.50±352. 28850352 14,712.24±3,520. 14712243520 10,295.95±3,453. 10295953453 2,447.91±644 24479164 1,989.67±763 19896776 p0 p=0. 270.57±211 2705721 84.55±252 845525 3,164.43±894 31644389 2,120.16±663 21201666 p<0. 3,204.32±351 32043235 736.51±972 7365197 823.40±175 8234017 288.50±352 2885035 14,712.24±3,520 1471224352 10,295.95±3,453 1029595345 2,447.91±64 2447916 1,989.67±76 1989677 p=0 270.57±21 270572 84.55±25 84552 3,164.43±89 3164438 2,120.16±66 2120166 p<0 3,204.32±35 3204323 736.51±97 736519 823.40±17 823401 288.50±35 288503 14,712.24±3,52 147122435 10,295.95±3,45 102959534 2,447.91±6 244791 1,989.67±7 198967 p= 270.57±2 27057 84.55±2 8455 3,164.43±8 316443 2,120.16±6 212016 p< 3,204.32±3 320432 736.51±9 73651 823.40±1 82340 288.50±3 28850 14,712.24±3,5 14712243 10,295.95±3,4 10295953 2,447.91± 24479 1,989.67± 19896 270.57± 2705 84.55± 845 3,164.43± 31644 2,120.16± 21201 3,204.32± 32043 736.51± 7365 823.40± 8234 288.50± 2885 14,712.24±3, 1471224 10,295.95±3, 1029595 2,447.91 2447 1,989.67 1989 270.57 84.55 3,164.43 3164 2,120.16 2120 3,204.32 3204 736.51 823.40 288.50 14,712.24±3 147122 10,295.95±3 102959 2,447.9 244 1,989.6 198 270.5 84.5 3,164.4 316 2,120.1 212 3,204.3 320 736.5 823.4 288.5 14,712.24± 14712 10,295.95± 10295 2,447. 1,989. 270. 84. 3,164. 31 2,120. 3,204. 736. 823. 288. 14,712.24 1471 10,295.95 1029 2,447 1,989 3,164 2,120 3,204 14,712.2 147 10,295.9 102 2,44 1,98 3,16 2,12 3,20 14,712. 10,295. 2,4 1,9 3,1 2,1 3,2 14,712 10,295 2, 1, 3, 14,71 10,29 14,7 10,2 14, 10,

RESUMO RACIONAL: A pesquisa em cirurgia robótica assistida cresceu dramaticamente nas últimas duas décadas e as vantagens sobre a videolaparoscopia tradicional têm sido amplamente debatidas. Para as hérnias, o sistema robótico pode aumentar as estratégias intraoperatórias, principalmente em hérnias complexas ou hérnias incisionais. OBJETIVOS: Comparar as diferenças de custo direto entre a hernioplastia incisional robótica e a laparoscópica e determinar cada fonte de gasto que pode estar relacionada ao aumento de custos em um programa de robótica na perspectiva de uma instituição pública brasileira. MÉTODOS: Investigar as diferenças nos custos diretos dos dados gerados a partir de um protocolo de ensaio clínico (ReBEC: RBR-5s6mnrf). Pacientes com hérnia incisional foram aleatoriamente designados para serem submetidos a reparo robótico ou laparoscópico (RVIHR). Os custos foram descritos na moeda brasileira (R$). RESULTADOS: Dezenove pacientes submetidos à cirurgia robótica foram comparados com dezoito submetidos à cirurgia laparoscópica. O valor gasto com tempo de centro cirúrgico (Robótica: 2.447,91±644,79; Robótica: 1.989,67±763,00; p=0,030), gases medicinais inalados em centro cirúrgico (Robótica: 270,57±211,51; Robótica: 84,55±252,34; p=0,023), recursos humanos em centro cirúrgico (Robótica: 3.164,43±894,97; Laparoscópica: 2.120,16±663,78; p<0,001), recursos materiais (Robótica : 3.204,32±351,55; Robótica: 736,51±972,32; p<0,001) e medicamentos (Robótica: 823,40±175,47; Robótica: 288,50 ± 352,55; p<0,001) para cirurgia robótica foi maior que cirurgia laparoscópica, implicando em maior custo total para cirurgia robótica (Robótica: 14.712,24±3.520,82; Laparoscópica: 10.295,95±3.453,59; p<0,001). Não foi observada diferença significativa nos custos relacionados à permanência hospitalar, recursos humanos em UTI e enfermaria, exames diagnósticos e telas. CONCLUSÕES: O sistema robótico adiciona um custo global significativo à hernioplastia incisional laparoscópica tradicional. O custo dos dispositivos médicos e robóticos, além de tempos cirúrgicos mais prolongados, são os principais fatores que impulsionam a diferença nos custos. RACIONAL debatidas intraoperatórias incisionais OBJETIVOS MÉTODOS ReBEC (ReBEC RBR5s6mnrf. RBR5s6mnrf RBRsmnrf RBR 5s6mnrf . s mnrf RBR-5s6mnrf) RVIHR. RVIHR (RVIHR) R$. R R$ (R$) RESULTADOS Robótica 2.447,91±644,79 24479164479 2 447 91 644 79 1.989,67±763,00 19896776300 1 989 67 763 00 p=0,030, p0030 p p=0,030 , 0 030 p=0,030) 270,57±211,51 2705721151 270 57 211 51 84,55±252,34 845525234 84 55 252 34 p=0,023, p0023 p=0,023 023 p=0,023) 3.164,43±894,97 31644389497 3 164 43 894 97 Laparoscópica 2.120,16±663,78 21201666378 120 16 663 78 p<0,001, p0001 p<0,001 001 3.204,32±351,55 32043235155 204 32 351 736,51±972,32 7365197232 736 972 823,40±175,47 8234017547 823 40 175 47 28850 288 50 288,5 352,55 35255 352 14.712,24±3.520,82 1471224352082 14 712 24 520 82 10.295,95±3.453,59 1029595345359 10 295 95 453 59 p<0,001. hospitalar enfermaria telas CONCLUSÕES robóticos prolongados smnrf RBR-5s6mnrf (RVIHR (R$ 2.447,91±644,7 2447916447 44 9 64 7 1.989,67±763,0 1989677630 98 6 76 p003 p=0,03 03 270,57±211,5 270572115 27 5 21 84,55±252,3 84552523 8 25 p002 p=0,02 02 3.164,43±894,9 3164438949 4 89 2.120,16±663,7 2120166637 12 66 p000 p<0,00 3.204,32±351,5 3204323515 20 35 736,51±972,3 736519723 73 823,40±175,4 823401754 17 2885 28 288, 352,5 3525 14.712,24±3.520,8 147122435208 71 52 10.295,95±3.453,5 102959534535 29 45 (R 2.447,91±644, 244791644 1.989,67±763, 198967763 p00 p=0,0 270,57±211, 27057211 84,55±252, 8455252 3.164,43±894, 316443894 2.120,16±663, 212016663 p<0,0 3.204,32±351, 320432351 736,51±972, 73651972 823,40±175, 82340175 352, 14.712,24±3.520, 14712243520 10.295,95±3.453, 10295953453 2.447,91±644 24479164 1.989,67±763 19896776 p0 p=0, 270,57±211 2705721 84,55±252 845525 3.164,43±894 31644389 2.120,16±663 21201666 p<0, 3.204,32±351 32043235 736,51±972 7365197 823,40±175 8234017 14.712,24±3.520 1471224352 10.295,95±3.453 1029595345 2.447,91±64 2447916 1.989,67±76 1989677 p=0 270,57±21 270572 84,55±25 84552 3.164,43±89 3164438 2.120,16±66 2120166 p<0 3.204,32±35 3204323 736,51±97 736519 823,40±17 823401 14.712,24±3.52 147122435 10.295,95±3.45 102959534 2.447,91±6 244791 1.989,67±7 198967 p= 270,57±2 27057 84,55±2 8455 3.164,43±8 316443 2.120,16±6 212016 p< 3.204,32±3 320432 736,51±9 73651 823,40±1 82340 14.712,24±3.5 14712243 10.295,95±3.4 10295953 2.447,91± 24479 1.989,67± 19896 270,57± 2705 84,55± 845 3.164,43± 31644 2.120,16± 21201 3.204,32± 32043 736,51± 7365 823,40± 8234 14.712,24±3. 1471224 10.295,95±3. 1029595 2.447,91 2447 1.989,67 1989 270,57 84,55 3.164,43 3164 2.120,16 2120 3.204,32 3204 736,51 823,40 14.712,24±3 147122 10.295,95±3 102959 2.447,9 244 1.989,6 198 270,5 84,5 3.164,4 316 2.120,1 212 3.204,3 320 736,5 823,4 14.712,24± 14712 10.295,95± 10295 2.447, 1.989, 19 270, 84, 3.164, 31 2.120, 3.204, 736, 823, 14.712,24 1471 10.295,95 1029 2.447 1.989 3.164 2.120 3.204 14.712,2 147 10.295,9 102 2.44 1.98 3.16 2.12 3.20 14.712, 10.295, 2.4 1.9 3.1 2.1 3.2 14.712 10.295 2. 1. 3. 14.71 10.29 14.7 10.2 14. 10.

ABSTRACT BACKGROUND: Esophageal cancer is an environment-related disease, and the most important risk factors are alcohol intake and smoking, in addition to gastroesophageal reflux in obese patients. The characterization of the patients’ personality can contribute to the perception of how everyone adapts to the social environment and what relationship one can establish with themselves and with others. AIM: The aim of this study was to identify the psychological typology in patients with esophageal cancer. METHODS: The psychological typology of patients was defined using the Typological Assessment Questionnaire. In addition, the aspects of psychological assessment were studied to access the particularities of each patient, especially their reaction to the diagnosis and the meaning attributed to the disease. RESULTS: A total of 90 patients with esophageal cancer, aged over 18 years, who completed high school, and were interviewed at the first medical appointment, were included. The introverted attitude was predominant (83.33%). The most common psychological type was introverted sensation, with feeling as a secondary function (43.3%), and the second most frequent was introverted feeling, with sensation as a secondary function (24.4%). From this psychological assessment, a variety of defensive mechanisms were found to minimize distress. Most patients made use of adaptive defenses in the face of the illness process. CONCLUSION: The identification of the psychological typology allows the most effective assistance in directing the peculiar needs of each patient. In addition, it contributes to the care team to individualize treatments based on specific psychological characteristics. BACKGROUND environmentrelated related disease smoking others AIM METHODS Questionnaire patient RESULTS 9 1 years school appointment included 83.33%. 8333 83.33% . 83 33 (83.33%) 43.3%, 433 43.3% , 43 3 (43.3%) 24.4%. 244 24.4% 24 4 (24.4%) distress process CONCLUSION characteristics 833 83.33 8 (83.33% 43.3 (43.3% 24.4 2 (24.4% 83.3 (83.33 43. (43.3 24. (24.4 83. (83.3 (43. (24. (83. (43 (24 (83 (4 (2 (8 (

RESUMO RACIONAL: O câncer de esôfago é uma doença relacionada ao meio ambiente, e os fatores de risco mais importantes são a ingestão de álcool e tabagismo, além do refluxo gastroesofágico em pacientes obesos. A caracterização da personalidade do paciente contribui para a percepção de como cada indivíduo se adapta ao meio social e que relação pode estabelecer consigo mesmo e com os outros. OBJETIVO: Identificar a tipologia psicológica em pacientes com câncer de esôfago. MÉTODOS: Definiu-se a tipologia psicológica utilizando o Questionário de Avaliação Tipológica. Estudaram-se os aspectos da avaliação psicológica para acessar as particularidades de cada um dos pacientes, principalmente no que diz respeito à sua reação ao diagnóstico e ao significado atribuído à doença. RESULTADOS: Foram incluídos noventa pacientes, com mais de 18 anos, ensino médio completo, diagnóstico de câncer de esôfago e que foram entrevistados na primeira consulta médica. A atitude introvertida foi a preponderante (83,33%). O tipo psicológico mais comum foi introvertido — sensação, tendo o sentimento como função secundária (43,3%), e introvertido — sentimento com sensação como função secundária foi o segundo tipo mais frequente (24,4%). A partir dessa avaliação psicológica, encontrou-se uma variedade de mecanismos defensivos para minimizar a angústia. A maioria dos pacientes fez uso de defesas adaptativas diante do processo de adoecimento. CONCLUSÕES: A identificação da tipologia psicológica permite o auxílio mais eficaz no direcionamento das necessidades peculiares de cada indivíduo. Além disso, contribui com a equipe de atendimento a fim de individualizar os tratamentos com base nas características psicológicas específicas. RACIONAL ambiente tabagismo obesos outros OBJETIVO MÉTODOS Definiuse Definiu Tipológica Estudaramse Estudaram RESULTADOS 1 anos completo médica 83,33%. 8333 83,33% . 83 33 (83,33%) 43,3%, 433 43,3% , 43 3 (43,3%) 24,4%. 244 24,4% 24 4 (24,4%) encontrouse encontrou angústia adoecimento CONCLUSÕES disso específicas 833 83,33 8 (83,33% 43,3 (43,3% 24,4 2 (24,4% 83,3 (83,33 43, (43,3 24, (24,4 83, (83,3 (43, (24, (83, (43 (24 (83 (4 (2 (8 (

RESUMO - RACIONAL: Pelo menos 12 linfonodos (LNs) devem ser examinados após a ressecção cirúrgica do câncer de cólon. Como é difícil encontrar LNs pequenos, fixadores de clareadores de gordura foram propostos, mas não há consenso sobre a melhor opção. OBJETIVO: Verificar se a solução de Carnoy (SC) aumenta o número de LNs obtidos em espécimes de câncer de cólon esquerdo. MÉTODOS: Ensaio prospectivo randomizado (clinictrials.gov: NCT02629315) com 60 pacientes com adenocarcinoma de cólon esquerdo submetidos à retossigmoidectomia. As amostras foram randomizadas para fixação com SC ou formalina tamponada neutra a 10% (NBF). Após a dissecção, a gordura pericólica do grupo NBF foi imersa em SC e redissecada (Revisão). O endpoint primário foi o número total de LNs recuperados. RESULTADOS: O número médio de LNs foi de 36,6 e 26,8 para os grupos CS e NBF, respectivamente (p=0,004). O número de casos com <12 LNs foi 0 (CS) e 3 (NBF, p=0,237). A duração da dissecção foi semelhante. LNs foram recuperados em todos os casos durante a revisão (média de 19, intervalo: 4-37), representando quase 40% dos LNs deste braço do estudo. Após a revisão, nenhum caso no braço NBF permaneceu com <12 LNs. Dois pacientes tiveram LNs metastáticos encontrados durante a revisão (não ocorreu upstaging). CONCLUSÃO: Em comparação com NBF, a SC aumenta a contagem de LNs em espécimes de câncer de cólon. Após a análise patológica convencional, a fixação da gordura pericólica com SC e a realização de uma segunda dissecção aumentaram o número de LNs.

ABSTRACT - BACKGROUND: At least 12 lymph nodes (LNs) should be examined following surgical resection of colon cancer. As it is difficult to find small LNs, fat clearing fixatives have been proposed, but there is no consensus about the best option. AIM: The objective of this study was to verify if Carnoy’s solution (CS) increases the LN count in left colon cancer specimens. METHODS: A prospective randomized trial (clinicaltrials.gov registration: NCT02629315) with 60 patients with left colon adenocarcinoma who underwent rectosigmoidectomy. Specimens were randomized for fixation with CS or 10% neutral buffered formalin (NBF). After dissection, the pericolic fat from the NBF group was immersed in CS and re-dissected (Revision). The primary endpoint was the total number of LNs retrieved. RESULTS: Mean LN count was 36.6 and 26.8 for CS and NBF groups, respectively (p=0.004). The number of cases with <12 LNs was 0 (CS) and 3 (NBF, p=0.237). The duration of dissection was similar. LNs were retrieved in all cases during the revision (mean: 19, range: 4-37), accounting for nearly 40% of the LNs of this arm of the study. After the revision, no case was found in the NBF arm with <12 LNs. Two patients had metastatic LNs during the revision (no upstaging occurred). CONCLUSION: Compared to NBF, CS increases LN count in colon cancer specimens. After conventional pathologic analysis, fixing the pericolic fat with CS and performing a second dissection substantially increased the number of LNs.

RESUMO CONTEXTO: Conforme a idade avança, se esperam mais morbidades e menor reserva funcional. Entretanto não está claro qual o impacto do envelhecimento nos resultados cirúrgicos do câncer gástrico (CaG). OBJETIVO: O intuito deste estudo é avaliar os resultados cirúrgicos de pacientes com CaG de acordo com o grupo etário. MÉTODOS: Pacientes submetidos a gastrectomia por adenocarcinoma gástrico com intuito curativo foram divididos em quartis. Cada grupo incluiu 150 indivíduos e os limites etários foram: ≤54,8; 54,9-63,7; 63,8-72; >72. Os resultados avaliados foram: complicações pós-operatórias (CPO), mortalidade em 90 dias, sobrevida livre de doença (SLD) e sobrevida global (SG). RESULTADOS: Complicações cirúrgicas maiores ocorreram em 2,7% dos pacientes no quartil mais jovem vs 12% para os demais (P=0,007). A incidência de complicações clínicas maiores aumentou conforme o quartil: 0,7% vs 4,7% vs 5,3% vs 7,3% (P<0,042). A pontuação ASA e a idade foram fatores de risco independentes para CPO maiores. A mortalidade em 90 dias aumentou progressivamente conforme o quartil etário: 1,3% vs 6,0% vs 7,3% vs 14% (P<0,001). A SLD foi equivalente entre os quartis, enquanto a SG foi significativamente pior para os >72 anos de idade. Linfadenectomia D2 aumentou a SG apenas para os 3 quartis mais jovens. Idade > 72 foi fator independente de risco para pior SG (razão de chances de 1,72) CONCLUSÃO: Pacientes < 55 anos tem menos complicações cirúrgicas. Conforme a idade avança, as complicações clínicas e a mortalidade em 90 dias aumenta gradualmente. A SG é pior se >72 anos e a indicação de linfadenectomia D2 deve ser individualizada a partir dessa idade.

ABSTRACT BACKGROUND: As age advances, a higher burden of comorbidities and less functional reserve are expected, however, the impact of aging in the surgical outcomes of gastric cancer (GC) patients is unknown. OBJECTIVE: The aim of this study is to evaluate surgical outcomes of GC patients according to their age group. METHODS: Patients submitted to gastrectomy with curative intent due to gastric adenocarcinoma were divided in quartiles. Each group had 150 patients and age limits were: ≤54.8, 54.9-63.7, 63.8-72, >72. The outcomes assessed were: postoperative complications (POC), 90-day postoperative mortality, disease-free survival (DFS) and overall survival (OS). RESULTS: Major surgical complications were 2.7% in the younger quartile vs 12% for the others (P=0.007). Major clinical complications raised according to the age quartile: 0.7% vs 4.7% vs 5.3% vs 7.3% (P<0.042). ASA score and age were independent risk factors for major POC. The 90-day mortality progressively increased according to the age quartile: 1.3% vs 6.0% vs 7.3% vs 14% (P<0.001). DFS was equivalent among quartile groups, while OS was significantly worse for those >72-year-old. D2 lymphadenectomy only improved OS in the three younger quartiles. Age >72 was an independent risk factor for worse OS (hazard ratio of 1.72). CONCLUSION: Patients <55-year-old have less surgical complications. As age progresses, clinical complications and 90-day mortality gradually rise. OS is worse for those above age 72, and D2 lymphadenectomy should be individualized after this age.

RESUMO Racional: O II Consenso Brasileiro de Câncer Gástrico da Associação Brasileira de Câncer Gástrico ABCG (Parte 1) foi recentemente publicado. Nesta ocasião inúmeros especialistas que atuam no tratamento desta doença expressaram suas opiniões diante declarações apresentadas. Objetivo: Apresentar as Diretrizes da ABCG (Parte 2) quanto às indicações de tratamento cirúrgico, técnicas operatórias, extensão de ressecção e terapia combinada. Métodos: Para formulação destas diretrizes os autores realizaram extensa e atual revisão referente a cada declaração presente no II Consenso, utilizando as bases Medline/PubMed, Cochrane Library e SciELO, inicialmente com os seguintes descritores: câncer gástrico, gastrectomia, linfadenectomia, terapia combinada. Ainda, cada declaração foi classificada de acordo com o nível de evidência e grau de recomendação. Resultados: Das 43 declarações presentes neste estudo, 11 (25,6%) foram classificadas com nível de evidência A, 20 (46,5%) B e 12 (27,9%) C. Quanto ao grau de recomendação, 18 (41,9%) declarações obtiveram grau de recomendação 1, 14 (32,6%) 2a, 10 (23,3%) 2b e um (2,3%) 3. Conclusão: O complemento das diretrizes aqui presentes possibilita que cirurgiões e oncologistas que atuam no combate ao câncer gástrico possam oferecer o melhor tratamento possível, de acordo com as condições locais disponíveis.

ABSTRACT Background : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. Aim : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. Methods: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. Conclusion : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.

RESUMO Racional: O tratamento da doença hemorroidária pela técnica de THD (Transanal Hemorrhoidal Dearterialization) é minimamente invasivo e tem se mostrado seguro e eficiente. No entanto, dados sobre a recorrência e complicações (dor e tenesmo) no pós-operatório são muito variáveis. Objetivo: Avaliar se a desarterialização e mucopexia seletiva, sem o uso de Doppler, é suficiente para o controle de sintomas e se a morbidade pós-operatória é menor com esta técnica. Métodos: Vinte pacientes foram tratados com essa técnica e avaliados sobre controle de sintomas, morbidade pós-operatória e recorrência. Resultados: Controle do prolapso e sangramento foi observado em todos pacientes (n=20). Complicações pós-operatórias foram: tenesmo (n=2), trombose hemorroidária externa (n=2), retenção urinária (n=2). Após um seguimento médio de 13 meses, nenhuma recorrência foi detectada. Conclusões: O procedimento de desarterialização e mucopexias seletivas é seguro e eficiente em termos de controle do prolapso e sangramento. Esta técnica resulta em menor morbidade cirúrgica, uma vez que diminui o número de suturas no canal anal, resultando em menos dor e tenesmo pós-operatório. Para este procedimento o uso de ultrassom Doppler é desnecessário, o que diminui custos e o torna mais atrativo do ponto de vista econômico.

ABSTRACT Background: Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Methods: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. Results: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. Conclusion: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.