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ABSTRACT Schistosomiasis is an infectious disease caused by parasitic flatworms of the genus Schistosoma. The species Schistosoma mansoni is associated with hepatosplenic disease. Schistosomiasis involving the gallbladder alone is highly unusual, with a few cases reported. Herein, we present the case of a woman from a region with endemic schistosomiasis who presented with a painless solid lesion and wall thickening of the gallbladder. She underwent an uneventful laparoscopic cholecystectomy. Microscopic examination of the surgical specimen revealed Schistosoma mansoni eggs associated with granulomatous reaction, leading to the diagnosis of schistosomiasis of the gallbladder, prompting subsequent treatment with praziquantel and follow-up. This case illustrates the importance of suspicion for this diagnosis in endemic areas, as it can be misdiagnosed with malignancy if not examined microscopically. Complications and treatment strategies are poorly characterized for the few cases of schistosomiasis; reporting this case can serve as a helpful reminder of a rare presentation of this disease. unusual reported Herein cholecystectomy reaction followup. followup follow up. up follow-up areas microscopically

https://doi.org/10.4322/acr.2024.516

Economic evaluations of colorectal cancer screening: A systematic review and quality assessment screening
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Ramos, Marcela Castro

; Passone, Julio Augusto de Lima

; Lopes, Ana Carolina de Freitas

; Safatle-Ribeiro, Adriana Vaz

; Ribeiro Júnior, Ulysses

; Soárez, Patrícia Coelho de

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2023, Volume 78 elocation 100203

Abstract: En | Text: En | PDF: En

Abstract Colorectal Cancer (CRC) is the third most common type of cancer worldwide and ranks second in mortality. Screening programs for early detection and treatment have been implemented in several countries. Economic evaluations are an important tool to support decision-making about reimbursement and coverage decisions in health systems and, therefore, to support efficient resource allocation. The article aims to review the up-to-date evidence on economic evaluations of CRC screening strategies. MEDLINE, EMBASE, Web of Science, SCOPUS, SciELO, Lilacs, CRD databases, and lists of references were reviewed to identify relevant literature regarding full economic evaluations of CRC screening in asymptomatic average-risk individuals over 40 years old. Searches were conducted with no restriction to language, setting, or date. Qualitative syntheses described CRC screening strategies and comparators (baseline context), study designs, key parameter inputs and incremental cost-effectiveness ratios. Seventy-nine articles were included. Most of the studies were from high-income countries and a third-party payer perspective. Markov models were predominantly used, although microsimulation has been increasingly adopted in the last 15 years. The authors found 88 different screening strategies for CRC, which differed in the type of technique, the interval of screening, and the strategy, i.e., isolated or combined. The annual fecal immunochemical test was the most predominant screening strategy. All studies reported cost-effective results in their scenarios compared to no screening scenarios. One-quarter of the publications reported cost-saving results. It is still necessary to develop future economic evaluations in Low- and Middle-Income Countries (LMICs), which account for the high burden of disease. (CRC mortality decisionmaking decision making therefore allocation uptodate up date MEDLINE EMBASE Science SCOPUS SciELO Lilacs databases averagerisk average risk 4 old language setting baseline context, context , context) designs costeffectiveness cost effectiveness ratios Seventynine Seventy nine included highincome income thirdparty party perspective used 1 8 technique strategy ie i e i.e. combined costeffective effective Onequarter One quarter costsaving saving Low MiddleIncome Middle Income LMICs, LMICs (LMICs) disease i.e (LMICs

https://doi.org/10.1016/j.clinsp.2023.100203

TUMOR MARKERS EXPRESSION LEVELS IN GASTRIC CANCER PATIENT’S PERIPHERAL BLOOD BY RT-PCR ASSESSMENT PATIENTS PATIENT S RTPCR RT PCR
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KAWAKAMI, Gabriel da Silva

; PEREIRA, Marina Alessandra

; KUBRUSLY, Márcia Saldanha

; CARRASCO, Alexis Germán Murillo

; RAMOS, Marcus Fernando Kodama Pertille

; RIBEIRO JÚNIOR, Ulysses

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2023, Volume 36 elocation e1789

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO RACIONAL: A recorrência hematológica é a segunda causa mais frequente de falha no tratamento do câncer gástrico. A detecção de marcadores tumorais circulantes no sangue periférico, pelo método de reação em cadeia da polimerase de transcrição reversa quantitativa (qRT-PCR) pode ser uma ferramenta útil para prever a recorrência e determinar o prognóstico do paciente. No entanto, ainda não foi alcançado consenso em relação à associação entre o nível de marcadores tumorais circulantes no sangue periférico e seu impacto na sobrevida do paciente. OBJETIVOS: Avaliar a expressão de CK20 e MUC1 em amostras de sangue periférico de pacientes com câncer gástrico por meio de qRT-PCR e verificar a associação dos níveis de expressão com características clinicopatológicas e sobrevida. MÉTODOS: Trinta e um pacientes com adenocarcinoma gástrico foram incluídos, prospectivamente. Os níveis de expressão de CK20 e MUC1 foram analisados a partir de sangue periférico por meio de qRT-PCR. RESULTADOS: Não houve associação estatisticamente significativa (p>0,05) entre os níveis de expressão de CK20 com características clínicas, patológicas e cirúrgicas. Níveis mais elevados de expressão de MUC1 estavam associados a pacientes do sexo feminino (p=0,01). Houve correlação entre os níveis de ambos os genes (R=0,81, p<0,001), nível de CK20 e tamanho do tumor (R=0,39, p=0,034). CONCLUSÕES: Os níveis de CK20 e MUC1 podem ser avaliados por qRT-PCR a partir de amostras de sangue periférico total de pacientes com câncer gástrico, os níveis de CK20 estavam correlacionados com os de MUC1, assim como tamanho do tumor. Não houve diferença de sobrevida global ou livre de doença em relação à expressão de ambos marcadores genéticos nesta série. RACIONAL qRTPCR qRT PCR (qRT-PCR paciente entanto OBJETIVOS CK CK2 MUC MÉTODOS incluídos prospectivamente qRTPCR. PCR. RESULTADOS p>0,05 p005 p 0 05 (p>0,05 clínicas cirúrgicas p=0,01. p001 p=0,01 . 01 (p=0,01) R=0,81, R081 R 81 (R=0,81 p<0,001, p0001 p<0,001 , 001 p<0,001) R=0,39, R039 39 (R=0,39 p=0,034. p0034 p=0,034 034 p=0,034) CONCLUSÕES série p>0,0 p00 (p>0,0 p=0,0 (p=0,01 R=0,81 R08 8 (R=0,8 p000 p<0,00 00 R=0,39 R03 3 (R=0,3 p003 p=0,03 03 p>0, p0 (p>0, p=0, (p=0,0 R=0,8 R0 (R=0, p<0,0 R=0,3 p>0 (p>0 p=0 (p=0, R=0, (R=0 p<0, p> (p> p= (p=0 R=0 (R= p<0 (p (p= R= (R p<

ABSTRACT BACKGROUND: Hematological recurrence is the second most frequent cause of failure in the treatment of gastric cancer. The detection of circulating tumor markers in peripheral blood by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) method may be a useful tool to predict recurrence and determine the patient’s prognosis. However, no consensus has been reached regarding the association between the tumor markers level in peripheral blood and its impact on patient survival. AIMS: To evaluate the expression of the circulating tumor markers CK20 and MUC1 in peripheral blood samples from patients with gastric cancer by qRT-PCR, and to verify the association of their expression levels with clinicopathological characteristics and survival. METHODS: A total of 31 patients with gastric adenocarcinoma were prospectively included in this study. CK20 and MUC1 expression levels were analyzed from peripheral blood by the qRT-PCR technique. RESULTS: There was no statistically significant (p>0.05) association between CK20 expression levels and clinical, pathological, and surgical features. Higher MUC1 expression levels were associated with female patients (p=0.01). There was a correlation between both gene levels (R=0.81, p<0.001), and CK20 level and tumor size (R=0.39, p=0.034). CONCLUSIONS: CK20 and MUC1 expression levels could be assessed by qRT-PCR from total peripheral blood samples of patients with gastric cancer. CK20 levels were correlated to MUC1 levels as well as to tumor size. There was no difference in disease-free survival and overall survival regarding both genetic markers expression in this series. BACKGROUND qRTPCR qRT PCR (qRT-PCR s prognosis However AIMS CK CK2 MUC qRTPCR, PCR, METHODS 3 study technique RESULTS p>0.05 p005 p 0 05 (p>0.05 clinical pathological features p=0.01. p001 p=0.01 . 01 (p=0.01) R=0.81, R081 R 81 (R=0.81 p<0.001, p0001 p<0.001 , 001 p<0.001) R=0.39, R039 39 (R=0.39 p=0.034. p0034 p=0.034 034 p=0.034) CONCLUSIONS diseasefree disease free series p>0.0 p00 (p>0.0 p=0.0 (p=0.01 R=0.81 R08 8 (R=0.8 p000 p<0.00 00 R=0.39 R03 (R=0.3 p003 p=0.03 03 p>0. p0 (p>0. p=0. (p=0.0 R=0.8 R0 (R=0. p<0.0 R=0.3 p>0 (p>0 p=0 (p=0. R=0. (R=0 p<0. p> (p> p= (p=0 R=0 (R= p<0 (p (p= R= (R p<

https://doi.org/10.1590/0102-672020230071e1789

Methylene tetrahydrofolate reductase (MTHFR) and vascular endothelial growth factor (VEGF) polymorphisms in Brazilian patients with Hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC)
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Carvalho, Sylene C.R.

; Vasconcelos, Luydson R.S.

; Fonseca, Leonardo da

; Carmo, Rodrigo F.

; Tomitão, Michele T.

; Aroucha, Dayse C.B.L.

; Pereira, Leila M.M.B.

; Stefano, José Tadeu

; Ribeiro-Júnior, Ulysses

; Oliveira, Claudia P.

; Carrilho, Flair J.

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2021, Volume 76 elocation e2881

Abstract: En | Text: En | PDF: En

OBJECTIVE: The folate pathway is involved in hepatic carcinogenesis and angiogenesis. Polymorphisms in genes related to such processes, including methylene tetrahydrofolate reductase (MTHFR) and vascular endothelial growth factor (VEGF)] may play an important role in the development of hepatocellular carcinoma (HCC). The objective of this study was to evaluate MTHFR and VEGF polymorphisms in Brazilian patients with hepatitis C virus (HCV)-related HCC. METHODS: A total of 119 patients diagnosed with confirmed HCC and HCV were included in the study. SNP genotyping assays were performed using real-time PCR. VEGFA (rs2010963, rs3025039, and rs833061) and MTHFRC677T (rs1801133, rs1801131) polymorphisms were evaluated. RESULTS: The C alleles of MTHFR (rs1801131) and VEGF (rs2010963) were associated with protection against the development of multinodular HCC, while the T allele of MTHFR (rs1801133) was associated with a higher risk of multinodular presentation [p=0.04 OR 1.835 CI (1.022-3.297)]. Multivariate analysis revealed that the GG/GC genotypes of VEGF rs2010963 were independently associated with multinodular tumors at diagnosis (p=0.013; OR 4.78 CI (1.38-16.67)]. CONCLUSION: Our results suggest that these polymorphisms may increase the risk of rapid tumor progression in patients with HCV infection. This subgroup of patients with HCC and who present polymorphism is more likely to be diagnosed with multinodular disease and not be amenable to receiving curative treatments. These data must be validated in larger cohorts, and the screening intervals can be customized based on genetic history.

https://doi.org/10.6061/clinics/2021/e2881 141 downloads

Common variable immunodeficiency: an important but little-known risk factor for gastric cancer
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KREIN, PAULA

; YOGOLARE, GUSTAVO GONÇALVES

; PEREIRA, MARINA ALESSANDRA

; GRECCO, OCTAVIO

; BARROS, MYRTHES ANNA MARAGNA TOLEDO

; DIAS, ANDRE RONCON

; MARINHO, ANA KAROLINA BARRETO BERSELLI

; ZILBERSTEIN, BRUNO

; KOKRON, CRISTINA MARIA

; RIBEIRO-JÚNIOR, ULYSSES

; KALIL, JORGE

; NAHAS, SERGIO CARLOS

; RAMOS, MARCUS FERNANDO KODAMA PERTILLE

Revista do Colégio Brasileiro de Cirurgiões

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2021, Volume 48 elocation e20213133

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: embora seja uma doença rara, a imunodeficiência comum variável (IDCV) destaca-se como a imunodeficiência primária sintomática mais frequente. Os portadores são propensos a uma série de infecções bacterianas recorrentes, além do risco de desenvolver doenças autoimunes e neoplasias incluindo o câncer gástrico (CG). Apesar do risco reconhecido, não existem protocolos específicos padronizados para o manejo do CG nesses pacientes, de modo que os resultados oncológicos relatados são variados. Assim, esse estudo tem como objetivo descrever as características clinicopatológicas e prognóstico de pacientes com IDCV submetidos ao tratamento cirúrgico do CG. Métodos: foram avaliados retrospectivamente todos os pacientes com CG submetidos a tratamento cirúrgico entre 2009 e 2020. Posteriormente foram identificados pacientes com diagnóstico de IDCV e esse grupo foi comparado com o restante dos pacientes sem nenhuma imunodeficiência. Resultados: dentre os 1101 pacientes com CG avaliados no período, 10 apresentavam algum tipo de imunodeficiência e 5 foram diagnosticados com IDCV. Os pacientes com IDCV apresentaram idade menos avançada, menor IMC e lesões com menor diâmetro em comparação aqueles sem IDCV. Quatro pacientes foram submetidos à gastrectomia curativa e um paciente realizou jejunostomia. Dois pacientes foram a óbito (1 paliativo e 1 curativo) e um paciente apresentou recidiva da doença. Não houve diferença estatisticamente significativa em relação à incidência de complicações pós-operatórias e sobrevida entre os grupos avaliados. Conclusão: a incidência IDCV nos pacientes com CG submetidos à tratamento cirúrgico foi de 0,5% ocorrendo em idade menos avançada mas sem diferença com relação aos resultados cirúrgicos e oncológicos.

ABSTRACT Introduction: although it is a rare disease, common variable immunodeficiency (CVID) stands out as the most frequent primary symptomatic immunodeficiency. Carriers are prone to a variety of recurrent bacterial infections, in addition to the risk of developing autoimmune diseases and neoplasms including gastric cancer (GC). Despite the recognized risk, there are no specific standardized protocols for the management of GC in these patients, so the reported oncological results are varied. Thus, this study aims to describe the clinicopathological characteristics and prognosis of patients with CVID undergoing surgical treatment of GC. Methods: all patients with GC undergoing surgical treatment between 2009 and 2020 were retrospectively evaluated. Later, patients diagnosed with CVID were identified and this group was compared with the remaining patients without any immunodeficiency. Results: among the 1101 patients with GC evaluated in the period, 10 had some type of immunodeficiency, and 5 were diagnosed with CVID. Patients with CVID had younger age, lower BMI, and smaller lesions compared to those without CVID. Four patients underwent curative gastrectomy and one patient underwent jejunostomy. Two patients died (1 palliative and 1 curative) and one patient had disease recurrence. There was no statistically significant difference regarding the incidence of postoperative complications and survival between the evaluated groups. Conclusion: the CVID incidence in patients with GC undergoing surgical treatment was 0.5%, occurring at a less advanced age, but with no difference regarding surgical and oncological results.

https://doi.org/10.1590/0100-6991e-20213133

Is it Safe to Perform Elective Colorectal Surgical Procedures during the COVID-19 Pandemic? A Single Institution Experience with 103 Patients
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Sobrado, Lucas Faraco

; Nahas, Caio Sergio Rizkallah

; Marques, Carlos Frederico Sparapan

; Cotti, Guilherme Cutait de Castro

; Imperiale, Antônio Rocco

; Averbach, Pedro

; Meira Júnior, José Donizeti de

; Horvat, Natally

; Ribeiro-Júnior, Ulysses

; Cecconello, Ivan

; Nahas, Sergio Carlos

Clinics

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2021, Volume 76 elocation e2507

Abstract: En | Text: En | PDF: En

OBJECTIVES: Since the outbreak of the novel coronavirus disease 2019 (COVID-19), all health services worldwide underwent profound changes, leading to the suspension of many elective surgeries. This study aimed to evaluate the safety of elective colorectal surgery during the pandemic. METHODS: This was a retrospective, cross-sectional, single-center study. Patients who underwent elective colorectal surgery during the COVID-19 pandemic between March 10 and September 9, 2020, were included. Patient data on sex, age, diagnosis, types of procedures, hospital stay, mortality, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperative screening tests were recorded. RESULTS: A total of 103 colorectal surgical procedures were planned, and 99 were performed. Four surgeries were postponed due to positive preoperative screening for SARS-CoV-2. Surgical procedures were performed for colorectal cancer (n=90) and inflammatory bowel disease (n=9). Laparoscopy was the approach of choice for 43 patients (43.4%), 53 (53.5%) procedures were open, and 3 (3%) procedures were robotic. Five patients developed COVID-19 in the postoperative period, and three of them died in the intensive care unit (n=3/5, 60% mortality). Two other patients died due to surgical complications unrelated to COVID-19 (n=2/94, 2.1% mortality) (p<0.01). Hospital stay was longer in patients with SARS-CoV-2 infection than in those without (38.4 versushttps://doi.org/10.3 days, respectively, p<0.01). Of the 99 patients who received surgical care during the pandemic, 94 were safely discharged (95%). CONCLUSION: Our study demonstrated that elective colorectal surgical procedures may be safely performed during the pandemic; however, preoperative testing should be performed to reduce in-hospital infection rates, since the mortality rate due to SARS-CoV-2 in this setting is particularly high.

https://doi.org/10.6061/clinics/2021/e2507 434 downloads

Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil
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Pombo, Amanda A.M.

; Lenz, Luciano

; Paulo, Gustavo A.

; Santos, Mônica A.

; Tamae, Patricia K.

; Santos, Alisson L.D.R.

; Rezende, Daniel T.

; Martins, Bruno

; Kawaguti, Fabio S.

; Pennachi, Caterina M.P.S.

; Gusmon-Oliveira, Carla C.

; Uemura, Ricardo S.

; Geiger, Sebastian

; Lima, Marcelo S.

; Baba, Elisa R.

; Figueiredo, Viviane R.

; Safatle-Ribeiro, Adriana

; Maluf-Filho, Fauze

; Ribeiro-Júnior, Ulysses

Clinics

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2021, Volume 76 elocation e2280

Abstract: En | Text: En | PDF: En

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.

https://doi.org/10.6061/clinics/2021/e2280 501 downloads

How should health systems prepare for the evolving COVID-19 pandemic? Reflections from the perspective of a Tertiary Cancer Center
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Chen, Andre Tsin Chih

; Moniz, Camila Motta Venchiarutti

; Ribeiro-Júnior, Ulysses

; Diz, Maria Del Pilar Estevez

; Salvajoli, João Victor

; Da Conceição Vasconcelos, Karina Gondim Moutinho

; Auler-Júnior, José Otávio Costa

; Cecconello, Ivan

; Abdala, Edson

; Hoff, Paulo Marcelo Gehm

Clinics

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2020, Volume 75 elocation e1864

Abstract: En | Text: En | PDF: En

https://doi.org/10.6061/clinics/2020/e1864 2142 downloads

Neutrophil-lymphocyte ratio change after curative gastrectomy for gastric cancer: a subgroup analysis
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Szor, Daniel José

; Dias, André Roncon

; Pereira, Marina Alessandra

; Ramos, Marcus Fernando Kodama Pertille

; Zilberstein, Bruno

; Cecconello, Ivan

; Ribeiro Júnior, Ulysses

einstein (São Paulo)

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2020, Volume 18 elocation eAO4860

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar o impacto da alteração da relação neutrófilo-linfócito após ressecção curativa por câncer gástrico. Métodos: Realizou-se análise retrospectiva de pacientes com câncer gástrico submetidos à gastrectomia curativa entre 2009 e 2017. Foi estabelecido valor de corte para a relação neutrófilo-linfócito nos períodos pré e pós-operatório de acordo com a mediana, e quatro subgrupos foram formados (baixo-baixo/baixo-alto/alto-baixo/alto-alto). Dados clínicos e patológicos e de sobrevida foram analisados e relacionados com estes subgrupos. Resultados: Foram incluídos no estudo 325 pacientes. Os valores de corte para a relação neutrófilo-linfócito foram 2,14 e 1,8 para os períodos pré e pós-operatório, respectivamente. Em pacientes com estádios I e II, o subgrupo alto-alto apresentou pior sobrevida global (p=0,016) e sobrevida livre de doença (p=0,001). As complicações ocorreram mais em pacientes do subgrupo baixo-alto. Conclusão: A relação neutrófilo-linfócito é um marcador de baixo custo, eficiente e reprodutível. A individualização do prognóstico pode ser realizada de acordo com a identificação de subgrupos com maior risco de complicações e pior prognóstico.

ABSTRACT Objective: To evaluate the impact of neutrophil-lymphocyte ratio change after curative surgery for gastric cancer. Methods: A retrospective analysis of patients with gastric cancer who underwent curative surgery between 2009 and 2017 was performed. A cutoff value was established for the neutrophil-lymphocyte ratio in the pre- and postoperative periods, according to the median value, and four subgroups were formed (low-low/low-high/high-low/high-high). Clinical-pathological and survival data were analyzed and related to these subgroups. Results: A total of 325 patients were included in the study. The cutoff values of the neutrophil-lymphocyte ratio were 2.14 and 1.8 for the pre and postoperative periods, respectively. In patients with stages I and II, the high-high subgroup presented worse overall survival (p=0.016) and disease-free survival (p=0.001). Complications were higher in the low-high subgroup of patients. Conclusion: The neutrophil-lymphocyte ratio is a low cost, efficient and reproducible marker. The prognosis individualization can be performed according to the identification of subgroups at a higher risk of complications and worse prognosis.

https://doi.org/10.31744/einstein_journal/2020ao4860 790 downloads

10.

Cancer pain treatment during the COVID-19 pandemic: institutional recommendations
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Sousa, Angela Maria

; Grigio, Thiago Ramos

; Ashmawi, Hazem Adel

; Ribeiro Júnior, Ulysses

Clinics

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2020, Volume 75 elocation e2208

Abstract: En | Text: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2208 287 downloads

11.

INTESTINAL PERFORATION CAUSED BY COVID-19
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NAHAS, Sergio Carlos

; MEIRA-JÚNIOR, José Donizeti de

; SOBRADO, Lucas Faraco

; SORBELLO, Maurício

; SEGATELLI, Vanderlei

; ABDALA, Edson

; RIBEIRO-JÚNIOR, Ulysses

; CECCONELLO, Ivan

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2020, Volume 33 N. 2 elocation e1515

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/0102-672020190001e1515 3078 downloads

12.

BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 1): AN UPDATE ON DIAGNOSIS, STAGING, ENDOSCOPIC TREATMENT AND FOLLOW-UP
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BARCHI, Leandro Cardoso

; RAMOS, Marcus Fernando Kodama Pertille

; YAGI, Osmar Kenji

; MUCERINO, Donato Roberto

; BRESCIANI, Claudio José Caldas

; RIBEIRO JÚNIOR, Ulysses

; ANDREOLLO, Nelson Adami

; ASSUMPÇÃO, Paulo Pimentel

; WESTON, Antônio Carlos

; COLLEONI NETO, Ramiro

; ZILBERSTEIN, Bruno

; Ferraz, Álvaro Antônio Bandeira

; Charruf, Amir Zeide

; Dias, André Roncon

; Brandalise, André

; Silva, André Maciel da

; Alves, Barlon

; Malheiros, Carlos Alberto

; Marins, Carlos Augusto Martinez

; Leite, Celso Vieira

; Szor, Daniel

; Wohnrath, Durval R.

; Ilias, Elias Jirjoss

; Martins Filho, Euclides Dias

; Lopasso, Fabio Pinatel

; Coimbra, Felipe José Fernandez

; Felippe, Fernando E. Cruz

; Tomasisch, Flávio Daniel Saavedra

; Takeda, Flavio Roberto

; Ishak, Geraldo

; Laporte, Gustavo Andreazza

; Silva, Herbeth José Toledo

; Cecconello, Ivan

; Rodrigues, Joaquim José Gama

; Grande, José Carlos Del

; Lourenço, Laércio Gomes

; Motta, Leonardo Milhomem da

; Ferraz, Leonardo Rocha

; Moreira, Luis Fernando

; Lopes, Luis Roberto

; Toneto, Marcelo Garcia

; Mester, Marcelo

; Rodrigues, Marco Antônio Gonçalves

; Carvalho, Marineide Prudêncio de

; Franciss, Maurice Youssef

; Forones, Nora Manoukian

; Corletta, Oly Campos

; Castro, Osvaldo Antonio Prado

; Malafaia, Osvaldo

; Kassab, Paulo

; Savassi-Rocha, Paulo Roberto

; Oliveira, Rodrigo Jose de

; Sallun, Rubens Antonio Aissar

; Weschenfelder, Rui

; Oliveira, Saint Clair Vieira de

; Abreu, Thiago Boechat de

; Castria, Tiago Biachi de

; Barra, Williams

; Costa Júnior, Wilson Luiz da

; Freitas Júnior, Wilson Rodrigues de

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2020, Volume 33 N. 3 elocation e1535

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: O II Consenso Brasileiro de Câncer Gástrico da Associação Brasileira de Câncer Gástrico (ABCG) foi recentemente publicado. Nesta ocasião, inúmeros especialistas que atuam no tratamento desta doença expressaram sua opinião diante declarações apresentadas. Objetivo: Apresentar as Diretrizes da ABCG (Parte 1) quanto ao diagnóstico, estadiamento, tratamento endoscópico e seguimento dos pacientes com câncer gástrico. 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 com os seguintes descritores: câncer gástrico, estadiamento, tratamento endoscópico e seguimento. Ainda, cada declaração foi classificada de acordo com o nível de evidência e grau de recomendação. Resultados: Das 24 declarações, duas (8,3%) foram classificadas com nível de evidência A, 11 (45,8%) B e 11 (45,8%) C. Quanto ao grau de recomendação, seis (25%) declarações obtiveram grau de recomendação 1, nove (37,5%) grau 2a, seis (25%) 2b e três (12,5%) 3. Conclusão: As diretrizes aqui presentes têm a finalidade de auxiliar os profissionais que atuam no combate ao câncer gástrico com informações relevantes e atuais, permitindo que sejam aplicadas na prática médica diária.

ABSTRACT Background: The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented. Aim: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients. Methods: To forge these Guidelines, the authors carried out an extensive and current review regarding each statement present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases with the following descriptors: gastric cancer, staging, endoscopic treatment and follow-up. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results: Of the 24 statements, two (8.3%) were classified with level of evidence A, 11 (45.8%) with B and 11 (45.8%) with C. As for the degree of recommendation, six (25%) statements obtained grade of recommendation 1, nine (37.5%) recommendation 2a, six (25%) 2b and three (12.5%) grade 3. Conclusion: The guidelines presented here are intended to assist professionals working in the fight against gastric cancer with relevant and current information, granting them to be applied in the daily medical practice.

https://doi.org/10.1590/0102-672020200003e1535 2100 downloads

13.

CONVERSION THERAPY FOR GASTRIC CANCER: EXPANDING THE TREATMENT POSSIBILITIES
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RAMOS, Marcus Fernando Kodama Pertille

; PEREIRA, Marina Alessandra

; CHARRUF, Amir Zeide

; DIAS, André Roncon

; CASTRIA, Tiago Biachi de

; BARCHI, Leandro Cardoso

; RIBEIRO-JÚNIOR, Ulysses

; ZILBERSTEIN, Bruno

; CECCONELLO, Ivan

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2019, Volume 32 N. 2 elocation e1435

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional : A terapia de conversão no câncer gástrico (CG) é definida como o uso de quimio/radioterapia seguida de ressecção cirúrgica com intenção curativa de um tumor que era considerado irressecável ou oncologicamente incurável. Objetivo : Avaliar os resultados da terapia de conversão no tratamento do CG. Métodos : Análise retrospectiva de todas as operações de CG entre 2009 e 2018. Os pacientes que receberam alguma terapia antes da operação foram também identificados para definir o grupo de conversão. Resultados : Entre 1003 operações realizadas para o CG, 113 foram submetidos ao tratamento neoadjuvante e 16 (1,6%) considerados como terapia de conversão. As principais indicações para o tratamento foram: lesões T4b (n=10), metástase linfonodal (n=4), carcinomatose peritoneal e metástase hepática em 1 caso cada. O diagnóstico foi feito por exame de imagem em 14 casos (75%) e durante o procedimento cirúrgico em 4 casos (25%). Os esquemas quimioterápicos mais utilizados foram XP e mFLOX. Complicações cirúrgicas maiores ocorreram em 4 casos (25%) e 1 (6,3%) foi a óbito. Após seguimento médio de 20 meses, 11 pacientes (68,7%) apresentaram recidiva e 9 (56,3%) morreram. Sobrevida livre de recidiva prolongada acima de 40 meses ocorreu em dois casos. Conclusão : A terapia de conversão pode oferecer possibilidade de sobrevida prolongada para um grupo de pacientes com CG considerados inicialmente fora das possibilidades terapêuticas.

ABSTRACT Background: Conversion therapy in gastric cancer (GC) is defined as the use of chemotherapy/radiotherapy followed by surgical resection with curative intent of a tumor that was prior considered unresectable or oncologically incurable. Aim: To evaluate the results of conversion therapy in the treatment of GC. Methods: Retrospective analysis of all GC surgeries between 2009 and 2018. Patients who received any therapy before surgery were further identified to define the conversion group. Results: Out of 1003 surgeries performed for GC, 113 cases underwent neoadjuvant treatment and 16 (1.6%) were considered as conversion therapy. The main indication for treatment was: T4b lesions (n=10), lymph node metastasis (n=4), peritoneal carcinomatosis and hepatic metastasis in one case each. The diagnosis was made by imaging in 14 cases (75%) and during surgical procedure in four (25%). The most commonly used chemotherapy regimens were XP and mFLOX. Major surgical complications occurred in four cases (25%) and one (6.3%) died. After an average follow-up of 20 months, 11 patients (68.7%) had recurrence and nine (56.3%) died. Prolonged recurrence-free survival over 40 months occurred in two cases. Conclusion: Conversion therapy may offer the possibility of prolonged survival for a group of GC patients initially considered beyond therapeutic possibility.

https://doi.org/10.1590/0102-672020190001e1435 3217 downloads

14.

TOTAL OMENTECTOMY IN GASTRIC CANCER SURGERY: IS IT ALWAYS NECESSARY?
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BARCHI, Leandro Cardoso

; RAMOS, Marcus Fernando Kodama Pertille

; DIAS, André Roncon

; YAGI, Osmar Kenji

; RIBEIRO-JÚNIOR, Ulysses

; ZILBERSTEIN, Bruno

; CECCONELLO, Ivan

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2019, Volume 32 N. 1 elocation e1425

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: Tradicionalmente a omentectomia total é realizada juntamente com a ressecção gástrica associada à linfadenectomia na cirurgia do câncer gástrico. No entanto, evidências sólidas em relação ao seu benefício oncológico são escassas . Objetivo: Avaliar a incidência de metástases em linfonodos do omento maior em pacientes submetidos à gastrectomia potencialmente curativa por câncer gástrico, assim como, avaliar os fatores de risco para a ocorrência e a evolução dos pacientes. Métodos: Pacientes consecutivos submetidos à gastrectomia D2/D2 modificada devido ao adenocarcinoma gástrico foram analisados retrospectivamente a partir de um banco de dados. Resultados: Dos 284 pacientes, cinco (1,8%) tinham linfonodos metastáticos no omento maior (um pT3N3bM0; dois pT4aN3bM0; um pT4aN2M0 e um pT4bN3bM0). Quatro faleceram e um estava em tratamento paliativo com quimioterapia devido à recidiva da doença. Os linfonodos metastáticos no omento maior tiveram correlação significativa com o tamanho do tumor (p=0,018), estádio N (p<0,001), estádio clínico (p=0,022), invasão venosa (p=0,003), recorrência (p=0,006), local de recorrência (peritônio p=0,008; fígado p=0,023; ovário p=0,035) e óbito (p=0,008). Conclusão: A incidência de linfonodos metastático no omento maior de pacientes submetidos à gastrectomia radical por câncer gástrico é baixa. A omentectomia total pode ser evitada em tumores menores que 5,25 cm e estádios T1/T2. Entretanto, a presença de metástases linfonodais no omento maior está associada à recidiva no peritônio, fígado, ovário e óbito.

ABSTRACT Background: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce. Aim: To evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing curative gastrectomy for GC, as well as its risk factors and patients’ outcomes. Methods: All consecutive patients submitted to D2/modified D2 gastrectomy due to gastric adenocarcinoma from March 2009 to April 2016 were retrospectively reviewed from a prospective collected database. Results: Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor’s size (p=0.018), N stage (p<0.001), clinical stage (p=0.022), venous invasion growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). Conclusion: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low. Total omentectomy may be avoided in tumors smaller than 5.25 cm and T1/T2 tumors. However, the presence of lymph node metastases in the greater omentum is associated with recurrence in the peritoneum, liver, ovary and death.

https://doi.org/10.1590/0102-672020180001e1425 4868 downloads

15.

Risk factors associated with the development of gastric cancer — case-control study
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Ramos, Marcus Fernando Kodama Pertille

; Ribeiro Júnior, Ulysses

; Viscondi, Juliana Kodaira Yukari

; Zilberstein, Bruno

; Cecconello, Ivan

; Eluf-Neto, José

Revista da Associação Médica Brasileira

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jul 2018, Volume 64 N. 7 Pages 611 - 619

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1806-9282.64.07.611 5374 downloads

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