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RESUMO Racional: Carcinoma incidental da vesícula biliar é definido como uma neoplasia descoberta por exame histológico após colecistectomia videolaparoscópica. É potencialmente uma doença curável. Entretanto algumas questões relacionadas ao seu manuseio permanecem controversas e uma estratégia definida está associada com melhor prognóstico. Objetivo: Desenvolver o primeiro consenso baseado em evidências para o manuseio de pacientes com carcinoma incidental da vesícula biliar no Brasil. Métodos: Dezesseis questões foram selecionadas e para responder as questões e 36 membros das sociedades brasileiras e internacionais foram incluídos. As recomendações foram baseadas em evidências da literatura atual. Um relatório final foi enviado para os membros do painel para avaliação de concordância. Resultados: Avaliação intraoperatória da peça cirúrgica, uso de bolsas para retirar a peça cirúrgica e exame histopatológico de rotina, foram recomendados. Avaliação pré-operatória completa é necessária e deve ser realizada assim que o estadiamento final esteja disponível. Avaliação da margem do ducto cístico e biópsia de rotina do linfonodo 16b1 são recomendadas. Quimioterapia deve ser considerada e quimioradioterapia indicada se a margem cirúrgica microscópica seja positiva. Os portais devem ser ressecados excepcionalmente. O estadiamento laparoscópico antes da operação é recomendado, mas o tratamento radical por abordagem minimamente invasiva deve ser realizado apenas em centros especializados em cirurgia hepatopancreatobiliar minimamente invasiva. A extensão da ressecção hepática é aceitável até que seja alcançada a ressecção R0. A linfadenectomia padrão é indicada para tumores iguais ou superiores a T2, mas a ressecção da via biliar não é recomendada de rotina. Conclusões: Recomendações seguras foram preparadas para carcinoma incidental da vesícula biliar, destacando os mais frequentes tópicos do trabalho diário do cirurgião do aparelho digestivo e hepatopancreatobiliar.

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

https://doi.org/10.1590/0102-672020190001e1496 2194 downloads

Surgery as a component of universal healthcare: Where is South Africa?
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Reddy, Ché L

; Makasa, Emmanuel M

; Biccard, Bruce

; Smith, Martin

; Steyn, Elmin

; Fieggen, Graham

; Maswime, Salome

; Meara, John G

; Chu, Kathryn

SAMJ: South African Medical Journal

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sep 2019, Volume 109 N. 9 Pages 624 - 625

Abstract: En | Text: En | PDF: En

https://doi.org/10.7196/samj.2019.v109i9.14233 193 downloads

A survey of the ichthyofauna in the Noetsie Estuary, Western Cape Province, South Africa
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Smith, Martin K.S.

; Rodrigues, Demi

; Currie, Bianca

Koedoe

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2018, Volume 60 N. 1 Pages 1 - 7

Abstract: En | Text: En | PDF: En

The fish assemblage in the Noetsie Estuary, a temporarily open and closed estuary on the southern coast of South Africa, was sampled using multiple gears. A total of 12 species from 8 families were recorded. Collectively, estuarine-dependent marine species dominated seine net catches numerically and in terms of biomass for both sampling seasons. Estuarine round herring (Gilchristella aestuaria) was numerically the dominant species in late summer, while juvenile Mugilidae dominated catches in winter. Size class distributions of various fish species indicate that the estuary both serves a nursery function for important euryhaline marine species and supports estuarine resident taxa. Application of the Estuarine Fish Community Index indicates the ecological condition of the estuary to be 'good'. This study contributes to the species list for the estuary while also reporting the presence of an alien invasive freshwater species, Gambusia affinis. Recommendations include the development of a management plan and the formalisation of an estuarine management committee. CONSERVATION IMPLICATIONS: The Noetsie Estuary serves a nursery function for important euryhaline marine species, while supporting healthy populations of estuarine resident taxa. The presence of one alien invasive fish species is documented with potential implications for the conservation of biodiversity in the estuary.

https://doi.org/10.4102/koedoe.v60i1.1513 274 downloads

Minimising the 'cost' of laparoscopic cholecystectomy
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Thomson, Sandie R

; Smith, Martin D

SAMJ: South African Medical Journal

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jun 2015, Volume 105 N. 6 Pages 451 - 452

Abstract: En | Text: En | PDF: En

https://doi.org/10.7196/SAMJ.9791 1200 downloads

New possibilities for research on reef fish across the continental shelf of South Africa
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Bernard, Anthony T.F.

; Götz, Albrecht

; Parker, Denham

; Heyns, Elodie R.

; Halse, Sarah J.

; Riddin, Nicholas A.

; Smith, Martin K.S.

; Paterson, Angus W.

; Winker, Henning

; Fullwood, Laura

; Langlois, Timothy J.

; Harvey, Euan S.

South African Journal of Science

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oct 2014, Volume 110 N. 9-10 Pages 01 - 05

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/sajs.2014/a0079 1188 downloads

Perspectives of South African general surgeons regarding their postgraduate training
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Smith, Martin D

South African Journal of Surgery

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aug 2014, Volume 52 N. 3 Pages 66 - 66

Abstract: En | Text: En | PDF: En

https://doi.org/10.7196/sajs.2391 332 downloads

A METHODOLOGICAL MODEL TO ASSIST IN THE OPTIMIZATION AND RISK MANAGEMENT OF MINING INVESTMENT DECISIONS
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BOTÍN, JOSÉ A.

; GUZMÁN, RONALD R.

; SMITH, MARTIN L.

DYNA

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dec 2011, Volume 78 N. 170 Pages 221 - 226

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Identificar, cuantificar y minimizar el riesgo técnico asociado a las decisiones de inversión es un desafío clave para los directivos de la industria minera y los inversores. Sin embargo, en la mayor parte de los estudios de factibilidad bancables, el análisis de riesgo se basa en la modelización estocástica del “Valor actual neto” del proyecto (VAN) que, en la mayoría de los casos, no aporta a los tomadores de decisión una análisis completo de los riesgos derivados de la incertidumbre técnica y de gestión y por ello, resulta de escasa utilidad en el análisis de riesgo y la optimización del proyecto. Este articulo presenta un planteamiento de la gestión de riesgo basado en la cadena de valor, en el que el riesgo del proyecto se evalúa en cada etapa del ciclo de vida del proyecto, desde la exploración al cierre de la mina, y la gestión del riesgo forma parte de un proceso en etapas de valor agregado y optimización.

Identifying, quantifying, and minimizing technical risks associated with investment decisions is a key challenge for mineral industry decision makers and investors. However, risk analysis in most bankable mine feasibility studies are based on the stochastic modelling of project “Net Present Value” (NPV)which, in most cases, fails to provide decision makers with a truly comprehensive analysis of risks associated with technical and management uncertainty and, as a result, are of little use for risk management and project optimization. This paper presents a value-chain risk management approach where project risk is evaluated for each step of the project lifecycle, from exploration to mine closure, and risk management is performed as a part of a stepwise value-added optimization process.

2747 downloads

Acinar cell carcinoma - a rare tumour of the pancreas
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Klipin, Michael

; Sparaco, Anna

; Omoshoro-Jones, Jones

; Smith, Martin Derek

South African Journal of Surgery

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aug 2008, Volume 46 N. 3 Pages 88 - 88

Abstract: En | Text: En | PDF: En

224 downloads

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