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 The authors aim to study Religiosity/Spirituality (R/S) and Quality of Life (QoL) in patients with Crohn's disease and their correlation with the disease phenotypes. Methods Prospective cross-sectional cohort study with 151 consecutive patients enrolled from March 2021 to October 2021 at the Colorectal IBD Outpatient of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Sociodemographic, Religiosity/Spirituality (Duke University Religion Index - Durel) questionnaires and QoL (Inflammatory Bowel Disease Questionnaire - Short IBDQ-S) were applied. When necessary, qualitative variables were evaluated using the chi-square or Fisher's exact test. The Mann-Whitney and Kruskall-Wallis tests were used to analyze quantitative variables and compare more than two groups, both non-parametric statistical techniques. Results The most frequent location was Ileocolonic followed by Ileal and colonic (41.1 %, 27.2 %, and 25.2 %); only 6.6 % of subjects had a perianal presentation. Inflammatory, stenosing, and penetrating behaviors showed 36.4 %, 19.1 %, and 44.4 % respectively. The majority of the population is Catholic, Evangelical, or Spiritualist (92.4 %). QoL score showed no significant difference in the phenotypes. The scores for DUREL domains were 61.4 % for organizational religiosity, 75 % for non-organizational religiosity, 98.6 %, 93.6 % and 89.3 % for intrinsic spirituality, with high results in all disease phenotypes. Conclusions The studied population presented homogeneous sociodemographic results and high religious and spiritual activity. R/S in a positive context were not associated with better QoL or phenotype. R/S is present in the patients’ lives and could be seen as an important tool for adherence to treatment and the professional relationship between doctor and patient. The homogeneity of the sample difficult for an appropriate evaluation, which leads us to suggest new studies with more heterogeneous groups. ReligiositySpirituality Religiosity Spirituality RS R S (R/S (QoL Crohns Crohn s phenotypes crosssectional cross sectional 15 202 HCFMUSP. HCFMUSP . (HCFMUSP) Sociodemographic Duke Durel Inflammatory IBDQS IBDQ IBDQ-S applied necessary chisquare chi square Fishers Fisher test MannWhitney Mann Whitney KruskallWallis Kruskall Wallis groups nonparametric non parametric techniques 41.1 411 41 1 (41. 272 27 2 27. 252 25 25. %) 66 6 6. presentation stenosing 364 36 4 36. 191 19 19. 444 44 44. respectively Catholic Evangelical 92.4 924 92 (92. %. 614 61 61. religiosity 7 nonorganizational 986 98 98. 936 93 93. 893 89 3 89. spirituality activity phenotype patient evaluation 20 (HCFMUSP 41. (41 92. 9 (92 8 (4 (9 (

ABSTRACT Introduction: We aim to publish our innovative modified biplanar 0-90 endoscopic guided puncture technique for percutaneous nephrolithotomy in supine recorded with a GoPro® camera for standardization of the technique. It solves drawbacks of the fluoroscopic technique, i.e., in kidneys with complex anatomy, it may be challenging to distinguish calyces as they are often superposed, and it does not allow for all benefits of a combined endoscopic approach (1, 2). Our technique shortens puncture and fluoroscopic time and is easy to teach and reproduce. Methods: A 77-year-old female patient had previous double J insertion due to an obstructing stone in the right distal ureter. She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care (3, 4) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen. The tip of the flexible scope was used to mark point A with the C-arm in the 0-degree position and line B in the 90-degree position. Puncture was fast and the MiniECIRS was uneventful with a single mid-pole access guided by the flexible scope. The surgeon had a Full-HD GoPro® camera mounted on his head, controlled by the surgical staff. All essential surgical steps were recorded. Results: The quality of the recorded movie was graded as excellent, and the camera did not cause any discomfort to the surgeon. Operative and X-Ray time were 120minutes and 2minutes (7.64mGy). Hemoglobin drop was 0.8g/dL. The post-operative day-1 computed tomography scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The patient remained asymptomatic and metabolic evaluation revealed a calcium oxalate stone, low urinary volume and hypocitraturia which were treated with potassium citrate and hydration. Conclusion: The Modified Biplanar (0-90 degree) Endoscopic-Guided Puncture Technique for Percutaneous Nephrolithotomy joins the reproducibility of the same technique under fluoroscopy with advantages regarding safety and efficiency of ECIRS. Introduction 090 0 90 0-9 GoPro ie i e i.e. anatomy superposed 1, 1 (1 2. 2 . 2) reproduce Methods 77yearold yearold 77 year old ureter mm 1300HU HU (1300HU pelvis 3, 3 (3 4 ECIRS (ECIRS) chosen Carm C arm 0degree degree 90degree midpole mid pole FullHD Full HD head staff Results excellent XRay X Ray minutes 7.64mGy. 764mGy mGy 7.64mGy 7 64mGy (7.64mGy) 08gdL gdL 8g dL g 0.8g/dL postoperative post operative day1 day day- stonefree. stonefree free. free stone-free h 5days days hydration Conclusion (0-9 EndoscopicGuided Endoscopic Guided 09 9 0- i.e ( (ECIRS (7.64mGy (0- (0

RESUMO RACIONAL: Apesar dos enormes avanços no tratamento das doenças inflamatórias intestinais (DII), alguns pacientes apresentam quadros de colite aguda refratária ao tratamento clínico, e necessitam de cirurgia de urgência. OBJETIVOS: Avaliar os fatores de risco associados com complicações pós-operatórias precoces nos pacientes com colite aguda submetidos a colectomia na era das terapias biológicas. MÉTODOS: Pacientes com DII admitidos com colite aguda grave submetidos a colectomia total em hospital terciário no período de 2012 a 2022 foram analisados. As complicações pós-operatórias foram graduadas de acordo com a classificação Clavien-Dindo (CCD). Pacientes com complicações mais graves (CCD≥2) foram comparados com os menos graves (CCD<2). RESULTADOS: Foram submetidos a cirurgia 46 pacientes. As indicações foram: falha do tratamento conservador (n=34), preferência do paciente ou do cirurgião (n=5), hemorragia (n=3), megacólon tóxico (n=2) e perfuração intestinal (n=2). Reoperação foi necessária em oito pacientes, 60,9% tiveram complicações classificadas como CCD≥2, e três pacientes foram a óbito. Análise univariada identificou que uso de antibióticos no pré-operatório, diagnóstico de colite ulcerativa, hipoalbuminemia na admissão e período de internação maior que sete dias foi associada à complicações pós-operatória mais graves. CONCLUSÕES: Pacientes com colite aguda submetidos a cirurgia de urgência apresentaram alta taxa de complicações pós-operatórias. Uso pré-operatório de antibióticos, diagnóstico de retocolite ulcerativa, hipoalbuminemia na admissão e retardo na operação por mais que sete dias, esteve associado a complicações pós-operatórias mais graves. Uso de biológicos não se associou a piores desfechos. RACIONAL DII, , (DII) clínico OBJETIVOS pósoperatórias pós operatórias biológicas MÉTODOS 201 202 analisados ClavienDindo Clavien Dindo CCD. CCD . (CCD) CCD≥2 CCD2 2 (CCD≥2 CCD<2. CCD<2 (CCD<2) RESULTADOS 4 n=34, n34 n n=34 34 (n=34) n=5, n5 n=5 5 (n=5) n=3, n3 n=3 3 (n=3) n=2 n2 (n=2 n=2. 609 60 9 60,9 óbito préoperatório, préoperatório pré operatório, operatório ulcerativa pósoperatória operatória CONCLUSÕES pósoperatórias. operatórias. desfechos (DII 20 (CCD CCD≥ (CCD≥ CCD< (CCD<2 (n=34 n= (n=5 (n=3 (n= 6 60, (CCD< (n

ABSTRACT BACKGROUND: Despite major advances in the clinical treatment of inflammatory bowel disease, some patients still present with acute colitis and require emergency surgery. AIMS: To evaluate the risk factors for early postoperative complications in patients undergoing surgery for acute colitis in the era of biologic therapy. METHODS: Patients with inflammatory bowel disease admitted for acute colitis who underwent total colectomy at a single tertiary hospital from 2012 to 2022 were evaluated. Postoperative complications were graded according to Clavien-Dindo classification (CDC). Patients with more severe complications (CDC≥2) were compared with those with less severe complications (CDC<2). RESULTS: A total of 46 patients underwent surgery. The indications were: failure of clinical treatment (n=34), patients’ or surgeon's preference (n=5), hemorrhage (n=3), toxic megacolon (n=2), and bowel perforation (n=2). There were eight reoperations, 60.9% of postoperative complications classified as CDC≥2, and three deaths. In univariate analyses, preoperative antibiotics use, ulcerative colitis diagnosis, lower albumin levels at admission, and preoperative hospital stay longer than seven days were associated with more severe postoperative complications. CONCLUSIONS: Emergency surgery for acute colitis was associated with a high incidence of postoperative complications. Preoperative use of antibiotics, ulcerative colitis, lower albumin levels at admission, and delaying surgery for more than seven days were associated with more severe early postoperative complications. The use of biologics was not associated with worse outcomes. BACKGROUND AIMS therapy METHODS 201 202 evaluated ClavienDindo Clavien Dindo CDC. CDC . (CDC) CDC≥2 CDC2 2 (CDC≥2 CDC<2. CDC<2 (CDC<2) RESULTS 4 n=34, n34 n n=34 , 34 (n=34) surgeons surgeon s n=5, n5 n=5 5 (n=5) n=3, n3 n=3 3 (n=3) n=2, n2 n=2 (n=2) n=2. reoperations 609 60 9 60.9 deaths analyses diagnosis admission CONCLUSIONS outcomes 20 (CDC CDC≥ (CDC≥ CDC< (CDC<2 (n=34 n= (n=5 (n=3 (n=2 6 60. (CDC< (n= (n

Abstract Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50-75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC. (FIT . (CRC) Brazil lowincome low income city PPV (PPV complications 201 2019 5075 75 50-7 old ≥ ( 5 ng/mL ngmL ng mL 10057 10 057 10,05 analysis 98.2% 982 98 2 (98.2% 9881 9 881 9,88 valid 648 64 8 64.8 participants 553 55 3 55.3 school 78 7 7.8 776/9881. 7769881 776/9881 776 (776/9881) 689 68 68.9 535/776. 535776 535/776 535 (535/776) 632 63 63.2 332/525 332525 332 525 (332/525 314 31 4 31.4 165/525. 165525 165/525 165 (165/525) 59 5.9 31/525, 31525 31/525 , (31/525) adenocarcinoma 32 3.2 1/31, 131 1/31 1 (1/31) 29 9/31, 931 9/31 (9/31) 677 67 67.7 21/31. 2131 21/31 21 (21/31) 452 45 45.2 14/31 1431 14 (14/31 cases Therefore both (CRC 20 507 50- 1005 05 10,0 98.2 (98.2 988 88 9,8 6 64. 55. 7. 776988 776/988 77 (776/9881 68. 53577 535/77 53 (535/776 63. 332/52 33252 33 52 (332/52 31. 16552 165/52 16 (165/525 5. 3152 31/52 (31/525 3. 13 1/3 (1/31 93 9/3 (9/31 67. 213 21/3 (21/31 45. 14/3 143 (14/3 100 0 10, 98. (98. 9, 77698 776/98 (776/988 5357 535/7 (535/77 332/5 3325 (332/5 1655 165/5 (165/52 315 31/5 (31/52 1/ (1/3 9/ (9/3 21/ (21/3 14/ (14/ (98 7769 776/9 (776/98 535/ (535/7 332/ (332/ 165/ (165/5 31/ (31/5 (1/ (9/ (21/ (14 (9 776/ (776/9 (535/ (332 (165/ (31/ (1 (21 (776/ (535 (33 (165 (31 (2 (776 (53 (3 (16 (77 (5 (7

RESUMO RACIONAL: A abordagem laparoscópica reduziu consideravelmente a morbidade da cirurgia colorretal quando comparada à abordagem aberta. Entre seus benefícios podemos destacar o menor sangramento intraoperatório, ingestão oral precoce, menor índice de infecção de incisão cirúrgica e hérnia incisional, menor índice de dor pós-operatória e alta hospitalar mais precoce. OBJETIVOS: Comparar a morbidade perioperatória da colectomia direita versus esquerda para câncer e a qualidade da ressecção oncológica laparoscópica. MÉTODOS: Análise retrospectiva de pacientes submetidos à olectomia laparoscópica direit e esquerda entre 2006 e 2016. As complicações pós-operatórias foram classificadas pela escala Clavien-Dindo, 30 dias após a cirurgia. RESULTADOS: Um total de 293 pacientes foram analisados, 97 casos de colectomia direita (33.1%) e 196 de esquerda (66.9%). A idade média foi de 62,8 anos. Os grupos foram comparáveis em termos de idade, comorbidades, índice de massa corporal e classificação da Sociedade Americana de Anestesiologia (ASA). A transfusão pré-operatória foi maior no grupo da colectomia direita (5,1% versus 0,4%, p=0,004, p<0,05). No geral, 233 pacientes (79.5%) não apresentaram complicações. As complicações encontradas foram graus I e II em 62 pacientes (21,1%), egraus III a V em 37 (12,6%). Vinte e três pacientes (7,8%) foram reoperados. A comparação entre a colectomia laparoscópica esquerda e direita não foi estatisticamente diferente para tempo operatório, conversão, reoperação, complicações pós-operatórias graves e tempo de internação. A taxa de fístula anastomótica foi comparável em ambos os grupos (5,6% versus 2,1%, p=0,232, p>0,05). Os resultados oncológicos foram semelhantes nas duas cirurgias. Na regressão logística múltipla, a ASA influenciou estatisticamente os piores resultados (≥ III; p=0,029, p<0,05). CONCLUSÕES: Os resultados cirúrgicos e oncológicos das colectomias laparoscópicas direita e esquerda são semelhantes, tornando esta a abordagem preferida para ambos os procedimentos. RACIONAL aberta intraoperatório precoce incisional pósoperatória pós operatória OBJETIVOS MÉTODOS 200 2016 pósoperatórias operatórias ClavienDindo, ClavienDindo Clavien Dindo, Dindo Clavien-Dindo 3 RESULTADOS 29 analisados 9 33.1% 331 33 1 (33.1% 19 66.9%. 669 66.9% . 66 (66.9%) 628 8 62, anos comorbidades ASA. (ASA) préoperatória pré 5,1% 51 5 (5,1 04 0 4 0,4% p0004 p 004 p=0,004 p<0,05. p005 p<0,05 05 p<0,05) geral 23 79.5% 795 79 (79.5% 6 21,1%, 211 21,1% , 21 (21,1%) 12,6%. 126 12,6% 12 (12,6%) 7,8% 78 7 (7,8% reoperados operatório conversão reoperação internação 5,6% 56 (5,6 2 2,1% p0232 232 p=0,232 p>0,05. p>0,05 p>0,05) cirurgias múltipla ≥ ( p0029 029 p=0,029 CONCLUSÕES procedimentos 20 201 33.1 (33.1 66.9 (66.9% (ASA 5,1 (5, 0,4 p000 00 p=0,00 p00 p<0,0 79.5 (79.5 21,1 (21,1% 12,6 (12,6% 7,8 (7,8 5,6 2,1 p023 p=0,23 p>0,0 p002 02 p=0,02 33. (33. 66. (66.9 5, (5 0, p=0,0 p0 p<0, 79. (79. 21, (21,1 12, (12,6 7, (7, 2, p02 p=0,2 p>0, (33 (66. p=0, p<0 (79 (21, (12, (7 p>0 (3 (66 p=0 p< (21 (12 p> (6 p= (2 (1

ABSTRACT BACKGROUND: The laparoscopic approach considerably reduced the morbidity of colorectal surgery when compared to the open approach. Among its benefits, we can highlight less intraoperative bleeding, early oral intake, lower rates of surgical site infection, incisional hernia, and postoperative pain, and earlier hospital discharge. AIMS: To compare the perioperative morbidity of right versus left colectomy for cancer and the quality of laparoscopic oncologic resection. METHODS: Retrospective analysis of patients submitted to laparoscopic right and left colctomy between 2006 and 2016. Postoperative complications were classified using the Clavien-Dindo scale, 30 days after surgery. RESULTS: A total of 293 patients were analyzed, 97 right colectomies (33.1%) and 196 left colectomies (66.9%). The averageage was 62.8 years. The groups were comparable in terms of age, comorbidities, body mass index, and the American Society of Anesthesiology (ASA) classification. Preoperative transfusion was higher in the right colectomy group (5.1% versus 0.4%, p=0.004, p<0.05). Overall, 233 patients (79.5%) had no complications. Complications found were grade I and II in 62 patients (21.1%) and grade III to V in 37 (12.6%). Twenty-three patients (7.8%) underwent reoperation. The comparison between left and right colectomy was not statistically different for operative time, conversion, reoperation, severe postoperative complications, and length of stay. The anastomotic leak rate was comparable in both groups(5.6% versus 2.1%, p=0.232, p>0.05). The oncological results were similar in both surgeries. In multiple logistic regression, ASA statistically influenced the worst results (≥ III; p=0.029, p<0.05). CONCLUSIONS: The surgical and oncological results of laparoscopic right and left colectomies are similar, making this the preferred approach for both procedures. BACKGROUND benefits bleeding intake infection hernia pain discharge AIMS resection METHODS 200 2016 ClavienDindo Clavien Dindo scale 3 RESULTS 29 analyzed 9 33.1% 331 33 1 (33.1% 19 66.9%. 669 66.9% . 66 (66.9%) 628 8 62. years age comorbidities index (ASA classification 5.1% 51 5 (5.1 04 0 4 0.4% p0004 p 004 p=0.004 p<0.05. p005 p<0.05 05 p<0.05) Overall 23 79.5% 795 79 (79.5% 6 21.1% 211 21 (21.1% 12.6%. 126 12.6% 12 (12.6%) Twentythree Twenty three 7.8% 78 7 (7.8% reoperation time conversion stay groups5.6% groups56 5.6% groups(5.6 2 2.1% p0232 232 p=0.232 p>0.05. p>0.05 p>0.05) surgeries regression ≥ ( p0029 029 p=0.029 CONCLUSIONS procedures 20 201 33.1 (33.1 66.9 (66.9% 5.1 (5. 0.4 p000 00 p=0.00 p00 p<0.0 79.5 (79.5 21.1 (21.1 12.6 (12.6% 7.8 (7.8 groups5 groups5.6 56 5.6 groups(5. 2.1 p023 p=0.23 p>0.0 p002 02 p=0.02 33. (33. 66. (66.9 5. (5 0. p=0.0 p0 p<0. 79. (79. 21. (21. 12. (12.6 7. (7. groups5. groups(5 2. p02 p=0.2 p>0. (33 (66. p=0. p<0 (79 (21 (12. (7 groups( p>0 (3 (66 p=0 p< (2 (12 p> (6 p= (1

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.

Abstract Objectives: To evaluate results of patients undergoing liver resection in a single center over the past two decades with a particular look at Colorectal Liver Metastasis (CRLM) and Hepatocellular Carcinoma (HCC). Method: Patients were divided into two eras, from 2000 to 2010 (Era 1) and 2011 to 2020 (Era 2). The most frequent diagnosis was CRLM and HCC, with 738 (52.4%) and 227 (16.1%) cases respectively. An evaluation of all liver resection cases and a subgroup analysis of both CRLM and HCC were performed. Preoperative and per operative variables and long-term outcomes were evaluated. Results: 1409 liver resections were performed. In Era 2 the authors observed higher BMI, more: minimally invasive surgeries, Pringle maneuvers, and minor liver resections; and less transfusion, less ICU necessity, and shorter length of hospital stay. Severe complications were observed in 14.7% of patients, and 90-day mortality was 4.2%. Morbidity and mortality between eras were not different. From 738 CRLM resections, in Era 2 there were significantly more patients submitted to neoadjuvant chemotherapy, bilateral metastases, and smaller sizes with significantly less transfusion, the necessity of ICU, and shorter length of hospital stay. More pedicle clamping, minimally invasive surgeries, and minor resections were also observed. From 227 HCC resections, in Era 2 significantly more minimally invasive surgeries, fewer transfusions, less necessity of ICU, and shorter length of hospital stay were observed. OS was not different between eras for CRLM and HCC. Conclusions: Surgical resection in a multidisciplinary environment remains the cornerstone for the curative treatment of primary and metastatic liver tumors.

RESUMO RACIONAL: A ressecção cirúrgica é o principal fator determinante na sobrevida de pacientes com câncer gástrico, mas não é indicada na presença de doença metastática. O peritônio é local comum de metástase, porém os métodos de imagem ainda falham na sua detecção. OBJETIVO: Avaliar o papel da Laparoscopia Diagnóstica no estadiamento de pacientes com câncer gástrico avançado em um centro oncológico ocidental terciário. MÉTODOS: Foram avaliados 130 pacientes com adenocarcinoma gástrico submetidos a Laparoscopia Diagnóstica de 2009 a 2020, a partir de um banco de dados prospectivo. As características clínico-patológicas foram analisadas para identificar fatores associados à presença de metástase peritoneal. Foram também avaliadas a acurácia e concordância entre a tomografia computadorizada e a Laparoscopia Diagnóstica na detecção de metástase peritoneal e na mudança de conduta após a Laparoscopia Diagnóstica. RESULTADOS: As metástases peritoneais foram identificadas em 66 pacientes (50,76%). A sensibilidade, especificidade e acurácia da tomografia computadorizada na sua detecção foram de 51,5%, 87,5% e 69,2%, respectivamente. De acordo com o coeficiente Kappa, a concordância entre a Laparoscopia Diagnóstica e a tomografia computadorizada foi de 38,8%. Na análise multivariada, ascite (p=0,001) e suspeita de metástase peritoneal na tomografia computadorizada (p=0,007) foram estatisticamente correlacionadas com metástase peritoneal. Em 40 pacientes (30,8%), o estadiamento e as estratégias de tratamento mudaram após a Laparoscopia Diagóstica (32 pacientes evitaram laparotomia e 8 pacientes, anteriormente considerados estágio IVb, foram tratados cirurgicamente). CONCLUSÕES: A Laparoscopia Diagnóstica demonstrou um papel importante no diagnóstico de metástases peritoneais, mesmo com métodos de imagem avançados. RACIONAL metastática OBJETIVO terciário MÉTODOS 13 200 2020 prospectivo clínicopatológicas clínico patológicas RESULTADOS 6 50,76%. 5076 50,76% . 50 76 (50,76%) sensibilidade 515 51 5 51,5% 875 87 87,5 692 69 2 69,2% respectivamente Kappa 388 38 38,8% multivariada p=0,001 p0001 p 0 001 (p=0,001 p=0,007 p0007 007 (p=0,007 4 30,8%, 308 30,8% , 30 (30,8%) 32 (3 IVb cirurgicamente. cirurgicamente cirurgicamente) CONCLUSÕES avançados 1 20 202 507 50,76 7 (50,76% 51,5 87, 69,2 3 38,8 p=0,00 p000 00 (p=0,00 30,8 (30,8% ( 50,7 (50,76 51, 69, 38, p=0,0 p00 (p=0,0 30, (30,8 50, (50,7 p=0, p0 (p=0, (30, (50, p=0 (p=0 (30 (50 p= (p= (5 (p

ABSTRACT BACKGROUND: Complete surgical resection is the main determining factor in the survival of advanced gastric cancer patients, but is not indicated in metastatic disease. The peritoneum is a common site of metastasis and preoperative imaging techniques still fail to detect it. AIM: The aim of this study was to evaluate the role of staging laparoscopy in the staging of advanced gastric cancer patients in a Western tertiary cancer center. METHODS: A total of 130 patients with gastric adenocarcinoma who underwent staging laparoscopy from 2009 to 2020 were evaluated from a prospective database. Clinicopathological characteristics were analyzed to identify factors associated with the presence of peritoneal metastasis and were also evaluated the accuracy and strength of agreement between computed tomography and staging laparoscopy in detecting peritoneal metastasis and the change in treatment strategy after the procedure. RESULTS: The peritoneal metastasis was identified in 66 (50.76%) patients. The sensitivity, specificity, and accuracy of computed tomography in detecting peritoneal metastasis were 51.5, 87.5, and 69.2%, respectively. According to the Kappa coefficient, the concordance between staging laparoscopy and computed tomography was 38.8%. In multivariate analysis, ascites (p=0.001) and suspected peritoneal metastasis on computed tomography (p=0.007) were statistically correlated with peritoneal metastasis. In 40 (30.8%) patients, staging and treatment plans changed after staging laparoscopy (32 patients avoided unnecessary laparotomy, and 8 patients, who were previously considered stage IVb by computed tomography, were referred to surgical treatment). CONCLUSION: The staging laparoscopy demonstrated an important role in the diagnosis of peritoneal metastasis, even with current advances in imaging techniques. BACKGROUND disease it AIM center METHODS 13 200 202 database procedure RESULTS 6 50.76% 5076 50 76 (50.76% sensitivity specificity 515 51 5 51.5 875 87 87.5 692 69 2 69.2% respectively coefficient 388 38 38.8% analysis p=0.001 p0001 p 0 001 (p=0.001 p=0.007 p0007 007 (p=0.007 4 30.8% 308 30 (30.8% 32 (3 laparotomy treatment. . treatment) CONCLUSION 1 20 50.76 507 7 (50.76 51. 87. 69.2 3 38.8 p=0.00 p000 00 (p=0.00 30.8 (30.8 ( 50.7 (50.7 69. 38. p=0.0 p00 (p=0.0 30. (30. 50. (50. p=0. p0 (p=0. (30 (50 p=0 (p=0 (5 p= (p= (p

RESUMO RACIONAL: A neoplasia sólida pseudopapilífera do pâncreas é um tumor pancreático incomum, mais frequente em mulheres jovens. A polipose adenomatosa familiar, por sua vez, é uma condição genética associada a câncer colorretal e que também aumenta o risco de desenvolvimento de outros tumores. OBJETIVOS: Discutir a associação entre polipose adenomatosa familiar e neoplasia sólida pseudopapilífera, que é bastante rara. MÉTODOS: Reportamos dois casos de pacientes com polipose adenomatosa familiar, um homem e uma mulher, que desenvolveram neoplasia sólida pseudopapilífera do pâncreas e foram submetidos a ressecção laparoscópica com preservação esplênica. RESULTADOS: As vias de sinalização da ß-catenina e Wnt tem um papel importante na tumorigênese da neoplasia sólida pseudopapilífera, e sua ativação constitutiva devido a inativação do gene adenomatous polyposis coli na polipose adenomatosa familiar pode explicar a relação entre polipose adenomatosa familiar e neoplasia sólida pseudopapilífera. CONCLUSÕES: A ressecção do cólon deve ser priorizada, com preferência pela abordagem minimamente invasiva para minimizar o risco de desenvolvimento de tumor desmoide. A ressecção pancreática geralmente não requer linfadenectomia extensa para neoplasia sólida pseudopapilífera, portanto, a preservação esplênica é factível. RACIONAL incomum jovens vez tumores OBJETIVOS rara MÉTODOS mulher RESULTADOS ßcatenina ß catenina CONCLUSÕES priorizada desmoide portanto factível

ABSTRACT BACKGROUND: Solid pseudopapillary neoplasm of the pancreas is an uncommon pancreatic tumor, which is more frequent in young adult women. Familial adenomatous polyposis is a genetic condition associated with colorectal cancer that also increases the risk of developing other tumors as well. AIM: The aim of this study was to discuss the association of familial adenomatous polyposis with solid pseudopapillary neoplasm of the pancreas, which is very rare. METHODS: We report two cases of patients with familial adenomatous polyposis who developed solid pseudopapillary neoplasm of the pancreas of the pancreas and were submitted to laparoscopic pancreatic resections with splenic preservation (one male and one female). RESULTS: ß-catenin and Wnt signaling pathways have been found to play an important role in the tumorigenesis of solid pseudopapillary neoplasm of the pancreas, and their constitutive activation due to adenomatous polyposis coli gene inactivation in familial adenomatous polyposis may explain the relationship between familial adenomatous polyposis and solid pseudopapillary neoplasm of the pancreas. CONCLUSION: Colonic resection must be prioritized, and a minimally invasive approach is preferred to minimize the risk of developing desmoid tumor. Pancreatic resection usually does not require extensive lymphadenectomy for solid pseudopapillary neoplasm of the pancreas, and splenic preservation is feasible. BACKGROUND tumor women well AIM rare METHODS female. female . female) RESULTS ßcatenin ß catenin CONCLUSION prioritized feasible

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 - RACIONAL: Mesmo no câncer gástrico (CG) em estágio clínico IV (ECIV), procedimentos cirúrgicos podem ser necessários para aliviar sintomas ou na tentativa de melhorar a sobrevida. No entanto, a sobrevida limitada desses pacientes levanta dúvidas sobre quem realmente se beneficiaria. OBJETIVO: Analisar os resultados cirúrgicos do CG ECIV tratado com procedimentos cirúrgicos sem intenção curativa. MÉTODOS: Análise retrospectiva dos pacientes com CG ECIV submetido a procedimentos cirúrgicos, incluindo: ressecção tumoral, bypass, jejunostomia e laparoscopia diagnóstica. Pacientes submetidos à gastrectomia curativa serviram como grupo de comparação. RESULTADOS: Os procedimentos cirúrgicos em ECIV foram realizados em 363 pacientes. Comparado à cirurgia curativa (680 pacientes), os pacientes em ECIV apresentaram maior taxa de comorbidades e classificação ASA III/IV. Os procedimentos cirúrgicos realizados foram: 107 (29,4%) bypass (partição/anastomose gastrojejunal), 85 (23,4%) jejunostomias, 76 (20,9%) ressecções e 76 (20,9%) laparoscopias diagnósticas. Em relação às características dos pacientes, os ressecados apresentaram predomínio de metástases distantes (p=0,011); os de bypass associaram-se a doença em mais de um sítio (p<0,001); e os laparoscópicos, metástases peritoneais (p<0,001). A sobrevida global mediana de acordo com o tipo de cirurgia foi: ressecção (13,6 meses), bypass (7,8 meses), jejunostomia (2,7 meses) e diagnóstica (7,8 meses) (p<0,001). Na análise multivariada, níveis baixos de albumina, mais de um sítio de doença, jejunostomia e laparoscopia associaram-se a pior sobrevida. CONCLUSÃO: Pacientes em ECIV ressecados apresentam melhor sobrevida, enquanto aqueles submetidos à jejunostomia e laparoscopia diagnóstica tiveram piores resultados. A identificação adequada dos pacientes que se beneficiariam com a ressecção cirúrgica pode melhorar a sobrevida e evitar procedimentos pouco eficazes.

ABSTRACT - BACKGROUND: Even in clinical stage IV gastric cancer (GC), surgical procedures may be required to palliate symptoms or in an attempt to improve survival. However, the limited survival of these patients raises doubts about who really had benefits from it. AIM: This study aimed to analyze the surgical outcomes in stage IV GC treated with surgical procedures without curative intent. METHODS: Retrospective analyses of patients with stage IV GC submitted to surgical procedures including tumor resection, bypass, jejunostomy, and diagnostic laparoscopy were performed. Patients with GC undergoing curative gastrectomy served as the comparison group. RESULTS: Surgical procedures in clinical stage IV were performed in 363 patients. Compared to curative surgery (680 patients), stage IV patients had a higher rate of comorbidities and ASA III/IV classification. The surgical procedures that were performed included 107 (29.4%) bypass procedures (partitioning/gastrojejunal anastomosis), 85 (23.4%) jejunostomies, 76 (20.9%) resections, and 76 (20.9%) diagnostic laparoscopies. Regarding patients’ characteristics, resected patients had more distant metastasis (p=0.011), bypass patients were associated with disease in more than one site (p<0.001), and laparoscopy patients had more peritoneal metastasis (p<0.001). According to the type of surgery, the median overall survival was as follows: resection (13.6 months), bypass (7.8 months), jejunostomy (2.7 months), and diagnostic (7.8 months, p<0.001). On multivariate analysis, low albumin levels, in case of more than one site of disease, jejunostomy, and laparoscopy, were associated with worse survival. CONCLUSION: Stage IV resected cases have better survival, while patients submitted to jejunostomy and diagnostic laparoscopy had the worst results. The proper identification of patients who would benefit from surgical resection may improve survival and avoid futile procedures.