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Development of pouch cancer is a great challenge to both surgeons and patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy (RPC).
We aimed to present our experience with pouch cancer diagnosis and review literature data regarding incidence and associated risk factors.
This retrospective study enrolled FAP patients undergoing RPC between 1981 and 2023 in our academic institution. It included only J-pouch stapled patients with at least three years of follow-up. Patients’ demographics and disease features were retrieved.
After excluding seven patients, we selected 87 RPC, and three cases (3.4%) of pouch cancer were identified. They were diagnosed in three men aged 23–40 years at RPC and 41–62 years at cancer diagnosis. Interval from RPC to pouch cancer diagnosis varied from 11.6 to 20 years (average 14.6 years). All patients had colorectal cancers (CRC) detected in the specimen from the index surgery, two of them with multicenter lesions. A brief review of the literature series showed that pouch cancer has been detected in incidences ranging from 0.8 to 3.4%. Male sex, CRC in the RPC specimen, pouch phenotype during follow-up and an association with duodenal adenomas are considered risk factors.
Pouch cancer is a rare event associated with specific risk factors. After RPC, all patients should undergo endoscopic surveillance, with special attention to those who develop an aggressive phenotype during the first decade of follow-up.
Gastric neuroendocrine tumors (gNETs) are uncommon neoplasms arising from enterochromaffin-like cells, representing a distinct subset of gastric malignancies, with challenging clinical management.
To analyse the classification, treatment indication, and survival of patients diagnosed with gNETs.
We retrospectively analyzed patients diagnosed with gNETs between 2009 and 2025 at a high-volume tertiary center in Brazil. Clinical, pathological, and treatment data were reviewed, and tumors were classified according to World Health Organization and clinicopathological criteria into Types I, II, and III.
Of the 75 patients included, 53 (70.7%) were classified as Type I, 5 (6.7%) as Type II, and 17 (22.6%) as Type III. Treatment included surgery in 25 patients (33.3%) and endoscopic resection in 50 (66.7%). Type I tumors predominated in females (p<0.001), were frequently multifocal (p<0.001), associated with higher body mass index (p=0.002), and were mainly managed endoscopically (p=0.008). Type II tumors were rare and associated with multiple endocrine neoplasia Type 1, while Type III tumors were predominantly male, larger, high-grade (G3), and frequently metastatic, requiring surgical resection and palliative therapy. Among the 25 surgically treated patients, most were men (52%) and included 12 patients (48.0%) with Type I, 3 (12.0%) with Type II, and 10 (40.0%) with Type III tumors. Survival analysis showed significantly worse outcomes for Type III and G3 tumors. Multivariable analysis identified advanced age (hazards ratio 4.11; 95% confidence interval (95%CI): 1.14–14.80; p=0.030) and tumor, lymph node, metastasis (TNM) stage III/IV (HR 5.42; 95%CI: 1.26–23.26; p=0.023) as independent predictors of poorer survival.
gNETs exhibit heterogeneous clinical behavior, with Type I tumors predominating in the Brazilian population. Tumor type, grade, and TNM stage are critical determinants of prognosis and should guide individualized treatment strategies.
Uterus transplantation was a transformative innovation in reproductive medicine and organ transplantation in general, and an alternative for the treatment of infertility. The problem of infertility affects 8–12% of the population of reproductive age, causing an enormous social impact. Uterus transplantation, a relatively new treatment, has emerged as an excellent option for couples with absolute uterine infertility. The first uterus transplant performed was in 2000, in Saudi Arabia. At this same time, a Swedish researcher began several experimental works with uterine transplantation in different animal models. Only more than a decade after the first attempt in humans was a second case performed, in Turkey, in 2011. The first transplant in the Americas was performed in the United States of America, in 2016, with a deceased donor. In the same year, in Brazil, the group from Hospital das Clínicas, Faculty of Medicine, University of São Paulo, performed the first uterus transplant in Latin America, also with a deceased donor. This Brazilian case resulted in the world’s first birth from a deceased donor uterus transplant in December 2017, making Brazil and Hospital das Clínicas in a vanguard position in the world transplant scenario. Even so, we have today more than 100 transplants performed on the planet, with the birth of more than 70 children.
The preoperative evaluation of serum tumor markers provides valuable prognostic and therapeutic insights in solid malignancies. Although not diagnostic by themselves, increased preoperative concentrations often reflect greater tumor burden, advanced disease stage, and unfavorable clinical outcomes.
The aim of this study was to investigate the expression and diagnostic-prognostic potential of the tumor markers aldehyde dehydrogenase 1 (ALDH1) and activated leukocyte cell adhesion molecule (ALCAM) in the blood of rectal cancer patients under the influence of short- or long-term radio-/chemoradiotherapy (RTx/RCTx).
Serum samples taken from patients with rectal carcinoma (n=164) at different time points during and after RTx/RCTx were retrospectively examined to determine whether these markers could predict disease progression and long-term survival.
Kaplan-Meier analysis confirmed the prognostic relevance of the Union for International Cancer Control (UICC) staging, while no significant associations were observed between serum levels of the investigated biomarkers and individual patient or tumor characteristics such as age, sex, or tumor stage. Overall, ALCAM and ALDH1 in this limited patient cohort exhibited elevated serum levels compared with healthy controls, and tumor tissues demonstrated stage-dependent increases in marker expression (UICC III/IV versus I/II).
Serum concentrations of ALCAM and ALDH1 were significantly elevated in our patient cohort with rectal cancer but showed no significant correlation with tumor stage or survival, whenever serum samples were obtained either during or after neoadjuvant and adjuvant therapy, which may be particularly due to the limited number of studied subjects. Although their prognostic utility remains limited, their consistent elevation in cancer patients underscores their potential value in early detection or as components of a broader biomarker panel.
Complete neoadjuvant treatment for gastric cancer is not always tolerated due to nutritional and clinical reasons, such as gastric outlet obstruction. In this context, upfront surgery becomes an alternative.
The aim of the study was to compare upfront resection with neoadjuvant systemic therapy followed by surgery and identify factors influencing their outcomes.
Retrospective study of 410 patients with locally advanced gastric adenocarcinoma followed between 2012 and 2020, comparing upfront surgery and perioperative treatment. Patients with early tumor (cT1N0), metastasis, and stump cancer were excluded. The comparison was stratified by stage without the influence of systemic treatment (primary stage). Resections with D2 dissection, no residual tumor (no R2), and no complications were considered optimal surgery.
Upfront resection was performed in 216 patients (85% of upfront surgeries). Gastrectomy after neoadjuvant treatment was performed in 47 cases (76% of indications), and another four were resected among 39 previous unsuccessful surgeries (10%). In total, there were 51 resections after chemotherapy. Independent factors associated with overall survival at 60 months were: preoperative chemotherapy (57.3% vs. 40.7%, p=0.029); complication rate; D2 lymphadenectomy; and primary stage. Initial cases showed a better outcome in the neoadjuvant group without statistical significance (p=0.447), but it was present in more advanced tumors (p=0.027). Optimal surgery was achieved in 68.6% of the neoadjuvant group and 51.9% of the upfront group (p=0.030) and resulted in similar overall survival (56.6% vs. 52.4%, p=0.904).
Optimal upfront surgery followed by adjuvant therapy, particularly with D2 dissection, is effective and was not statistically inferior to neoadjuvant treatment.
The Pringle maneuver remains a widely used technique in hepatic surgery with varying opinions on its effects on postoperative outcomes and survival, requiring evidence-based evaluation of its impact on liver function and long-term results.
The aim of this study was to evaluate the impact of the intermittent Pringle maneuver on postoperative liver function and survival in hepatectomy patients, focusing on early dysfunction markers as prognostic factors.
In this retrospective cohort of 198 patients (106 women and 92 men; mean age, 59 years), the Pringle group showed longer surgical times (226.87±82.18 vs. 184.00±80.90 min, p<0.001) and extended intensive care unit stays (4.02±2.1 vs 3.11±1.9 days, p=0.026), but lower bilirubin levels (2.18±0.33 vs. 3.13±0.39 mg/dL, p=0.049). Multivariate analysis revealed that the Pringle maneuver reduced mortality risk (hazard ratio [HR]=0.540, 95% confidence interval [95%CI]: 0.333–0.876, p=0.013). Early liver dysfunction markers strongly predicted worse outcomes: elevated bilirubin nearly doubled mortality risk (HR 1.975, 95%CI 1.100–3.545, p=0.023), and decreased prothrombin activity tripled it (HR 3.055, 95%CI 1.839–5.075, p<0.001).
While the Pringle maneuver extends operative time and intensive care unit stay, it demonstrates a protective effect on survival. Early postoperative liver dysfunction strongly predicts poor outcomes, emphasizing the importance of careful postoperative monitoring regardless of vascular control strategy. These findings suggest that a controlled intermittent Pringle maneuver offers survival benefits when properly timed.
Malabsorption of micronutrients including calcium and vitamin D may lead to pathological bone fractures in the late postoperative period of bariatric surgery.
The aim of this study was to evaluate the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on bone mineral density (BMD) and calcium and vitamin D intake after 3 years of surgery.
Cross-sectional study that included 66 patients in the late postoperative period of bariatric surgery to analyze their BMD. Anthropometric and demographic data were collected, and a 24-hour recall questionnaire was carried out to assess food consumption patterns. BMD was assessed by bone densitometry of the femur and spine, and the values were expressed as z-scores.
The mean age was 40.1 years, 86.4% were female. RYGB was performed in 60.3% and SG in 39.7%. There was no significant difference between the techniques when comparing anthropometry, body composition, and food consumption patterns. There was a positive correlation, after RYGB, between femoral z-score, calcium and vitamin D intake, and multivitamin supplementation. A total of 12.7% of the sample had compromised bones, and among these, 87.5% underwent RYGB, 100% had inadequate consumption of calcium and vitamin D, and 12.5% were in menopause.
A small percentage of the sample showed bone loss after RYGB and SG. The type of surgery was not a significant factor in changing BMD. However, all those affected had a low intake of calcium and vitamin D.
Groove pancreatitis (GP) is a rare and segmental form of chronic pancreatitis that affects the pancreaticoduodenal sulcus. Its pathophysiology is still not well known, and several etiological factors have been attributed, with chronic alcohol consumption being the most common association. Its treatment still generates controversy. The initial clinical approach followed by endoscopic therapies prevails. Surgery is indicated when these treatment options fail.
The aim of this study was to analyze the clinical, imaging, and surgical treatment data of a series of patients diagnosed with GP.
The clinical, radiological, surgical, and postoperative follow-up data were analyzed, in addition to the histopathological results of chronic pancreatitis, in patients undergoing pancreaticoduodenectomy.
A total of eight patients were included, of whom six were male, and their mean age was 45 years. The main symptom presented was long-standing abdominal pain with the use of analgesics and weight loss; all patients were chronic alcoholics. Imaging methods defined the diagnosis of GP in the preoperative period in five patients. In three patients, the preoperative diagnosis was neoplasia of the head of the pancreas. All patients underwent pancreaticoduodenectomy and one patient developed pancreatic fistula. There was a regression of pain in all patients.
For patients with GP who do not respond to the clinical approach, or in the face of diagnostic doubt, pancreaticoduodenectomy constitutes a good therapeutic option.
Weight loss (WL) is the most commonly used datum to measure the results of metabolic and bariatric surgery. The amount of WL is generally directly and proportionally associated with the improvement in quality of life (QoL), as the greater the former, the greater the perception of well-being.
To assess the relationship between the amount of weight lost after laparoscopic Roux-en-Y gastric bypass (LRYGB) and self-perceived improvement in quality of life (QoL).
The medical records of patients who underwent LRYGB between January 2017 and December 2019 with a minimum follow-up of 3 years were analyzed. The data obtained in the subgroups made up according to percentage of total weight loss (%TWL), age, and time elapsed since surgery were compared with the self-perceived QoL by the Short Form Survey 36 (SF-36) questionnaire.
A total of 95 individuals (71.6% women) with an average age of 45 years and an average postoperative (PO) follow-up of 61.1 months were enrolled. The mean pre- and postoperative weight was 114 kg and 73.4 kg, respectively, and the mean %TWL was 35.6%. According to the comparison between the data from the medical records and the self-perceived QoL assessment, D1 (physical functioning) was the best scoring domain, while D3 (pain) was the worst. There was a significant improvement of the D4 (general health) domain in patients with %TWL greater than 30% (p<0.05), D7 (role emotional), and D8 (mental health) domains in patients older than 45 years (p<0.05) and better results in D7 (role emotional) domain in patients over 5 years after surgery (p<0.05).
Greater weight loss and age and longer time after surgery showed important self-perceived improvement in QoL after LRYGB in some assessment domains, both physical and emotional.
Patients with advanced cancer experience a range of distressing symptoms. Palliative care (PC) emerges as an essential area to be implemented by health systems in the care of patients with irreversible diseases and beyond therapeutic possibilities.
To compare the perception of caregivers of patients in palliative care offered by two public hospitals using the CODETM questionnaire; to determine the score obtained by the questionnaire and its usefulness in the evaluation of the palliative care offered.
The post-death questionnaire “Care of the Dying Evaluation” (CODETM) was applied to the family members who accompanied the patients in the last days, assessing the perception of the quality of care provided to the patient and the level of support to the family.
No statistical difference in demographics. Participants who received palliative care had higher scores in the score, as well as in the ward and ICU unit compared to the emergency unit. The predictive cut-off value for adequate palliative care practice was 97 points, corresponding to 78.6% of the score.
There was no statistical difference between the caregivers’ perception of the care offered to patients between the two hospitals, being worse in the emergency unit. The cut-off value was 78.6% and was considered adequate and the CODETM questionnaire was a useful tool in the evaluation of palliative care offered by hospitals to patients and can be applied to propose improvements in palliative care. Therefore, there is a need for an instrument that can constantly classify and qualify the care provided to patients and their families in order to offer dignified, comprehensive and humanized care, as proposed by the CODETM questionnaire
Developed by Surya MKT