Microscopic analysis of tumor budding (TB) may be an essential predictive tool for regional lymph node metastases in colorectal cancer, especially among patients in intermediate stages, who exhibit considerable prognostic variability.
The aim of this study was to assess the predictive power of BT regarding the presence of lymph node metastases and its association with other characteristics related to colorectal carcinoma progression.
This is a cross-sectional, retrospective study with a quantitative approach, focusing on the review of medical records and histopathological reports of patients who underwent oncologic surgery for colorectal cancer.
A total of 153 patient records were examined, with a predominance of the 61-70 age group and a male majority (50.98%). Adenocarcinoma not otherwise specified was the most common histological type (60.78%), with the majority exhibiting moderate differentiation (87.58%). From the total sample, 97 cases (63.39%) exhibited TB, with 51.55% classified as a high budding score. Invasion of adipose tissue/subserosa was the most prevalent, occurring in 46.41% of cases. Regional lymph node metastases and angiolymphatic invasion were observed in 66 and 101 patients, respectively. Cross-tabulation analysis showed a statistically significant association between TB and lymph node metastasis (p<0.05).
The relationship between TB and lymph node metastasis highlights the significance of this histological factor in the risk stratification and prognosis of patients with colorectal cancer, complementing TNM staging. Therefore, the assessment of tumor budding is crucial in histopathological reports, potentially influencing additional therapeutic decisions.
Research indicates that patients undergoing bariatric surgery face a six to seven times higher risk of developing alcohol use disorder (AUD) compared with the population of obese individuals not undergoing surgical intervention. Studies suggest that problematic alcohol consumption encompassing depression escalates gradually after surgery.
The purpose of this study was to evaluate the impact of bariatric surgery on the incidence of AUD and depression during the postoperative period.
Prospective study that evaluated 68 patients who underwent either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). The presence of AUD and depression was assessed both pre- and post-operatively. AUD assessment utilized the AUD identification test-C score, whereas depression assessment employed the Beck Depression Inventory (BDI).
The average age of the sample was 42.81±9.28 years, with 85.3% being female. The mean follow-up was 16.54±7.41 months. In the preoperative assessment, 92.6% of the sample fell into the low-risk category for AUD. No significant difference was observed between the RYGB and SG groups. Postoperatively, 89.7% of the sample was classified as low risk for AUD, with no significant differences compared with the preoperative assessment. Regarding depression, there was no significant difference between pre- and post-operative periods for all patients. However, a notable trend toward a reduction in “severe depression” was observed in the postoperative period for patients undergoing SG (pre: 14.0% vs. post: 7.0%, p=0.013).
There is no significant difference in the presence of AUD and depression between pre- and post-operative assessments in patients who have undergone bariatric surgery.
Colonoscopy is a widely used endoscopic procedure to investigate diseases of the colon and rectum. Colonoscopy procedure has difficulties for the patient and endoscopist.
To investigate whether the use of an abdominal corset can make the colonoscopy procedure easier and faster.
This is a prospective randomised controlled study. Patients over 18 years of age who underwent elective colonoscopy in our clinic were evaluated. Patients were divided into two groups according to the use of the corset. Variables were compared between the groups.
A total of 204 patients were included in the study. Corsets were used in 97 patients and not used in 107 patients. The need for manual compression was found to be decreased in the corset use group. There was no effect of corset use on cecal intubation time in the general population. It was found that cecal intubation time decreased with corset use in patients with body mass index - BMI<30 and male gender.
The need for manual compression can be reduced by the use of an abdominal corset during colonoscopy. The use of an abdominal corset may make the colonoscopy procedure faster and easier for the endoscopist and the patient.
Differences in skin color have socioeconomic and health implications; however, gaps persist in understanding health-related quality of life (HRQoL) perception.
To examine whether skin color differences influence HRQoL in obese patients undergoing Roux-en-Y gastric bypass surgery.
Cross-sectional study with participants of both genders, aged 18 to 60, and three to six months postoperatively. Data were collected from October 2018 to July 2019 at a bariatric clinic in Salvador, Bahia. Skin color, Moorehead-Ardelt II Quality of Life Questionnaire (MAQOL-II) scores, anthropometric measurements, socioeconomic status, physical activity, and body image perceptions were recorded.
Of 196 patients, 67.35% were Black. “Self-esteem” in MAQOL-II demonstrated the most significant post-surgical improvement, with 62.8% reporting “much better” outcomes. Adjusted residuals associated “much better” and “unchanged” responses with skin color. The overall MAQOL-II score indicated lower HRQoL scores (M=1.65; standard deviation - SD=0.98) for individuals with black skin compared to those with white skin. Analyzing questionnaire responses, both racial groups exhibited equal percentages (45.3%) reporting “much better” and “better” post-surgery progress. However, no statistically significant differences in HRQoL were observed when comparing skin color.
Skin color appears not to significantly impact the HRQoL of obese patients undergoing Roux-en-Y gastric bypass.
Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), lacks a known etiology. Although clinical symptoms, imaging, and colonoscopy are common diagnostic tools, fecal calprotectin (FC) serves as a widely used biomarker to track disease activity. Metabolomics, within the omics sciences, holds promise for identifying disease progression biomarkers. This approach involves studying metabolites in biological media to uncover pathological factors.
The purpose of this study was to explore fecal metabolomics in IBD patients, evaluate its potential in differentiating subtypes, and assess disease activity using FC.
Cross-sectional study including IBD patients, clinical data, and FC measurements (=200 μg/g as an indicator of active disease).
Fecal metabolomics utilized chromatography mass spectrometry/solid phase microextraction with MetaboAnalyst 5.0 software for analysis. Of 52 patients (29 UC, 23 CD), 36 (69.2%) exhibited inflammatory activity. We identified 56 fecal metabolites, with hexadecanoic acid, squalene, and octadecanoic acid notably distinguishing CD from UC. For UC, octadecanoic and hexadecanoic acids correlated with disease activity, whereas octadecanoic acid was most relevant in CD.
These findings highlight the potential of metabolomics as a noninvasive complement for evaluating IBD, aiding diagnosis, and assessing disease activity.
The carcinogenesis of colorectal cancer is well understood. Adenomas are the precursor lesions in about 70% of cases, highlighting the importance of screening programs.
The aim of this study was to analyze the effectiveness of colonoscopy examinations performed in a private tertiary service by calculating the polyp detection rate (PDR) and adenoma detection rate (ADR) and comparing these rates with literature data.
This retrospective observational study evaluated colonoscopies performed at Hospital Centro Médico de Campinas between 2018 and 2020. It assessed the indications and complications of colonoscopy, sex, age group, bowel preparation, cecal intubation rate, ADR, PDR, and advanced adenoma detection rate (AADR).
During the period, 3,686 colonoscopies were performed, and 3,076 were included in the analysis. The mean patient age was 57.2 years, and most patients were female (53.5%). Complications occurred in 39 colonoscopies (1.3%), with bleeding in six cases and perforation in one case. Tubular adenoma was the most prevalent histological subtype found in 20% of tests and in 62.7% of those with positive findings. The PDR was 23% and significantly increased with advancing age (p<0.01). The ADR was 20% and also significantly increased with age (p<0.001). This rate was higher in men (27%). The AADR was 4%.
Colonoscopy is an effective polyp detection method, and the PDR was higher in men and significantly increased with age. The ADR and AADR were comparable to the literature data.
Patients undergoing Crohn’s disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients.
The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy.
This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher’s exact) test, Student’s t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used.
There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50).
Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.
Obesity is a predisposing factor for serious comorbidities, particularly those related to elevated cardiovascular mortality. The atherogenic index of plasma (AIP) has been shown to be a useful indicator of patients with insulin resistance.
The aim of this study was to assess cardiovascular risk before and after surgical treatment of obesity.
A total of 615 patients undergoing bariatric surgery between 2007 and 2012 were evaluated using the analysis of electronic records (triglyceride/high-density lipoprotein cholesterol) before and after surgery. The AIP levels >3.5 mg/dL for men and >2.5 mg/dL for women were insulin-resistant and predisposed to cardiovascular events.
A total of 117 men had an AIP >3.5 mg/dL during the preoperative period, 13.5% during the early postoperative period, 14.3% during the intermediate period, and 18.2% during the late postoperative period. Among 498 women, 56.2% had an AIP >2.5 mg/dL before surgery, 17.9% in early postoperative period, 13.5% in the intermediate period, and 11.4% in the late period.
Bariatric surgery resulted in a significant effect on the AIP, insulin resistance, metabolic syndrome, and therefore, the risk of cardiovascular diseases.
The COVID-19 pandemic has overloaded healthcare systems worldwide. Other diseases, such as neoplasms, including gastric cancer, remained prevalent and had their treatment compromised.
The aim of this study was to evaluate the impact of the COVID-19 pandemic on the treatment of gastric cancer and adherence to the recommended preoperative COVID-19 screening protocol.
A retrospective study evaluated patients diagnosed with gastric adenocarcinoma who underwent surgical treatment between 2015 and 2023.
A total of 769 patients with gastric cancer were evaluated and organized into two groups: (i) pre-COVID group and (ii) COVID group. The pre-COVID group consisted of 527 patients operated on between 2015 and 2019, and the COVID group consisted of 242 patients from 2020 to 2023. The average number of surgical procedures per year in the pre-COVID group was 105 and 81 in the COVID group. There was a statistically significant difference between ASA classification (p=0.002) and clinical staging (p=0.015), which were worse in the COVID group. We observed an increase in diagnostic surgeries (p=0.026), with an increase in the minimally invasive route (p<0.001). In patients undergoing curative surgery, there was a greater indication for postoperative ICU (p=0.022) and neoadjuvant chemotherapy (p<0.001). There was no difference in 30- and 90-day mortality.
The surgical and oncological outcomes for patients operated on during the pandemic remained uncompromised, even though many presented with more advanced initial stages and poorer clinical performance. High adherence to protocols and a low rate of complications related to coronavirus indicate that surgeries were performed safely during this period.
Preoperative hospitalization with the purpose to obtain more effective weight loss provides intensive care for patients who have a higher body mass index (BMI) and associated diseases that involve a greater risk of peri- and postoperative complications. It is a therapeutic strategy that can make it possible to overcome obstacles related to the difficulty of adhering to obesity treatment.
To analyze the implementation of a preoperative hospitalization strategy for weight loss in patients eligible for bariatric surgery.
Retrospective study that included 194 patients with a BMI=50 kg/m2. They were grouped according to preoperative preparation strategies: inpatient (n=32) and outpatient (n=162), who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2020. The groups were compared regarding preoperative weight loss before and after the strategies and postoperative up to two years after surgery.
Most patients were female and there were significant differences in age group (an average of 42.94 years in the preoperative hospitalization strategy group and 37.73 in the outpatient strategy group). The mean BMI in the hospitalized group was 63.01±8.72 kg/m2, and in the outpatient group it was 54.95±4.31 kg/m2. There was a significant difference only between initial and preoperative weight in the hospitalized group. Furthermore, the difference between initial weight and last recorded weight up to two years after surgery was significant in each group. The occurrence of associated diseases was higher in the outpatient group.
Patients following the preoperative hospitalization strategy experienced significant weight loss before surgery.
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