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The analysis of tumor budding (TB) and its prognostic value in gastric adenocarcinoma (GA) has been the focus of several studies, with inconsistent results. This parameter is not included in gastric prognostic classifications or standardized pathological reports.
To evaluate TB in GA and its prognostic significance through survival analysis, in addition to investigating the association between TB and clinicopathological markers that are considered prognostic factors for this type of cancer.
This retrospective study covers a period of ten years, from January 2008 to December 2017. It included patients who underwent surgery for GA. TB evaluation followed the 2016 consensus guidelines for colorectal cancer, with three grades: Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (10 or more buds). Additionally, a two-grade classification system was employed, distinguishing between low-grade budding (fewer than 10 buds) and high-grade budding (10 or more buds).
TB was classified as low-grade in 69% of the cases and high-grade in 31%. High-grade TB was significantly correlated with perineural invasion (HR [hazard ratio]: 2.98, 95%CI [95% confidence interval] 1.04–8.53, p=0.004), stages III and IV (HR 4.04, 95%CI 1.27–12.83, p=0.01), and mortality (HR 3.65, 95%CI 1.24–10.74, p=0.02). It was an independent prognostic factor for recurrence-free survival (RFS) (p=0.005, p<0.05).
We have demonstrated that TB prognostic and predictive value in GA is significant, particularly regarding patient survival.
Perioperative chemotherapy is the standard curative treatment for resectable gastric adenocarcinoma, significantly improving both overall and recurrence-free survival. The histological response to neoadjuvant therapy is a critical prognostic factor, commonly assessed through grading systems such as Mandard’s tumor regression grade (TRG).
The aim of the study was to identify predictive factors for histological response to neoadjuvant therapy in gastric adenocarcinoma.
A retrospective study was performed on patients with gastric adenocarcinoma who underwent surgery following neoadjuvant chemotherapy, from 2015 to 2020. The histological response was evaluated using Mandard TRG, which includes five grades (1–5), based on the proportion of residual viable tumor cells and fibrosis. Grades 1–3 were considered a response, and Grades 4 and 5 were considered no response. Students’ t-test, chi-squared test, and multivariate logistic regression were used, with significance set at p<0.05.
Forty patients were included (male-to-female ratio 2.64, mean age 63 years). Histological response (TRG 1–3) was observed in 48%, while 52% showed no response (TRG 4–5). Univariate analysis showed significant correlations between histological response and tumor size >38 mm (p=0.03), differentiation (p=0.02), parietal wall invasion, absence of nodal involvement (both p<0.001), pathological tumor, node, and metastasis stage (p<0.001), and absence of vascular and perineural invasion (both p=0.001). Multivariate analysis identified parietal wall invasion (odds ratio=2.351, p=0.022) and absence of lymph node metastases (odds ratio=1.491, p=0.01) as independent predictive factors.
Parietal wall invasion and absence of nodal metastases are predictive of histological response to neoadjuvant therapy in gastric adenocarcinoma.
Bariatric surgery is currently the gold standard for the treatment of obesity. However, weight recurrence varies among the different surgical methods.
To compare changes in weight one and two years after bariatric surgery considering the gastric bypass and gastric sleeve methods.
A cross-sectional study was conducted at a hospital with adults of both sexes followed up for two years after surgery. Anthropometric, sociodemographic, clinical, and lifestyle characteristics were analyzed.
A total of 184 patients, predominantly women (82.1%), were assessed (136 submitted to gastric sleeve and 48 to gastric bypass). Good adherence to the multivitamin, but not to diet or physical activity, was verified in both groups. The percentages of weight loss and excess weight loss were higher in the gastric bypass group (one year after surgery: p<0.001 and p=0.010, respectively; two years after surgery: p<0.001 and p<0.001, respectively). Average weight gain was 2.37 kg and higher after gastric sleeve (p=0.042), whereas no difference between methods was found for the percentage of weight recurrence. Weight loss and recurrence at the two-year follow-up were influenced by diet in both groups. The percentage of weight loss was higher after gastric bypass one and two years after surgery. Weight recurrence was higher after the gastric sleeve method, without interfering with the surgical success of the technique.
We verified greater efficacy in the gastric bypass technique in terms of weight loss at 12 and 24 months postoperatively. Weight recurrence was found 24 months after both methods, especially in the gastric sleeve group, without constituting surgical failure.
The systematized approach to patients with small bowel bleeding (SBB) can reduce risks and costs for both patients and the Unified Health System (SUS).
Evaluate the evolution of the systematized approach to SBB in a regulated, hierarchically organized healthcare network of varying complexity.
Analysis of the medical records of patients with SBB treated at a tertiary, public, and teaching hospital in two distinct periods: before the implementation of a specialized service and algorithm for SBB (2001–2014, group without algorithm—GSA) and after the establishment of a trained, dedicated team, availability of capsule endoscopy and enteroscopy (2015–2023, group with algorithm—GCA). Demographic, clinical, and care-related data from 184 patient records were collected and entered into the REDCap platform. Additionally, a cost analysis was conducted.
Among the 184 patients, 82 (45%) were in the GSA group and 102 (55%) in the GCA group. The average number of specific exams per patient was 7.19 in GSA and 6.37 in GCA (p=0.02, p<0.05). Blood transfusions were performed in 64 patients (78.05%) in GSA and 68 patients (66.67%) in GCA (p=0.05). The average time to reach diagnosis was 309.9 weeks in GSA and 75.37 weeks in GCA (p<0.01). The average hospital stay was 7.57 weeks in GSA and 2.55 weeks in GCA (p<0.01). In GSA, 19 patients (23.2%) died due to SBB, while in GCA only six did (5.9%) (p=0.001, p<0.05). The average cost was higher compared to GCA (p<0.01).
The results of organizing a reference service for SBB care support are sufficient to subsidize the planning of services and regional healthcare networks.
Aggressive fibromatosis, also known as desmoid tumor (DT), is a locally aggressive myofibroblastic neoplasm originating from deep soft tissues, characterized by an infiltrative growth pattern with a tendency for local recurrence. DTs account for 0.03% of all neoplasms, and cases associated with familial adenomatous polyposis (FAP) account for 5–15% of DTs.
The aim of this study was to report the prevalence of DTs in patients operated on for FAP, describe the epidemiological profile, and evaluate the risk factors for tumor development, treatments performed, associated complications, and follow-up.
This retrospective study assessed the medical records of patients with FAP who underwent surgery between 1990 and 2021 and developed DTs during follow-up.
In the study period, 147 patients with FAP were operated on; of these, 97 underwent total proctocolectomy with ileal-pouch anal anastomosis, 33 underwent total colectomy with ileorectal anastomosis (IRA), 14 underwent total proctocolectomy with terminal ileostomy, and three underwent total colectomy with partial proctectomy and low IRA using an ileal-pouch. A total of 26 patients (17.7%) developed DT; most were female (61.5%), were White (73.1%), and had a family history (84.6%). The most frequent complications were intestinal and ureteral obstructions. Long-term follow-up showed that six patients were free of disease, 14 were stable and undergoing drug therapy, four died due to complications of the disease, and two were lost to follow-up.
The prevalence of DT tumor was relatively high and more commonly observed in patients with a family history of the tumor. The disease presented high rates of morbidity and mortality.
Renal carcinoma is the third most common urological cancer, with 30% of patients presenting with metastases at diagnosis. Metastases to the small intestine are rare (0.7–1.1%), and their presentation as intestinal intussusception is even more uncommon, with only a few cases reported in the literature.
The aim of the study was to present a case of stage IV clear cell renal carcinoma with a rare presentation of intestinal intussusception, leading to emergency department admission due to severe anemia and melena.
A 62-year-old man presented with melena for 2 months and a critically low hemoglobin level of 2.9 g/dL (normal range: 13.5–17.5 g/dL). Abdominal and pelvic angiotomography identified an exophytic lesion in the left kidney consistent with renal carcinoma and an approximately 16 cm ileal intussusception.
Exploratory laparotomy revealed intestinal intussusception and a 4 cm lesion on the antimesenteric border, suspected to be a tumor. A segmental resection with primary anastomosis was performed, resulting in a favorable postoperative recovery. Histopathological and immunohistochemical analyses confirmed poorly differentiated metastatic clear cell renal carcinoma.
This report underscores the need to consider gastrointestinal symptoms in patients with renal carcinoma, as an intestinal metastasis, although rare, is a potential complication. Synchronous metastases are even rarer and present a significant diagnostic challenge.
Inguinal hernia is the most frequently diagnosed hernia and affects approximately one-third of the male population. Several risk factors have been identified, including advanced age, limited physical activity, smoking, and increased intra-abdominal pressure, among others.
The aim of the study was to determine whether constipation is a risk factor for inguinal hernia in the adult population.
A case-control study was conducted at the Department of Surgery of one hospital in the north of Peru, including 121 patients with a confirmed diagnosis of inguinal hernia as cases and 242 patients without such a diagnosis as controls. Inclusion and exclusion criteria were applied, and data were collected through individual interviews using a structured questionnaire that addressed clinical aspects, lifestyles, and the presence of constipation, assessed according to the Rome IV criteria.
Results:
The results revealed significant differences between the groups of patients with and without inguinal hernia in terms of age, sex, and anthropometric characteristics. In addition, statistically significant associations were found between the presence of an inguinal hernia and type 2 diabetes, smoking, and constipation. A multivariate analysis showed that age, male sex, body mass index, high blood pressure, and constipation were significant and independent factors associated with the presence of inguinal hernia.
Constipation is a significant risk factor for inguinal hernia in the adult population. These results support the importance of considering constipation as a risk factor in the evaluation and management of patients with inguinal hernia, highlighting the relevance of adequate clinical care in this group of patients.
Low Anterior Resection Syndrome (LARS) is a common postoperative bowel dysfunction in patients undergoing sphincter-preserving surgery for rectal cancer. Symptoms include fecal and gas incontinence, urgency, increased bowel frequency, and fragmented evacuations. LARS significantly impairs quality of life, affecting up to 90% of patients. Various factors contribute to its development, such as tumor height, extent of mesorectal excision, preoperative radiotherapy, and ileostomy. However, these factors are less studied in South American populations, where racial, cultural, and healthcare system differences may influence outcomes.
The aim of the study was to evaluate risk factors associated with LARS in a Chilean cohort of rectal cancer patients, with emphasis on cases classified as severe.
A non-concurrent prospective cohort study including patients who underwent low anterior resection between 2012 and 2021. Perioperative data collected included tumor height, surgical procedure type, preoperative radiotherapy, and protective ileostomy. Univariate and multivariate analyses were conducted to identify factors significantly associated with severe LARS, using the LARS score adapted to Chilean Spanish.
A total of 110 patients were included, with a median follow-up of 51 months. LARS was identified in 52.7% of cases, with 29.1% classified as major. Younger age, lower tumors, total mesorectal excision, preoperative radiotherapy, and ileostomy were significantly associated with severe LARS in univariate analysis. In multivariate analysis, only younger age and preoperative radiotherapy remained as independent risk factors.
In this Chilean cohort, nearly half of patients undergoing sphincterpreserving surgery for rectal cancer developed LARS. About one-third had the severe form, highlighting the need for targeted strategies to mitigate LARS and improve patient quality of life.
Gastric cancer is the fifth most common cancer in the world and the fourth leading cause of deaths in oncology.
The aim of this study was to investigate the factors that affect the survival of patients with gastric adenocarcinoma undergoing gastrectomy in a tertiary center in South Brazil.
This was a cross-sectional, observational, and retrospective study of 82 patients with gastric adenocarcinoma who underwent surgical treatment from January 2018 to August 2022. Epidemiological and prognostic factors were analyzed, such as age, sex, tumor location in the stomach, lymph node invasion, tumor extension, angiolymphatic invasion, tumor differentiation, presence of distant metastasis, compromised surgical margins, adjuvant or neoadjuvant chemotherapy, and patient survival time.
Of the 82 patients, 41.5% died during the follow-up period, with a maximum follow-up period of 56 months. The median time to death was 22.4 months after performing the gastrectomy. Advanced age (hazard ratio [HR]=2.76; p=0.014, p<0.05), location of the tumor in the fundus of the stomach (HR=2.77; p=0.020, p>0.05), and presence of distant metastasis (HR=2.13; p=0.039) showed a significant negative impact on survival in the multivariate analysis. On the other hand, patients undergoing adjuvant (HR=5.33; p=0.001, p<0.05) or neoadjuvant (HR=3.36; p=0.006, p<0.05) chemotherapy had a positive impact.
The present study demonstrated that survival in patients with gastric adenocarcinoma is negatively influenced by advanced age, tumor location in the fundus of the stomach, and the presence of distant metastases, in contrast to the positive impact of performing adjuvant or neoadjuvant chemotherapy.
Bariatric surgery is the most effective treatment for weight loss and also promotes remission of preoperative metabolic comorbidities.
The aim of this study was to analyze preoperative comorbidities, evaluate postoperative outcomes, and assess complications 6 months after bariatric surgery in a hospital in the state of Santa Catarina, Brazil.
A retrospective cohort study was conducted with patients who underwent bariatric surgery between 2021 and 2022 and were followed up for a period of 6 months after the procedure.
There was a predominance of female patients (81.6%), with a mean age of 38.7 years. The preoperative prevalence of hypertension, Type 2 diabetes, dyslipidemia, and hepatic steatosis was 36.7, 22.4, 22.4, and 32.7%, respectively. The postoperative remission rates for these conditions were 55, 64, 70, and 69%, respectively. Except for diabetes, no significant differences were found between the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) groups. There was a significant reduction in weight (p<0.01) and body mass index (BMI) (p<0.01), with no statistical differences between the RYGB and SG groups. Postoperative complications occurred in 73.5% of patients, including anemia, vitamin deficiencies, cholelithiasis, dumping syndrome, anastomotic ulcer, chronic diarrhea, and anastomotic stricture.
The study described the preoperative comorbidity profile, postoperative outcomes, and complications with findings consistent with existing literature, except for underreporting dyslipidemia and hepatic steatosis. No statistical difference was observed between the surgical techniques performed.
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