Menu
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.
Esophagectomy is a major, invasive, and long-lasting surgery performed in patients with comorbidities and compromised nutritional conditions. The historical challenges of surgical treatment of esophageal cancer are to overcome mortality, improve survival, and decrease morbidity.
The aim of the study is to compare the intraoperative morbidity of two distinct surgical techniques of esophagectomy in esophageal cancer, transhiatal esophagectomy and video-assisted thoracoscopy in the prone position, analyzing intraoperative physiological parameters, scores on admission to the intensive care unit (ICU) (APACHE II, SOFA, and SAPS III), and postoperative evolution.
Retrospective, cross-sectional study evaluating patients admitted to the ICU in the immediate postoperative period of elective esophagectomy for esophageal neoplasia (squamous cell carcinoma and adenocarcinoma). Data were obtained from a computerized registry database of the ICU and from patient records.
Sixty-three patients over 18 years of age were evaluated and divided into two groups: 31 (49.21%) underwent transhiatal esophagectomy, and 32 (50.79%) underwent videoassisted thoracoscopic esophagectomy. No statistically significant difference was observed for length of ICU stay (p=0.5309), length of postoperative hospital stay (p=0.3066), or death in the perioperative period (30 days, p=0.6562). Regarding intraoperative parameters, no statistically significant difference was observed for patients who received blood transfusion (p=0.2097); amount in milliliters (p=0.2893); patients who used vasoactive drugs (VADs) (p=0.9243); time VAD use (p=0.9327); volume of fluids infused in milliliters (p=0.7825); or diuresis in milliliters (p=0.7286). A statistically significant difference was observed for surgical time (310 min in transhiatal esophagectomy vs. 373 min in video-assisted thoracoscopy, p=0.0012) and anesthetic time (385 minutes in transhiatal vs. 467 min in video-assisted thoracoscopy, p<0.0001). A statistically significant difference was observed in the number of patients extubated at the end of the procedure (48.38% in transhiatal vs. 9.37% in video-assisted thoracoscopy, p=0.0022). Regarding gasometric parameters at the end of the surgical procedure, only pO2 showed a statistically significant difference (p=0.0010). Regarding ICU admission scores, there were no differences regarding APACHE II (p=0.6542), SOFA (p=0.8949), and SAPS III (p=0.7656).
This study showed no differences between the transhiatal and thoracoscopic esophagectomy in the prone position, in prognostic score performance, studied operative parameters, ICU stay and hospital stay times, and perioperative mortality, in agreement with literature findings. The advent of minimally invasive techniques in video-assisted esophagectomies brought the same benefits as thoracotomy, offering greater safety in mediastinal dissection under direct vision, in addition to mitigating the physiological repercussions of thoracotomies.
Data on the influence of donor gender on post-liver transplant outcomes is scarce and is lacking.
The aim of this study was to evaluate the prognostic factors of mortality in patients undergoing liver transplantation (LT) with a thorough evaluation of the influence of the donor variables.
All patients undergoing LT at a single center from December 2011 to December 2018 were included. The main outcome measure of the study was overall patient survival. The mortality predictors were evaluated using Cox regression.
The study analyzed 202 patients, 118 (58.1%) being males, and the average age was 54.19±11.66 years. Post-LT survival for the entire cohort of 202 patients as assessed by the KaplanMeier method at 1, 3, 5, and 7 years was 81.6, 73.1, 67.6, and 63%, respectively. The only predictor of increased overall mortality was female donor gender [HR 1.918, 95%CI 1.150–3.201, p=0.013]. Weight and height differences between donor and recipient were not related to mortality (p=0.545 for weight and p=0.964 height).
Female donor gender was associated with an increase in overall post-LT mortality, especially for male recipients, regardless of anthropometric parameters. For male patients receiving livers from female donors, infection was the most common cause of mortality, occurring in the first year following LT.
The effects of bariatric surgery in metabolically healthy obese (MHO) versus metabolically unhealthy obese (MUO) patients are underexplored in the literature.
The aim of the study was to compare the impact of bariatric surgery on weight loss, body composition, plasma biochemical parameters, and hepatic steatosis in MHO and MUO individuals.
Preoperative and 1-year postoperative medical records of 82 men and women aged 18–65 years, with body mass index >30 kg/m2, who underwent bariatric surgery from September 2021 to March 2023 were analyzed. MUO individuals were defined as those, metabolically unhealthy obese, with two metabolic syndrome risk factors, in preoperative data.
The prevalence of MHO and MUO individuals was 22 and 78%, respectively. Preoperative neck circumference and visceral adiposity index were higher in MUO individuals. Hepatic steatosis was the most common comorbidity in both groups. After 1 year, both groups demonstrated similar benefits from bariatric surgery in reducing body weight, adiposity, and anthropometric indices. Bariatric surgery also improved blood glucose, insulin sensitivity, and dyslipidemia in MUO individuals. However, 30% of MUO individuals presented with steatosis, compared to only 5.6% of MHO individuals. This outcome was accompanied by higher plasma levels of ferritin, alanine aminotransferase, and aspartate aminotransferase in MUO individuals.
Bariatric surgery provided similar benefits in body mass for MHO and MUO individuals. However, after 1 year, MUO individuals still exhibited elevated markers of inflammation, liver injury, and steatosis, suggesting greater residual metabolic vulnerability.
Artificial intelligence (AI)-assisted colonoscopy has emerged as a tool to enhance adenoma detection rates (ADRs) and improve lesion characterization. However, its performance in real-world settings, especially in developing countries, remains uncertain.
The aim of this study was to evaluate the impact of AI on ADRs and its concordance with histopathological diagnosis.
A matched case–control study was conducted at a colorectal cancer (CRC) referral center, including 146 patients aged 45–75 years who underwent colonoscopy for CRC screening or surveillance. Patients were allocated into two groups: AI-assisted colonoscopy (n=74) and high-definition conventional colonoscopy (n=72). The primary outcome was ADR, and the secondary outcome was the agreement between AI-based lesion characterization and histopathology. Statistical analysis was performed with a significance level of p<0.05.
ADR was higher in the AI group (60%) than in the control group (50%), but this difference was not statistically significant (p>0.05). AI-assisted lesion characterization showed substantial agreement with histopathology (kappa=0.692). No significant difference was found in withdrawal time (29 min vs. 27 min; p>0.05), indicating that AI did not delay the procedure
Although AI did not significantly increase ADR compared to conventional colonoscopy, it demonstrated strong histopathological concordance, supporting its reliability in lesion characterization. AI may reduce interobserver variability and optimize real-time decision-making, reinforcing its clinical utility in CRC screening.
Desenvolvido por Surya MKT