The management of gastric cancer has become increasingly complex, highlighting the importance of clinical guidelines to ensure standardized care. The Second Brazilian Consensus on Gastric Cancer was developed to guide clinical practice across the country.
The aim of this study was to evaluate the degree of implementation of the 2nd Brazilian Consensus recommendations in cancer reference centers in Brazil.
This multicenter study involved 18 cancer centers that prospectively collected data over a one-year period. Notably, 21 key statements from the Consensus were assessed. Adherence was defined as following the recommendation in more than 80% of applicable cases.
Of the 21 statements, 11 (52.4%) met the predefined adherence threshold. The selective use of endoscopic ultrasound and PET-CT was consistent with the recommendations. However, diagnostic laparoscopy was underutilized, performed in only 24.7% of patients. Preoperative nutritional therapy, another key recommendation, was provided in just 42% of cases. D2 lymphadenectomy was performed in 79.8% of surgeries, but only 63.3% of specimens included ≥25 lymph nodes, the recommended minimum for adequate staging. Minimally invasive surgery (MIS) was performed in approximately 25% of early distal tumors but was rarely used in advanced proximal tumors. Despite not being recommended for early stage tumors, omentectomy and bursectomy were still performed in a significant number of T1/T2 cases. Preoperative chemotherapy was used in 35.4% of distal tumors ≥IB and 54.3% of proximal tumors, showing partial adherence to this recommendation.
Just over half of the II Brazilian Consensus recommendations were implemented in routine practice. There was strong adherence to D2 lymphadenectomy and MIS for early distal tumors. However, there is still room for improvement in areas such as diagnostic laparoscopy, nutritional support, adequate lymph node retrieval, and using more neoadjuvant chemotherapy to enhance care and follow national guidelines.
The development of consensus statements and clinical guidelines supports decision-making in clinical practice. However, recommendations formulated by experts may not always reflect real-world clinical practice. In this study, 21 key statements from the 2nd Brazilian Consensus on Gastric Cancer were evaluated across multiple cancer reference centers. It was found that, in 10 of these statements, current clinical practice diverged from the consensus recommendations.
Some consensus statements may be revised in future editions to better reflect the realities of clinical practice in the national context. To enhance adherence to the recommendations, broad dissemination of the study results is essential, alongside the implementation of educational initiatives and institutional policies aimed at promoting guideline compliance. These measures may contribute to closing the gap between consensus recommendations and everyday clinical practice, ultimately improving patient outcomes.
Liver transplantation (LT) is increasingly recognized as a treatment option for various diseases affecting a growing elderly population. However, its use in patients over 70 years of age remains controversial in centers with suboptimal outcomes or high waitlist mortality.
The aim of this study was to evaluate the effectiveness of LT as a treatment option for elderly patients aged 70 years or older, in comparison with younger recipients.
This retrospective study was conducted based on medical record data from 309 liver transplant recipients treated by the same surgical team across three hospitals — two located in São Paulo, São Paulo state (SP) and one in Rio Branco, Acre state (AC). Patients were divided into two groups for comparison: those aged up to 69 years (Group I) and those aged 70 years or older (Group II).
Donor characteristics were similar between the two groups, except for a higher norepinephrine dose in Group I (p<0.05). Group II showed greater transfusion requirements and longer intensive care unit (ICU) stays (p<0.05), as well as higher rates of malnutrition and comorbidities. Notably, 90-day survival was comparable between the groups.
Patients aged 70 years or older can achieve outcomes comparable to those of younger recipients, provided they receive grafts from carefully selected donors. This population should not be excluded from transplant waitlists, and specific allocation policies or scoring adjustments should be considered to ensure equitable access.
A retrospective analysis of liver transplants was performed, comparing patients over and under 70 years of age. The elderly group was transplanted with careful donor selection and obtained results comparable to those of the younger group.
This study aims to show that elderly patients over 70 years of age can have good results after liver transplantation, comparable to patients under 70 years of age, with good donor selection and perhaps additional points to favor their position on the waiting list.
Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide.
The aim of this study was to profile the doctors who treat patients with IBDs in Brazil and to understand and analyze the journey and importance of this care.
This is a cross-sectional study that descriptively and inferentially analyzed the pre-existing database of the Brazilian Inflammatory Bowel Disease Study Group and through this observed the reality of care for Crohn’s disease and ulcerative colitis, in the country.
In the descriptive analysis, we found results regarding the physicians’ profile such as specialty, number of patients treated with these diseases and their difficulties in accessing medications, complementary exams, and multidisciplinary team. In the statistical analysis regarding the Human Development Index of the states, the significant results were related to workplace, difficulty in accessing medications, and referral to other specialists. Regarding the association of variables with medical demographics, the results were significant in relation to workplace, difficulty in accessing medications, and complementary exams.
The study showed a profile of the doctors who treat patients with IBDs and who participated in this survey. In addition to analyzing and describing the doctor’s profile and their difficulties, we listed the main aspects that hinder both diagnosis and treatment, attributed to external factors, regardless of their reality and competence.
Inflammatory bowel diseases are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide. It is known that early diagnosis and short start of the correct indicated treatment alter the natural history of the disease, preventing complications; hence, it is necessary to know the profile of the doctors who treat these patients in Brazil and especially to understand the difficulties in care and evaluate them in relation to other variables.
This study showed the profile of physicians who treat inflammatory bowel disease (IBD) patients, through their registration in the Brazilian Inflammatory Bowel Disease Study Group. In addition to analyzing the physician’s profile and their difficulties, the main aspects that hinder both the diagnosis and treatment of the disease, attributed to external factors, were listed. Therefore, more effective public health policies should be planned and expanded, aiming at growth and adaptation focused on IBDs
Orthotopic liver transplantation (OLT) is a highly complex procedure, which can be difficult to control intraoperatively in patients with coagulopathies.
The aim of this study was to evaluate the prophylactic administration of epsilon aminocaproic acid (EACA) to reduce the need for transfusion of blood products and its relevance for thrombosis.
Patients were randomized into two groups: one group received EACA (20 mg/kg/h) before surgical incision until the end of OLT and a control group received a similar volume of 0.9% saline solution. Blood was collected to analyze fibrinolysis and coagulation disorders using rotational thromboelastometry (ROTEM®).
A total of 24 patients received EACA and 26 patients received saline solution. In the analysis of the fibrinolytic and hemostatic coagulation profile by ROTEM®, fibrinolysis was significantly less frequent in the group of patients treated with EACA (p<0.001) in the anhepatic phase. There were no significant differences in the other extrinsic pathway thromboelastometry and fibrinogen-specific thromboelastometry analyses. In addition, there were no significant differences between both groups regarding the average and percentage transfusion of blood products, postoperative complications, patients who were discharged from the hospital, and those who died within 3 months after liver transplantation.
Although the administration of EACA did not reduce the transfusion of blood products, this drug effectively treated fibrinolysis and was not associated with any complications with increased risk of vein and hepatic artery thrombosis or mortality within 3 months after liver transplantation.
A total of 105 patients were assessed for eligibility, and 55 were excluded. The remaining 50 patients were randomized, of which 24 patients were allocated to the intervention group and the other 26 to the saline placebo group. In the analysis of the fibrinolytic and hemostatic coagulation profile by rotational thromboelastometry, fibrinolysis was significantly less frequent in patients treated with epsilon aminocaproic acid (p<0.001) compared to those in the placebo group during the anhepatic phase. In the other analyses using thromboelastometry assays such as extrinsic pathway thromboelastometry (EXTEM) (clotting time [CT], clot formation time, alpha angle, amplitude of clot firmness 10 min after CT [A10], and maximum clot firmness [MCF]) and fibrinogen-specific thromboelastometry (FIBTEM) (A10 and MCF), there was no significant difference nor postoperative complications in both groups.
Some studies have shown that epsilon aminocaproic acid (EACA) inhibits the binding of plasminogen to lysine residues on the surface of fibrin and prevents conversion of plasminogen to plasmin and the degradation of glycoprotein Ib receptors, thus preserving platelet function. Although EACA did not reduce blood product transfusion, the drug effectively treated all cases and was not associated with any complications of increased risk of hepatic artery and vein thrombosis or mortality within 3 months after orthotopic liver transplantation (OLT). These results support the safety of EACA as the antifibrinolytic drug of choice in OLT. However, future studies involving larger randomized clinical trials and higher doses are needed to further investigate the results.
The surgical approach for esophagogastric junction cancers (EJC), Siewert II, has been controversial regarding margin control, reconstruction, and lymphadenectomy extension. Therefore, predicting the need for total/subtotal esophagectomy and proximal gastrectomy (TEPG) or total gastrectomy with distal esophagectomy (TGDE) can be challenging, with each direction usually excluding the other. Historically, complication rates for TEPG are higher, affecting further systemic treatment and long-term outcomes.
The aim of this study was to describe a surgical strategy for approaching tumors such as Siewert II EGJ, with the intraoperative decision to perform total gastrectomy with lymphadenectomy D2 or esophagectomy with lymphadenectomy based on intraoperative frozen sections.
All patients underwent laparotomy, beginning with greater curvature detachment while preserving the right gastroepiploic, right and left gastric arteries; dissection of the esophageal hiatus for node harvesting; and transection of the distal esophagus and its frozen section. TGDE was preferred if the proximal margin of the distal esophagus was negative; TEPG and gastric tube reconstruction were performed through transhiatal access if the margin was positive.
Among 38 Siewert II patients, 26 (69%) underwent TGDE and 12 (31%) underwent TEPG, regardless of the trend toward higher complication rates, positive margins, and shorter overall survival in the TEPG group, no statistically significant differences were detected.
Although no significant differences in morbidity between the two procedures were noted, type II errors could be a possible cause. This study suggests that unnecessary esophagectomies can be avoided without jeopardizing surgical or oncologic outcomes by opting for a less morbid procedure.
Dyspepsia is a set of symptoms of the upper abdomen and has a prevalence of 10–45% of the population with different etiological possibilities, including celiac disease.
The aim of this study was to evaluate the prevalence of celiac disease in patients with a clinical diagnosis of dyspeptic syndrome.
This is an observational research, based on a review of medical records of patients treated for uninvestigated dyspepsia. Patients over 18 years of age, with uninvestigated dyspepsia, and who had upper endoscopy, total immunoglobulin A (IgA), and antitissue transglutaminase IgA were included. Those with diarrhea, constipation, malabsorption, refractory lactose intolerance, or who presented extraintestinal signs or symptoms suggestive of celiac disease were excluded.
The initial sample was 1,802 records and the final 200 patients. Considering the total sample, the average age was 45.13 years and the female sex was predominant. Symptoms associated with gluten were reported in 6% of the patients. The antitissue transglutaminase IgA was positive in 1.5% of the patients. Considering the sample of 100 patients, the diagnosis of celiac disease had a prevalence of 3%.
The prevalence of celiac disease in patients with a clinical diagnosis of dyspeptic syndrome was 3%.
Esophageal cancer remains one of the most aggressive malignancies of the gastrointestinal tract, with high rates of recurrence and mortality despite curative-intent surgery and adjuvant therapies. Identifying factors associated with recurrence is crucial for improving outcomes and guiding personalized treatment.
The aim of this study was to evaluate pretreatment and treatment-related variables associated with recurrence in patients with esophageal cancer undergoing surgical resection.
This retrospective study analyzed data from patients with stage I–III esophageal carcinoma who underwent esophagectomy between 2000 and 2025, using the Fundação Oncocentro de São Paulo (FOSP) database. Clinical, histological, and treatment-related variables were evaluated. Disease-free survival and recurrence patterns were assessed using Cox proportional hazards models and Fine–Gray subdistribution hazard models.
A total of 2,057 patients were included, with a mean follow-up of 36.5 months (±44.8). In the multivariate analysis, advanced tumor stage (stage II: HR 1.68, 95%CI 1.21–2.33; stage III: HR 3.23, 95%CI 2.29–4.56; both p<0.01), location (middle esophagus: HR 1.31, 95%CI 1.11–1.54; p=0.001; upper esophagus: HR 1.54, 95%CI 1.21–1.96; p<0.001), and histological subtype (rare histologies: HR 2.17, 95%CI 1.35–3.49; p=0.001) were associated with worse disease-free survival. Multimodal therapy improved disease-free survival (HR 0.40, 95%CI 0.24–0.66) in stage III tumors. Squamous cell carcinoma was independently associated with locoregional recurrence (SHR 1.52, 95%CI 1.05–2.20; p=0.027). For distant recurrence, squamous cell carcinoma showed a protective effect (SHR 0.52, 95%CI 0.31–0.88; p=0.015), while high tumor grade (grade II: SHR 3.65, 95%CI 1.98–6.72; p<0.001) was associated with an increased risk. Multimodal treatments influenced recurrence patterns but did not independently predict outcomes after adjustment.
Tumor stage, location, and histology were strong predictors of disease-free survival after surgery for esophageal cancer. Histological subtypes significantly influenced recurrence patterns. Squamous cell carcinoma was associated with a higher risk of locoregional recurrence but a lower risk of distant metastasis compared to adenocarcinoma. Multimodal therapy demonstrated a protective effect in stage III disease.
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.
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.
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).
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.
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.
Surgical resection represents the main treatment for resectable nonmetastatic gastric gastrointestinal stromal tumors. Despite the feasibility and safety of laparoscopic resection, its standard use in gastric tumors larger than 5 cm is yet to be established.
This study aimed to compare the current evidence on laparoscopic resection with the classical open surgical approach in terms of perioperative, postoperative, and oncological outcomes.
The PubMed, Scopus, and Web of Science databases were consulted. Articles comparing the approach to gastric gastric gastrointestinal stromal tumors larger than 5 cm by open and laparoscopic surgery were eligible. A post hoc subgroup analysis based on the extent of the surgery was performed to evaluate the operative time, blood loss, and length of hospital stay.
A total of nine studies met the eligibility criteria. In the study, 246 patients undergoing laparoscopic surgery and 301 patients undergoing open surgery were included. The laparoscopic approach had statistically significant lower intraoperative blood loss (p=0.01) and time to oral intake (p<0.01), time to first flatus (p<0.01), and length of hospital stay (0.01), compared to the open surgery approach. No significant differences were found when operative time (0.25), postoperative complications (0.08), R0 resection (0.76), and recurrence rate (0.09) were evaluated. The comparative subgroup analysis between studies could not explain the substantial heterogeneity obtained in the respective outcomes.
The laparoscopic approach in gastric gastrointestinal stromal tumors larger than 5 cm compared to the open surgical approach is a technically safe and feasible surgical method with similar oncological results.
Hiatal hernias are at high risk of recurrence. Mesh reinforcement after primary approximation of the hiatal crura has been advocated to reduce this risk of recurrence, analogous to mesh repair of abdominal wall hernias. However, the results of such repairs have been mixed, at best. In addition, repairs using some type of mesh have led to significant complications, such as erosion and esophageal stricture. At present, there is no consensus as to (1) whether mesh should be used, (2) indications for use, (3) the type of mesh, and (4) in what configuration. This lack of consensus is likely secondary to the notion that recurrence occurs at the site of crural approximation. We have explored the theory that many, if not most, “recurrences” occur in the anterior and left lateral aspects of the hiatus, normally where the mesh is not placed. We theorized that “recurrence” actually represents progression of the hernia, rather than a true recurrence. This has led to our development of a new mesh configuration to enhance the tensile strength of the hiatus and counteract continued stresses from intra-abdominal pressure.
Desenvolvido por Surya MKT