Iatrogenic ureteral injuries (IUI) are rare surgical complications in abdominopelvic surgeries, with an incidence varying between 0.15 and 1.0%.
To evaluate the incidence of IUI in elective colorectal surgeries performed in a tertiary university hospital.
This is a retrospective analysis of patients operated from 2004 to 2022, who presented IUI. Demographic data, underlying disease, predisposing factors, surgery access, location of the lesions and their characteristics, diagnosis time, treatment carried out, and follow-up were analyzed.
In the period, 2,312 abdominopelvic surgeries were performed, of which 1,998 were open and 314 were laparoscopic, with 19 IUI (0.82%). The mean age was 55.6 years, 57.9% were male, and 89.5% were white. The majority of patients were overweight (52.6%), and 73.7% had a history of abdominal surgery. Primary rectal adenocarcinoma was the most common disease (47.4%), followed by tumor recurrences (21.0%). IUI occurred in 1.91% of laparoscopic surgeries and 0.65% of open surgeries (p=0.053); patients with tumor recurrence presented more IUI than those with primary tumors or benign diseases (p=0.006). They were commonly observed in the left ureter (52.6%) and in the distal portion (89.5%), the main mechanism being the section (57.9%). Intraoperative diagnosis occurred in 12 patients (63.2%). IUI correction was predominant in ureteral reimplantation and end-to-end ureteral anastomosis. Postoperative complications were common (47.4%), and one patient died from causes unrelated to surgery.
IUI presented low incidence in colorectal elective surgeries and were more frequent in surgeries for tumor recurrences, in the left ureter and the distal third. Early diagnosis with repair of the injury provided better results.
The physiological response of the lower esophageal sphincter (LES) to abdominal pressure (AP) plays a key role in the esophagogastric junction (EGJ) integrity. However, in obesity, this interplay remains unclear, particularly in the presence of anatomical alterations.
This study aims to evaluate the correlation between abdominal pressure and LES basal pressure in obese patients, and to analyze the influence of EGJ morphology on this interaction.
This retrospective cross-sectional study included 47 obese patients (BMI>35 kg/m2) who underwent high-resolution esophageal manometry. Patients were divided into two groups based on EGJ morphology: normal (Type I) and abnormal (Types II/III, hiatal hernia) and were compared based on clinical and manometric variables. Correlation analyses between AP and LES pressure were performed for the entire sample and stratified by EGJ morphology.
No statistically significant correlation was found between AP and LES pressure in the overall sample (rho=0.05; p=0.737). In the subgroup analysis, there was a non-significant trend toward increased LES pressure in patients with normal EGJ morphology (r=0.26; p=0.150) and decreased LES pressure in those with hiatal hernia (r=-0.39; p=0.131). No significant differences in BMI, abdominal circumference, AP, or LES pressure were observed between groups.
In obese individuals, abdominal pressure does not show correlation with LES pressure. However, EGJ morphology may influence sphincteric behavior, with a trend toward LES pressure increase in normal EGJ and reduction in altered morphologies. These findings highlight the multifactorial nature of esophagogastric dysfunction.
Local excision (LE) has a limited role in the management of anal squamous cell carcinoma (SCC), typically restricted to carefully selected early-stage tumors. However, in clinical practice, LE is often performed in broader contexts, particularly in patients with large perianal lesions without prior confirmation of invasive carcinoma, in whom diagnostic uncertainty may influence treatment decisions.
To evaluate oncologic outcomes after LE for anal SCC, with particular emphasis on the role of lesion characteristics, diagnostic uncertainty, and treatment patterns in real-world practice.
This was a retrospective study of patients with anal SCC who underwent LE as primary treatment and were followed at a tertiary cancer center between 2010 and 2024. Clinical, pathological, and treatment data were collected, including tumor characteristics, margin status, use of adjuvant therapy, and oncologic outcomes.
A total of 20 patients with invasive anal SCC were included. The mean tumor size was 3.24 cm (standard deviation ±1.75 cm), with lesions up to 6.9 cm. No patients received chemoradiotherapy before LE. Only two patients met conventional criteria for LE (<2 cm, well or moderately differentiated tumors). Overall, 14 patients (70%) required additional treatment following LE, including chemoradiotherapy or abdominoperineal resection. Among patients initially managed with surveillance, 44% developed local recurrence, even in cases with negative margins.
Outcomes following LE for anal SCC are strongly influenced by patient selection and clinical context. In this real-world cohort, most patients outside established criteria required additional treatment, underscoring the limitations of LE in large perianal lesions. These findings highlight the importance of careful preoperative evaluation and maintaining a high index of suspicion for invasive carcinoma to guide appropriate initial management.
Early-onset colorectal cancer (EOCRC), defined as diagnosis before 50 years of age, has increased in incidence globally, but its clinicopathologic profile and prognostic significance remain incompletely characterized, particularly in Southeast Asian populations with limited access to organized screening.
To compare clinicopathologic characteristics and survival outcomes between EOCRC and late-onset colorectal cancer (LOCRC) following curative resection, and to identify independent prognostic determinants in a regional Vietnamese surgical cohort.
This retrospective cohort study included 486 patients with stage I-III colorectal adenocarcinoma who underwent curative laparoscopic resection at a tertiary center in the Mekong Delta between 2016 and 2022.
EOCRC (184 patients, 37.9%) was associated with higher rates of poor differentiation, mucinous or signet-ring cell histology, lymphovascular invasion, and perineural invasion compared with LOCRC (all p<0.05). Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) did not differ significantly between groups. In the overall cohort (log-rank p=0.72, 0.15, and 0.96, respectively). On multivariable analysis, postoperative complications were the dominant independent prognostic factor for OS (hazard ratio [HZ] 8.28; 95% confidence interval [CI] 4.87-14.09) and RFS (HZ 4.81; 95%CI 3.03-7.65), whereas age at onset was not independently associated with either outcome. Stage-stratified curves suggested a less favorable survival pattern among patients with stage III EOCRC, particularly for CSS and RFS.
Despite a more aggressive histopathologic profile, EOCRC showed comparable survival to LOCRC in the overall cohort. Stage-stratified curves suggested a less favorable survival pattern among patients with stage III EOCRC, while postoperative complications represented the dominant modifiable determinant of outcome.
Gastric adenocarcinoma remains one of the leading causes of cancer mortality worldwide, according to the International Agency for Research on Cancer. Stage III, as defined by the 8th edition of the American Joint Committee on Cancer Tumor, Node, and Metastasis (TNM) system, comprises a biologically heterogeneous group, resulting in clinicopathological variations that directly impact prognosis and therapeutic decisions.
To evaluate the clinicopathological features, surgical morbidity and mortality, and overall survival of patients with gastric adenocarcinoma treated at a tertiary center, and to analyze prognostic differences among stage III subgroups.
This retrospective cohort study included patients treated between 2008 and 2018. Demographic variables, tumor characteristics, TNM staging (8th edition), type of surgical procedure, complications according to the Clavien-Dindo classification, and 30-day mortality were analyzed. Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test, with a significance level of 5%.
This retrospective cohort study included patients treated between 2008 and 2018. We analyzed demographic variables, tumor characteristics, TNM staging (8th edition), type of surgical procedure, complications according to the Clavien-Dindo classification, and 30-day mortality. Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test, with a significance level of 5%.
Stage III gastric adenocarcinoma demonstrates marked clinicopathological heterogeneity, which directly impacts morbidity, mortality, and survival. Lymph node involvement is a relevant prognostic determinant.
The pathophysiology of necrotizing enterocolitis (NEC) involves changes in intestinal development that hinder its functionality, leading to both metabolic and gene and phenotypic changes. Among the genetic factors the 896A/G polymorphism in the Toll-Like Receptor 4 (TLR4) gene can trigger is an inappropriate and persistent inflammatory response, leading to the progression of lesions and necrosis of the intestinal mucosa, and reduced perfusion of the microvasculature, increasing susceptibility to the disease.
To determine the prevalence of the 896A/G polymorphism in the TLR4 gene in neonates with and without NEC.
Case-control study, in which 100 neonates were evaluated, 50 diagnosed with NEC (Case Group) and 50 without the disease (Control Group), of both sexes. DNA was extracted from peripheral blood leukocytes, and the region encompassing the polymorphism was amplified by polymerase chain reaction/restriction fragment length polymorphism.
Males were predominant in both groups: Cases (54%) and Controls (56%) (p=1.0000). Moderately and extremely preterm infants were the most frequent in the Case (90%) and Controls (96%) (p=0.6132) groups. Very low birth weight and extremely low birth weight neonates were predominant in the Case Group (60%) and in the Control Group (72%) (p=0.0995). Of the 50 neonates with NEC, 66% responded positively to clinical treatment, and 86% were discharged from hospital. The 896A/G polymorphism in the TLR4 gene was not identified in the 200 alleles analyzed (100%).
The absence of the 896A/G polymorphism in the TLR4 gene in NBs with and without NEC does not exclude the possibility of alterations in this and/or other genes, highlighting the importance of additional studies to elucidate this relationship.
Single-stage outpatient treatment of cholecystocholedocholithiasis is feasible, highlighting the importance of appropriate patient selection, professional training, and healthcare service organization to support this approach.
To identify clinical and procedural factors associated with outpatient management and hospital stay following single-stage laparoendoscopic treatment of cholecystocholedocholithiasis.
A retrospective cohort study was conducted at hospitals affiliated with the Ribeirão Preto School of Medicine, Universidade de São Paulo (FMRP-USP), between 2019 and 2024. Patients were stratified into three groups according to care setting: outpatient (G1); outpatient with overnight stay (G2); and inpatient (G3). Clinical, surgical, and outcome data were analyzed using logistic regression models, χ2 tests, and Fisher’s exact tests (p=0.05).
Among 177 patients included, 41 were allocated to G1, 80 to G2, and 56 to G3. Compared with G2, G1 patients had shorter operative time (124.2 vs. 143.8 min; p=0.038), more frequent use of the Rendez-Vous technique (p=0.044), and less frequent use of papillary dilation (p=0.041). Patients in G3 had a higher prevalence of ASA III physical status (p=0.045), higher rates of postoperative complications (p=0.025) and biliary stent use (p=0.001), and lower bile duct clearance rates (p=0.004).
Single-stage outpatient laparoendoscopic treatment of cholecystocholedocholithiasis is safe and effective. Clinical severity, treatment complexity, and failure of bile duct clearance were more strongly associated with inpatient hospitalization, whereas overnight stay among outpatients was not associated with improved postoperative outcomes. The implementation of enhanced recovery protocols and telemedicine-based postoperative assessment strategies may further reduce hospital stay.
Pancreatic neuroendocrine tumors (pNETS) constitute a heterogeneous and rare disease worldwide. Diagnosis rates have been increasing, and the evaluation of prognostic factors has become even more important in the treatment decision-making process.
To present results and prognostic factors in patients undergoing surgical treatment for pNETS at a single Brazilian center.
The most frequently performed surgical procedure was PCC+S 60.0%. The median hospital stay was 8 (5-13) days, and postoperative mortality occurred in 1.7%. Overall survival in 3 and 5 years was 93.8 and 92.1%, respectively. Disease-free survival at 3 and 5 years was 87.1 and 71.8%, respectively. Patients with tumors smaller than 2.0 cm did not present with lymph node disease or recurrence, and patients with tumors measuring 2.1-2.5cm had lymph node disease in 11.1% and recurrence in 11.1%. In univariate and multivariate analysis, the presence of lymphatic and perineural invasion and Ki67 (3-20) were strongly correlated with positive lymph node disease and recurrence, respectively.
The presence of lymphatic and perineural invasion, Ki67 (3 to 20), and tumors larger than 2.5 cm correlated with positive lymph node disease and recurrence.
Obesity is a multifactorial disease with a high prevalence that leads to several comorbidities, posing significant challenges for healthcare systems. Bariatric and metabolic surgery (BMS) has been established as the most effective treatment for patients with obesity; however, in Brazil, limited access remains a critical barrier.
This study aimed to evaluate the clinical, demographic, and metabolic characteristics of patients with obesity undergoing BMS in the Brazilian Unified Health System and to analyze the relationship between waiting time and comorbidities.
A retrospective cohort study was conducted involving 1,000 patients with obesity who underwent treatment between July 2022 and June 2024. Clinical, anthropometric, and laboratory variables were analyzed using regression analysis and statistical tests to assess the association between waiting time and comorbidities.
A significant correlation was found between prolonged waiting time and an increased number of comorbidities (R²=0.686; p<0.001). Furthermore, the number of comorbidities explained 60% of the variability in waiting time (R²=0.600; p<0.001), with a mean increase of 1.92 years for each additional comorbidity (95%CI 1.82–2.02). Patients on the waiting list for more than 10 years had higher rates of hypertension, type 2 diabetes, and dyslipidemia. Waiting time also had an impact on some metabolic syndrome parameters, including glycated hemoglobin (Hb1Ac) (r=+680, p=0.031), low-density lipoprotein (LDL) (r=+640, p=0.044), and total cholesterol (r=+830, p=0.008).
Prolonged waiting time for bariatric and metabolic surgery is associated with an increased burden of metabolic comorbidities and their consequences.
Pancreatoduodenectomy is still the most common surgical treatment for patients with duodenal tumors. However, in selected cases where duodenal resection is technically feasible, it could represent a valid alternative, reducing the risk of postoperative complications, being a less invasive procedure.
The objective of this study was to evaluate the results of this procedure at our institution.
We collected data from all patients undergoing duodenal resection for oncologic disease between January 2020 and June 2025 at our institution. After a multidisciplinary evaluation, duodenal resection was indicated when the distance between the duodenal tumor and papilla of Vater measured endoscopically was at least 2 cm, and the tumor was operable with radical intent.
Eight patients were treated with this procedure. No major postoperative complications were observed. Two patients had postoperative nausea and vomiting, which resolved with antiemetics. Average hospital stay was five days. There has been no recurrence or death to date.
Duodenal resection seems a valid alternative to pancreatoduodenectomy for the treatment of duodenal tumors in selected cases. It reduces the risk of postoperative complications, eliminating the risk of complications specific to pancreatoduodenectomy, such as pancreatic and biliary fistulas. It is a less invasive and shorter procedure, less severely compromises the patients general condition, and reduces hospital stay. Further studies are needed to confirm these results and draw generalizable conclusions.
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