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Isthmin-1, a recently discovered adipokine, was first characterized for its role in early brain development. Subsequent studies have demonstrated that isthmin-1 is involved in a broad range of biological processes, including metabolism, immunity, tumorigenesis, cellular proliferation, endothelial permeability, and organ development.
This study aimed to evaluate isthmin-1 immunoreactivity in tumor tissues obtained from gastric cancer patients using immunohistochemistry and to assess its usefulness in the diagnosis and histological evaluation of gastric cancer.
The patients were divided into three groups: adenocarcinoma, intestinal metaplasia, and healthy controls. Endoscopic biopsies, obtained according to the Sydney protocol, were examined for the control group and patients diagnosed with intestinal metaplasia. In contrast, surgical resection tissues were used for patients diagnosed with gastric adenocarcinoma.
All materials were examined histopathologically. No significant difference in isthmin-1 levels was detected between the control and intestinal metaplasia groups, based on immunohistochemical staining. However, when gastric adenocarcinoma cases were compared with the control and intestinal metaplasia groups, a significant decrease in isthmin-1 immunoreactivity was observed in adenocarcinoma cases. Patients with adenocarcinoma were grouped as well-differentiated, moderately differentiated, and poorly differentiated, and then staged according to the TNM staging system. Histopathological examination revealed no significant differences in the degree of differentiation or TNM stage.
We believe that isthmin-1 can be used as a biomarker in the diagnosis of malignant gastric diseases in the future. However, more comprehensive and extensive scientific studies are needed to determine its usefulness in tumor staging or prognosis monitoring.
The prognostic value of tumor-infiltrating lymphocytes has been studied in several cancers, but in gastric cancer, their evaluation by standard hematoxylin-eosin staining remains controversial.
To analyze the prognostic value of tumor-infiltrating lymphocytes in gastric cancer and to investigate the association between tumor-infiltrating lymphocyte levels and a range of clinical and pathological factors in gastric cancer.
Forty-four patients were included with a mean age of 62 years, and 77% of the patients were classified as having pathological tumor stage 3 or pathological tumor stage 4. Lymph node metastases were noted in 66% of our patients. At diagnosis, 57% of patients were at an advanced stage (III). Patients with distant metastases were not included in this study. Evaluation of tumor-infiltrating lymphocytes in hematoxylin-eosin staining found that the mean tumor-infiltrating lymphocyte rate was 43 (extremes: 5-90%). 36% of patients had a tumor-infiltrating lymphocyte rate >50%. The overall survival of our patients was 40 months. Patients with tumor-infiltrating lymphocytes >50% had greater survival, without a significant correlation (p=0.275). A tumor-infiltrating lymphocyte rate =50% was correlated with age >50 years (p=0.030), presence of lymph node involvement (p=0.023), and advanced tumor stage (III+IV) (p=0.05). In a multivariate analysis, the presence of lymph node involvement (p=0.045) and advanced tumor stage (III+IV) (p=0.015) were identified as independent factors associated with a low tumor-infiltrating lymphocyte rate =50%.
Poor prognostic factors for gastric cancer (age >50 years, presence of lymph node involvement, and advanced tumor stage) were associated with a low tumor-infiltrating lymphocyte rate assessed by hematoxylin-eosin staining. However, standardization of tumor-infiltrating lymphocyte assessment is essential to allow comparability between studies and integrate this parameter into routine practice.
Laparoscopic inguinal hernia repair using the transabdominal preperitoneal (TAPP) technique requires a stapler for mesh fixation, making the method expensive.
To demonstrate the feasibility of videolaparoscopic inguinal hernioplasty (TAPP) without mesh fixation in patients who are not stage 3 according to the European Hernia Society classification.
Forty patients underwent videolaparoscopic inguinal hernioplasty (TAPP) with a polypropylene mesh and without fixation from October 2017 to October 2018. After the procedure, outpatient follow-up appointments were scheduled until the 6th postoperative month. In June 2020, the patients were contacted by phone and a follow-up questionnaire was administered.
A total of 52 hernias were operated on, as 25% of patients had bilateral hernias. No patient presented with recurrence or chronic pain. Late in the course of the procedure, 72.5% of patients were contacted, with a mean follow-up of 27.2 months. The incidence of surgical site infection was 12.5%.
The inguinal hernia repair by hernioplasty (TAPP) without mesh fixation in grade I and II patients (European Hernia Society) is feasible.
Recent evidence suggests that Epstein-Barr virus (EBV) and Helicobacter pylori co-infection increase the prevalence of gastric cancer in the younger age group and are associated with poor prognosis. Identifying the association between these agents has important implications for the management of gastric cancer and also for defining populations at high risk of developing gastric malignancy.
To determine the prevalence of H. pylori and EBV co-infection in patients with gastric cancer.
This is a single-center prospective analytical study. A total of 182 patients were included. The study group (n=91) comprised all consecutive patients of age ≥18 years with gastric cancer. The control group (n=91) included individuals with normal endoscopy findings. Both groups were analyzed for the presence of H. pylori and EBV.
The overall prevalence of H. pylori infection in gastric cancer patients was 70.3%, EBV infection was 63.7%, and H. pylori and EBV co-infection was 51.6%. The H. pylori and EBV co-infection in the study and control groups was 51.6% versus 13.1% (p<0.001). The remaining parameters such as smoking, socioeconomic class, dietary habits, prior gastric surgery, tumor location, histological subtype, stage of the tumor, distant metastasis, and lymph node metastasis did not show any significance.
There was a significantly higher prevalence of EBV infection and H. pylori and EBV co-infection in patients with gastric cancer. The prognostic and therapeutic role of co-infection requires long-term follow-up and assessment of treatment response.
The use of robotic systems in bariatric surgery has reached a stage of maturity that supports its application with consistent results in the management of severe obesity. At the same time, the improvement of communication networks and digital support bases has renewed the debate on telesurgery as an alternative to extend the reach of specialized surgical care, particularly in contexts marked by the unequal concentration of highly complex services.
To present the first teleassisted bariatric robotic operation in Latin America between two states of Brazil separated by 3,200 km, in order to demonstrate its operational capacity in real time.
Vertical gastrectomy was performed with two separate teams: one performing the procedure in the metropolitan area of Curitiba (PR), and the other in the city of João Pessoa (PB), both in Brazil.
The procedure was performed without significant operative differences when compared to the face-to-face system and in the same way that it could have been done without the use of telesurgery.
Within this transition process, robotic assisted bariatric surgery stands out as a strategic environment for experimentation, systematic evaluation and consolidation, giving access to new approaches, such as telesurgery, contributing to the construction of a more integrated and innovative surgical model.
Central pancreatectomy (CP) is a parenchyma-sparing alternative to standard resections for benign or low-grade lesions of the pancreatic neck. While it aims to preserve endocrine and exocrine function, it is associated with significant technical complexity and high rates of postoperative pancreatic fistula (POPF).
To analyze the CP at a single high-volume Brazilian center.
A retrospective analysis of a prospectively maintained database was conducted. All patients undergoing CP at a single high-volume Brazilian center between January 2009 and December 2024 were included. Data on demographics, operative details, pathology, complications (International Study Group of Pancreatic Surgery – ISGPS/Clavien-Dindo criteria), and long-term pancreatic function were collected.
Twenty-two patients underwent CP (mean age 54 years, 72% female). The majority of lesions were cystic (50%) or neuroendocrine tumors (36.4%). The POPF rate was 86.4%, all Grade B, most managed conservatively via prolonged drainage. No Grade C fistulas, postoperative hemorrhages, or mortality occurred. Delayed gastric emptying occurred in 22.7%. After a median follow-up of 5.59 years, endocrine insufficiency developed in 9% of patients without prior diabetes (none insulin-dependent), and exocrine insufficiency in 13.6%. Only one locoregional recurrence was observed (isolated metastasis).
This first Latin American series demonstrates that central pancreatectomy is a feasible and effective parenchyma-sparing procedure. It provides excellent long-term preservation of pancreatic function with low severe morbidity, despite high rates of manageable POPF. These outcomes support its role as a valuable surgical option for selected patients in experienced centers.
Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening.
To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction.
Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity.
After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed.
Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication reliably demonstrates postoperative anatomy and helps better understand hiatal hernia recurrence.
Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening.
To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction.
Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity.
After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed.
Collis gastroplasty reliably produces a tubular gastric conduit resembling the native esophagus in shape and volume. 3D CT is a promising tool for evaluating the postoperative morphology of the repair and anatomical recurrences, demonstrating the durable anatomical structure of Collis gastroplasty.
Abdominal wall hernia is a common disease, with an incidence of around 20%. Recent studies have shown the benefits of using stem cells, especially mesenchymal ones, to improve tissue healing.
Evaluate the use of mesenchymal stem cells derived from adipocytes adhered to a suture filament to enhance tensile strength and collagen formation in aponeurosis.
Human stem cells derived from adipocytes were adhered to a suture filament. Thirty-seven rats of the species Sprague Dawley were divided into three groups: Group 1 was the control group, Group 2 used only a regular suture filament to close abdominal aponeurosis, and Group 3 used a suture filament with stem cells. These animals were evaluated seven, 14, and 56 days after the intervention.
Rupture occurred at the semilunar line and the midline. All animals from Groups 2 and 3, submitted to incision and closure, evaluated at D7 and D14, showed a rupture in the midline. However, all animals evaluated at D56 (all groups) ruptured at the semilunar line. Furthermore, tensile strength was significantly lower at D7 in Groups 2 and 3 compared to Group 1 (p<0,001). On D14, Groups 2 and 3 showed a similar increase in tensile strength, but still inferior to the one observed in Group 1 (p<0,05). On D56, all groups reached similar values (p=0,074, p>0.05). Collagen histologic analysis showed that animals from Group 3 had the highest values in all time points, and Group 2 had higher values than Group 1 in all time points (p>0,05). In graphical analysis, Groups 2 and 3, on D7, had an increase in collagen, but on D14 showed a decrease, with a similar level on D56 (p>0,05).
This study do not support the use of mesenchymal stem cells to improve the healing of a midline abdominal incision in healthy subjects. However, an option for future studies is to employ this filament, combined with matrices for reconstructive purposes, in areas requiring extensive repair, such as large hernias where the aponeurosis is insufficient for defect correction.
Development of pouch cancer is a great challenge to both surgeons and patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy (RPC).
We aimed to present our experience with pouch cancer diagnosis and review literature data regarding incidence and associated risk factors.
This retrospective study enrolled FAP patients undergoing RPC between 1981 and 2023 in our academic institution. It included only J-pouch stapled patients with at least three years of follow-up. Patients’ demographics and disease features were retrieved.
After excluding seven patients, we selected 87 RPC, and three cases (3.4%) of pouch cancer were identified. They were diagnosed in three men aged 23–40 years at RPC and 41–62 years at cancer diagnosis. Interval from RPC to pouch cancer diagnosis varied from 11.6 to 20 years (average 14.6 years). All patients had colorectal cancers (CRC) detected in the specimen from the index surgery, two of them with multicenter lesions. A brief review of the literature series showed that pouch cancer has been detected in incidences ranging from 0.8 to 3.4%. Male sex, CRC in the RPC specimen, pouch phenotype during follow-up and an association with duodenal adenomas are considered risk factors.
Pouch cancer is a rare event associated with specific risk factors. After RPC, all patients should undergo endoscopic surveillance, with special attention to those who develop an aggressive phenotype during the first decade of follow-up.
Desenvolvido por Surya MKT