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.
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.
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.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with a rising incidence largely driven by chronic liver disease. Accurate diagnosis and appropriate clinical assessment at the time of presentation are essential, as therapeutic strategies and prognosis depend on tumor burden, liver function, portal hypertension, and patient performance status.
To develop evidence-based, multidisciplinary recommendations to guide the diagnosis, clinical assessment, and staging of patients with HCC.
This consensus was developed by 43 experts from surgical oncology, hepatology, clinical oncology, radiology, interventional radiology, pathology, liver transplantation, gastroenterology, radiation oncology, and palliative care, under the coordination of the Brazilian Society of Surgical Oncology and 13 collaborating national medical societies. A scientific steering committee predefined clinically relevant questions addressing radiological and histopathological diagnosis, clinical assessment, diagnostic work-up, management of patients at the time of HCC diagnosis, and staging. These questions were discussed and refined in multidisciplinary meetings and submitted to structured voting rounds.
The panel formulated 18 recommendations covering key aspects of HCC evaluation, including standardized application of Liver Imaging Reporting and Data System (LI-RADS®) for imaging-based diagnosis, management of indeterminate lesions, indications for biopsy, histopathological classification and reporting, immunohistochemical markers, assessment of hepatic function and portal hypertension, staging systems, diagnostic work-up, and the role of multidisciplinary care. The recommendations emphasize integration of imaging findings with liver-related factors and clinical context to support individualized decision-making.
This multidisciplinary consensus provides practical, evidence-based recommendations for the diagnosis, clinical assessment, and staging of HCC. By promoting standardized diagnostic practices while reinforcing comprehensive patient evaluation and multidisciplinary management, this document aims to improve diagnostic accuracy, optimize treatment selection, and support safe care.
Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10–27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial.
The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer.
A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission).
In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors.
This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.
The rectum cancer is associated with high rates of complications and morbidities with great impact on the lives of affected individuals.
To evaluate quality of life, pain, anxiety and depression in patients treated for medium and lower rectum cancer, submitted to surgical intervention.
A descriptive cross-sectional study. Eighty-eight records of patients with medium and lower rectum cancer, submitted to surgical intervention were selected, and enrolled. Forty-seven patients died within the study period, and the other 41 were studied. Question forms EORTC QLQ-C30 and EORTC QLQ-CR38 were used to assess quality of life. Pain evaluation was carried out using the Visual Analogical Scale, depression and anxiety were assessed through Depression Inventories and Beck's Anxiety, respectively. The correlation between pain intensity, depression and anxiety was carried out, and between these and the EORTC QLQ-C30 General Scale for Health Status and overall quality of life, as well as the EORTC QLQ-CR38 functional and symptom scales.
Of the 41 patients of the study, 52% presented pain, depression in 47%, and anxiety in 39%. There was a marking positive correlation between pain intensity and depression. There was a moderate negative correlation between depression and general health status, and overall quality of life as well as pain intensity with the latter. There was a statistically significant negative correlation between future depression perspective and sexual function, and also a strong positive correlation between depression and sexual impairments. A positive correlation between anxiety and gastro-intestinal problems, both statistically significant, was observed.
Evaluation scales showed detriment on quality life evaluation, besides an elevated incidence of pain, depression, and anxiety; a correlation among these, and factors which influence on the quality of life of post-surgical medium and lower rectum cancer patients was observed.
The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea is to accomplish this surgical procedure, comparing the manual and mechanical suture, in order to evaluate the real benefit of the mechanical technique.
To evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture with regard to local and systemic complications.
Fifty-seven patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagogram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (group B).
In the postoperative period, one patient of group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, three patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from group A presented such complication. Lung infection was present in five patients, being two (8.3%) of group A and three (9.0%) on B, having good outcomes after specific treatment. In the late review, done with 43 patients (94.4%) of group A and 22 (88.0%) on B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing.
The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual one, because it provided a lower index of local post-surgical complications.
Liver metastases are a frequent event in the course of colorectal cancer and some studies indicate them as the cause of two thirds of deaths from this disease. Treatment is complex and involves a range of therapeutic options that vary through behavior and timing of metastases diagnosis, as well as the background of the patient. The volume of medical knowledge published every year on this topic is on the rise, with information with different levels of evidence, coming as a torrent of data that daily challenges those involved in the care of these patients. These professionals, in turn, should belong to multidisciplinary teams able to evaluate together the best treatment options as well as their sequence, according to the specifics of each case.
These are the premises that supported the initiative to hold the First Brazilian Consensus of Multimodal Treatment of Liver Metastases from Colorectal Cancer, including, unprecedentedly in Brazil, the specialty societies involved in this care, namely the Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA), the Brazilian Society of Surgical Oncology (BSSO), the Brazilian Society of Clinical Oncology (BSCO), the Brazilian College of Digestive Surgery (BCDS) and the Brazilian College of Surgeons (BCS), also relying on the support of the Americas Hepato-Pancreato-Biliary Association (AHPBA). Experts from other areas were also involved in specific points of the discussion, such as radiologists, interventional radiologists and pathologists. The Consensus meeting was held on August 23, 2014 during the X International Symposium on Cancer of the Digestive Apparatus of CEPGIO / International Symposium BC-IHPBA / Postgraduate Course of AHPBA at A.C. Camargo Cancer Center in São Paulo.
Schistosomiasis is endemic problem in Brazil affecting about three to four million people, and digestive hemorrhage caused by esophageal varices rupture is the main complication of the disease. Surgical treatment has become a therapeutic option, especially for secondary prophylaxis after at least one episode of bleeding. The surgical technique used by the vast majority of surgeons for the prevention of rebleeding is esophagogastric devascularization and splenectomy. Although with good postoperative results, rebleeding rate is significant, showing the need to follow-up endoscopy in all patients.
To evaluate long-term results of patients submitted to esophagogastric devascularization and splenectomy and postoperative endoscopic treatment regarding esophageal varices caliber and rebleeding rates.
A retrospective study of 12 patients underwent esophagogastric devascularization and splenectomy followed for more than five years.
All patients showed varices size reduction, and no patient had postoperative bleeding recurrence.
Esophagogastric devascularization and splenectomy decreased significantly the esophageal variceal size when associated with endoscopic follow-up, being effective for bleeding recurrence prophylaxis.
The use of measures in colonic anastomoses to prevent dehiscences is of great medical interest. Sugarcane molasses, which has adequate tolerability and compatibility in vivo, has not yet been tested for this purpose.
To analyze the biomechanical parameters of colonic suture in rats undergoing colectomy, using sugarcane molasses polysaccharide as tape or gel.
45 Wistar rats (Rattus norvegicus albinus) were randomized into three groups of 15 animals: irrigation of enteric sutures with 0.9% saline solution; application of sugarcane molasses polysaccharide as tape; and sugarcane molasses polysaccharide as gel. The rats underwent colon ressection, with subsequent reanastomosis using polypropylene suture; they were treated according to their respective groups. Five rats from each group were evaluated at different times after the procedure: 30, 90 and 180 days postoperatively. The following variables were evaluated: maximum rupture force, modulus of elasticity and specific deformation of maximum force.
The biomechanical variables among the scheduled times and treatment groups were statistically calculated. The characteristics of maximum rupture force and modulus of elasticity of the specimens remained identical, regardless of treatment with saline, polysaccharide gel or tape, and treatment time. However, it was found that the specific deformation of maximum force of the intestinal wall was higher after 180 days in the group treated with sugarcane polysaccharide gel (p=0.09).
Compared to control, it was detected greater elasticity of the intestinal wall in mice treated with sugarcane polysaccharide gel, without changing other biomechanical characteristics, regardless of type or time of treatment.
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