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  • 1
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    Prevenção do tromboembolismo na cirurgia do câncer do aparelho digestivo
    FapUNIFESP (SciELO) ; 2012
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 25, No. 4 ( 2012-12), p. 216-223
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 25, No. 4 ( 2012-12), p. 216-223
    Abstract: BACKGROUND: The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism. AIM: To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies. METHODS: The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome), allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID). Evidence manual search was also conducted (BDTD and IBICT). The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores) according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for studies not randomized). After defining potential studies to support the recommendations, they were selected by the strength of evidence and grade of recommendation according to the classification of Oxford, including the available evidence of greater strength. RESULTS: A total of 53,555 papers by title and / or abstract related to issue were found. Of this total were selected (1st selection) 478 studies that were evaluated as full-text. From them to support the recommendations were included in the consensus 132 papers. The 15 questions could be answered with evidence grade of articles with 31 A, 130 B, 1 C and 0 D. CONCLUSION: It was possible to prepare safe recommendations as guidance for thromboembolism prophylaxis in operations on the digestive tract malignancies, addressing the most frequent topics of everyday work of digestive and general surgeons.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202012000400002
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2012
    detail.hit.zdb_id: 2560235-4
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  • 2
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    LYMPHOCYTE COUNT AND PLATELET VOLUME PREDICTS POSTOPERATIVE COMPLICATIONS IN ESOPHAGECTOMY FOR CANCER: A COHORT STUDY
    FapUNIFESP (SciELO) ; 2019
    In:  Arquivos de Gastroenterologia Vol. 56, No. 4 ( 2019-10), p. 377-385
    Details
    In: Arquivos de Gastroenterologia, FapUNIFESP (SciELO), Vol. 56, No. 4 ( 2019-10), p. 377-385
    Abstract: RESUMO CONTEXTO: Os biomarcadores obtidos do hemograma completo são fatores prognósticos a longo prazo em pacientes com câncer. No entanto, o valor desses biomarcadores no contexto da terapia trimodal para o câncer de esôfago na predição de resultados pós-operatórios precoces não é estudado. OBJETIVO: O presente estudo avaliou o papel dos componentes celulares do sangue na predição de mortalidade e morbidade pós-operatória. MÉTODOS: Uma coorte de 149 pacientes consecutivos submetidos à quimiorradioterapia usando esquemas baseados em platina e taxano seguidos por esofagectomia foi analisada. Os componentes celulares do sangue coletados antes da terapia neoadjuvante (período A) e antes da cirurgia (período B) foram avaliados quanto à mortalidade e complicações pós-operatórias. Modelos de regressão de Cox univariada e multivariada foram aplicados para avaliar a significância prognóstica independente das variáveis da contagem sanguínea. RESULTADOS: A morbidade pós-operatória esteve presente em 46% dos pacientes. Na análise de regressão múltipla, o volume plaquetário (B) (OR: 1,53; IC95%: 1,2-2,33) foi um preditor independente de complicações gerais. Complicações cirúrgicas pós-operatórias graves estavam presentes em 17% dos pacientes. Na análise de regressão múltipla, a diminuição de linfócitos entre os períodos B-A (OR: 0,992; 95% CI: 0,990-0,997) esteve relacionada ao maior risco de complicações graves. Fístula da anastomose cervical esteve presente em 25,6% dos pacientes. Na análise univariada, a contagem de eosinófilos nos períodos A e B relacionou-se com a fístula da anastomose cervical. Para este resultado, o modelo multivariado de articulação não conseguiu identificar variáveis de risco independentes entre os componentes celulares do sangue. A taxa de mortalidade em 30 dias foi de 7,4%. Na análise univariada, a contagem no período B foi associada a maior risco de mortalidade. O modelo multivariado de articulação não pôde predizer mortalidade devido ao pequeno número de pacientes no grupo de mortalidade. CONCLUSÃO: Este é o primeiro estudo a avaliar o papel das variáveis do hemograma durante a quimiorradioterapia neoadjuvante para câncer na predição de complicações pós-operatórias. Volume plaquetário e variação da contagem de linfócitos séricos antes da cirurgia podem ser utilizados como biomarcadores preditivos de complicações pós-operatórias nos pacientes com neoplasia de esôfago submetidos a terapia trimodal.
    Type of Medium: Online Resource
    ISSN: 1678-4219 , 0004-2803
    URL: Article
    DOI: 10.1590/s0004-2803.201900000-70
    Language: English
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2019
    detail.hit.zdb_id: 2210583-9
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  • 3
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    Preoperative botulinum toxin type A: A case report of a proposed new strategy for giant hiatal hernia management
    Wiley ; 2020
    In:  Clinical Case Reports Vol. 8, No. 12 ( 2020-12), p. 3411-3414
    Details
    In: Clinical Case Reports, Wiley, Vol. 8, No. 12 ( 2020-12), p. 3411-3414
    Abstract: The use of preoperative ventral botulinum toxin for giant hiatal hernia management.
    Type of Medium: Online Resource
    ISSN: 2050-0904 , 2050-0904
    URL: Issue
    URL: Article
    DOI: 10.1002/ccr3.v8.12
    DOI: 10.1002/ccr3.3416
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2740234-4
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  • 4
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    The value of cellular components of blood in the setting of trimodal therapy for esophageal cancer
    Wiley ; 2020
    In:  Journal of Surgical Oncology Vol. 121, No. 5 ( 2020-04), p. 784-794
    Details
    In: Journal of Surgical Oncology, Wiley, Vol. 121, No. 5 ( 2020-04), p. 784-794
    Abstract: Inflammation status plays an important role in the natural history of malignancy. Consequently, hematological markers of systemic inflammation may predict prognosis in neoplasms. This study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by esophagectomy for cancer in predicting prognosis. Methods A cohort of 149 patients was analyzed. Cellular components of blood were assessed before neoadjuvant therapy (A); before surgery (B); and 3 to 5 months after surgery (C); for the following outcomes: pathological response, overall survival (OS), and disease‐free survival (DFS). Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. Results Low hematocrit (Ht) (C) (HR, 0.85; 95% CI, 0.79‐0.92) and high neutrophil‐to‐lymphocyte ratio (NLR) (C) (HR, 1.07; 95% CI, 1.07‐1.10) were related to poor OS. Low Hb (C) (HR, 0.72; 95% CI, 0.58‐0.88), red cell distribution width (RDW) (C‐A) (HR, 1.16; 95% CI, 1.02‐1.31), and NLR (C‐A) (1.06; 95% CI, 1.03‐1.09) were related to poor DFS. RDW (B‐A) (HR, 1.15; 95% CI, 1.08‐1.22), RDW (C) (HR, 1.12; 95% CI, 1.04‐1.2), NLR (C) (HR, 1.12; 95% CI, 1.08‐1.17) were related to systemic recurrence. Conclusion Variables of routine blood count are easily assessable and their changes throughout trimodal therapy for esophageal carcinoma provide important information for cancer patient's prognosis.
    Type of Medium: Online Resource
    ISSN: 0022-4790 , 1096-9098
    URL: Issue
    URL: Article
    DOI: 10.1002/jso.v121.5
    DOI: 10.1002/jso.25778
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1475314-5
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  • 5
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    Comparative study of transhiatal and transthoracic thoracoscopic esophagectomy results in adenocarcinoma of the esophagogastric junction.
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 4_suppl ( 2018-02-01), p. 185-185
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 4_suppl ( 2018-02-01), p. 185-185
    Abstract: 185 Background: The surgical treatment of adenocarcinoma of the esophagogastric junction surgical treatment (AGEJ) is still controversial, particularly concerning to survival and postoperative complications. To compare thoracoscopic esophagectomy (group A) with transhiatal esophagectomy (group B) in patients with AGEJ in relation to the occurrence of complications and mortality; number of ressected lymph nodes, the positive and the ratio between the ressected and positive; overall and disease free survival; and survival after relapse. Methods: There was a selection of 147 patients from 2000 to 2017. Epidemiological data were analyzed and compared between the groups. Postoperative complications were evaluated. The anatomopathological staging was evaluated, analyzing the resected lymph nodes. Analysis of overall survival, disease free survival and survival after relapse were made, besides multivariate analysis of survival related factors. Results: In relation to the complications, group A presented greater occurrence of hoarseness and surgical infections. In relation to mortality, group A presented 2 cases (3.7%) and group B presented 4 (4.3%), without statistical difference. In group A, the average number of ressected lymph nodes was 31.88 and in group B was 20.73 (p 〈 0.001), however the average number of affected lymph nodes was 3.96 in group A and 4.25 in group B. The general overall survival was 42.3%, in group A was 38.9% and in group B was 47.6% (p = 0.298). In the multivariate analysis of overall survival only lymphatic invasion (p = 0.005), diabetes mellitus (p = 0.038) and surgical infection (p-0.001) were significant. However, in tumors with stage until 2B, group A overall survival was 80.4% and group B was 38.5% (p = 0.001). Conclusions: Both methods are safe with similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a larger ressection in the number of lymph nodes. Overall survival and disease free survival are similar, however until stage 2B thoracoscopic esophagectomy improves overall survival. Diabetes and lymphatic invasion interfere in overall and disease free survival.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2018.36.4_suppl.185
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 6
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    Robotic-assisted (RAMIE) x thoracoscopic esophagectomy (MIE): Comparison on safety and lymph nodal dissection in 181 cases.
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 4_suppl ( 2018-02-01), p. 150-150
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 4_suppl ( 2018-02-01), p. 150-150
    Abstract: 150 Background: Robotic-assisted esophagectomy (RAMIE) gained evidence among the major oncological procedures due possibilities on lymph nodal dissection. The concept of esophagectomy and extensive lymphadenectomy with low morbidity boosted by the videothoracoscopic esophagectomy(MIE) is now focused on the robotic approach. Methods: The first 37 cases of RAMIE were studied. The thoracic field performed in the prone position with three robotic arms and abdominal field idem, as performed in the upper GI robotics procedures. Conversion to open or laparoscopic procedures, morbidity and mortality as well as the length of the lymphadenectomy were evaluated. These data were compared to the first 154 cases of MIE operated by the same surgical team in those early results. Also the late survival of the MIE group is presented. Results: All except 2 RAMIE cases were Siewert I or II Adenocarcinoma, 32 post neoadjuvancy: MAGIC (7) or CROSS (25). There was no conversion to lap or open procedures. No patient received blood transfusion. One complication was observed: a partial rotation of gastroplasty in the thorax, that required thoracoscopic approach in the day 7. Mortality (90 days) was zero. Mean resected lymph nodes was 42.5 (30-76). In the MIE group, complications were: respiratory (26.2%), infectious (8.4%), cervical fistula (17.7%), vocal cord palsy (8.4%). 30 and 90 days mortality were one (0.93%) and 3 (2.8%). Mean dissected lymph nodes = 31.6 (± 14.3), 1:57 positives (± 3.21) and RAD 00:05 (± 0:09). The overall five-year survival was 69% (95% CI: 57% - 83%), 75% in stage 0 / I / II and 42% in III/IV. Conclusions: RAMIE with these technical proposal, seams to be safe without mortality. Lymph nodal achieved was equal to greater than the practiced through MIE. After those cases we started a randomized prospective trial on this issue (NCT02292914).
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2018.36.4_suppl.150
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 7
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    Anatomical topography of the tumor is related to prognostic survival in adenocarcinoma of esophagogastric junction?: Multivariable analysis.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 4_suppl ( 2019-02-01), p. 108-108
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 4_suppl ( 2019-02-01), p. 108-108
    Abstract: 108 Background: The adenocarcinoma of the esophagogastric junction (AJEG) is divided according to its anatomopathological classification (Siewert classification) for the choice of surgical treatment. However, both the Siewert classification and the location of the AJEG are related to different prognoses reported in the literature. Objectives: To compare the survival of patients with AJEG submitted to surgical treatment according to different topographies in the esophagogastric junction. Methods: 147 patients were selected between 2000 and 2016. One hundred and thirty (88%) males, mean age 64 years. Analyzing the retrieved lymph nodes, affected and the relation of resected and affected. AEGG (E: esophagus, E/TEG: gastric esophagus, TEG: gastric esophagus transition, TEG/G: esophageal gastric and stomach transition, and E/TEG/G: esophagus, transition and stomach) were analyzed for global survival, free of disease, and after relapse. Results: In relation to epidemiological data, the mean age was 63.1 years. Of the 147 patients 90 (61.2%) were submitted to neoadjuvant treatment. There was no statistical difference between the groups regarding histological grade, pT, pN, stage, tumor extension, lymphatic, venous and perineural invasion. The mean extension of the tumor was 5.4 cm. The mean number of retrieved lymphnodes were 32. Overall survival was E: 90%, E/TEG: 60%, TEG: 52%, TEG/G: 50% and E/TEG/G: 21%. (p 〈 0.0001). Disease free of survival was E: 78%, E/TEG: 48%, TEG: 43%, TEG/G: 38% and E/TEG/G: 15%. (p 〈 0.001). Conclusions: The survival of the AJEG varies according to the topography of the lesion, the tumors located closer to the stomach present worse survival than those located in the esophagus, except when the tumor is very extensive, from the esophagus to the stomach.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.4_suppl.108
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 8
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    Prognostic Value of Tumor Regression Grade Based on Ryan Score in Squamous Cell Carcinoma and Adenocarcinoma of Esophagus
    Springer Science and Business Media LLC ; 2020
    In:  Annals of Surgical Oncology Vol. 27, No. 4 ( 2020-04), p. 1241-1247
    Details
    In: Annals of Surgical Oncology, Springer Science and Business Media LLC, Vol. 27, No. 4 ( 2020-04), p. 1241-1247
    Type of Medium: Online Resource
    ISSN: 1068-9265 , 1534-4681
    URL: Article
    DOI: 10.1245/s10434-019-07967-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2074021-9
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  • 9
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    Does a history of head and neck cancer affect outcome of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma?
    Georg Thieme Verlag KG ; 2020
    In:  Endoscopy International Open Vol. 08, No. 07 ( 2020-07), p. E900-E910
    Details
    In: Endoscopy International Open, Georg Thieme Verlag KG, Vol. 08, No. 07 ( 2020-07), p. E900-E910
    Abstract: Background and study aims Esophageal squamous cell carcinoma (ESCC) is the most common secondary tumor in patients with head and neck squamous cell cancer (HNSCC). Currently, endoscopic submucosal dissection (ESD) is the preferred approach to manage superficial ESCC, however, it remains to be elucidated whether patients with HNSCC and early ESCC managed by ESD have different outcomes. Patients and methods We retrospectively analyzed esophageal ESD for early ESCC from September 2009 to September 2017 and the following variables: demographics, tumor and specimen size, Paris classification, location, en bloc and R0 resection rates, overall survival (OS) and adverse events (AEs). To reduce selection bias, propensity score matching was applied to compare the results. Results Eighty-nine ESDs were performed in 81 consecutive patients (47 with HNSCC and 34 without HNSCC). Patients with HNSCC who developed superficial ESCC were found to be younger and to refer a more frequent history of alcohol ingestion and smoking. There was no difference in lesion size, number of lesions, procedure time, en bloc resection rate, R0 resection rate, local recurrence and adverse event rate between the two groups. The histological depth of invasion for patients with HNSCC was significantly shallower before (P = 0.016) and after (P = 0.047) matching. The overall survival rate was similar in both groups. Conclusions Patients with HNSCC have earlier detection of ESCC, probably due to endoscopic screening. Previous history of chemoradiation and surgery for HNSCC does not affect procedure time, AEs and OS.
    Type of Medium: Online Resource
    ISSN: 2364-3722 , 2196-9736
    URL: Article
    DOI: 10.1055/a-1147-8977
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 2761052-4
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  • 10
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    Prognostic Value of Bone Marrow Uptake Using 18F-FDG PET/CT Scans in Solid Neoplasms
    MDPI AG ; 2022
    In:  Journal of Imaging Vol. 8, No. 11 ( 2022-10-31), p. 297-
    Details
    In: Journal of Imaging, MDPI AG, Vol. 8, No. 11 ( 2022-10-31), p. 297-
    Abstract: Background: Fluorine-18-fluorodeoxyglucose positron emission tomography/computerized tomography (18F-FDG PET/CT) uptake is known to increase in infective and inflammatory conditions. Systemic inflammation plays a role in oncologic prognosis. Consequently, bone marrow increased uptake in oncology patients could potentially depict the systemic cancer burden. Methods: A single institute cohort analysis and a systematic review were performed, evaluating the prognostic role of 18F-FDG uptake in the bone marrow in solid neoplasms before treatment. The cohort included 113 esophageal cancer patients (adenocarcinoma or squamous cell carcinoma). The systematic review was based on 18 studies evaluating solid neoplasms, including gynecological, lung, pleura, breast, pancreas, head and neck, esophagus, stomach, colorectal, and anus. Results: Bone marrow 18F-FDG uptake in esophageal cancer was not correlated with staging, pathological response, and survival. High bone marrow uptake was related to advanced staging in colorectal, head and neck, and breast cancer, but not in lung cancer. Bone marrow 18F-FDG uptake was significantly associated with survival rates for lung, head and neck, breast, gastric, colorectal, pancreatic, and gynecological neoplasms but was not significantly associated with survival in pediatric neuroblastoma and esophageal cancer. Conclusion: 18F-FDG bone marrow uptake in PET/CT has prognostic value in several solid neoplasms, including lung, gastric, colorectal, head and neck, breast, pancreas, and gynecological cancers. However, future studies are still needed to define the role of bone marrow role in cancer prognostication.
    Type of Medium: Online Resource
    ISSN: 2313-433X
    URL: Article
    DOI: 10.3390/jimaging8110297
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2824270-1
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