Hospital volume, postoperative mortality, and costs after gastrectomy for gastric cancer in colombia: is there any association? / Volume hospitalar, mortalidade pós-operatória e custos após gastrectomia por câncer gástrico na colômbia: existe associação?

ABSTRACT BACKGROUND: There are no information in the literature associating the volume of gastrectomies with survival and costs for the health system in the treatment of patients with gastric cancer in Colombia. AIMS: The aim of this study was to analyze how gastrectomy for gastric cancer is associated with hospital volume, 30-day and 180-day postoperative mortality, and healthcare costs in Bogotá, Colombia. METHODS: A retrospective cohort study based on hospital data of all adult patients with gastric cancer who underwent gastrectomy between 2014 and 2016 using a paired propensity score. The surgical volume was identified as the average annual number of gastrectomies performed by the hospital. RESULTS: A total of 743 patients were included in the study. Hospital mortality at 30 and 180 days postoperatively was 36 (4.85%) and 127 (17.09%) patients, respectively. The average health care cost was USD 3,200. A total of 26 or more surgeries were determined to be the high surgical volume cutoff. Patients operated on in hospitals with a high surgical volume had lower 6-month mortality (HR 0.44; 95%CI 0.27-0.71; p=0.001), and no differences were found in health costs (mean difference 398.38; 95%CI-418.93-1,215.69; p=0.339). CONCLUSIONS: This study concluded that in Bogotá (Colombia), surgery in a high-volume hospital is associated with better 6-month survival and no additional costs to the health system.

RESUMO RACIONAL: Não há informações na literatura relacionando o volume de gastrectomias bem como a sobrevida e os custos para o sistema de saúde, no tratamento de pacientes com câncer gástrico na Colômbia. OBJETIVOS: analisar como a gastrectomia para câncer gástrico está associada ao volume hospitalar, mortalidade pós-operatória de 30 e 180 dias e custos de saúde em Bogotá, Colômbia. MÉTODOS: Estudo de coorte retrospectivo baseado em dados hospitalares de todos os pacientes adultos com câncer gástrico submetidos à gastrectomia entre 2014 e 2016, utilizando um escore de propensão pareado. O volume cirúrgico foi identificado como o número médio anual de gastrectomias realizadas pelo hospital. RESULTADOS: Foram incluídos no estudo 743 pacientes. A mortalidade hospitalar aos 30 e 180 dias de pós-operatório, foram respectivamente, 36 (4,85%) e 127 (17,09%) pacientes. O custo médio de saúde foi de US$ 3.200. Vinte e seis ou mais cirurgias foram determinadas como ponto de corte de alto volume cirúrgico. Pacientes operados em hospitais de alto volume cirúrgico tiveram menor mortalidade em seis meses (HR 0,44; IC95% 0,27-0,71; p=0,001) e não foram encontradas diferenças nos custos com saúde (diferença média 398,38; IC95% −418,93-1215,69; p=0,339). CONCLUSÕES: Este estudo concluiu que em Bogotá (Colômbia), a cirurgia em um hospital com alto volume cirúrgico está associada a uma melhor sobrevida de seis meses e não há custos adicionais para o sistema de saúde.

Laparoscopía de etapificación y citología peritoneal en cáncer gástrico: descripción de la técnica quirúrgica / Staging laparoscopy and peritoneal cytology in gastric cancer: technique description and review of the literature

Resumen Introducción: El cáncer gástrico continúa representando la más alta mortalidad por cáncer en hombres en Chile. En una revisión sistemática, evidenciaron que en el 59% de los pacientes que se catalogaron como M0 mediante diferentes estudios como TC, resonancia magnética y PET, se detectaron metástasis a la laparoscopia de etapificación. El objetivo de este estudio es describir la técnica quirúrgica de esta laparoscopía incluida la citología peritoneal y una revisión de la literatura en cuanto a sus indicaciones y posibilidad de cambio de conducta. Materiales y Método: Se realizó la búsqueda de artículos vía MED - LINE/PubMed (U.S.A. National Library of Medicine), Cochrane Library, Elsevier, SciELO; no se aplicó análisis estadístico, se incluyeron 23 referencias relacionadas al tema y materias afines internacionales y nacionales. El procedimiento que describiremos será la laparoscopia diagnóstica y la citología de líquido peritoneal para estudio anatomopatológico. Discusión y Conclusiones: La laparoscopía de etapificación, logra un cambio de conducta en un 20% aproximadamente de los casos, pero hacen faltan más estudios de validación de esta en los centros que tratan dicha enfermedad en el país.

Introduction: Gastric cancer continues to represent the highest mortality from cancer in men in Chile. In a systematic review, they showed that 59% of the patients who were classified as M0 by different studies such as CT, magnetic resonance imaging and PET, metastases were detected at staging laparoscopy. The objective of this study is to describe the surgical technique of staging laparoscopy including peritoneal cytology and a review of the literature regarding its indications and the possibility of behavior change. Materials and Method: Articles were searched via MEDLINE/PubMed (U.S.A. National Library of Medicine), Cochrane Library, Elsevier, SciELO, no statistical analysis was applied, 23 references related to the topic and related international and national subjects were included. The procedure to be described will be diagnostic laparoscopy and peritoneal fluid cytology for pathological study. Discussion and Conclusions: Staging laparoscopy achieve a change in behavior in approximately 20% of the cases, but more validation studies are needed in the centers that treat this disease in the country.

Mortalidad por cáncer gástrico y tendencias temporales en Cuba. 2007- 2017 / Gastric cancer mortality and temporary trends in Cuba. 2007-2017

Introducción: El estudio de la mortalidad es una herramienta fundamental para la toma de decisiones en salud. El cáncer gástrico es el cuarto tumor maligno más frecuente en el mundo. Objetivo: Caracterizar la mortalidad por cáncer gástrico y determinar cambios en la tendencia de la mortalidad en Cuba entre 2007 y 2017. Material y Métodos: Estudio observacional descriptivo transversal en Cuba en el período 2007-2017. Universo: total de fallecidos en el país cuya causa básica de muerte recogida en el certificado de defunción fue el cáncer gástrico. Los datos procedieron de la base de datos de mortalidad, digitalizadas por la Dirección de Registros Médicos y Estadísticas del Ministerio de Salud Pública. Para el estudio de la tendencia se utilizó la técnica estadística de regresión segmentada (jointpoint regression versión 4.7). Resultados: En el período se registraron 9 370 defunciones, 79,6 por ciento eran adultos mayores de 60 años, el sexo masculino con 61,0 por ciento. Las tasas específicas de mortalidad por grupos de edad aumentan después de la sexta década de la vida. Conclusiones: Se incrementa las tendencia del cáncer gástrico en los 16 años de estudio, lo que puede estar influenciado por el envejecimiento, y otros factores asociados no investigados en este estudio(AU)

Introduction: The study of mortality is a fundamental tool for decision-marking in health. Gastric cancer is the fourth most common malignant tumor in the world. Objective: To characterize gastric cancer mortality and determine changes in the mortality trends in Cuba between 2007 and 2017. Material and Methods: Cross-sectorial descriptive observational study conducted in Cuba in the period 2007-2017. Universe: total number of deaths in the country whose basic cause of death included in the death certificate was gastric cancer. The data were taken from the mortality database digitized by the Directorate of Medical Records and Statistics of the Ministry of Public Health. Joinpoint Regression Program version 4.7 was used for the analysis of temporary trends. Results: A total of 9 370 deaths were registered within the period; 79,6 percent of them were adults over 60 years old, the male sex with 61,0 percent. Specific mortality rates by age groups increased after the sixth decade of life. Mortality showed a tendency to increase in both sexes. Conclusions: Gastric cancer trends increased during the 16 years of study. They may be influenced by aging and other associated factors that are not considered in this study(AU)

Sobrevida a 5 años de pacientes sometidos a gastrectomía por adenocarcinoma gástrico en el Hospital Naval Almirante Nef entre 2010-2015 / 5-year survival of patients undergoing gastrectomy for gastric adenocarcinoma at Hospital Naval Almirante Nef between 2010-2015

Resumen Introducción: El cáncer gástrico es de los tumores malignos más comunes en el mundo y es de alta prevalencia en Chile. La tasa de mortalidad anual es de 26/100.000 habitantes para hombres y 12/100.000 para mujeres. La cirugía es el tratamiento con mayor probabilidad de curación, prolonga la sobrevida global y libre de enfermedad. La sobrevida global a 5 años reportada a nivel mundial es cercana al 30%. No contamos con datos en la región de Valparaíso sobre la sobrevida en pacientes con cáncer gástrico. Objetivo: Caracterizar a los pacientes operados por adenocarcinoma y estimar su sobrevida a 5 años. Materiales y Método: Realizamos un estudio retrospectivo a partir de la revisión de fichas clínicas de pacientes sometidos a gastrectomía por adenocarcinoma gástrico. La variable principal analizada fue la sobrevida a 5 años. Resultados: Se incluyeron 69 pacientes, el promedio de sobrevida fue de 31,7 (DE 25,3) meses y la sobrevida fue de 46% a 5 años. Encontramos diferencia al comparar grados de compromiso ganglionar según TNM (p = 0,0001). Según estadio se obtuvo un valor P cercano a la significancia estadística (p = 0,083). Otras variables sugieren diferencia en sobrevida sin lograr significancia estadística. Discusión: Presentamos resultados similares a estudios nacionales, posicionándonos con mejores resultados que países de occidente, pero aún muy por debajo de la sobrevida reportada en Japón (> 70%). Conclusión: Logramos caracterizar acabadamente a los pacientes operados por adenocarcinoma, su sobrevida a 5 años, además de apoyar la asociación entre distintos grados de compromiso ganglionar.

Introduction: Gastric cancer is one of the most common cancers worldwide. It is highly prevalent in Chile, with a mortality rate of 26/100,000 inhabitants for men and 12/100,000 for women. Surgical resection remains the treatment of choice, it aims to improve the quality of life and prolong overall survival and disease-free survival. The 5-year survival rate reported worldwide is close to 30%. We do not have data on survival rates in Valparaíso for patients with gastric cancer. Aim: To characterize patients with gastric adenocarcinoma that underwent gastric resection and determine their survival rate at 5 years post gastrectomy. Materials and Method: We performed a retrospective descriptive review of medical records of patients who underwent gastrectomy for gastric adenocarcinoma. The main variable analyzed was the 5-year survival rate. Results: 69 patients were included; the average survival was 31.7 (SD 25.3) months and the survival rate at 5 years was 46%. A difference was found when comparing degrees of lymph node involvement according to TNM (p = 0.0001). Depending on the stage, we obtained a P value close to being statistically significant (p = 0.083). Other variables suggested differences in survival rates without achieving statistical significance. Discussion: We obtained similar results to national studies. We obtained better survival rates than western countries, however our results are still lower than those from Japan (> 70%). Conclusions: We were able to finely characterize patients with gastric adenocarcinoma who underwent gastrectomy, their 5-year survival rate, and also to support association between different degrees of lymph node involvement and survival rates.

Morbimortalidad por cáncer gástrico en un servicio de cirugía general / Morbidity and mortality from gastric cancer in a general surgery service

RESUMEN Introducción: El cáncer de estómago representa la segunda causa más frecuente de muerte relacionada con neoplasias en el mundo, es responsable del 8 al 10 por ciento de todas las muertes por cáncer. Objetivo: Determinar la morbilidad y la mortalidad por cáncer gástrico en el servicio de cirugía del Hospital Universitario "General Calixto García". Métodos: Se realizó un estudio observacional descriptivo, transversal. El universo estuvo conformado por 145 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: El 67,6 por ciento de los pacientes pertenecían al sexo masculino, mientras que 87 se ubicaron en los grupos de edades entre 60 y 79 años. El 37,2 por ciento de los pacientes presentaron lesión ulcerada infiltrante de acuerdo a la clasificación endoscópica de Borrmann. El adenocarcinoma gástrico fue el tipo histológico más encontrado. La técnica quirúrgica más empleada fue la gastrectomía subtotal, y la gastroyeyunostomía. La complicación postoperatoria más frecuente la constituyó la bronconeumonía con 35 pacientes. La mayoría de los pacientes egresaron vivos. Conclusiones: La investigación sugiere que el diagnóstico precoz y la cirugía en la actualidad es la única modalidad con potencial curativo y puede elevar la calidad de vida y mejorar los índices de morbimortalidad en la población(AU)

ABSTRACT Introduction: Stomach cancer is the second leading cause of death related to neoplasms worldwide. It is responsible for 8-10 percent of all cancer-related deaths. Objective: To determine the morbidity and mortality for gastric cancer in the surgery service of General Calixto García University Hospital. Methods: A descriptive, cross-sectional and observational study was carried out. The universe consisted of 145 patients who met the inclusion criteria. Descriptive statistical methods and calculations with percentage values were used. Results: 67.6 percent of the patients belonged to the male sex, while 87 were located in the age groups between 60 and 79 years. 37.2 percent of the patients presented an infiltrating ulcerated lesion according to Borrmann endoscopic classification. Gastric adenocarcinoma was the most common histological type. The most used surgical technique was subtotal gastrectomy, followed by gastrojejunostomy. The most frequent postoperative complication was bronchopneumonia, accounting for 35 patients. Most of the patients were discharged alive. Conclusions: Research suggests that early diagnosis and surgery are currently the only modality with curative potential and can raise the quality of life as well as improve morbidity and mortality rates among the population(AU)

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

ABSTRACT BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Surgical results of remnant gastric cancer treatment / Resultados cirúrgicos do tratamento dos tumores do coto gástrico

ABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p<0.001), hemoglobin values (10.9 vs. 12.3; p<0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. Conclusion: despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered.

RESUMO Antecedentes: o câncer do coto ou remanescente gástrico (CRG) se desenvolve cinco anos ou mais após a ressecção gástrica por lesão benigna ou maligna. O tratamento é realizado através da gastrectomia total complementar (GTC) com linfadenectomia. Alguns relatos consideram que esse procedimento pode estar associado a maiores taxas de morbimortalidade. Objetivo: avaliar os resultados cirúrgicos e a sobrevida após GTC em pacientes com CRG. Métodos: 54 pacientes submetidos a GTC entre 2009 e 2019 foram incluídos no estudo. Como grupo de comparação, foram selecionados 215 pacientes com câncer gástrico primário (CGP) submetidos à gastrectomia total (GT) no mesmo período. Resultados: dentre as características iniciais, a idade média (68,0 vs. 60,5; p <0,001), os valores de hemoglobina (10,9 vs. 12,3; p <0,001) e o índice de massa corporal (22,5 vs. 24,6; p = 0,005) diferiram entre os grupos CRG e CGP, respectivamente. As complicações pós-operatórias mais frequentes foram pulmonares, infecciosas e fístulas nos dois grupos. Houve maior incidência de fístula esofagojejunal no grupo GTC (14,8% vs 6,5%, p = 0,055). A mortalidade perioperatória foi maior nos pacientes com CRG (9,3% vs. 5,1%), mas sem significância (p = 0,329). O tempo de internação hospitalar, complicações pós-operatórias (Clavien-Dindo), mortalidade aos 30 e 90 dias não foram diferentes entre os grupos. Não houve diferença significativa na sobrevida livre de doença e global entre os grupos CRG e CGP. Conclusão: apesar dos relatos anteriores, os resultados cirúrgicos e a sobrevida foram semelhantes entre os grupos. Maior risco de fístula esofagojejunal dever ser considerado.

An age-period-cohort analysis of mortality rates for stomach, colorectal, liver, and lung cancer among prefectures in Japan, 1999-2018

BACKGROUND@#Although change in the birth cohort effect on cancer mortality rates is known to be highly associated with the decreasing rates of age-standardized cancer mortality rates in Japan, the differences in the trends of cohort effect for representative cancer types among the prefectures remain unknown. This study aimed to investigate the differences in the decreasing rate of cohort effects among the prefectures for representative cancer types using age-period-cohort (APC) analysis.@*METHODS@#Data on stomach, colorectal, liver, and lung cancer mortality for each prefecture and the population data from 1999 to 2018 were obtained from the Vital Statistics in Japan. Mortality data for individuals aged 50 to 79 years grouped in 5-year increments were used, and corresponding birth cohorts born 1920-1924 through 1964-1978 were used for analysis. We estimated the effects of age, period, and cohort on each type of mortality rate for each prefecture by sex. Then, we calculated the decreasing rates of cohort effects for each prefecture. We also calculated the mortality rate ratio of each prefecture compared with all of Japan for cohorts using the estimates.@*RESULTS@#As a result of APC analysis, we found that the decreasing rates of period effects were small and that there was a little difference in the decreasing rates among prefectures for all types of cancer among both sexes. On the other hand, there was a large difference in the decreasing rates of cohort effects for stomach and liver cancer mortality rates among prefectures, particularly for men. For men, the decreasing rates of cohort effects in cohorts born between 1920-1924 and 1964-1978 varied among prefectures, ranging from 4.1 to 84.0% for stomach cancer and from 20.2 to 92.4% for liver cancers, respectively. On the other hand, the differences in the decreasing rates of cohort effects among prefectures for colorectal and lung cancer were relatively smaller.@*CONCLUSIONS@#The decreasing rates of cohort effects for stomach and liver cancer varied widely among prefectures. It is possible that this will influence cancer mortality rates in each prefecture in the future.

Biomarcadores suPAR y citocinas en la detección temprana de cáncer gástrico / suPAR and cytokines as biomarkers in early detection of gastric cancer

El cáncer gástrico (CG) es un problema prevalente a nivel mundial, presentándose aproximadamente 18 millones de casos nuevos en el año 2018, representa el 5.7% del total de cánceres, siendo la quinta neoplasia maligna más común en el mundo. En Guatemala se sitúa entre los primeros cinco cánceres respecto a morbilidad y mor-talidad. El CG se ha asociado de manera contundente a infección por Helicobacter pylori el cual desencadena un proceso inflamatorio crónico; adicionalmente algunas cepas de H. pylori producen toxinas bacterianas capaces de inducir cambios celulares que conllevan al desarrollo del proceso neoplásico. La alta mortalidad por CG en parte, se relaciona con la etapa tardía en la que se diagnostica ya que se requiere el uso de métodos invasivos, lo que dificulta su detección temprana. El objetivo de la presente revisión, fue realizar una narrativa de los estudios y las evidencias científicas, respecto de la identificación de biomarcadores séricos en la detección temprana del cáncer gástrico. Se revisaron dos tipos de biomarcadores, la proteína soluble uPAR (suPAR) que es el receptor del activador del plasminógeno (uroquinasa) y promotora de angiogénesis y por otro lado, la detección sérica de las citocinas IL-1ß, IL-6, TNFα, IL-10, IFNγ, IL-4 e IL-17 en el CG así como su potencial utilidad en su detección temprana. Estos biomarcadores fueron seleccionados por la ventaja que tendrían de ser métodos no invasivos que podrían mejorar la detección, tratamiento y pronóstico de esta enfermedad.

Gastric cancer (GC) is a prevalent problem worldwide, presenting approximately 18 million new cases in 2018, representing 5.7% of all cancers, being the fifth most common malignancy in the world. In Guatemala it is among the first five cancers in terms of morbidity and mortality. CG has been strongly associated with Helicobacter pylori infection, which triggers a chronic inflammatory process; additionally, some strains of H. pylori produce bacterial toxins capable of inducing cellular changes that lead to the development of cancer. The high mortality due to GC in part is related to the late stage in which it is diagnosed since the use of invasive methods is required, making it difficult to detect it early. The objective of this review was to make a narrative of the studies carried out and the scientific evidence regarding the identification of serum biomarkers in the early detection of gastric cancer. Two types of biomarkers were reviewed, the soluble protein uPAR (suPAR) which is the receptor for plasminogen activator (urokinase) and promoter of angiogenesis and, on the other hand, serum detection of cytokines IL-1ß, IL-6, TNFα, IL-10, IFNγ, IL-4 and IL-17 in the CG as well as its potential usefulness in its early detection. These biomarkers were selected for the advantage they would have of being non-invasive methods that could improve the detection, treatment and prognosis of this disease.

Cáncer gástrico avanzado: resultados de una cirugía resectiva en un centro privado y regional de salud / Advanced gastric cancer: resective surgery results in a private and regional health establishment

El cáncer gástrico (CG), representa el cuarto lugar de enfermedades oncológicas en mujeres y el primero en hombres. La mejor opción de tratamiento para pacientes con CG avanzado (CGA), sigue siendo la cirugía, lo que supone la realización de una gastrectomía total o subtotal, asociado a linfadenectomía D2 (LD2 ). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia (SV) en pacientes resecados por CGA sin neoadyuvancia. La metodología usada fue serie de casos en retrospectiva de pacientes con CGA sometidos a gastrectomía total o subtotal con LD2 , de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2008 y 2017. La variable resultado fue SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria, MPO, y recurrencia. Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier y long Rank test. Se intervinieron 29 pacientes (72,4 % hombres), con una mediana de edad de 63 años. La localización más frecuente fue subcardial (51,7 %); el tipo de resección más frecuente fue gastrectomía total (51,7 %). La medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fue de 185 min, 32 y 6 días respectivamente. La MPO fue 17,2 %. Con una mediana de seguimiento de 26 meses, se verificó recurrencia de 37,9 %; y SVAG a 5 años para estadios IIIA, IIIB y IV fue de 47,6 %, 34,3 % y 15,4 % respectivamente (p < 0,05). Los resultados obtenidos, en términos de MPO, mortalidad y SVAG, fueron similares a series de centros de derivación nacionales e internacionales en los que no se ha aplicado terapias neoadyuvantes.

Gastric cancer (CG) represents the fourth place of oncological diseases in women and the first in men. The best treatment option for patients with advanced CG (ACG) is still surgery, which involves making total or subtotal gastrectomies and D2 lymphadenectomy (D2L). The aim of this study is to determine postoperative morbidity (POM) and overall survival (OS) in patients resected by CGA without neoadjuvant therapy. The methodology used was a series of cases in retrospective of patients with CGA undergoing total or subtotal gastrectomies and D2L, consecutively at RedSalud Mayor Temuco Clinic, between 2008 and 2017. The outcome variable was OS at 5 years. Other variables of interest were: surgical time, number of resected lymph nodes, hospital stay, POM, and recurrence. Patients were followed clinically. Descriptive statistics was used, and OS analysis was applied using long Rank test. Twenty-nine patients (72.4% men), with a median age of 63 years, were operated. The most frequent location was subcardinal (51.7%). The most frequent type of resection was total gastrectomy (51.7%). The median of surgical time, number of resected lymph nodes and hospital stay; was 185 min, 32 and 6 days respectively. MPO was 17.2%. With a median follow-up of 26 months, a recurrence of 37.9% was verified; and 5-year OS for stages IIIA, IIIB and IV were 47.6%, 34.3% and 15.4% respectively (p <0.05). The results achieved, in terms of POM and OS series were similar to national and international series in which neoadjuvant therapies have not been applied.

Conversion therapy for gastric cancer: expanding the treatment possibilities / Terapia de conversão no câncer gástrico: ampliando as possibilidades de tratamento

ABSTRACT Background: Conversion therapy in gastric cancer (GC) is defined as the use of chemotherapy/radiotherapy followed by surgical resection with curative intent of a tumor that was prior considered unresectable or oncologically incurable. Aim: To evaluate the results of conversion therapy in the treatment of GC. Methods: Retrospective analysis of all GC surgeries between 2009 and 2018. Patients who received any therapy before surgery were further identified to define the conversion group. Results: Out of 1003 surgeries performed for GC, 113 cases underwent neoadjuvant treatment and 16 (1.6%) were considered as conversion therapy. The main indication for treatment was: T4b lesions (n=10), lymph node metastasis (n=4), peritoneal carcinomatosis and hepatic metastasis in one case each. The diagnosis was made by imaging in 14 cases (75%) and during surgical procedure in four (25%). The most commonly used chemotherapy regimens were XP and mFLOX. Major surgical complications occurred in four cases (25%) and one (6.3%) died. After an average follow-up of 20 months, 11 patients (68.7%) had recurrence and nine (56.3%) died. Prolonged recurrence-free survival over 40 months occurred in two cases. Conclusion: Conversion therapy may offer the possibility of prolonged survival for a group of GC patients initially considered beyond therapeutic possibility.

RESUMO Racional : A terapia de conversão no câncer gástrico (CG) é definida como o uso de quimio/radioterapia seguida de ressecção cirúrgica com intenção curativa de um tumor que era considerado irressecável ou oncologicamente incurável. Objetivo : Avaliar os resultados da terapia de conversão no tratamento do CG. Métodos : Análise retrospectiva de todas as operações de CG entre 2009 e 2018. Os pacientes que receberam alguma terapia antes da operação foram também identificados para definir o grupo de conversão. Resultados : Entre 1003 operações realizadas para o CG, 113 foram submetidos ao tratamento neoadjuvante e 16 (1,6%) considerados como terapia de conversão. As principais indicações para o tratamento foram: lesões T4b (n=10), metástase linfonodal (n=4), carcinomatose peritoneal e metástase hepática em 1 caso cada. O diagnóstico foi feito por exame de imagem em 14 casos (75%) e durante o procedimento cirúrgico em 4 casos (25%). Os esquemas quimioterápicos mais utilizados foram XP e mFLOX. Complicações cirúrgicas maiores ocorreram em 4 casos (25%) e 1 (6,3%) foi a óbito. Após seguimento médio de 20 meses, 11 pacientes (68,7%) apresentaram recidiva e 9 (56,3%) morreram. Sobrevida livre de recidiva prolongada acima de 40 meses ocorreu em dois casos. Conclusão : A terapia de conversão pode oferecer possibilidade de sobrevida prolongada para um grupo de pacientes com CG considerados inicialmente fora das possibilidades terapêuticas.

Introduction of the new lymphoparietal index for gastric cancer patients / Introdução de novo índice linfoparietal para pacientes de câncer gástrico

ABSTRACT Background: The identification of prognostic factors of gastric cancer (GC) has allowed to predict the evolution of patients. Aim: Assess the reliability of the lymphoparietal index in the prediction of long-term survival in GC treated with curative intent. Method: Prospective study of the Universidad de Chile Clinical Hospital, between May 2004 and May 2012. Included all gastric cancer surgeries with curative intent. Exclusion criteria were: gastrectomies due to benign lesions, stage 4 cancers, R1 resections, palliative procedures, complete esophagogastrectomies and emergency surgeries. Results: A total of 284 patients were included; of the sample 65.4% were male,mean age of 64.5 years,75% were advanced cancers, 72.5% required a total gastrectomy, 30 lymph nodes harvest. Surgical morbidity and mortality were 17.2% and 1.7%. 5-year survival was 56.9%. The N+/T index could predict long-term survival in all de subgrups (p<0.0001), although had a reliable prediction in early GC (p=0.005), advanced GC (p<0.0001), signet ring cell GC (p<0.0001), proximal GC (p<0.0001) and distal GC (p<0.0001). The ROC curves N+/T index, LNR and T classification presented areas below the curve of 0.789, 0.786 and 0,790 respectively, without a significant statistical difference (p=0.96). Conclusion: The N+/T index is a reliable quotient in the prognostic evaluation of gastric adenocarcinoma patients who have been resected with curative intent.

RESUMO Racional: A identificação de fatores prognósticos do câncer gástrico (GC) permitiu predizer a evolução dos pacientes. Objetivo: Avaliar a confiabilidade do índice linfoparietal na predição de sobrevida em longo prazo em pacientes tratados com intenção curativa. Método: Estudo prospectivo do Hospital das Clínicas da Universidade de Chile, entre maio de 2004 e maio de 2012. Todas as operações de câncer gástrico foram com intenção curativa. Os critérios de exclusão foram: gastrectomia por lesões benignas, cânceres estágio 4, ressecções R1, procedimentos paliativos, esofagogastrectomias completas e operações de emergência. Resultados: Foi incluído um total de 284 pacientes; da amostra 65,4% eram homens, com média de idade de 64,5 anos, 75% eram cânceres avançados, 72,5% necessitaram de gastrectomia total e 30 coletas de linfonodos. A morbimortalidade cirúrgica foi de 17,2% e 1,7%. Sobrevida em cinco anos foi de 56,9%. O índice N +/T pôde predizer a sobrevida em longo prazo em todos os subgrupos (p<0,0001), embora tivesse previsão confiável em GC precoce (p=0,005), GC avançado (p<0,0001), célula GC de anel de sinete (p< 0,0001), GC proximal (p<0,0001) e GC distal (p<0,0001). As curvas ROC N +/T, LNR e T apresentaram áreas abaixo da curva de 0,789, 0,786 e 0,790, respectivamente, sem diferença estatística significativa (p=0,96 ). Conclusão: O índice N +/T é um quociente confiável no prognóstico na avaliação de pacientes com adenocarcinoma gástrico que foram ressecados com intenção curativa.

ErbB1 and ErbB3 co-over expression as a prognostic factor in gastric cancer

BACKGROUND: Epidermal growth factor receptor family members such as ErbB1 and ErbB3 are involved in tumor progression and metastasis. Although, there are various reports about the prognostic value of EGFR members separately in gastric cancer, there is not any report about the probable correlation between ErbB1 and ErbB3 co-expression and gastric cancer prognosis. In present study, we assessed the correlation between ErbB1 and ErbB3 co-overexpression (in the level of mRNA and protein expression) and gastric cancer prognosis for the first time. METHODS: ErbB1 and ErbB3 expressions were analyzed by immunohistochemistry and real-time PCR in 50 patients with gastric cancer. Parametric correlations were done between the ErbB1 and ErbB3 expression and clinicopathological features. Multivariate and logistic regression analyses were also done to assess the roles of ErbB1 and ErbB3 in tumor prognosis and survival. RESULTS: There were significant correlations between ErbB1/ErbB3 co-overexpression and tumor size (p = 0.026), macroscopic features (p < 0.05), tumor differentiation (p < 0.05), stage of tumor (p < 0.05), and recurrence (p < 0.05). Moreover, ErbB1/ErbB3 co-overexpression may predict the survival status of patients (p < 0.05). CONCLUSION: ErbB1 and ErbB3 co-overexpression is accompanied with the poor prognosis and can be used efficiently in targeted therapy of gastric cancer patients.

Protein expression profiles and clinicopathologic characteristics associate with gastric cancer survival

BACKGROUND: Prognosis remains one of most crucial determinants of gastric cancer (GC) treatment, but current methods do not predict prognosis accurately. Identification of additional biomarkers is urgently required to identify patients at risk of poor prognoses. METHODS: Tissue microarrays were used to measure expression of nine GC-associated proteins in GC tissue and normal gastric tissue samples. Hierarchical cluster analysis of microarray data and feature selection for factors associated with survival were performed. Based on these data, prognostic scoring models were established to predict clinical outcomes. Finally, ingenuity pathway analysis (IPA) was used to identify a biological GC network. RESULTS: Eight proteins were upregulated in GC tissues versus normal gastric tissues. Hierarchical cluster analysis and feature selection showed that overall survival was worse in cyclin dependent kinase (CDK)2, Akt1, X-linked inhibitor of apoptosis protein (XIAP), Notch4, and phosphorylated (p)-protein kinase C (PKC) α/ß2 immunopositive patients than in patients that were immunonegative for these proteins. Risk score models based on these five proteins and clinicopathological characteristics were established to determine prognoses of GC patients. These proteins were found to be involved in cancer related-signaling pathways and upstream regulators were identified. CONCLUSION: This study identified proteins that can be used as clinical biomarkers and established a risk score model based on these proteins and clinicopathological characteristics to assess GC prognosis.

Survival and perioperative morbidity of totally laparoscopic versus open gastrectomy for early gastric cancer: analysis from a single latin american centre / Comparação da sobrevida e morbidade perioperatória da gastrectomia totalmente laparoscópica vs. laparotômica para tratamento do câncer gástrico precoce em um centro latino-americano

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

Câncer gástrico em adultos jovens: um grupo de pior prognóstico? / Gastric cancer in young adults: a worse prognosis group?

RESUMO Objetivo: avaliar as características clínico-patológicas e sobrevivência de pacientes jovens, portadores de câncer gástrico, independentemente da intenção de tratamento. Métodos: análise retrospectiva de todos os pacientes com câncer gástrico submetidos a qualquer tratamento cirúrgico entre 2008 e 2017. Pacientes com idade inferior a 45 anos foram considerados adultos jovens, e aqueles com mais de 45 anos foram definidos como grupo com idade avançada. Resultados: dos 875 pacientes avaliados, 84 (9,6%) eram adultos jovens e 791 (90,4%) tinham idade avançada. Jovens associaram-se ao sexo feminino (p<0,001), menor escore de Charlson (p=0,002), ASA I/II (p<0,001), tipo difuso de Lauren (p<0,001) e tumores pouco diferenciados (p<0,001). Não houve diferença entre os grupos quanto à intenção de tratamento (paliativo versus curativo) (p=0,267) e estádio clínico cTNM (p=0,120). A sobrevida livre de doença foi pior nos jovens (p=0,049), mas a sobrevida global foi semelhante entre os grupos (p=0,578). A análise multivariada identificou gastrectomia total, pT3/T4, pN+ e tipo difuso de Lauren como fatores prognósticos associados a pior sobrevida livre de doença e sobrevida global. A idade não foi um fator independente associado a pior prognóstico. Conclusão: apesar de os jovens apresentarem uma menor sobrevida livre de doença, a sobrevida global foi semelhante entre os grupos, e a idade não demonstrou ser um fator prognóstico independente significativo.

ABSTRACT Objective: to evaluate the clinical and pathological characteristics and survival of young patients with gastric cancer, regardless of the intention of treatment. Methods: we conducted a retrospective analysis of all gastric cancer patients undergoing any surgical treatment between 2008 and 2017. We considered patients under 45 years old as young adults and those over 45 years old, as of advanced age. Results: of the 875 patients evaluated, 84 (9.6%) were young adults and 791 (90.4%) were older. Younger patients were associated with female gender (p<0.001), lower Charlson score (p=0.002), ASA I/II (p<0.001), diffuse Lauren type (p<0.001) and poorly differentiated tumors (p<0.001). There was no difference between groups regarding treatment intention (palliative versus curative) (p=0.267) and cTNM clinical stage (p=0.120). Disease-free survival was worse in younger individuals (p=0.049), but overall survival was similar between groups (p=0.578). Multivariate analysis identified total gastrectomy, pT3/T4, pN+, and diffuse Lauren type as prognostic factors associated with worse disease-free survival and overall survival. Age was not an independent factor associated with worse prognosis. Conclusion: although younger patients had lower disease-free survival, overall survival was similar between groups, and age was not a significant independent prognostic factor.

Cáncer gástrico: algunas consideraciones sobre factores de riesgo y Helicobacter pylori / Gastric cancer: some considerations on risk factors and Helicobacter

RESUMEN La Organización Mundial de la Salud señala que el cáncer gástrico es una neoplasia frecuente en el mundo contemporáneo. Constituye la segunda causa de muerte en el hombre y la tercera en las mujeres. Numerosos son los factores de riesgo que se asocian con la aparición del cáncer gástrico, en determinadas regiones del mundo. El descubrimiento del Helicobacter pylori y la asociación con las enfermedades gastroduodenales ha revolucionado los aspectos fisiopatológicos y terapéuticos hasta el punto de considerar la bacteria como agente precursor del cáncer gástrico. Por tal motivo se realizó una revisión de los factores de riesgo y el papel del Helicobacter pylori en la formación de la neoplasia gástrica, con el objetivo de aportar conocimientos relacionados con el cáncer gástrico y su prevención (AU).

ABSTRACT The World Health Organization points out that gastric cancer is a frequent neoplasia in the contemporary world. It is the second cause of death in men and the third one in women. There are several risk factors associated to the development of gastric cancer in specific regions of the world. The discovery of Helicobacter pylori and its association to gastro duodenal diseases has renewed the physiopathological and therapeutic aspects up to the point of considering the bacteria as precursor agent of gastric cancer. For that cause, it was carried out a review of the risk factors and the role of Helicobacter pylori in the formation of gastric neoplasia, with the objective of giving out knowledge related to gastric cancer and its prevention (AU).

Adductor pollicis muscle thickness and prediction of postoperative mortality in patients with stomach cancer / Espessura do músculo adutor do polegar e predição de mortalidade pós-operatória em pacientes com câncer gástrico

ABSTRACT Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment Aim: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality Methods: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile Results: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007) Conclusion: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

RESUMO Racional: A desnutrição é muito prevalente em pacientes com câncer gástrico e aumenta o risco de morbidade e mortalidade. A espessura do músculo adutor do polegar (APMT) aparece como uma importante medida objetiva, rápida, barata e não invasiva para avaliar o compartimento muscular. Objetivo: O objetivo deste estudo foi comparar a APMT e outros métodos de avaliação nutricional e correlacionar esses métodos com a mortalidade pós-operatória. Métodos: Quarenta e quatro pacientes, 29 homens e 15 mulheres; média (SD) de 63 anos (10,2) e variando de 34 a 83 anos, que foram submetidos a 9 (20,5%) gastrectomias parciais e 34 (77,3%) totais por câncer de estômago (Estágio II a IIIa) e avaliados no pré operatório por Avaliação Subjetiva Global Produzida Pelo Paciente (PG-SGA), antropometria e perfil laboratorial. Resultados: APMT melhor predisse morte (p<0,001) em ambas mãos, dominante e não-dominante, e se correlacionou bem com albumina (p=0,039) e PG-SGA (p=0,007). Conclusão: APMT permitiu claramente determinar a desnutrição e prever o risco de morte em pacientes com câncer gástrico.

Prognostic value of carcinoembryonic antigen levels in transoperative peritoneal lavage in patients with gastric cancer / Valor prognóstico dos níveis transoperatórios de antígeno carcinoembriônico em lavagem peritoneal de pacientes com câncer gástrico

ABSTRACT Background: The carcinoembryonic antigen level in peritoneal lavage has been showing to be a reliable prognostic factor in gastric cancer. Aim: To identify any association between carcinoembryonic antigen level in peritoneal lavage, in gastric cancer patients, with mortality, peritoneal recurrence, tumor relapse or other prognostic factors. Methods: In total, 30 patients (22 men, 8 women; median age 66 years) with resectable gastric cancer (mainly stage III and IV) were studied. Carcinoembryonic antigen level in peritoneal lavage was detected at operation by immunocytochemical method and a level over 210 ng/g of protein was considered as positive. Results: There were detected 10 positive cases (33.3%) of plCEA levels. These levels were associated with mortality, RR: 2.1 (p=0.018); peritoneal recurrence, OR: 9.0 (p=0.015); and relapse or gastric cancer progression, OR: 27.0 (p=0.001). Conclusion: Increased levels of plCEA fairly predicts mortality, peritoneal recurrence tumor relapse or cancer progression.

RESUMO Racional: Os níveis do antígeno carcinoembriônico no lavado peritoneal têm sido demonstrados como possível fator prognóstico de recidiva e mortalidade em pacientes com câncer gástrico. Objetivos: Medir seus níveis em lavado peritoneal durante operação de ressecção de câncer gástrico e ver se eles aumentados estão relacionados com mortalidade, recorrência, recidiva e outros fatores prognósticos. Métodos: Foi realizado lavado peritoneal durante ressecções de câncer gástrico; os níveis do antígeno carcinoembriônico nesse lavado maiores ou iguais a 210 ng/g foram considerados aumentados ou positivos. Resultados: Foram estudados 30 pacientes, destes, 33,33 % apresentaram níveis aumentados, os quais foram fator de risco para mortalidade em seis meses OR: 8,5 (1,458-49,539) IC 95%, mortalidade geral RR: 2,111 (1,314-3,391) IC 95%, mortalidade devido à doença OR: 12 (1,885-76,376) IC 95%, recorrência peritoneal OR: 9 (1,325-61,138) IC 95%, e recidiva ou progressão da doença OR: 27 (2,705-269,460) IC 95%. Conclusões: Os níveis aumentados do antígeno carcinoembriônico no lavado peritoneal foram fatores de risco para mortalidade, recorrência peritoneal, recidiva e progressão da doença em pacientes com câncer gástrico.

Surgical treatment of gastric cancer: a 10-year experience in a high-volume university hospital

OBJECTIVES: Surgery remains the cornerstone treatment modality for gastric cancer, the fifth most common type of tumor in Brazil. The aim of this study was to analyze the surgical treatment outcomes of patients with gastric cancer who were referred to a high-volume university hospital. METHODS: We reviewed all consecutive patients who underwent any surgical procedure due to gastric cancer from a prospectively collected database. Clinicopathological characteristics, surgical and survival outcomes were evaluated, with emphasis on patients treated with curative intent. RESULTS: From 2008 to 2017, 934 patients with gastric tumors underwent surgical procedures in our center. Gastric adenocarcinoma accounted for the majority of cases. Of the 875 patients with gastric adenocarcinoma, resection with curative intent was performed in 63.5%, and palliative treatment was performed in 22.4%. The postoperative surgical mortality rate for resected cases was 5.3% and was related to D1 lymphadenectomy and the presence of comorbidities. Analysis of patients treated with curative intent showed that resection extent, pT category, pN category and final pTNM stage were related to disease-free survival (DFS) and overall survival (OS). The DFS rates for D1 and D2 lymphadenectomy were similar, but D2 lymphadenectomy significantly improved the OS rate. Additionally, clinical factors and the presence of comorbidities had influence on the OS. CONCLUSIONS: TNM stage and the type of lymphadenectomy were independent factors related to prognosis. Early diagnosis should be sought to offer the optimal surgical approach in patients with less-advanced disease.