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1.
Rev. cir. (Impr.) ; 72(3): 245-249, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1115550

ABSTRACT

Resumen Introducción: Los tumores neuroendocrinos (TNE), son tumores compuestos por células productoras de péptidos y aminas. Los TNE gástricos, representan el 1% de todas las neoplasias, sin embargo su incidencia ha ido en aumento. Son generalmente asintomáticos y no funcionantes. El tratamiento es generalmente la resección local. Caso Clínico: paciente de 48 años con sospecha de cáncer gástrico; su estudio demuestra un TNE gástrico bien diferenciado tipo 1. Se realiza etapificación y se define en comité oncológico la vigilancia endoscópica. El hallazgo de un TNE, en el estudio de cáncer gástrico, es un hallazgo poco frecuente. Debido al aumento progresivo en la realización de endoscopías digestivas altas, secundario a la alta prevalencia de cáncer gástrico en nuestro país, se espera que aumenten hallazgos como un TNE. Es por esto que realizamos una revisión de la literatura y planteamos algunas conclusiones al respecto.


Introduction: Neuroendocrine tumors (NETs) are composed of cells that produce peptides and amines. Gastric NETs represent 1% of all neoplasms; however their incidence has been increasing. They are usually asymptomatic and non-functioning. The treatment is usually local resection. Case Report: We present the case of a 48-year-old patient who was suspected of gastric cancer; her study shows a well-differentiated type 1 gastric NET. Staging is performed and endoscopic surveillance is defined in the oncology board. The finding of a NET, in the study of gastric cancer, is a rare finding. Due to the progressive increase in the performance of upper gastrointestinal endoscopies, secondary to the high prevalence of gastric cancer in our country, it is expected to increase findings as a NET. That is why we conducted a review of the literature and made some conclusions about it.


Subject(s)
Humans , Female , Middle Aged , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/etiology , Neuroendocrine Tumors/therapy , Stomach Neoplasms/diagnosis , Stomach Neoplasms/physiopathology , Stomach Neoplasms/therapy , Incidence , Medical Oncology/methods , Neoplasm Staging
2.
São Paulo; s.n; 2020. 33 p.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1178933

ABSTRACT

Introdução: A quimioterapia perioperatória e cirurgia são o padrão de tratamento para pacientes com câncer gastroesofágico avançado, entretanto, seu impacto entre aqueles tratados com cirurgia radical carece de avaliação mais detalhada. Apresentamos os resultados desta abordagem de tratamento multimodal em uma coorte de pacientes com câncer gástrico tratados com linfadenectomia D2. Objetivo: identificar fatores prognósticos associados à melhora da sobrevida e resposta patológica associados ao tratamento neoadjuvante. Pacientes e métodos. Este estudo de coorte retrospectivo envolveu pacientes tratados com quimioterapia perioperatória e ressecção em um único centro oncológico no Brasil entre 2006 e 2016. Indivíduos com tumores do coto gástrico, tumores de esôfago ou tratados com quimioterapia intra-peritoneal foram excluídos. A análise de sobrevivência com intenção de tratar foi realizada para todos os indivíduos que iniciaram a quimioterapia neoadjuvante, e os fatores prognósticos foram determinados entre aqueles que tiveram ressecção R0. Resultados. Este estudo incluiu 239 pacientes, dos quais 198 tiveram ressecção R0. A média de idade foi de 59,9 anos e a maioria apresentava doença em estágio clínico IIB ou III (88%). Entre os 239 pacientes que iniciaram quimioterapia neoadjuvante, 207 (86,6%) completaram todos os ciclos de tratamento neoadjuvante, e a ressecção cirúrgica foi realizada em 225 indivíduos (94,1%). As taxas gerais de morbidade e mortalidade em 60 dias foram de 35,6% e 4,4%, respectivamente. Para toda a coorte, a sobrevida mediana foi de 78 meses e a taxa de sobrevida em 5 anos foi de 55,3%. Os fatores associados à pior sobrevida foram estágio ypT3­4, ypN, estágio, ressecção estendida e sem quimioterapia adjuvante. Conclusões. A quimioterapia perioperatória resultou em resultados muito bons para pacientes tratados com cirurgia radical, e o downstaging após a quimioterapia mostrou ser um determinante principal do prognóstico


Background. Perioperative chemotherapy and surgery are the standard of care in advanced gastroesophageal cancer patients, but its impact among those treated with radical surgery still needs further assessment. We present the results of this multimodality treatment approach in a gastric cancer patients cohort treated with D2 lymphadenectomy. We aimed to identify prognostic factors associated with improved survival. Patients and Methods. This retrospective cohort study enrolled patients treated with perioperative chemotherapy and resection in a single cancer center in Brazil between 2006 and 2016. Subjects presenting tumors of the gastric stump, esophageal tumors, or treated with intraperitoneal chemotherapy were excluded. Intention-to-treat survival analysis was performed for all subjects who started neoadjuvant chemotherapy, and prognostic factors were determined among those who had R0 resection. Results. This study included 239 patients, of whom 198 had R0 resection. The mean age was 59.9 years, and most had clinical stage IIB or III disease (88%). Among the 239 patients who started neoadjuvant chemotherapy, 207 (86.6%) completed all neoadjuvant treatment cycles, and surgical resection was performed in 225 subjects (94.1%). Overall 60-day morbidity and mortality rates were 35.6% and 4.4%, respectively. For the entire cohort, median survival was 78 months and the 5-year survival rate was 55.3%. Factors associated with worse survival were ypT3­4 stage, ypN stage, extended resection, and no adjuvant chemotherapy. Conclusions. Perioperative chemotherapy resulted in very good outcomes for patients treated with radical surgery, and downstaging after chemotherapy was shown to be a major determinant of prognosis


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Prognosis , Stomach Neoplasms/therapy , Survival , Chemotherapy, Adjuvant/adverse effects
3.
Braz. j. infect. dis ; 23(6): 451-461, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1089312

ABSTRACT

ABSTRACT Background: Papiliotrema laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection, since it was previously considered saprophyte and thought to be non-pathogenic to humans. Nevertheless, increasing number of reports of human infection have emerged in recent years, mostly in oncologic patients. Aim: To report a case of a female patient with pyloric obstructive cancer with a catheter-related Papiliotrema laurentii blood stream infection and systematically review the available evidence on P. laurentii infection in humans. Methods: Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually. Results: The search strategy retrieved 1703 references. In the final analysis, 31 references were included, with the description of 35 cases. Every patient but one had a previous co-morbidity - 48.4 % of patients had a neoplasm. Amphotericin B was the most used treatment and only a single case of resistance to it was reported. Most patients were cured of the infection. Conclusion: P. laurentii infection in humans is usually associated to neoplasia and multiple co-morbidities, and amphotericin B seems to be a reliable agent for treatment.


Subject(s)
Humans , Female , Aged , Stomach Neoplasms/diagnostic imaging , Catheter-Related Infections/diagnostic imaging , Stomach Neoplasms/microbiology , Stomach Neoplasms/therapy , Biopsy , Vancomycin/therapeutic use , Tomography, X-Ray Computed , Fluconazole/therapeutic use , Amphotericin B/therapeutic use , Bacteremia/microbiology , Cryptococcus/isolation & purification , Catheter-Related Infections/etiology , Catheter-Related Infections/microbiology , Catheter-Related Infections/drug therapy , Piperacillin, Tazobactam Drug Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use
4.
Ciênc. Saúde Colet ; 24(5): 1597-1607, Mai. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001783

ABSTRACT

Abstract Gastric cancer (GC) is a public health issue with high incidence and mortality in Colombia due to tardy diagnosis and barriers to access to curative treatment; this leaves palliative care (PC) as the only option. Our aim is to describe the access barriers to PC perceived by adults with GC, caregivers and physician in Santander, Colombia. A qualitative study was carried out with the analysis of the grounded theory (Strauss and Corbin), through semi-structured interviews, after sampling for convenience we found that the access barriers were: administrative, economic, cultural, knowledge, communication, institutional and geographical; strategies to overcome barriers: screening programs, governmental surveillance, and investment in health. In conclusion, access to PC requires remove barriers to timely and integral access and strengthen health and education policies to facilitate procedures and services that ensure the attention required by the adult with GC.


Resumo O câncer gástrico (CG) é um problema de saúde pública com alta incidência e mortalidade na Colômbia, devido ao seu diagnóstico tardio e às barreiras ao tratamento curativo, o que deixa os cuidados paliativos (CP) como única opção terapêutica. O objetivo é descrever as barreiras aos cuidados de CP percebidos pelo adulto com CG, cuidador e médico assistente em Santander, Colômbia. Um estudo qualitativo foi realizado com a análise da teoria fundamentada (Strauss e Corbin), por meio de entrevistas semiestruturadas, após amostragem por conveniência, constatou-se que as barreiras de acesso foram; administrativo, econômico, cultural, conhecimento, comunicação, institucional e geográfico; as estratégias para superá-los: programas de triagem, vigilância governamental e investimento em saúde. Em conclusão, o acesso à PC deve ser melhorado, eliminando barreiras ao acesso oportuno e abrangente e fortalecendo as políticas de saúde e educação, com a participação ativa do Estado e da comunidade para garantir a assistência à saúde.


Subject(s)
Humans , Male , Female , Adult , Palliative Care/statistics & numerical data , Stomach Neoplasms/therapy , Caregivers/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Physicians/statistics & numerical data , Interviews as Topic , Colombia
5.
Rev. bras. cancerol ; 65(4)20191216.
Article in Portuguese | LILACS | ID: biblio-1049118

ABSTRACT

Introdução: A interdisciplinaridade é vista como uma alternativa que, somada ao desenvolvimento tecnológico, possa a contribuir para a melhoria do cuidado em saúde, mas cuja construção é cercada de desafios. O Grupo de Estudos e Tratamento do Câncer Gástrico e Esofágico de um hospital referência em tratamento de câncer, composto por equipe multiprofissional, foi criado no sentido de promover interação entre a equipe e a melhoria no atendimento ao paciente, mas ainda precisa avançar no sentido da interdisciplinaridade. Objetivo: Conhecer e analisar os desafios à intervenção interdisciplinar no olhar dos profissionais que integram a equipe. Método: Pesquisa qualitativa, cuja coleta de dados se deu por entrevista com profissionais das categorias inseridas no grupo e análise com base na hermenêutica-dialética. Resultados: O entendimento acerca do propósito do grupo e das temáticas integralidade e interdisciplinaridade, incluindo-se a percepção sobre a rede de cuidados ao paciente. Foram apresentados desafios objetivos e subjetivos, vinculados, respectivamente, à gestão e à relação entre a equipe e entre os profissionais e os pacientes, para os quais é fundamental destinar o cuidado. Foram ainda apresentados avanços e resultados positivos e a necessidade de se direcionar o olhar também à equipe e ao seu cuidado. Conclusão: Verifica-se a importância de levar os profissionais à reflexão acerca de sua intervenção, individual e coletiva, tendo em vista as possibilidades que estão ao alcance da equipe e de outras que poderiam ser alvo de pleitos e lutas para a efetiva implementação do Sistema Único de Saúde, como também valorizar as potencialidades e os ganhos já conquistados.


Introduction: The interdisciplinarity is seen as an alternative that, added to the technological development, could contribute to the improvement of healthcare, but whose construction faces challenges. The Gastric and Esophageal Cancer Study and Treatment Group of a referral cancer treatment hospital formed by a multi-professional team, was created to promote interaction between the team and the improvement of patient care; nevertheless, still needs to move towards interdisciplinarity. Objective: To know and analyze the challenges of interdisciplinary intervention through the vision of the professionals who belong to the team. Method: Qualitative approach, with data collected through interviews with professionals of the group's categories and analysis based on hermeneutic-dialectic. Results: One of the results was the understanding about the purpose of the group and the concepts of integrality and interdisciplinarity, including the perception about the patient care network. Other result was the presentation of objective and subjective challenges and their relation, respectively, to the management and relationship between the team, and between professionals and patients, for whom care is provided. In addition, it were presented positive results and progress, and the necessity to focus the attention to the team and its own care. Conclusion: It was verified the importance to encourage the professionals to think about their own individual and collective intervention, bearing in mind the possibilities that are within the scope of the team and others that could be the object of pledges and struggles for the effective implementation of National Health System and to value the potentialities and conquests already achieved.


Introducción: La interdisciplinariedad se considera una alternativa que, sumada al desarrollo tecnológico, puede contribuir a la mejora de la atención médica, pero cuya construcción está rodeada de desafíos El Grupo de Estudio y Tratamiento del Cáncer Gástrico y Esofágico de un hospital de referencia para el tratamiento del cáncer, compuesto por un equipo multiprofesional, fue creado para promover la interacción del equipo y mejorar la atención al paciente, pero aún necesita avanzar hacia la interdisciplinariedad. Objetivo: Conocer y analizar los desafíos de la intervención interdisciplinaria a los ojos de los profesionales que forman parte del equipo. Método: Investigación cualitativa, cuya recopilación de datos se realizó mediante entrevista con profesionales de las categorías incluidas en el grupo y el análisis basado en la dialéctica hermenéutica. Resultados: La comprensión sobre el propósito del grupo y los temas de integralidad e interdisciplinariedad, incluida la percepción sobre la red de atención al paciente. Se presentaron desafíos objetivos y subjetivos, vinculados, respectivamente, al manejo y la relación entre el equipo y entre profesionales y pacientes, para lo cual la atención es esencial. También se presentaron avances y resultados positivos, así como la necesidad de dirigir la mirada hacia el equipo y su cuidado. Conclusión: Existe la importancia de que los profesionales líderes reflexionen sobre su intervención individual y colectiva, considerando las posibilidades que están al alcance del equipo y otros que podrían ser el objetivo de reclamos y luchas para la implementación efectiva del Sistema Único de Salud, además de valorar el potencial y los logros ya alcanzados.


Subject(s)
Humans , Patient Care Team , Stomach Neoplasms/therapy , Esophageal Neoplasms/therapy , Integrality in Health , Interdisciplinary Placement , Brazil , Cancer Care Facilities , Qualitative Research , Hermeneutics
6.
Medwave ; 19(8): e7692, 2019.
Article in English, Spanish | LILACS | ID: biblio-1021438

ABSTRACT

OBJETIVO Describir las características clínicas, los patrones de tratamiento y los costos asociados en pacientes con cáncer gástrico localmente avanzado o metastásico en Argentina, en los sectores público y privado. MÉTODOS Una cohorte histórica de pacientes que recibieron tratamiento de quimioterapia de primera línea (análogo de platino y/o una fluoropirimidina) y fueron seguidos durante al menos tres meses después de la última administración de un agente citotóxico de primera línea fueron elegibles. Se extrajeron los datos a través de un cuestionario estructurado a partir de los registros médicos de cuatro hospitales argentinos. Las estimaciones de los costos de tratamiento también se calcularon utilizando los costos unitarios de los hospitales participantes. RESULTADOS Entre los 101 pacientes, más de tres cuartas partes (79,2%) eran hombres, 41,6% fueron diagnosticados con enfermedad metastásica en estadio IV, la edad media fue de 57,7 años y el 27,7% tenían antecedentes de tabaquismo. Antes del diagnóstico de cáncer gástrico metastásico, el 42,4% de los pacientes habían recibido gastrectomía total. El 97% de los pacientes recibió una terapia doble o triplete, de los cuales el tratamiento más frecuente fue la epirubicina en combinación con oxaliplatino y capecitabina (38%), seguida de capecitabina + oxaliplatino (29%). Alrededor del 36% de los pacientes respondieron al tratamiento de primera línea (respuesta completa y parcial). Del 76,2% de los pacientes que siguieron un tratamiento de segunda línea, al 37,7% todavía se les administró un análogo de platino y/o fluoropirimidina. Durante el período de seguimiento, el 50% de los pacientes progresó y el 32,8% tenía enfermedad estable. La terapia de apoyo consistió principalmente en visitas ambulatorias después de la última línea de quimioterapia (16,8%), radioterapia paliativa (16,8%) y cirugía (30,7%). Se observaron diferencias significativas entre los costos de los hospitales públicos y privado. CONCLUSIONES Comprender los patrones de tratamiento en pacientes con cáncer gástrico localmente avanzado o metastásico puede ayudar a abordar las necesidades médicas no satisfechas para un mejor manejo del paciente y la mejora de sus resultados clínicos en Argentina.


AIM To assess patient and disease characteristics, treatment patterns and associated costs in patients with locally advanced or metastatic gastric cancer in Argentina, in the public and private sectors. METHODS A historic cohort of patients who had received first-line chemotherapy treatment (platinum analog and/or a fluoropyrimidine) and were followed-up for at least three months after the last administration of a first-line cytotoxic agent were eligible. Case-report forms were prepared based on medical records from four Argentinian hospitals. Estimates of treatment costs were also calculated using the unit costs of the participating hospitals. RESULTS Of 101 patients, more than three quarters (79.2%) were male, 41.6% were diagnosed with metastatic stage IV disease (mean age, 57.7years), and 27.7 % had a smoking history. Before locally advanced or metastatic gastric cancer diagnosis, 42.4% of the patients had received total gastrectomy. Ninety-seven percent of the patients received a doublet or triplet therapy, of which epirubicin in combination with oxaliplatin and capecitabine was the most common treatment (38%), followed by capecitabine plus oxaliplatin (29%). Around 36% of the patients responded to first-line treatment (complete and partial response). Out of the 76.2% of the patients who followed a second-line treatment, 37.7% were still administered a platinum analog and/or fluoropyrimidine. During the reported follow-up period, 50% of the patients progressed, and 32.8% had stable disease. The best supportive care consisted mostly of outpatient visits after last-line therapy (16.8%), palliative radiotherapy (16.8%), and surgery (30.7%). We observed significant differences between public and private hospital costs. CONCLUSIONS Understanding treatment patterns in patients with locally advanced or metastatic gastric cancer may help address unmet medical needs for better patient management and improvement of their clinical outcome in Argentina.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Stomach Neoplasms/epidemiology , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Gastrectomy/methods , Argentina , Stomach Neoplasms/pathology , Stomach Neoplasms/therapy , Retrospective Studies , Cohort Studies , Follow-Up Studies , Hospital Costs/statistics & numerical data , Neoplasm Metastasis , Neoplasm Staging
7.
ABCD arq. bras. cir. dig ; 32(4): e1464, 2019. tab, graf
Article in English | LILACS | ID: biblio-1054598

ABSTRACT

ABSTRACT Background: The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim: To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods: Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion: Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.


RESUMO Racional: O tratamento do câncer gástrico avançado com intenção curativa é essencialmente cirúrgico e a quimiorradioterapia está indicada como neo ou adjuvância para controlar a doença e prolongar a sobrevida. Objetivos: Avaliar a sobrevida dos doentes submetidos à gastrectomia subtotal ou total com linfadenectomia D2 seguidos de quimiorradioterapia adjuvante. Métodos: Foram analisados retrospectivamente 87 gastrectomizados portadores de adenocarcinoma gástrico avançado considerandos estádios IB até IIIC e submetidos à quimiorradioterapia adjuvante (protocolo INT 0116). Foram excluídos os tumores da transição esofagogástrica, com implantes peritoneais, metástases à distância e os que após a operação apresentaram margem cirúrgica comprometida ou óbito precoce. Foram separados quanto à extensão da gastrectomia e analisados em relação ao local e histopatologia do tumor, invasão linfonodal, estadiamento, morbidade e sobrevida. Resultados: O número de doentes que conseguiu completar o esquema adjuvante na sua totalidade foi de 45 (51,7%). Os que iniciaram o tratamento e interromperam por toxicidade, piora relacionada ao tumor, ou perda de seguimento foram 10 (11,5%) e relacionados como adjuvância incompleta. O número de doentes que recusou ou não iniciou o tratamento adjuvante foi de 33 (48,3%). A gastrectomia subtotal foi indicada em 60 (68,9%) e a total em 27 (31,1%) e esta apresentou menor sobrevida. A média de linfonodos ressecados foi de 30,8. O estadiamento e o número de linfonodos acometidos foram preditores de pior sobrevida e quanto mais avançado foi o tumor. Os pacientes submetidos à terapia adjuvante com quimiorradioterapia completa mostraram sobrevida maior quando comparados àqueles que a fizeram de forma incompleta ou submetidos à operação exclusiva. Por outro lado, comparando-se os doentes estádios T4b (IIIB + IIIC) que tiveram adjuvância completa com os submetidos à operação exclusiva ou que não completaram a adjuvância, houve significativa diferença na sobrevida. Conclusão - A quimiorradioterapia adjuvante apresenta ganho de sobrevida para doentes em estádio T4b submetidos ao tratamento cirúrgico com intenção curativa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Stomach Neoplasms/therapy , Chemoradiotherapy, Adjuvant , Gastrectomy/methods , Retrospective Studies , Disease-Free Survival , Lymph Node Excision , Neoplasm Staging
8.
ABCD arq. bras. cir. dig ; 32(2): e1435, 2019. tab, graf
Article in English | LILACS | ID: biblio-1001040

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Stomach Neoplasms/therapy , Carcinoma/therapy , Adenocarcinoma/therapy , Palliative Care , Stomach Neoplasms/mortality , Time Factors , Carcinoma/mortality , Adenocarcinoma/mortality , Retrospective Studies , Treatment Outcome , Sex Distribution , Kaplan-Meier Estimate , Neoplasm Recurrence, Local
9.
Rev. méd. Chile ; 146(10): 1205-1209, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-978757

ABSTRACT

Gastric squamous cell carcinoma (SCC) is a rare type of cancer. We report three patients with the tumor. A 65 years old male presenting with weight los and heartburn. An upper gastrointestinal endoscopy revealed an ulcerated tumor whose biopsy disclosed a gastric epidermoid carcinoma. The patient was operated and chemotherapy was attempted, but he died five months later. A 39 years old male with an antral tumor corresponding to an epidermoid carcinoma. He was operated and received chemotherapy and radiotherapy and died one year later. A 79 years old female with a distal antral tumor corresponding to a undifferentiated epidermoid carcinoma. She received palliative therapy and died two months later.


Subject(s)
Humans , Male , Female , Adult , Aged , Stomach Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Stomach Neoplasms/therapy , Biopsy , Carcinoma, Squamous Cell/therapy , Fatal Outcome
10.
Food Sci. Technol (SBCTA, Impr.) ; 38(1): 78-83, Jan.-Mar. 2018. tab
Article in English | LILACS | ID: biblio-892251

ABSTRACT

Abstract This study investigated the inhibitory effect of Dendrobium officinale polysaccharide (DOPA) on human gastric cancer cell SGC-7901 xenografts in nude mice. The nude mice with SGC-7901 xenografts were randomly divided into model, 5-fluorouracil (5-Fu), low-dose DOPA, middle-dose DOPA and high-dose DOPA group. The later four groups were intragastrically administrated with 100, 200 and 400 mg·kg-1·day-1 DOPA, 400 mg·kg-1·day-1 5-Fu and normal saline, respectively. After treatment for 20 days, the tumor inhibition rate of in high-dose DOPA group was basically equivalent to 5-Fu group. Compared with 5-Fu, DOPA had no obvious toxic side effect on spleen or thymus indexes, routine blood indexes or liver and kidney functions of nude mice. Compared with model group, the serum tumor necrosis factor-α and interleukin-2 levels in middle- and high-dose DOPA group were significantly increased (P < 0.05), Bax protein expression was significantly increased (P < 0.05), and Bcl-2 protein expression was significantly decreased (P < 0.05). DOPA can inhibit the growth of SGC-7901 cell xenografts in nude mice. The mechanism may be related to its increase of serum TNF-α and IL-2 levels, up-regulation of Bax protein expression and down-regulation of Bcl-2 protein expression.


Subject(s)
Humans , Animals , Mice , Stomach Neoplasms , Xenograft Model Antitumor Assays , Plants, Medicinal , Polysaccharides , Stomach Neoplasms/therapy , Dendrobium , Heterografts , Mice, Nude
11.
Rev. bras. cancerol ; 64(1): 107-112, Jan/Fev/Mar 2018.
Article in Portuguese | LILACS | ID: biblio-969228

ABSTRACT

Introdução: O surgimento de metástase gástrica oriunda de neoplasia da mama é raro. Entretanto, o suporte nutricional nesses casos é imprescindível, já que tumores gástricos estão relacionados a complicações nutricionais, favorecendo desfechos clínicos negativos. Relato do caso: Paciente com diagnóstico de adenocarcinoma de mama, com progressão para ossos, ovário e estômago, internada em razão das complicações clínicas. Apresentou perda de peso grave durante a internação, além de diagnóstico de risco de desnutrição pela avaliação subjetiva global produzida pelo paciente. Em virtude do quadro de odinofagia severa, a alimentação via oral tornou-se impossibilitada, sendo optado pelo uso de sonda nasoentérica após discussão com equipe interdisciplinar. Conclusão: A terapia nutricional em pacientes com câncer avançado ainda é um dilema entre os profissionais e sua execução deve ser discutida e decidida por uma equipe interdisciplinar, com participação indispensável do nutricionista, do paciente e de seus familiares. Para isso, os serviços de saúde devem estar preparados para o correto manejo da conduta nutricional, a fim de promover qualidade de vida para esses pacientes.


Introduction: It is uncommon for breast cancer to metastasize to the stomach. However, when it does occur, nutritional support is indispensable, because gastric tumors are associated with nutritional complications, which worsen clinical outcomes. Case report: We report the case of a female patient diagnosed with breast adenocarcinoma that had metastasized to the bones, ovary, and stomach, who was hospitalized because of clinical complications. During hospitalization, she presented severe weight loss and was classified as being at nutritional risk, as determined by the Patient-Generated Subjective Global Assessment. Due to severe odynophagia, oral intake was not possible. Therefore, after consultation with the multidisciplinary team, the decision was made to insert a nasogastric tube. Conclusion: Nutritional therapy in patients with advanced cancer still constitutes a dilemma facing professionals and needs to be discussed by a multidisciplinary team, the participation of the nutritionist, patient, and family being indispensable. Therefore, health care services must be prepared to manage nutritional therapy correctly, in order to promote better quality of life for such patients.


Introducción: El surgimiento de metástasis gástrica proveniente de neoplasia de mama es raro. Sin embargo, el soporte nutricional en estos casos es imprescindible, ya que los tumores gástricos están relacionados a complicaciones nutricionales, favoreciendo los resultados clínicos negativos. Informe de caso: Paciente con diagnóstico de adenocarcinoma de mama, con progresión para huesos, ovario y estómago, internada debido a complicaciones clínicas. Se presentó una pérdida de peso grave durante la internación, además de diagnóstico de riesgo de desnutrición por la evaluación subjetiva global producida por el paciente. Debido a un cuadro de odinofagia severa, la alimentación oral se volvió imposibilitada, siendo optado por el uso de sonda nasoentérica después de la discusión con el equipo interdisciplinario. Conclusión: La terapia nutricional en pacientes con cáncer avanzado sigue siendo un dilema entre los profesionales y su ejecución debe ser discutida y decidida por un equipo interdisciplinario, con participación indispensable del nutricionista, del paciente y de sus familiares. Para ello, los servicios de salud deben estar preparados para el correcto manejo de la co


Subject(s)
Humans , Female , Middle Aged , Stomach Neoplasms/therapy , Breast Neoplasms/therapy , Adenocarcinoma/therapy , Carcinoma, Lobular/therapy , Nutrition Therapy , Body Mass Index , Nutritional Status
12.
ABCD arq. bras. cir. dig ; 31(2): e1373, 2018.
Article in English | LILACS | ID: biblio-949230

ABSTRACT

ABSTRACT Background: The complexity of the management of gastric cancer requires a multidisciplinary evaluation of patients with this tumor. Several treatments have been employed, associated to the surgical resection. Objective: To review the available therapeutic alternatives for the treatment of gastric adenocarcinoma. Methods : A review of selected articles on multidisciplinary treatment of gastric adenocarcinoma in the Pubmed and Medline databases between 2000 and 2017 was carried out. The following headings were related: stomach cancer, treatment, chemotherapy and radiotherapy. Results : There are several valid alternatives, with good results for the treatment of gastric cancer: chemoradiotherapy or chemotherapy in the adjuvant scenario; perioperative chemotherapy; and chemoradiotherapy after neoadjuvance with isolated chemotherapy. Conclusion : Current evidences suggest that combined multidisciplinary treatment is superior to surgery alone. However, the optimal treatment regimen is not yet established, and depends on a number of factors, especially the type of surgical resection employed. Therefore, the therapeutic decision should be made by a multidisciplinary team, assessing patient's personal characteristics, biology of the tumor, residual disease, risks and side effects.


RESUMO Introdução : A complexidade do manejo do câncer gástrico torna necessária a avaliação multidisciplinar dos pacientes com esse tumor. Diversas alternativas de tratamento têm sido empregadas, associadas com a ressecção cirúrgica. Objetivo: Analisar as alternativas disponíveis para o tratamento do adenocarcinoma gástrico. Método : Foi realizada revisão de artigos selecionados sobre tratamento multidisciplinar do adenocarcinoma gástrico nas bases de dados Pubmed e Medline entre 2000 e 2017. Os seguintes descritores foram relacionados: câncer de estômago, tratamento, quimioterapia e radioterapia. Resultados : Existem várias alternativas válidas, com bons resultados para o tratamento do câncer gástrico: adjuvância com químio e radioterapia ou quimioterapia isolada; quimioterapia perioperatória; e químio e radioterapia após neoadjuvância com quimioterapia isolada. Conclusão : As evidências sugerem que o tratamento combinado é superior ao da cirurgia isolada. Entretanto, o esquema ideal de tratamento ainda não está estabelecido e depende de uma série de fatores, principalmente o tipo de ressecção cirúrgica empregada. Portanto, a decisão terapêutica deve ser tomada por equipe multidisciplinar, avaliando características pessoais do paciente, biologia do tumor, possibilidade de doença residual, riscos e a capacidade do paciente de tolerar tratamentos não isentos de efeitos colaterais.


Subject(s)
Humans , Stomach Neoplasms/therapy , Adenocarcinoma/therapy , Combined Modality Therapy
13.
Rev. chil. cir ; 69(6): 502-507, dic. 2017.
Article in Spanish | LILACS | ID: biblio-899645

ABSTRACT

Resumen El cáncer gástrico es uno de los cánceres más frecuentes en el mundo. Recientes estudios han contribuido en la comprensión de esta enfermedad. El objetivo de este artículo es revisar de manera crítica y actualizada distintos aspectos del cáncer gástrico tanto a nivel mundial como a nivel chileno. Este artículo revisa algunos aspectos relacionados con el cáncer gástrico, tales como epidemiología, dieta, estudio histológico, búsqueda de lesiones precancerosas, prevención, Helicobacter pylori, estilos de vida, factores metabólicos y tratamiento.


Abstract Gastric cancer is one of the most common cancers in the world. Recent studies have contributed to the understanding of this disease. The aim of this article is to critically review various aspects of gastric cancer both globally and Chilean. This article reviews some aspects related to gastric cancer, such as epidemiology, diet, histology, screening of precancerous lesions, prevention, Helicobacter pylori, lifestyles, metabolic factors and treatment.


Subject(s)
Humans , Stomach Neoplasms/therapy , Stomach Neoplasms/epidemiology , Precancerous Conditions/epidemiology , Stomach Neoplasms/prevention & control , Chile , Global Health , Helicobacter Infections/epidemiology , Life Style
14.
ABCD arq. bras. cir. dig ; 30(2): 150-154, Apr.-June 2017. graf
Article in English | LILACS | ID: biblio-885703

ABSTRACT

ABSTRACT Introduction: The frequency of gastric neuroendocrine tumors is increasing. Reasons are the popularization of endoscopy and its technical refinements. Despite this, they are still poorly understood and have complex management. Aim: Update the knowledge on gastric neuroendocrine tumor and expose the future perspectives on the diagnosis and treatment of this disease. Method: Literature review using the following databases: Medline/PubMed, Cochrane Library and SciELO. Search terms were: gastric carcinoid, gastric neuroendocrine tumor, treatment. From the selected articles, 38 were included in this review. Results: Gastric neuroendocrine tumors are classified in four clinical types. Correct identification of the clinical type and histological grade is fundamental, since treatment varies accordingly and defines survival. Conclusion: Gastric neuroendocrine tumors comprise different subtypes with distinct management and prognosis. Correct identification allows for a tailored therapy. Further studies will clarify the diseases biology and improve its treatment.


RESUMO Introdução: A frequência de tumores neuroendócrinos gástricos está aumentando. As razões são a popularização da endoscopia e seus refinamentos técnicos. Apesar disso, os gástricos ainda são pouco compreendidos e têm manejo complexo. Objetivo: Atualizar os conhecimentos nos tumores neuroendócrinos gástricos e expor as perspectivas futuras no diagnóstico e tratamento. Método: Revisão da literatura utilizando as seguintes bases de dados: Medline/PubMed, Cochrane Library e SciELO. Os descritores da busca foram: carcinóide gástrico, tumor neuroendócrino gástrico, tratamento. Dos artigos selecionados, 38 foram incluídos nesta revisão. Resultados: Tumores neuroendócrinos gástricos são classificados em quatro tipos clínicos. A identificação correta do tipo clínico e grau histológico é fundamental, pois a conduta é variável e define a sobrevida. Conclusão: Tumor neuroendócrino gástrico possui diferentes subtipos com tratamento e prognóstico distintos. A identificação correta destes e seu entendimento permite o tratamento individualizado. Estudos futuros ajudarão a esclarecer a biologia desta doença e melhorar o tratamento.


Subject(s)
Humans , Stomach Neoplasms/classification , Stomach Neoplasms/diagnosis , Stomach Neoplasms/therapy , Neuroendocrine Tumors/classification , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/therapy , Algorithms
16.
Rev. latinoam. enferm. (Online) ; 25: e2879, 2017. tab
Article in English | LILACS, BDENF | ID: biblio-845295

ABSTRACT

ABSTRACT Objective: to identify the time between symptoms, the request for care and the beginning of treatment in patients with stomach and colorectal cancer as well as the factors that interfere in these processes. Method: correlational descriptive study, including 101 patients diagnosed with stomach or colorectal cancer, treated in a hospital specialized in oncology. Results: the 101 patients investigated there was predominance of males, mean age of 61.7 years. The search for medical care occurred within 30 days after the onset of symptoms, in most cases. The mean total time between the onset of symptoms and the beginning of treatment ranged from 15 to 16 months, and the mean time between the search for medical care and the diagnosis was 4.78 months. The family history of cancer (p=0.008) and the implementation of preventive follow-up (p<0.001) were associated with shorter periods between the search for care and the beginning of treatment. Nausea, vomiting, hematochezia, weight loss and pain were associated with faster demand for care. Conclusion: the longer interval between the search for medical care and the diagnosis was possibly due to the non-association between the presented symptoms and the disease.


RESUMO Objetivo: identificar o tempo entre os sintomas, a busca por assistência e o início do tratamento em pacientes com câncer de estômago e colorretal e os fatores que interferem nesses processos. Método: estudo descritivo correlacional, incluindo 101 pacientes com diagnóstico de câncer de estômago ou colorretal, atendidos por um hospital especializado em oncologia. Resultados: dos 101 pacientes investigados, houve predomínio do sexo masculino, média de idade de 61,7 anos. A busca por assistência médica ocorreu em até 30 dias após o início dos sintomas, na maioria dos casos. O tempo médio total entre o aparecimento dos sintomas e o início do tratamento foi de 15,16 meses, sendo que, o tempo médio entre a busca por assistência médica e o diagnóstico foi de 4,78 meses. O histórico familiar de câncer (p=0,008) e a realização de acompanhamento preventivo (p<0,001) estiveram associados a menores períodos entre a busca por assistência e início do tratamento. Naúsea, vômito, hematoquesia, perda ponderal e dor foram associados à procura mais ágil por assistência. Conclusão: o maior intervalo entre a busca por assistência médica e o diagnóstico ocorreu, possivelmente, pela não associação entre os sintomas apresentados e a doença.


RESUMEN Objetivo: identificar el tiempo entre los síntomas, la búsqueda de asistencia y el inicio del tratamiento en pacientes con cáncer gástrico y colorrectal y los factores que interfieren en estos procesos. Método: estudio descriptivo correlacional, incluyendo 101 pacientes con diagnostico de cáncer gástrico o colorrectal, atendidos en un hospital especializado en oncología. Resultados: de 101 pacientes investigados la mayoria eran hombres, con edad media de 61,7 años. La búsqueda de la atención médica se produjo dentro de los 30 días después de la aparición de los síntomas, en la mayoría de los casos. El promedio de tiempo total entre el inicio de los síntomas y el inicio del tratamiento fue de 15,16 meses y el tiempo medio entre la búsqueda de la atención médica y el diagnóstico fue de 4,78 meses. La historia familiar de cáncer (p=0,008) y la realización de seguimiento preventivo (p<0,001) se asociaron con períodos más cortos entre la búsqueda de la atención y el tratamiento temprano. Náuseas, vómitos, hematoquecia, pérdida de peso y dolor se asociaron con la búsqueda más rápida de la asistencia. Conclusión: el intervalo más largo entre la búsqueda de la atención médica y el diagnóstico se produjo posiblemente por asociación negativa entre los síntomas que se presentan y las enfermedades.


Subject(s)
Humans , Male , Female , Middle Aged , Stomach Neoplasms/therapy , Colorectal Neoplasms/therapy , Patient Acceptance of Health Care
17.
Rev. cuba. cir ; 55(2): 0-0, abr.-jun. 2016. tab
Article in Spanish | LILACS | ID: lil-791489

ABSTRACT

Introducción: el cáncer de esófago es la neoplasia del tubo digestivo de peor pronóstico. Su tratamiento constituye un desafío al tratarse de pacientes con deterioro nutricional con incapacidad de ingerir alimentos. La mayoría son tributarios de tratamiento paliativo. Objetivo: describir la experiencia en la atención nutricional de los pacientes con cáncer de esófago y cardias con la introducción del grupo de apoyo nutricional en el Hospital Universitario Comandante Manuel Fajardo. Método: se presentan 126 enfermos con cáncer de esófago y cardias, 51 de ellos con lesiones resecables a los que se realizó esofagectomía y 75 enfermos con cáncer avanzado e intervenciones paliativas, atendidos desde 2006 hasta 2015, según los protocolos de actuación del grupo de apoyo nutricional. Resultados: todos los pacientes se encontraban entre 46 y 76 años, 69 por ciento mayor de 60 años, 87,3 port ciento del sexo masculino, 90 por ciento con antecedentes de tabaquismo y 80 por ciento de alcoholismo. La localización del tumor predominó en el un tercio inferior del esófago y cardias, seguido por tercio medio y el tercio superior. Presentaron desnutrición leve 4,1 por ciento, 53,9 por ciento moderada y 42 por ciento grave. Todos presentaron disminución de la albúmina y 57,9 por ciento, la capacidad funcional disminuida. Todos recibieron consejería dietética y dietoterapia orientada. Se incrementó la supervivencia en 14 meses en los casos paliativos y a 39 meses en los resectivos, comparado con un periodo anterior sin la presencia del grupo de apoyo nutricional. Conclusiones: la valoración nutricional debe ser parte de la evaluación clínica de los pacientes con cáncer de esófago desde el momento del diagnóstico y durante la enfermedad, para identificar y corregir el déficit nutricional, mantener y preservar el peso. Esto mejora la respuesta a los distintos tratamientos oncológicos, aumenta la supervivencia y mejora la calidad de vida(AU)


Introduction: esophageal cancer is a malignancy of the digestive tract with the worst prognosis. Its treatment constitutes a challenge in the case of patients with nutritional deterioration and inability to ingest food. Most of them are candidates for palliative treatment. Objective: to describe the experience regarding the nutritional care of patients with esophageal cancer and cardias, with the introduction of the nutritional support group at Comandante Manuel Fajardo University Hospital. Method: 126 patients with esophageal cancer and cardia presented: 51 of them with resectable lesions and who underwent esophagectomy, and 75 with advanced cancer and palliative interventions, treated from 2006 to 2015, according to the performance protocols of the nutritional support group. Results: all patients were at age 46-76 years (69 percent over 60 years), 87.3 percent were male, 90 percent had a history of smoking and 80 percent of alcohol. The predominant location of the tumor was the third-lower esophagus and the cardia, followed by the middle and upper thirds. They had mild malnutrition (4,1 percent), 53,9 percent had moderate and 42 percent, severe malnutrition. All of them showed decreased albumin and 57,9 percent showed decreased functional capacity. All of them received dietary counseling and oriented diet therapy. Survival after 14 months was increased in the palliative cases and after 39 months in respective cases, compared with a previous period without the presence of the nutritional support group. Conclusions: nutritional assessment should be part of the clinical evaluation of patients with esophageal cancer from the time of diagnosis and during illness, in order to identify and correct nutritional deficit, maintain and preserve the weight, thus improving response to cancer treatments, and increasing survival, which improves quality of life(AU)


Subject(s)
Humans , Male , Adult , Aged , Esophageal Neoplasms/therapy , Esophagectomy , Quality of Life , Stomach Neoplasms/therapy
19.
Säo Paulo med. j ; 134(1): 84-87, Jan.-Feb. 2016. tab
Article in English | LILACS | ID: lil-777451

ABSTRACT

CONTEXT: Gastric stump cancer after gastric resection is a well-known disease. It may be a newly developed cancer after resection due to benign disease, or recurrent or residual disease after oncological surgery. The predominant histological type is usually adenocarcinoma. This study aimed to report on a rare occurrence of a mixed adenoneuroendocrine carcinoma (MANEC) on the gastric stump. CASE REPORT: The case of an 83-year-old female who presented a locally aggressive gastric stump MANEC, 35 years after Billroth II gastrectomy to treat a peptic ulcer, is reported. The patient underwent resection and adjuvant therapy. She has been followed up for one year without signs of recurrence. CONCLUSION: MANEC is a rare type of gastrointestinal neoplasm. The classification, histopathology, clinical features, treatment issues and prognosis are discussed along with a brief review of the literature.


CONTEXTO: O câncer de coto gástrico após gastrectomia é uma condição extensamente documentada. Pode se tratar de doença desenvolvida após a ressecção por doença benigna, ou ainda doença recorrente ou residual após cirurgia oncológica. Geralmente, o tipo histológico predominante é o adenocarcinoma. Este estudo tem como propósito relatar a rara ocorrência de um adenocarcinoma neuroendócrino misto (MANEC) no coto gástrico. RELATO DE CASO: É relatado o caso de uma mulher de 83 anos que apresentou um MANEC localmente agressivo 35 anos após uma gastrectomia à Billroth II devido a úlcera péptica. Foi submetida a ressecção e terapia adjuvante e foi seguida por 12 meses sem sinais de recorrência. CONCLUSÃO: Os MANECs constituem raro tipo de neoplasia gastrointestinal. Sua classificação, histopatologia, aspectos clínicos, tratamento e prognóstico são discutidos junto com uma breve revisão de literatura.


Subject(s)
Humans , Female , Aged, 80 and over , Stomach Neoplasms/surgery , Adenocarcinoma/surgery , Mixed Tumor, Malignant/surgery , Carcinoma, Neuroendocrine/surgery , Gastric Stump/surgery , Stomach Neoplasms/therapy , Gastroenterostomy , Adenocarcinoma/therapy , Mixed Tumor, Malignant/therapy , Carcinoma, Neuroendocrine/therapy , Chemoradiotherapy, Adjuvant/methods
20.
São Paulo; s.n; 2016. 81 p.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1178193

ABSTRACT

Introdução: O câncer gástrico localizado nos terços superior e médio é habitualmente tratado com uma gastrectomia total, embora em muitos casos às custas de morbidade e mortalidade mais elevadas. O objetivo deste estudo foi descrever os resultados de morbimortalidade e sobrevivência em gastrectomia total em um centro único. Métodos: Este estudo retrospectivo incluiu pacientes com adenocarcinoma gástrico tratados com uma gastrectomia total em um centro oncológico brasileiro, entre janeiro de 1988 e dezembro de 2011. Dados clínicos, cirúrgicos e anatomopatológicos foram analisados ao longo do tempo e três intervalos de 8 anos foram estabelecidos. Fatores prognósticos de sobrevida foram avaliados apenas entre os pacientes tratados com intuito curativo. Resultados: O estudo incluiu 413 indivíduos. A maior parte era do sexo masculino e sua idade mediana foi de 59 anos. A maioria dos pacientes teve perda de peso e foram classificados como ASA 2. Ressecção curativa foi realizada em 336 doentes paliativa em 77. A morbidade global foi de 37,3% a mortalidade em 60 dias 6,5%. Análise temporal da casuística identificou tumores mais avançados nos primeiros 8 anos, além de diferenças na extensão do tratamento cirúrgico, como uma linfadenectomia mais limitada realizada com maior frequência. Além disso, observou-se uma queda significativa na mortalidade, de 13% para 4%. Com um seguimento mediano de 74 meses entre os pacientes vivos, a sobrevida mediana foi de 56 meses e a sobrevida global em 5 anos 49,2%. Perda de peso, linfadenectomia, tamanho do tumor, estádios T e N foram fatores prognósticos em análise multivariada. Conclusões: A gastrectomia total é tratamento seguro e factível em mãos experientes. Avanços na técnica cirúrgica e nos cuidados perioperatórios tem melhorado os resultados ao longo do tempo.


Background: Advanced gastric cancer in the upper or middle third of the stomach is routinely treated with a total gastrectomy, albeit in some cases with higher morbidity and mortality. The aim of this study was to describe the morbimortality and survival results in total gastrectomy in a single center. Methods: This retrospective study included patients with gastric adenocarcinoma treated with a total gastrectomy at a single Brazilian cancer center between January 1988 and December 2011. Clinical, surgical and pathology information were analyzed through time, with three 8-year intervals being established. Prognostic factors for survival were evaluated only among the patients treated with curative intent. Results: The study comprised 413 individuals. Most were male and their median age was 59 years. The majority of patients had weight loss and was classified as ASA 2. A curative resection was performed in 336 subjects and a palliative one in 77. Overall morbidity was 37.3% and 60-day mortality 6.5%. Temporal analysis identified more advanced tumors in the first 8-year period along with differences in the surgical procedure, with more limited lymph node dissections. Also, a significant decrease in mortality was observed, from 13% to 4%. With median follow-up of 74 months among living patients, median survival was 56 months and 5-year overall survival 49.2%. Weight loss, lymphadenectomy, tumor size, T and N stages remained were prognostic factors in multivariate analysis. Conclusion: Total gastrectomy is a safe and feasible treatment in experienced hands. Advances in surgical technique and perioperative care have improved outcomes through time.


Subject(s)
Humans , Stomach Neoplasms/therapy , Survival Analysis , Gastrectomy , Prognosis
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