Brazilian Society of Surgical Oncology: Guidelines for the management of anal canal cancer.

BACKGROUND: Anal canal squamous cell carcinoma (SCC) is a relatively uncommon neoplasia, and it is mostly a local-regional cancer, of low metastatic potential (only 15%), resulting in cure in most cases treated with definitive chemoradiation. On the other hand, its incidence has been steadily increasing over the last decades, which makes it an important public health problem. In an effort to provide surgeons and oncologists who treat patients with anal cancer with the most updated information based on the best scientific evidence, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guideline for the management of anal canal SCC, focused on the main topics related to daily clinical practice. OBJECTIVES: The SBCO developed the present guidelines to provide recommendations on the main topics related to the management of anal canal squamous cell carcinoma (SCC) based on current scientific evidence. METHODS: Between October 2022 and January 2023, 14 experts met to develop the guidelines for the management of anal canal cancer. A total of 30 relevant topics were distributed among the participants. The methodological quality of a final list with 121 sources was evaluated, all the evidence was examined and revised, and the management guidelines were formulated by the 14-expert committee. To reach a final consensus, all the topics were reviewed in a meeting that was attended by all the experts. RESULTS: The proposed guidelines contained 30 topics considered to be highly relevant in the management of anal canal cancer, covering subjects related to screening recommendations, preventive measures, tests required for diagnosing and staging, treatment strategies, response assessment after chemoradiotherapy, surgical technique-related aspects, and follow-up recommendations. In addition, screening and response assessment algorithms, and a checklist were proposed to summarize the important information and offer an updated tool to assist surgeons and oncologists who treat anal canal cancer and in providing the best care to their patients. CONCLUSION: These guidelines summarize recommendations based on the most current scientific evidence on relevant aspects of anal canal cancer management and are a practical guide to help surgeons and oncologists who treat anal canal cancer make the best therapeutic decisions.

Weight loss outcome after Roux-en-Y gastric bypass: 10 years of follow-up.

BACKGROUND: By submitting obese people to surgical treatment, we hope they lose weight and stay slim. Long-term monitoring is essential to assess effectiveness of surgery. This study aims to evaluate weight loss over 10 years in an obese population undergoing banded Roux-en-Y gastric bypass (B-RYGBP). METHODS: The surgery was performed in 211 obese between May 1999 and December 2000. This prospective study evaluated excess weight loss (%EWL) and body mass index (BMI) during the period. We considered surgical treatment failure if %EWL was less than 50 %. RESULTS: We followed 54.9 % of the population (116 patients). Patients' %EWL was 67.6 ± 14.9 % 1 year after surgery, 72.6 ± 14.9 % after 2 years, 69.7 ± 15.1 % after 5 years, 66.8 ± 7.6 % after 8 years, and 67.1 ± 11.9 % after 10 years postoperatively. Surgical treatment failure occurred in 16 patients (14.6 %) over 10 years. CONCLUSIONS: B-RYGBP is a good technique to promote and maintain weight loss 10 years after surgery with low failure rate.

Influence of the actual diameter of the gastric pouch outlet in weight loss after silicon ring Roux-en-Y gastric bypass: an endoscopic study.

Some sort of restriction of the pouch emptying is supported by many surgeons to allow a sustained weight loss through the use of a ring placed circumferentially around the gastric pouch. Most previous studies focused on the length of the ring, not the actual diameter of the gastric pouch outlet. This study aims to evaluate the association between the actual diameter of the gastric pouch outlet and the weight loss in obese patients submitted to silicon ring Roux-en-Y gastric bypass. We studied prospectively 257 patients that underwent silicon ring (65 mm) Roux-en-Y gastric bypass between July 2005 and August 2007. Upper digestive endoscopy was performed to measure the diameter of the gastric pouch outlet at 1 and 2 years with the aid of calibrated balloons. The diameter of the gastric pouch outlet ranged from 9 to 14 mm (mean = 11 mm). Excess weight loss ranged from 37% to 127% (mean = 69%) during the first year and 29% to 110% (mean = 69%) during the second year. A negative correlation between the diameter of the gastric pouch outlet and excess weight loss at first year (r = -0.792, p < 0.001) and at the second year of follow-up (r = -0.921, p < 0.001) was found. The actual diameter of the gastric pouch outlet was associated with weight loss after silicon ring Roux-en-Y gastric bypass during the 2-year follow-up.

Weight loss outcome after silastic ring Roux-en-Y gastric bypass: five years of follow-up.

BACKGROUND: An underlying major aim of bariatric surgery is weight loss and its long-term maintainance. In spite of this, most studies regarding weight loss after surgical treatment of morbid obesity, show 3-year follow-up results. We evaluated the effectiveness of Silastic ring Roux-en-Y gastric bypass (SR-RYGBP) in promoting significant weight loss after a 5-year follow-up at the Londrina State University Hospital. METHODS: From May 1999 to December 2000, 211 morbidly obese patients were submitted to SR-RYGBP, by the same surgical team. The study's design was longitudinal, prospective and descriptive. The analysis of postoperative ponderal decrease was based on excess weight loss in percentage (%EWL) and the calculation of the BMI. Therapeutic failure was considered when patients lost <50% of excess weight at 2-years follow-up. RESULTS: Patient loss to follow-up loss was 13%; therefore 183 patients were included in this study. The average global EWL was: 67.6% +/- 14.9 at the first postoperative year; 72.6% +/- 14.9 at the second year; and 69.7% +/- 15.1 in the fifth postoperative year. Surgical treatment failure occurred in 12 patients (6.5%) during the 5-year follow-up. CONCLUSIONS: SR-RYGBP was effective in promoting and maintaining weight loss in the long-term, with a low failure rate.