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1.
Ecancermedicalscience ; 15: 1195, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889204

RESUMO

Oesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.

2.
Ecancermedicalscience ; 14: 1126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33209117

RESUMO

Gastric cancer is among the ten most common types of cancer worldwide. Most cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of gastric carcinomas. The Brazilian Group of Gastrointestinal Tumors (GTG) invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy and follow-up, which was followed by presentation, discussion, and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of gastric carcinomas in several scenarios and clinical settings.

3.
Clin Anat ; 32(1): 9-12, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30178488

RESUMO

Lymphadenectomy is a crucial part of the surgical therapy for gastric cancer. The number of normal lymph nodes could indicate the number of nodes that need to be retrieved during the procedure. The aim of this study is to analyze the number of lymph nodes in cadavers without gastric cancer according to the Japanese Gastric Cancer Association guidelines. Twenty fresh adult cadavers (14 males, mean age 55, range 24-93 years) were used. Abdominal lymph nodes were dissected and classified according to the Japanese Gastric Cancer Association. For total gastrectomy, the median number of lymph nodes that comprised D1 + dissection was 27 (range 15-42). The median and mean number of lymph nodes that comprised D2 dissection was 33, ranging from 18 to 50. For distal gastrectomy, the D1 + level comprised a median of 21 lymph nodes (range 11-38), and the D2 level 22 lymph nodes (range 11-39). In conclusion, considering gastrectomy + D2 lymphadenectomy as the standard treatment for gastric cancer, our results show that adequate lymphadenectomy must encompass around 30 lymph nodes. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Linfonodos/anatomia & histologia , Estômago/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
JAMA Surg ; 149(1): 18-25, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24225775

RESUMO

IMPORTANCE: There is growing interest in reducing the variations and deficiencies in the multidisciplinary management of gastric cancer. OBJECTIVE: To define optimal treatment strategies for gastric adenocarcinoma (GC). DESIGN, SETTING, AND PARTICIPANTS: RAND/UCLA Appropriateness Method involving a multidisciplinary expert panel of 16 physicians from 6 countries. INTERVENTIONS: Gastrectomy, perioperative chemotherapy, adjuvant chemoradiation, surveillance endoscopy, and best supportive care. MAIN OUTCOMES AND MEASURES: Panelists scored 416 scenarios regarding treatment scenarios for appropriateness from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores from 1 to 3 were considered inappropriate; 4 to 6, uncertain; and 7 to 9, appropriate. Agreement was reached when 12 of 16 panelists scored the scenario similarly. Appropriate scenarios agreed on were subsequently scored for necessity. RESULTS: For patients with T1N0 disease, surgery alone was considered appropriate, while there was no agreement over surgery alone for patients T2N0 disease. Perioperative chemotherapy was appropriate for patients who had T1-2N2-3 or T3-4 GC without major symptoms. Adjuvant chemoradiotherapy was classified as appropriate for T1-2N1-3 or T3-4 proximal GC and necessary for T1-2N2-3 or T3-4 distal GC. There was no agreement regarding surveillance imaging and endoscopy following gastrectomy. Surveillance endoscopy was deemed to be appropriate after endoscopic resection. For patients with metastatic GC, surgical resection was considered inappropriate for those with no major symptoms, unless the disease was limited to positive cytology alone, in which case there was disagreement. CONCLUSIONS AND RELEVANCE: Patients with GC being treated with curative intent should be considered for multimodal treatment. For patients with incurable disease, surgical interventions should be considered only for the management of major bleeding or obstruction.


Assuntos
Adenocarcinoma/terapia , Equipe de Assistência ao Paciente , Neoplasias Gástricas/terapia , Terapia Combinada , Humanos
5.
J Gastrointest Cancer ; 44(4): 410-6, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23812916

RESUMO

PURPOSE: Surgical treatment of gastric cancer has risks, and the current trend in developed countries is to centralize cases in high-volume centers. Many countries, however, particularly the developing ones, have to rely in low-volume centers for the most part of gastric cancer operations. We aimed to verify the characteristics of the patients and tumors as well as the in-hospital outcomes in a community hospital in Brazil treating gastric cancer. METHODS: This is a retrospective study on patients undergoing surgical treatment of gastric adenocarcinoma at a community hospital in Brazil. The authors reviewed demographic, clinical, pathological, and perioperative data. RESULTS: A total of 28 patients were operated on during the study period. Mean age was 69.5 years, 53.6% were male, 67.9% had anemia, 78.5% had ASA score ≥ 3, 89.3% were at nutritional risk, intestinal/diffuse ratio was 1.6, 68.5% had tumor ≥ 6 cm, involvement of lower/middle third of the stomach occurred in 96.4%, 73.7% had serosal invasion, 79% had stage III disease, median number of dissected nodes was 23, median operative time was 255 min, 21.4% had urgent procedures, 67.8% had curative surgery, 50% had distal gastrectomy, 43.5% had a Billroth I, median length of stay was 17 days, 53.6% had some admission to the intensive care unit, 21.4% required relaparotomy, 25% had wound infection/dehiscence, and mortality was 66.7/18.2% (urgent/non-urgent surgery). CONCLUSION: We treat elderly malnourished patients with multiple comorbidities and advanced cancer. Improvement is required in lymph node dissection, non-surgical therapies, and critical care.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia , Hospitais Comunitários , Excisão de Linfonodo , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de Sobrevida
7.
ABCD (São Paulo, Impr.) ; 25(2): 114-117, abr.-jun. 2012. ilus, graf, tab
Artigo em Português | LILACS | ID: lil-663876

RESUMO

OBJETIVO: Avaliar a concentração da célula Natural Killer (NK) no adenocarcinoma gástrico operado, e sua correlação com fatores prognósticos e sobrevida MÉTODOS: Foram estudados 72 doentes portadores de adenocarcinoma gástrico e que foram submetidos à gastrectomia com linfadenectomia D2. A concentração de célula NK foi avaliada por técnica de imunoistoquímica pelo reagente CD57. Os doentes foram divididos em dois grupos: alta concentração de células (n=32) (>15 células /10 campos de grande aumento) e baixa concentração (≤ 15 células/10 campos de grande aumento). Esses dois grupos foram comparados com seguintes fatores prognósticos: gênero, idade, localização do tumor, grau de diferenciação celular, classificação de Lauren, estádio, disseminação linfática, metástases e sobrevida. A curva de Kaplan-Meier foi empregada para avaliação de sobrevida e a análise multivariada para avaliação dos fatores prognósticos. RESULTADOS: Não houve relação das células NK com as diversas variáveis estudadas, a não ser com o estádio, onde houve significância (p<0,02), quando houve alta concentração nos estádios mais avançados. A sobrevida foi maior (p=0,0025) no grupo de Alta concentração de NK. Na análise de sobrevida no estádio tardio, o grupo de alta concentração obteve sobrevivência maior (p<0.0001). E na análise multivariada a concentração de células NK foi um fator prognóstico independente (p=0,0027, hazard ratio = 0.343). CONCLUSÕES: A concentração de células NK não difere entre as variáveis prognósticas, com exceção do estadiamento. Doentes com alta concentração de células NK apresentaram maior sobrevida quando comparados aos de baixa concentração, principalmente no estádio tardio.


AIM: To evaluate the concentration of Natural Killer cells (NK) cells in adenocarcinoma of the stomach, and its correlation with prognostic factors and survival. METHODS: Seventy-two patients with gastric adenocarcinoma who underwent gastric resection surgery and D2 lymphadenectomy in the period 1997-2007 were analyzed. The concentration of NK cells was evaluated by immunohistochemistry technique with the reagent CD57. Patients were divided into two groups: high concentration (n = 32) (more than 15 cells per 10 high power field) and low concentration (less or equal than 15 cells per 10 high power field). These two groups were compared with several prognostic factors such as: gender, age, tumor location, tumor differentiation, Lauren classification, stage, lymph nodes involvement, distant metastases and survival. The Kaplan-Meier curve was applied to evaluate survival and multivariate analysis of prognostic factors for evaluation. RESULTS: There was no relationship of NK cells with the several variables studied, except to the tumor stage (p<0.02) with high concentration in more advanced stages. Survival was better (p = 0.0025) in the group of high concentration of NK. The survival analysis in advanced stage shown that the group with high concentration had higher survival (p<0.0001). In multivariate analysis, the concentration of NK cells was an independent prognostic factor (p = 0.0027, Hazard Ratio = 0343). CONCLUSIONS: The concentration of NK cells did not differ among the prognostic variables, with the exception of the staging. Patients with high concentration of NK cells showed a higher survival rate when compared to the low concentration, especially in the advanced stage.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Células Matadoras Naturais/patologia , Neoplasias Gástricas/patologia , Prognóstico , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida
8.
Arq Bras Cir Dig ; 25(2): 114-7, 2012.
Artigo em Português | MEDLINE | ID: mdl-23381755

RESUMO

AIM: To evaluate the concentration of Natural Killer cells (NK) cells in adenocarcinoma of the stomach, and its correlation with prognostic factors and survival. METHODS: Seventy-two patients with gastric adenocarcinoma who underwent gastric resection surgery and D2 lymphadenectomy in the period 1997-2007 were analyzed. The concentration of NK cells was evaluated by immunohistochemistry technique with the reagent CD57. Patients were divided into two groups: high concentration (n = 32) (more than 15 cells per 10 high power field) and low concentration (less or equal than 15 cells per 10 high power field). These two groups were compared with several prognostic factors such as: gender, age, tumor location, tumor differentiation, Lauren classification, stage, lymph nodes involvement, distant metastases and survival. The Kaplan-Meier curve was applied to evaluate survival and multivariate analysis of prognostic factors for evaluation. RESULTS: There was no relationship of NK cells with the several variables studied, except to the tumor stage (p<0.02) with high concentration in more advanced stages. Survival was better (p = 0.0025) in the group of high concentration of NK. The survival analysis in advanced stage shown that the group with high concentration had higher survival (p<0.0001). In multivariate analysis, the concentration of NK cells was an independent prognostic factor (p = 0.0027, Hazard Ratio = 0343). CONCLUSIONS: The concentration of NK cells did not differ among the prognostic variables, with the exception of the staging. Patients with high concentration of NK cells showed a higher survival rate when compared to the low concentration, especially in the advanced stage.


Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Células Matadoras Naturais/patologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida
9.
J Surg Oncol ; 102(1): 54-63, 2010 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-20578079

RESUMO

OBJECTIVE: To describe the processes of care for gastric cancer in Ontario and identify areas in which care and possibly survival can be improved. SUMMARY BACKGROUND DATA: Survival in North America is poor for patients with gastric cancer, with stage-matched survival markedly worse than is seen in Asian and European series. Few Western studies have examined processes of care associated with gastric cancer. METHODS: We identified all cases of gastric cancer in Ontario, Canada from April 1, 2000 to March 31, 2005, and describe the demographics of patients, staging of the cancer, treatment, and survival. RESULTS: In this series of 3,666 patients, 81% of cases had a CT scan performed prior to resection and 90% of cases received an upper endoscopy. We found that 55% of patients were treated palliatively and only 1,645 patients underwent a curative-intent resection. Among patients who did not receive a resection over 50% of the cases appeared to have had a diagnostic laparoscopy rather than a laparotomy. Survival was related to the type of resection performed, likely reflecting the extent of disease. Higher institution volume and age were related to improved survival for curative-intent cases. CONCLUSION: In this population-based analysis, we found evidence of under-utilization of pre-operative radiology and endoscopy. Many patients were treated palliatively, reflecting presentation of the cancer at an advanced stage. For curative patients, survival was associated with age, surgical type, and resection in a higher volume institution.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Prognóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida
10.
Surg Laparosc Endosc Percutan Tech ; 16(1): 1-3, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16552369

RESUMO

Dieulafoy lesion is characterized by exteriorization of a large pulsatile arterial vessel through a minimal mucosal tear surrounded by normal mucosa, causing massive and recurrent upper digestive bleeding in previously healthy patients. More frequently presented than diagnosed, with the increase of its knowledge among endoscopists, a large number of cases are expected in the literature. Data from patients with upper gastrointestinal bleeding submitted to endoscopy at the Federal University of São Paulo, Gastrointestinal Endoscopy Unit from 1991 through 2002 were reviewed for Dieulafoy lesion. We found 15 patients with typical Dieulafoy gastric lesion. Their ages ranged from 18 to 78 years (mean age 49.9); 5 patients were female and 10 were male. Bleeding presented as hematemesis and melena in 7 cases (46.6%), hematemesis alone in 4 cases (26.6%), and melena alone in the other 4 cases (26.6%). Initial hemostatic approaches employed were: alcoholization (2 cases), epinephrine associated with alcohol injection (5 cases), sclerosis in 7 cases and surgery in 1 case. Dieulafoy lesion is a distinct nosologic entity that must be suspected in patients with massive digestive bleeding. Endoscopy became the procedure of choice for diagnosis and treatment of this disease.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Hemorragia Gastrointestinal/terapia , Gastroscopia , Úlcera Gástrica/terapia , Adolescente , Adulto , Idoso , Álcoois/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Hemorragia Gastrointestinal/etiologia , Técnicas Hemostáticas , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/administração & dosagem , Úlcera Gástrica/complicações , Vasoconstritores/administração & dosagem
11.
GED gastroenterol. endosc. dig ; 19(5): 208-210, set.-out. 2000. ilus
Artigo em Português | LILACS | ID: lil-298955

RESUMO

As neoplasias do intestino delgado são pouco frequentes; dentre elas, os leiomiomas correspodem a cerca de 15por cento. São comumente assintomáticos, sendo rara sua apresentação como hemorragia digestiva aguda recorrente. Os autores apresentam o caso de um paciente com leiomioma de jejuno manifestado por episódios de melena, cujo diagnostico foi firmado através de cirurgia


Assuntos
Adulto , Masculino , Hemorragia Gastrointestinal , Intestino Delgado , Leiomioma
12.
Acta cir. bras ; 4(3): 118-21, jul.-set. 1989.
Artigo em Português | LILACS | ID: lil-79153

RESUMO

A Isquemia Visceral Aguda é patologia rara e invariavelmente fatal (16). Foram analisados retrospectivamente 27 pacientes portadores de Abdome Agudo Vascular, nos últimos 10 anos na Disciplina de Gastroenterologia Cirúrgica da Escola Paulista de Medicina. O quadro clínico é insidioso e incaractéristico dificultando o diagnóstico, a indicaçäo da artériografia e, consequentemente, retardando a terapêutica. Artériografia é método propedêutico de valor inestimável para o diagnóstico e planejamento terapêutico da Isquemia Visceral Aguda


Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Abdome Agudo/diagnóstico , Oclusão Vascular Mesentérica/diagnóstico , Trombose/diagnóstico , Abdome Agudo/cirurgia , Angiografia , Embolia e Trombose Intracraniana/cirurgia , Artérias Mesentéricas , Oclusão Vascular Mesentérica/cirurgia , Estudos Retrospectivos
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