Treatment of esophageal cancer: surgical outcomes of 335 cases operated in a single center.

OBJECTIVES: the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. METHODS: this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p<0.05 was considered statistically significant. RESULTS: a total of 335 patients underwent esophagectomy or esophagogastrectomy. When the clinical characteristics of the 3 groups were compared, there was no statistically significant difference. Neoadjuvance was significantly higher in Period 3 (55.4% of patients). We found a histological change in the diagnosis over time, with a significant increase in adenocarcinoma. Morbidity and mortality rates were higher in Period 3. The main complications were pulmonary and anastomotic fistulas. Overall survival in 5 years increased over time, reaching 59.7% in Period 3. CONCLUSIONS: better neoadjuvant treatment contributed to increase the global survival of patients, despite greater rate of immediate complications to surgery.

A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults.

BACKGROUND: Although coronavirus disease 2019 (COVID-19) disproportionally affects older adults, the use of conventional triage tools in acute care settings ignores the key aspects of vulnerability. OBJECTIVE: This study aimed to determine the usefulness of adding a rapid vulnerability screening to an illness acuity tool to predict mortality in hospitalised COVID-19 patients. DESIGN: Cohort study. SETTING: Large university hospital dedicated to providing COVID-19 care. PARTICIPANTS: Participants included are 1,428 consecutive inpatients aged ≥50 years. METHODS: Vulnerability was assessed using the modified version of PRO-AGE score (0-7; higher = worse), a validated and easy-to-administer tool that rates physical impairment, recent hospitalisation, acute mental change, weight loss and fatigue. The baseline covariates included age, sex, Charlson comorbidity score and the National Early Warning Score (NEWS), a well-known illness acuity tool. Our outcome was time-to-death within 60 days of admission. RESULTS: The patients had a median age of 66 years, and 58% were male. The incidence of 60-day mortality ranged from 22% to 69% across the quartiles of modified PRO-AGE. In adjusted analysis, compared with modified PRO-AGE scores 0-1 ('lowest quartile'), the hazard ratios (95% confidence interval) for 60-day mortality for modified PRO-AGE scores 2-3, 4 and 5-7 were 1.4 (1.1-1.9), 2.0 (1.5-2.7) and 2.8 (2.1-3.8), respectively. The modified PRO-AGE predicted different mortality risk levels within each stratum of NEWS and improved the discrimination of mortality prediction models. CONCLUSIONS: Adding vulnerability to illness acuity improved accuracy of predicting mortality in hospitalised COVID-19 patients. Combining tools such as PRO-AGE and NEWS may help stratify the risk of mortality from COVID-19.

Treatment of esophageal cancer: surgical outcomes of 335 cases operated in a single center / Tratamento do câncer de esôfago: resultados cirúrgicos de 335 casos operados em um único centro

ABSTRACT Objectives: the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. Methods: this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p<0.05 was considered statistically significant. Results: a total of 335 patients underwent esophagectomy or esophagogastrectomy. When the clinical characteristics of the 3 groups were compared, there was no statistically significant difference. Neoadjuvance was significantly higher in Period 3 (55.4% of patients). We found a histological change in the diagnosis over time, with a significant increase in adenocarcinoma. Morbidity and mortality rates were higher in Period 3. The main complications were pulmonary and anastomotic fistulas. Overall survival in 5 years increased over time, reaching 59.7% in Period 3. Conclusions: better neoadjuvant treatment contributed to increase the global survival of patients, despite greater rate of immediate complications to surgery.

RESUMO Objetivo: A abordagem cirúrgica persiste como tratamento principal para o câncer de esôfago. O presente estudo compara as casuísticas da mesma instituição ao longo do tempo, em três momentos diferentes. Métodos: Estudo descritivo retrospectivo comparativo observacional dos resultados cirúrgicos obtidos pelo Serviço de Cirurgia Oncológica do Hospital Erasto Gaertner. A amostra foi dividida em: Período 1 (1987-1997), Período 2 (1998-2003) e Período 3 (2007-2015). Taxas de sobrevida e sobrevida livre de doença foram estimadas pelo método de Kaplan-Maier. Preditores de sobrevida foram identificados com regressão de Cox. Para a comparação entre os grupos foi utilizado teste ANOVA. Os dados foram analisados com os programas SPSS 25.0 e STATA 16, sendo p<0,05 considerado estatisticamente significativo. Resultados: Ao todo, 335 doentes foram submetidos a esofagectomia ou esofagogastrectomia. Quando comparadas as características clínicas dos 3 grupos não houve diferença estatística significativa. A realização de neoadjuvância foi significativamente maior no Período 3 (55,4% dos pacientes). Verificamos uma mudança histológica do diagnóstico no decorrer do tempo, com um aumento significativo do adenocarcinoma. As taxas de morbimortalidade foram superiores no Período 3. As principais complicações foram pulmonares e de fistulas anastomóticas. A sobrevida global em 5 anos foi aumentando no decorrer do tempo, atingindo 59,7% no Período 3. Conclusões: Melhor tratamento neoadjuvante contribuiu para aumentar a sobrevida global dos pacientes, apesar de maior incidência de complicações imediatas à cirurgia.