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Gonzales BA, Diniz AL, Torres SM, Salvador de Castro Ribeiro H, Correia de Farias I, Luís de Godoy A, Coimbra FJF, Fonseca de Jesus VH. Patterns of disease relapse and posttreatment follow-up of patients with resected pancreatic adenocarcinoma: A single-center analysis. J Surg Oncol 2022; 126:708-717. [PMID: 35699399 DOI: 10.1002/jso.26985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/02/2022] [Accepted: 06/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES To describe the patterns of disease relapse and follow-up of patients with resected pancreatic adenocarcinoma. Additionally, we looked at patients' characteristics at relapse and survival. METHODS We included patients with potentially resectable pancreatic adenocarcinoma diagnosed from 2008 to 2018 who were submitted to resection with clear macroscopic margins and started posttreatment surveillance. RESULTS The study population consists of 73 patients. The median interval between imaging studies was 3.2 months during the first 2 years of follow-up and 5.1 months thereafter. Forty-eight patients (65.8%) experienced disease relapse. The most frequent single site of relapse was locoregional (N = 21; 43.8%). At relapse, 31 patients (64.6%) were symptomatic and forty-two patients (87.6%) had Eastern Cooperative Oncology Group performance status 0 or 1. Most patients were able to undergo additional anticancer therapy (N = 41; 85.4%). Patients with asymptomatic relapses experienced longer median postrelapse survival (25.4 vs. 11.3 months; p = 0.015). CONCLUSIONS A follow-up protocol that included imaging studies every 3 months in the first 2 years and every 6 months thereafter is able to diagnose disease relapse when patients have adequate performance status and are still able to undergo additional anticancer treatment.
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Affiliation(s)
- Beatriz A Gonzales
- Department of Medical Oncology, A.C. Camargo Cancer, CenterSão Paulo, São Paulo, Brazil
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A.C. Camargo Cancer, CenterSão Paulo, São Paulo, Brazil
| | - Silvio M Torres
- Department of Abdominal Surgery, A.C. Camargo Cancer, CenterSão Paulo, São Paulo, Brazil
| | | | - Igor Correia de Farias
- Department of Abdominal Surgery, A.C. Camargo Cancer, CenterSão Paulo, São Paulo, Brazil
| | - André Luís de Godoy
- Department of Abdominal Surgery, A.C. Camargo Cancer, CenterSão Paulo, São Paulo, Brazil
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, A.C. Camargo Cancer, CenterSão Paulo, São Paulo, Brazil
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Carneiro VCG, Gifoni ACLVC, Rossi BM, da Cunha Andrade CEM, de Lima FT, de Campos Reis Galvão H, da Rocha JCC, da Silva Barreto LS, Ashton‐Prolla P, Guindalini RSC, de Farias TP, Andrade WP, de Sousa Fernandes PH, Ribeiro R, Lopes A, Tsunoda AT, Azevedo BRB, Marins CAM, de Albuquerque Oliveira Uchôa DN, Dos Santos EAS, Coimbra FJF, Filho FAD, de Oliveira Lopes FC, Fernandes FG, Ritt GF, Laporte GA, Guimaraes GC, Feitosa e Castro Neto H, dos Santos JC, de Carvalho Vilela JB, Junior JGM, da Cunha JR, Milhomem LM, da Silva LM, de Freitas Maciel L, Ramalho NM, Nunes RL, de Araújo RG, de Assunção Ehrhardt R, Bocanegra RED, Junior TCS, de Oliveira VR, Surimã WS, de Melo Melquiades M, de Castro Ribeiro HS, Oliveira AF. Cancer risk‐reducing surgery: Brazilian Society of Surgical Oncology Guideline Part 2 (Gastrointestinal and thyroid). J Surg Oncol 2022; 126:20-27. [DOI: 10.1002/jso.26813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Vandré C. G. Carneiro
- Surgey, Gynecology, Oncology Instituto de Medicina Integral Professor Fernando Figueira Recife Brazil
- Department of Pelvic Surgery, Hereditary Cancer Program Hospital de Câncer de Pernambuco Recife Brazil
- Department of Oncogenetic, Oncology Oncologia D'or Rio de Janeiro Brazil
| | | | - Benedito M. Rossi
- Oncogenetic, Surgical Oncology Hospital Sírio Libanês São Paulo Brazil
| | | | - Fernanda T. de Lima
- Department of Oncogenetic Hospital Israelita Albert Einstein São Paulo Brazil
- Department of Oncogenetic UNIFESP‐EPM São Paulo Brazil
| | | | - Jose C. C. da Rocha
- Department of Oncogenetic, Abdominal Surgery A.C. Camargo Cancer São Paulo Brazil
| | | | | | | | | | - Wesley P. Andrade
- Department of Surgery Hospital Beneficência Portuguesa São Paulo Brazil
- Department of Surgery Hospital Oswaldo Cruz São Paulo Brazil
- Department of Surgery Hospital Santa Catarina São Paulo Brazil
| | | | - Reitan Ribeiro
- Department of Surgical oncology Hospital Erasto Gaertner Curitiba Brazil
| | - Andre Lopes
- Department of Surgical Oncology São Camilo Oncologia São Paulo Brazil
| | - Audrey T. Tsunoda
- Department of Surgical oncology Hospital Erasto Gaertner Curitiba Brazil
- Department of Surgery Pontifícia Universidade Católica do Paraná Curitiba Brazil
| | - Bruno R. B. Azevedo
- surgical oncology Oncoclínicas Curitiba Brazil
- Department of Surgery Pilar Hospital Curitiba Brazil
| | - Carlos A. M. Marins
- Department of Head and neck, oncological surgery INCA Rio de Janeiro Brazil
- Department of Surgery Hospital Federal dos Servidores do Estado Rio de Janeiro Brazil
| | | | | | - Felipe J. F. Coimbra
- Department of Oncogenetic, Abdominal Surgery A.C. Camargo Cancer São Paulo Brazil
| | | | | | | | | | - Gustavo A. Laporte
- Department of Surgery Santa Casa de Misericórdia de Porto Alegre Porto Alegre Brazil
| | | | | | | | | | - Jorge G. M. Junior
- Department of Surgery Santa Casa de Misericórdia de Porto Alegre Porto Alegre Brazil
- Department of Surgery Hospital Santa Rita Porto Alegre Brazil
| | | | - Leonardo M. Milhomem
- Department of Surgery Hospital das Clínicas da Universidade Federal de Goiás Goiânia Brazil
| | - Luciana M. da Silva
- Department of Pelvic Surgery, Hereditary Cancer Program Hospital de Câncer de Pernambuco Recife Brazil
| | | | - Nathalia M. Ramalho
- Surgey, Gynecology, Oncology Instituto de Medicina Integral Professor Fernando Figueira Recife Brazil
- Department of Oncogenetic, Oncology Oncologia D'or Rio de Janeiro Brazil
| | - Rafael L. Nunes
- Department of Surgery GNDI Notredame Intermédica Hospital Salvalus São Paulo Brazil
| | - Rodrigo G. de Araújo
- Department of Pelvic Surgery, Hereditary Cancer Program Hospital de Câncer de Pernambuco Recife Brazil
| | | | | | | | | | | | | | - Heber S. de Castro Ribeiro
- Department of Oncogenetic, Abdominal Surgery A.C. Camargo Cancer São Paulo Brazil
- SBCO 2021‐2023 BBSO presidente Rio de Janeiro Brazil
| | - Alexandre F. Oliveira
- Department of Surgery Universidade Federal de Juiz de Fora Juiz de Fora Brazil
- SBCO 2019‐2021 BBSO presidente Rio de Janeiro Brazil
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3
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Arra DASM, Ribeiro HSC, Henklain G, Barbosa A, Torres SM, Diniz AL, Godoy AL, Farias IC, Costa WL, Coimbra FJF. Surgery or active surveillance for pNETs < 2 cm: Preliminary results from a single center Brazilian cohort. J Surg Oncol 2022; 126:168-174. [DOI: 10.1002/jso.26931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Wilson L. Costa
- A.C. Camargo Cancer Center Sao Paulo Brazil
- Department of Medicine/Epidemiology and Population Sciencies, Baylor College of Medicine Houston Texas USA
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de Albuquerque GE, Moda BS, Serpa MS, Branco GP, Defelicibus A, Takenaka IKTM, de Amorim MG, Miola EC, Martins VCA, Torres KL, Bezerra SM, Claro LCL, Pelosof AG, Sztokfisz CZ, Abrantes LLS, Coimbra FJF, Kowalski LP, Alves FA, Zequi SC, Udekwu KI, Silva IT, Nunes DN, Bartelli TF, Dias-Neto E. Evaluation of Bacteria and Fungi DNA Abundance in Human Tissues. Genes (Basel) 2022; 13:genes13020237. [PMID: 35205282 PMCID: PMC8872151 DOI: 10.3390/genes13020237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
Whereas targeted and shotgun sequencing approaches are both powerful in allowing the study of tissue-associated microbiota, the human: microorganism abundance ratios in tissues of interest will ultimately determine the most suitable sequencing approach. In addition, it is possible that the knowledge of the relative abundance of bacteria and fungi during a treatment course or in pathological conditions can be relevant in many medical conditions. Here, we present a qPCR-targeted approach to determine the absolute and relative amounts of bacteria and fungi and demonstrate their relative DNA abundance in nine different human tissue types for a total of 87 samples. In these tissues, fungi genomes are more abundant in stool and skin samples but have much lower levels in other tissues. Bacteria genomes prevail in stool, skin, oral swabs, saliva, and gastric fluids. These findings were confirmed by shotgun sequencing for stool and gastric fluids. This approach may contribute to a more comprehensive view of the human microbiota in targeted studies for assessing the abundance levels of microorganisms during disease treatment/progression and to indicate the most informative methods for studying microbial composition (shotgun versus targeted sequencing) for various samples types.
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Affiliation(s)
- Gabriela E. de Albuquerque
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
| | - Bruno S. Moda
- Laboratory of Computational Biology and Bioinformatics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (B.S.M.); (A.D.); (I.T.S.)
| | - Marianna S. Serpa
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
| | - Gabriela P. Branco
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
| | - Alexandre Defelicibus
- Laboratory of Computational Biology and Bioinformatics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (B.S.M.); (A.D.); (I.T.S.)
| | - Isabella K. T. M. Takenaka
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
| | - Maria G. de Amorim
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
| | - Elizabeth C. Miola
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
| | - Valquiria C. A. Martins
- Department of Education and Research, Fundação Centro de Controle de Oncologia do Estado do Amazonas, Manaus 69040-010, AM, Brazil; (V.C.A.M.); (K.L.T.)
| | - Katia L. Torres
- Department of Education and Research, Fundação Centro de Controle de Oncologia do Estado do Amazonas, Manaus 69040-010, AM, Brazil; (V.C.A.M.); (K.L.T.)
| | - Stephania M. Bezerra
- Department of Pathology, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil; (S.M.B.); (L.C.L.C.)
| | - Laura C. L. Claro
- Department of Pathology, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil; (S.M.B.); (L.C.L.C.)
- Rede D’Or São Luiz S/A, Sao Paulo 04321-130, SP, Brazil
- Santa Casa de Misericórdia de São Paulo, Sao Paulo 01221-010, SP, Brazil
| | - Adriane G. Pelosof
- Endoscopy, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil; (A.G.P.); (C.Z.S.)
| | - Claudia Z. Sztokfisz
- Endoscopy, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil; (A.G.P.); (C.Z.S.)
| | - Lais L. S. Abrantes
- International Research Center, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil;
| | - Felipe J. F. Coimbra
- Director Department of Abdominal Surgery, Head Upper GI Oncology Reference Center, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil;
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil;
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 01246-903, SP, Brazil
| | - Fábio A. Alves
- Department of Stomatology, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil;
| | - Stênio C. Zequi
- Department of Urology, A.C.Camargo Cancer Center, Sao Paulo 01509-001, SP, Brazil;
- National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation, A.C.Camargo Cancer Center, São Paulo 01509-001, SP, Brazil
| | - Klas I. Udekwu
- Department of Aquatic Sciences and Assessment, Swedish University of Agriculture, P.O. Box 7050, 75007 Uppsala, Sweden;
- Department of Medical Sciences, Gastroenterology/Hepatology, Uppsala University Akademiska Sjukhuset, Ingång 40, 75185 Uppsala, Sweden
| | - Israel T. Silva
- Laboratory of Computational Biology and Bioinformatics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (B.S.M.); (A.D.); (I.T.S.)
| | - Diana N. Nunes
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
| | - Thais F. Bartelli
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
- Correspondence: (T.F.B.); (E.D.-N.)
| | - Emmanuel Dias-Neto
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, Sao Paulo 01508-010, SP, Brazil; (G.E.d.A.); (M.S.S.); (G.P.B.); (I.K.T.M.T.); (M.G.d.A.); (E.C.M.); (D.N.N.)
- Laboratório de Neurociências Alzira Denise Hertzog Silva, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-010, SP, Brazil
- Correspondence: (T.F.B.); (E.D.-N.)
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Diniz TP, da Costa WL, Gomes CC, de Jesus VHF, Felismino TC, Torres SM, Ribeiro HSC, Diniz AL, de Godoy AL, de Farias IC, Dias-Neto E, Curado MP, Coimbra FJF. Symptomatic Recurrence and Survival Outcomes After Curative Treatment of Gastric Cancer: Does Intensive Follow-up Evaluation Improve Survival? Ann Surg Oncol 2021; 29:274-284. [PMID: 34782973 DOI: 10.1245/s10434-021-10724-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intensive surveillance after treatment of gastric cancer patients with curative intent may lead to an earlier diagnosis of disease recurrence, but its impact on survival is uncertain. This study aimed to evaluate whether early diagnosis of disease recurrence among asymptomatic patients was associated with long-term survival. METHODS This retrospective study analyzed patients with stages 1 to 3C gastric adenocarcinoma treated between 1999 and 2018. All recurrence events were classified as symptomatic or asymptomatic (detected by follow-up tests), and their clinicopathologic characteristics, patterns of recurrence, and survival were analyzed. RESULTS The cohort consisted of 669 patients treated with a total gastrectomy in 48.6% and a D2-lymphadenectomy in 88.8% of the cases. Most of the tumors were pT3-4 (46.5%), with 45.5% involving lymph node metastases and 42.3% manifesting a diffuse histology. During a median follow-up period of 80.1 months (95% confidence interval [CI], 75.3-84.8 months), 166 patients had recurrences (24.8%), 65.7% of which were symptomatic. The peritoneum was the main site of recurrence (37.2%), and peritoneal recurrence was associated with worse overall survival (OS) (hazard ratio, 1.69; 95%CI, 1.2-2.37). The median disease-free, post-recurrence survival, and OS periods in the asymptomatic and symptomatic groups were respectively 13.4 versus 17.2 months (p = 0.04), 11.9 versus 4.7 months (p < 0.001), and 29.9 versus 26.4 months (p = 0.21). When OS was analyzed among the patients with non-peritoneal recurrence, no difference was observed between the two groups (31.3 vs 31.1 months; p = 0.46). CONCLUSION Early diagnosis of asymptomatic disease recurrence did not affect the OS of the gastric cancer patients treated with curative intent. The use of intensive surveillance strategies in this scenario still requires further evidence.
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Affiliation(s)
| | - Wilson L da Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.,Department of Medicine, Epidemiology, and Population Sciences, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Camila Couto Gomes
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Tiago C Felismino
- Department of Clinical Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Silvio Melo Torres
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Héber S C Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - André Luís de Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Emmanuel Dias-Neto
- Medical Genomics Laboratory, CIPE/A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Maria Paula Curado
- Cancer Epidemiology and Statistics Group, International Research Center, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
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Rocha-Filho DR, Peixoto RD, Weschenfelder RF, Rego JFM, Riechelmann R, Coutinho AK, Fernandes GS, Jacome AA, Andrade AC, Murad AM, Mello CAL, Miguel DSCG, Gomes DBD, Racy DJ, Moraes ED, Akaishi EH, Carvalho ES, Mello ES, Filho FM, Coimbra FJF, Capareli FC, Arruda FF, Vieira FMAC, Takeda FR, Cotti GCC, Pereira GLS, Paulo GA, Ribeiro HSC, Lourenco LG, Crosara M, Toneto MG, Oliveira MB, de Lourdes Oliveira M, Begnami MD, Forones NM, Yagi O, Ashton-Prolla P, Aguillar PB, Amaral PCG, Hoff PM, Araujo RLC, Di Paula Filho RP, Gansl RC, Gil RA, Pfiffer TEF, Souza T, Ribeiro U, Jesus VHF, Costa WL, Prolla G. Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of oesophageal cancer. Ecancermedicalscience 2021; 15:1195. [PMID: 33889204 PMCID: PMC8043684 DOI: 10.3332/ecancer.2021.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Duilio R Rocha-Filho
- Hospital Universitário Walter Cantídio, 60430-372 Fortaleza, Brazil
- Grupo Oncologia D’Or, 04535-110 São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Diogo B D Gomes
- Hospital Israelita Albert Einstein, 05652-900, São Paulo, Brazil
| | - Douglas J Racy
- Hospital Beneficência Portuguesa de São Paulo, 01323-001 São Paulo, Brazil
| | | | - Eduardo H Akaishi
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | - Evandro S Mello
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | - Fauze Maluf Filho
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | | | | | - Flavio R Takeda
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | - Gustavo A Paulo
- Universidade Federal de São Paulo, 04040-003 São Paulo, Brazil
| | | | | | | | | | - Marcos B Oliveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, 01238-010 São Paulo, Brazil
| | | | | | - Nora M Forones
- Universidade Federal de São Paulo, 04040-003 São Paulo, Brazil
| | - Osmar Yagi
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | | | - Paulo M Hoff
- Grupo Oncologia D’Or, 04535-110 São Paulo, Brazil
| | | | | | | | | | | | - Tulio Souza
- Hospital Aliança de Salvador, 41920-900 Salvador, Brazil
| | - Ulysses Ribeiro
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
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Baiocchi G, Aguiar S, Duprat JP, Coimbra FJF, Makdissi FB, Vartanian JG, Zequi SDC, Gross JL, Nakagawa SA, Yazbek G, Diniz TP, Gonçalves BT, Zurstrassen CE, Campos HGDA, Joaquim EHG, França E Silva IA, Kowalski LP. Early postoperative outcomes among patients with delayed surgeries after preoperative positive test for SARS-CoV-2: A case-control study from a single institution. J Surg Oncol 2021; 123:823-833. [PMID: 33428790 PMCID: PMC8014861 DOI: 10.1002/jso.26377] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022]
Abstract
Background There are limited data on surgical complications for patients that have delayed surgery after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. We aimed to analyze the surgical outcomes of patients submitted to surgery after recovery from SARS‐CoV‐2 infection. Methods Asymptomatic patients that had surgery delayed after preoperative reverse‐transcription polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 were matched in a 1:2 ratio for age, type of surgery and American Society of Anesthesiologists to patients with negative RT‐PCR for SARS‐CoV‐2. Results About 1253 patients underwent surgical procedures and were subjected to screening for SARS‐CoV‐2. Forty‐nine cases with a delayed surgery were included in the coronavirus disease (COVID) recovery (COVID‐rec) group and were matched to 98 patients included in the COVID negative (COVID‐neg) group. Overall, 22 (15%) patients had 30‐days postoperative complications, but there was no statistically difference between groups –16.3% for COVID‐rec and 14.3% for COVID‐neg, respectively (odds ratio [OR] 1.17:95% confidence interval [CI] 0.45–3.0; p = .74). Moreover, we did not find difference regarding grades more than or equal to 3 complication rates – 8.2% for COVID‐rec and 6.1% for COVID‐neg (OR 1.36:95%CI 0.36‐5.0; p = .64). There were no pulmonary complications or SARS‐CoV‐2 related infection and no deaths within the 30‐days after surgery. Conclusions Our study suggests that patients with delayed elective surgeries due to asymptomatic preoperative positive SARS‐CoV‐2 test are not at higher risk of postoperative complications.
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Affiliation(s)
- Glauco Baiocchi
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Samuel Aguiar
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Joao P Duprat
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - José G Vartanian
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - Suely A Nakagawa
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Guilherme Yazbek
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Thiago P Diniz
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | | | | | - Luiz P Kowalski
- Division of Surgery, AC Camargo Cancer Center, Sao Paulo, Brazil
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Peixoto RD, Rocha-Filho DR, Weschenfelder RF, Rego JFM, Riechelmann R, Coutinho AK, Fernandes GS, Jacome AA, Andrade AC, Murad AM, Mello CAL, Miguel DSCG, Gomes DBD, Racy DJ, Moraes ED, Akaishi EH, Carvalho ES, Mello ES, Filho FM, Coimbra FJF, Capareli FC, Arruda FF, Vieira FMAC, Takeda FR, Cotti GCC, Pereira GLS, Paulo GA, Ribeiro HSC, Lourenco LG, Crosara M, Toneto MG, Oliveira MB, de Lourdes Oliveira M, Begnami MD, Forones NM, Yagi O, Ashton-Prolla P, Aguillar PB, Amaral PCG, Hoff PM, Araujo RLC, Filho RPDP, Gansl RC, Gil RA, Pfiffer TEF, Souza T, Jr. UR, Jesus VHF, Jr WLC, Prolla G. Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of gastric cancer. Ecancermedicalscience 2020; 14:1126. [PMID: 33209117 PMCID: PMC7652540 DOI: 10.3332/ecancer.2020.1126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Diogo B D Gomes
- Hospital Israelita Albert Einstein, São Paulo. Brazil, 05652- 900
| | - Douglas J Racy
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil, 01323-001
| | | | - Eduardo H Akaishi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | - Evandro S Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | - Fauze Maluf Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | | | | | - Flavio R Takeda
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | - Gustavo A Paulo
- Universidade Federal de São Paulo, São Paulo, Brazil, 04040-003
| | | | | | | | | | - Marcos B Oliveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Sâo Paulo, Brazil, 01238-010
| | | | | | - Nora M Forones
- Universidade Federal de São Paulo, São Paulo, Brazil, 04040-003
| | - Osmar Yagi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
| | | | | | | | | | | | | | | | | | | | - Tulio Souza
- Hospital Aliança de Salvador, Salvador, Brazil, 41920-900
| | - Ulysses Ribeiro Jr.
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 01246903
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9
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Pinheiro RN, Coimbra FJF, Costa-Jr WLDA, Ribeiro HSDEC, Ribeiro R, Wainstein AJA, Laporte GA, Coelho-Jr MJP, Fernandes PHDES, Cordeiro EZ, Sarmento BJQ, Guimaraes-Filho MAC, Anghinoni M, Baiocchi G, Oliveira AF. Surgical cancer care in the COVID-19 era: front line views and consensus. ACTA ACUST UNITED AC 2020; 47:e20202601. [PMID: 32638914 DOI: 10.1590/0100-6991e-20202601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE to suggest a script for surgical oncology assistance in COVID-19 pandemic in Brazil. METHOD a narrative review and a "brainstorming" consensus were carried out after discussion with more than 350 Brazilian specialists and renowned surgeons from Portugal, France, Italy and United States of America. RESULTS consensus on testing for COVID-19: 1- All patients to be operated should be tested between 24 and 48 before the procedure; 2- The team that has contact with sick or symptomatic patients should be tested; 3 - Chest tomography was suggested to investigate pulmonary changes. Consensus on protection of care teams: 1 - Use of surgical masks inside the hospitals. Use of N95 masks for all professionals in the operating room; 2 - Selection of cases for minimally invasive surgery and maximum pneumoperitoneal aspiration before removal of the surgical specimen; 2 - Optimization of the number of people in teams, with a minimum number of professionals, reducing their occupational exposure, the consumption of protective equipment and the circulation of people in the hospital environment; 3 - Isolation of contaminated patients. Priority consensus: 1- Construction of service priorities; 2 - Interdisciplinary discussion on minimally invasive or conventional pathways. CONCLUSION the Brazilian Society of Surgical Oncology (BSSO) suggests a script for coping with oncological treatment, remembering that the impoundment in the assistance of these cases, can configure a new wave of overload in health systems.
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Affiliation(s)
| | | | | | | | - Reitan Ribeiro
- Brazilian Society of Oncological Surgery, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | - Glauco Baiocchi
- Brazilian Society of Oncological Surgery, Rio de Janeiro, RJ, Brazil
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10
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Vaz da Silva DG, Ribeiro HSC, Arra DASM, Torres SM, Diniz AL, Godoy AL, Farias IC, Costa WL, Coimbra FJF. Predictors of long-term survival in patients with hepatic resection of colorectal metastases: Analysis of a Brazilian Cancer Center Cohort. J Surg Oncol 2020; 121:893-900. [PMID: 32153041 DOI: 10.1002/jso.25893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/22/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hepatic metastases are a major cause of death in patients with colorectal cancer. A comprehensive assessment of the prognostic factors associated with long-term survival could improve patient selection for surgical approaches and decrease morbidity and futile locoregional treatments. METHODS We performed a retrospective analysis of patients who underwent hepatectomy for colorectal liver metastases at a single center from 2000 to 2012. RESULTS To identify factors associated with 5- and 10-year overall (OS) and disease-free survival (DFS), we analyzed 280 patients and 150 patients in the 5- and 10-year cohorts, respectively. Only seven relapses occurred after 5 years of follow-up, and no relapses occurred after 10 years. Multivariable analysis indicated that bilobar disease and extra-hepatic disease before hepatectomy were independent 5- and 10-year predictors of OS, and major postoperative complications predicted OS in the 5-year survival cohort only. Our analysis indicated that prognostic factors associated with DFS included some confounders and was therefore inconclusive. CONCLUSIONS Taken together, our results suggest that the predictors of 5- and 10-year OS rates of colorectal cancer patients with hepatic metastases are similar, differing only by postoperative complications that influenced exclusively 5-year survival. Since no relapse occurred 10 years after hepatic resection, oncological remission is likely.
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Affiliation(s)
| | - Heber S C Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Dante A S M Arra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Silvio M Torres
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - André L Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Igor C Farias
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Wilson L Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.,Department of Medicine, Epidemiology, and Population Sciences, Dan L Duncan Comprehensive, Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
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11
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Torres SM, Vaz da Silva DG, Ribeiro HSC, Diniz AL, Lobo MM, de Godoy AL, de Farias IC, da Costa WL, de Jesus VHF, Coimbra FJF. Short-term outcomes after vascular resection for pancreatic tumors: Lessons learned from 72 cases from a single Brazilian Cancer Center. J Surg Oncol 2019; 121:857-862. [PMID: 31808559 DOI: 10.1002/jso.25799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Pancreatic malignant tumors are resectable at diagnosis in only 15% to 20% of cases and invasion of vascular structures is commonly present. Therefore, extended resections are needed for adequate local control and negative margins. However, morbidity and mortality associated with these enlarged resections are limiting factors. The aim of this study was to correlate demographic and technical aspects that influenced early and late outcomes. MATERIALS AND METHODS Between October 2007 and May 2019, 523 pancreatic surgeries were performed, of which 72 required vascular resections. Clinical and histopathological data, surgical techniques, and perioperative parameters were analyzed in a prospectively collected database. RESULTS Of the 72 cases of vascular resection, 31 were male and 41 females with a mean age of 60.9 years (34-81). The most commonly affected vascular structure was the portal vein (in 40.3%). Free margins were obtained in 77.8% of cases. Postoperative mortality rate at 60 days was 13.9%. American Society of Anesthesiologists (ASA) and age were the most important predictors of major complications. CONCLUSION Extended resections with vascular involvement in pancreatic surgeries are feasible and safe; furthermore, patient selection plays are key. ASA and age were the most important factors in the decision-making process for extended resections.
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Affiliation(s)
- Silvio Melo Torres
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Héber S C Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Matheus Melo Lobo
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - André Luís de Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Wilson L da Costa
- Department of Medicine Epidemiology and Population Sciences, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | | | - Felipe J F Coimbra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
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12
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Coimbra FJF, de Jesus VHF, Franco CP, Calsavara VF, Ribeiro HSC, Diniz AL, de Godoy AL, de Farias IC, Riechelmann RP, Begnami MDFS, da Costa WL. Predicting overall and major postoperative morbidity in gastric cancer patients. J Surg Oncol 2019; 120:1371-1378. [PMID: 31696512 DOI: 10.1002/jso.25743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative complications after gastric cancer resection vary in different series and they might have a significant impact in long-term outcomes. Our aim was to build a prediction rule on gastric cancer patients' overall and major morbidity risks. METHODS This retrospective study included 1223 patients from a single center who were resected between 1992 and 2016. Overall and major morbidity predictors were identified through multiple logistic regression. Models' performances were assessed through discrimination, calibration, and cross-validation, and nomograms were constructed. RESULTS The mean age was 61.3-year old and the male gender was more frequent (60%). The most common comorbidities were hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD). A D2-distal gastrectomy was the most frequent procedure and 87% of all lesions were located in the middle or distal third. Age, COPD, coronary heart disease, chronic liver disease, pancreatic resection, and operative time were independent predictors of overall and major morbidity. The extent of resection and splenectomy was associated with overall events and HTN with major ones. Both models were very effective in predicting events among patients at higher risk. CONCLUSIONS The overall and major morbidity models and nomograms included clinical- and surgical-related data that were very effective in predicting events, especially for high-risk patients.
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Affiliation(s)
- Felipe J F Coimbra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | - Héber S C Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - André Luís de Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | - Wilson L da Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
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13
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Pizzi MP, Bartelli TF, Pelosof AG, Freitas HC, Begnami MD, de Abrantes LLS, Sztokfisz C, Valieris R, Knebel FH, Coelho LGV, da Costa WL, Coimbra FJF, da Silva IT, de Amorim MG, Nunes DN, Dias-Neto E. Identification of DNA mutations in gastric washes from gastric adenocarcinoma patients: Possible implications for liquid biopsies and patient follow-up. Int J Cancer 2019; 145:1090-1098. [PMID: 30779121 DOI: 10.1002/ijc.32217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/09/2019] [Accepted: 02/04/2019] [Indexed: 12/12/2022]
Abstract
Whereas cancer patients have benefited from liquid biopsies, the scenario for gastric adenocarcinoma (GAC) is still dismal. We used next-generation deep sequencing of TP53-a highly mutated and informative gene in GAC-to assess mutations in tumor biopsies, plasma (PL) and stomach fluids (gastric wash-GW). We evaluated their potential to reveal tumor-derived mutations, useful for monitoring mutational dynamics at diagnosis, progression and treatment. Exon-capture libraries were constructed from 46 patients including tumor biopsies, GW and PL pre and post-treatment (196 samples), with high vertical coverage >8,000×. At diagnosis, we detected TP53 mutations in 15/46 biopsies (32.6%), 7/46 GW- (15.2%) and 6/46 PL-samples (13%). Biopsies and GW were concordant in 38/46 cases (82.6%) for the presence/absence of mutations and, furthermore, four GW-exclusive mutations were identified, suggesting tumor heterogeneity. Considering the combined analysis of GW and PL, TP53 mutations found in biopsies were also identified in 9/15 (60%) of cases, the highest detection level reported for GAC. Our study indicates that GW could be useful to track DNA alterations, especially if anchored to a comprehensive gene-panel designed for this malignancy.
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Affiliation(s)
- Melissa Pool Pizzi
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | - Helano Carioca Freitas
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.,Department of Clinical Oncology, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | - Renan Valieris
- Laboratory of Computational Biology, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Luiz Gonzaga Vaz Coelho
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Wilson Luiz da Costa
- Department of Abdominal Surgery, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Israel Tojal da Silva
- Laboratory of Computational Biology, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Diana Noronha Nunes
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Emmanuel Dias-Neto
- Laboratory of Medical Genomics, A.C.Camargo Cancer Center, São Paulo, SP, Brazil.,Laboratory of Neurosciences Alzira Denise Hertzog Silva (LIM-27), Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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14
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Abdallah EA, Braun AC, Flores BCTCP, Senda L, Urvanegia AC, Calsavara V, Fonseca de Jesus VH, Almeida MFA, Begnami MD, Coimbra FJF, da Costa WL, Nunes DN, Dias-Neto E, Chinen LTD. The Potential Clinical Implications of Circulating Tumor Cells and Circulating Tumor Microemboli in Gastric Cancer. Oncologist 2019; 24:e854-e863. [PMID: 30846515 DOI: 10.1634/theoncologist.2018-0741] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/01/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gastric adenocarcinoma (GAC) is the third deadliest malignant neoplasm worldwide, mostly because of late disease diagnosis, low chemotherapy response rates, and an overall lack of tumor biology understanding. Therefore, tools for prognosis and prediction of treatment response are needed. Quantification of circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) and their expression of biomarkers has potential clinical relevance. Our aim was to evaluate CTCs and CTM and their expression of HER2 and plakoglobin in patients with nonmetastatic GAC, correlating the findings to clinicopathological data. MATERIALS AND METHODS CTC enrichment was performed with isolation by size of epithelial tumor cells, and the analysis was performed with immunocytochemistry and microscopy. Two collections were made: one at diagnosis (55 samples before neoadjuvant treatment) and one after surgery and before adjuvant therapy (33 samples). RESULTS A high detection rate of CTCs (90%) was observed at baseline. We evaluated HER2 expression in 45/55 biopsy samples and in 42/55 CTC samples, with an overlap of 36 subjects. Besides the good agreement observed for HER2 expression in primary tumors and paired CTCs for 36 cases (69.4%; κ = 0.272), the analysis of HER2 in CTCs showed higher positivity (43%) compared with primary tumors (11%); 3/5 patients with disease progression had HER2-negative primary tumors but HER2-positive CTCs. A significant CTC count drop in follow-up was seen for CTC-HER2-positive cases (4.45 to 1.0 CTCs per mL) compared with CTC-HER2-negative cases (2.6 to 1.0 CTCs per mL). The same was observed for CTC-plakoglobin-positive cases (2.9 to 1.25 CTCs per mL). CONCLUSION CTC analysis, including their levels, plakoglobin, and HER2 expression, appears to be a promising tool in the understanding the biology and prognosis of GAC. IMPLICATIONS FOR PRACTICE The analysis of circulating tumor cell levels from the blood of patients with gastric adenocarcinoma, before and after neoadjuvant treatment, is useful to better understand the behavior of the disease as well as the patients more likely to respond to treatment.
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Affiliation(s)
- Emne A Abdallah
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Alexcia C Braun
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Laís Senda
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Vinicius Calsavara
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | - Felipe J F Coimbra
- Department of Abdominal Surgery - Surgical Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Wilson Luiz da Costa
- Department of Abdominal Surgery - Surgical Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Diana Noronha Nunes
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Emmanuel Dias-Neto
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
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15
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Marques MC, C Ribeiro HS, Costa WL, de Jesus VHF, de Macedo MP, Diniz AL, Godoy AL, Farias IC, Aguiar S, Riechelmann RSP, S Begnami MDF, Coimbra FJF. Is primary sidedness a prognostic factor in patients with resected colon cancer liver metastases (CLM)? J Surg Oncol 2018; 117:858-863. [PMID: 29611198 DOI: 10.1002/jso.25048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent studies have suggested that sidedness of origin from colorectal adenocarcinomas is a predictor of survival, however the impact of this factor in patients with resected colon cancer liver metastases (CLM) is not clear. So, in this study, we compared clinic and pathologic characteristics and long-term survival of patients with resected CLM according to the primary tumor location. METHODS This is a retrospective analyzes of a prospective database. Patients with resected CLM from 1998 to 2012 were included. Right colon included tumors from cecum to middle transverse colon, and left colon included tumors from splenic flexure to sigmoid. RESULTS One hundred fifty-one patients were included, 27 right colon and 124 left colon. In the latter group, there were more patients with synchronous disease (67.7 × 6.2%, P = 0.026) and a higher CEA (22.0 × 11.7 ng/mL, P = 0.001). However, K-Ras mutation was more frequent in right sided tumors (75.0 × 24.1%, P = 0.001). There was no difference in long term survival in both groups in this series even when adjusted for the confounding variables. CONCLUSION Sidedness do not seem to be a predictor of long term survival in patients with resected colon cancer liver metastases.
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Affiliation(s)
- Márcio C Marques
- Abdominal Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Héber S C Ribeiro
- Abdominal Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Wílson L Costa
- Abdominal Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Mariana P de Macedo
- Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Alessandro L Diniz
- Abdominal Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - André L Godoy
- Abdominal Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Igor C Farias
- Abdominal Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Samuel Aguiar
- Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | - Felipe J F Coimbra
- Abdominal Surgery Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
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16
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Fava BEC, da Costa WL, Medeiros MLL, Sonagli M, de Castro Ribeiro HS, Diniz AL, Godoy AL, de Farias IC, de Jesus VHF, Begnami MDFS, Coimbra FJF. Neoadjuvant intraperitoneal chemotherapy followed by radical surgery and HIPEC in patients with very advanced gastric cancer and peritoneal metastases: report of an initial experience in a western single center. World J Surg Oncol 2018; 16:62. [PMID: 29566715 PMCID: PMC5863812 DOI: 10.1186/s12957-018-1363-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/09/2018] [Indexed: 12/29/2022] Open
Abstract
Background The association of preoperative systemic and intraperitoneal chemotherapy has been described in Eastern patients with very good outcomes in treatment responders. The aim of this paper is to describe the initial results of this multidisciplinary regimen in gastric cancer patients with very advanced peritoneal metastases. Case presentation We present here the first four cases who received the treatment protocol. They had a baseline PCI between 19 and 33. Two patients had received systemic chemotherapy prior to this regimen. Three of them had significant response and were taken to cytoreductive surgery, while one patient who had 12 cycles of chemotherapy previously showed signs of disease progression and subsequently died. There was no significant postoperative morbidity, and three patients remain alive, two of them with no signs of recurrence. Conclusion Systemic and intraperitoneal chemotherapy led to a marked response in peritoneal disease extent in our initial experience and allowed three of four patients with very advanced disease to be treated with cytoreductive surgery.
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Affiliation(s)
- Bianca Escorel Costa Fava
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
| | - Wilson Luiz da Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil.
| | - Maria Luiza L Medeiros
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
| | - Marina Sonagli
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
| | - Héber Salvador de Castro Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
| | - André L Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
| | - Igor C de Farias
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
| | | | | | - Felipe J F Coimbra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente, 211, Liberdade, Sao Paulo, CEP 01501-900, Brazil
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17
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Valadares LJ, Costa Junior W, Ribeiro HSC, Diniz AL, Coimbra FJF, Herman P. Resection of liver metastasis from neuroendocrine tumors: evaluation of results and prognostic factors. Rev Col Bras Cir 2017; 42:25-31. [PMID: 25992697 DOI: 10.1590/0100-69912015001006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/20/2014] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES to determine the prognostic factors that may impact on morbidity and mortality and survival of patients undergoing surgical treatment of liver metastases from neuroendocrine tumors. METHODS We studied 22 patients undergoing liver resection for metastases from neuroendocrine tumors between 1997 and 2007. Epidemiological and clinical data were correlated with morbidity and mortality and overall and disease-free survivals. RESULTS twelve patients were male and ten female, with a mean age of 48.5 years. Bilobar disease was present in 17 patients (77.3%). In ten patients (45.5%) the primary tumor originated in the pancreas, terminal ileum in eight, duodenum in two, rectum in one and jejunum in one. Complete surgical resection (R0) was achieved in 59.1% of patients. Eight patients (36.3%) developed complications in the immediate postoperative period, one of them dying from septicemia. All patients undergoing re-hepatectomy and/or two-stage hepatectomy had complications in the postoperative period. The overall survival at one and five years was 77.3% and 44.2%. The disease-free survival at five years was 13.6%. The primary pancreatic neuroendocrine tumor (p = 0.006) was associated with reduced overall survival. Patients with number of metastatic nodules < 10 (p = 0.03) and asymptomatic at diagnosis (p = 0.015) had higher disease-free survival. CONCLUSION liver metastases originating from pancreatic neuroendocrine tumors proved to be a negative prognostic factor. Symptomatic patients with multiple metastatic nodules showed a significant reduction in disease-free survival.
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Affiliation(s)
| | | | | | - Alessandro L Diniz
- Department of Abdominal Surgery, Hospital A. C. Camargo, São Paulo, Brazil
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, Hospital A. C. Camargo, São Paulo, Brazil
| | - Paulo Herman
- Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Tyng CJ, Amoedo MK, Bohrer Y, Bitencourt AGV, Barbosa PNV, Almeida MFA, Zurstrassen CE, Coimbra FJF, da Costa WL, Chojniak R. A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses. Cardiovasc Intervent Radiol 2017; 40:769-775. [PMID: 28101617 DOI: 10.1007/s00270-017-1577-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/05/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Computed tomography (CT) is commonly used to guide drainage of deep-seated abdominal fluid collections. However, in some cases, these collections seem to be inaccessible due to surrounding organs or their being in difficult locations. The aim of this study is to describe a modified Trocar technique to drain collections in difficult locations, especially those in the subphrenic space, without passing through intervening organs. MATERIALS AND METHODS This retrospective case series study describes seven inpatients who underwent CT-guided drainage using a modified Trocar technique for abscesses that are difficult to access percutaneously. All patients provided written informed consent prior to the procedure. After placement of a 12-14F catheter inside the peritoneum, the Trocar stylet was removed so that the tip of the catheter became blunt and flexible to avoid injury to organs and structures in the catheter route, and the catheter was slowly advanced towards the collection using CT guidance and tactile sensation. After reaching the target, the stylet was reintroduced to enter the abscess wall. RESULTS All procedures were performed using an anterior abdominal wall access with adequate catheter positioning and resulted in clinical status improvement in the days after the drainage. No complications related to the procedure were identified in any of the patients. CONCLUSIONS The modified Trocar technique for percutaneous CT-guided drainage of abdominal abscesses may be feasible for lesions that are difficult to access with conventional methods.
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Affiliation(s)
- Chiang J Tyng
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil.
| | - Maurício K Amoedo
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Yves Bohrer
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Almir G V Bitencourt
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Paula N V Barbosa
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Maria Fernanda A Almeida
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Charles E Zurstrassen
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Wilson L da Costa
- Department of Abdominal Surgery, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
| | - Rubens Chojniak
- Department of Imaging, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211, São Paulo, SP, 01509-010, Brazil
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Sato-Kuwabara Y, Fregnani JHTG, Jampietro J, Carvalho KC, Franco CP, da Costa WL, Coimbra FJF, Soares FA. Comparative analysis of basaloid and conventional squamous cell carcinomas of the esophagus: prognostic relevance of clinicopathological features and protein expression. Tumour Biol 2015; 37:6691-9. [PMID: 26649862 DOI: 10.1007/s13277-015-4551-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/30/2015] [Indexed: 12/01/2022] Open
Abstract
Basaloid squamous cell carcinoma (BSCC), a variant of squamous cell carcinoma (SCC), is a rare and aggressive epithelial malignancy which has been reported in only 0.1-11 % of primary esophageal carcinomas. In this study, a comparison of clinicopathological features and protein expression between esophageal BSCC (EBSCC) and conventional esophageal SCC (ESCC) cases from Brazil was performed in order to find factors that can be relevant to better characterize EBSCC. The expression of HER2, epidermal growth factor receptor (EGFR), Ki-67, and cyclins (A, B1, and D1) in 111 cases (95 ESCC and 16 EBSCC) was evaluated by immunohistochemistry using tissue microarray. When the clinicopathological data were compared, no significant difference was found between the two histological types. Although the difference is not significant (p = 0.055), the EGFR expression was more frequent in the conventional ESCC than in the EBSCC group. Our results indicate that the clinicopathological profiles of conventional ESCC and EBSCC are similar and provide no indicators for differences in prognosis between these two groups.
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Affiliation(s)
- Yukie Sato-Kuwabara
- International Research Center, A.C. Camargo Cancer Center, Rua Taguá, 440 Liberdade, São Paulo, SP, 01508-010, Brazil.
| | - José Humberto T G Fregnani
- Gynecologic Oncology Department, Fundação Pio XII, Hospital do Câncer de Barretos, Rua Antenor Duarte Villela, 1331, Barretos, SP, 14784-400, Brazil
| | - Juliano Jampietro
- International Research Center, A.C. Camargo Cancer Center, Rua Taguá, 440 Liberdade, São Paulo, SP, 01508-010, Brazil
| | - Katia Cândido Carvalho
- Obstetrics and Gynecology Department, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455, São Paulo, SP, 01246-903, Brazil
| | - Carolina Parucce Franco
- Department of Abdominal Surgery, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil
| | - Wilson Luís da Costa
- Department of Abdominal Surgery, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil
| | - Fernando Augusto Soares
- Department of Anatomic Pathology, A.C. Camargo Cancer Center, Rua Antônio Prudente, 211, 1o. andar, São Paulo, SP, 01509-010, Brazil.,Department of Stomatology, School of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227, São Paulo, SP, 05508-000, Brazil
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Coimbra FJF, da Costa WL, Ribeiro HSC, Diniz AL, de Godoy AL, de Farias IC, Filho AMC, Fanelli MF, Begnami MDFS, Soares FA. Noncurative Resection for Gastric Cancer Patients: Who Could Benefit? : Determining Prognostic Factors for Patient Selection. Ann Surg Oncol 2015; 23:1212-9. [PMID: 26542593 DOI: 10.1245/s10434-015-4945-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Resections have long been recommended for patients with incurable gastric cancer. However, high morbidity rates and more efficient chemotherapy regimens have demanded more accurate patient selection. The aim of this study was to analyze the results of gastric cancer patients treated with noncurative resection in a single cancer center. METHODS Medical charts of patients treated with a noncurative resection between January 1988 and December 2012 were analyzed. Individuals who had M1 disease were included, along with those with no metastasis but who had an R2 resection. Morbidity, mortality, and survival prognostic factors were analyzed. RESULTS In the period, 192 patients were resected, 159 with previously diagnosed metastatic disease and the other 33 having resection with macroscopic residual disease (R2). A distal gastrectomy was performed in 117 patients and a total resection in 75, with a more limited lymph node dissection in 70 % of cases. A multivisceral resection was deemed necessary in 42 individuals (21.9 %). Overall morbidity was 26.6 % and 60-day mortality was 6.8 %. Splenectomy was the only independent prognostic factor for higher morbidity. Median survival was 10 months, and younger age, distal resection, and chemotherapy were independent prognostic factors for survival. A prognostic score obtained from these factors identified a 20-month median survival in patients with these favorable characteristics. CONCLUSION Noncurative surgery may be considered in selected gastric cancer patients as long as it has low morbidity and allows the realization of chemotherapy.
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Affiliation(s)
- Felipe J F Coimbra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
| | - Wilson Luiz da Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
| | - Héber S C Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
| | - André Luís de Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
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Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, Coimbra FJF, Jarnagin WR. Gallbladder cancer: expert consensus statement. HPB (Oxford) 2015; 17:681-90. [PMID: 26172135 PMCID: PMC4527853 DOI: 10.1111/hpb.12444] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists was convened on 15 January 2014 to review current evidence on the management of gallbladder carcinoma in order to establish practice guidelines. In summary, within high incidence areas, the assessment of routine gallbladder specimens should include the microscopic evaluation of a minimum of three sections and the cystic duct margin; specimens with dysplasia or proven cancer should be extensively sampled. Provided the patient is medically fit for surgery, data support the resection of all gallbladder polyps of >1.0 cm in diameter and those with imaging evidence of vascular stalks. The minimum staging evaluation of patients with suspected or proven gallbladder cancer includes contrasted cross-sectional imaging and diagnostic laparoscopy. Adequate lymphadenectomy includes assessment of any suspicious regional nodes, evaluation of the aortocaval nodal basin, and a goal recovery of at least six nodes. Patients with confirmed metastases to N2 nodal stations do not benefit from radical resection and should receive systemic and/or palliative treatments. Primary resection of patients with early T-stage (T1b-2) disease should include en bloc resection of adjacent liver parenchyma. Patients with T1b, T2 or T3 disease that is incidentally identified in a cholecystectomy specimen should undergo re-resection unless this is contraindicated by advanced disease or poor performance status. Re-resection should include complete portal lymphadenectomy and bile duct resection only when needed to achieve a negative margin (R0) resection. Patients with preoperatively staged T3 or T4 N1 disease should be considered for clinical trials of neoadjuvant chemotherapy. Following R0 resection of T2-4 disease in N1 gallbladder cancer, patients should be considered for adjuvant systemic chemotherapy and/or chemoradiotherapy.
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Affiliation(s)
- Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA,Correspondence Thomas A. Aloia, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030, USA. Tel: + 1 713 563 0189. Fax: + 1 713 745 1921. E-mail:
| | - Nicolas Járufe
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Católica de Chile)Santiago, Chile
| | - Milind Javle
- Department of GI Medical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - Juan C Roa
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Catolica de Chile)Santiago, Chile
| | - Volkan Adsay
- Department of Pathology and Laboratory Medicine, Winship Cancer InstituteEmory University, Atlanta, GA, USA
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, AC Camargo Cancer CentreSão Paulo, Brazil
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
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Costa WL, Mantoan H, Brito RH, Ribeiro HSC, Diniz AL, Godoy AL, Farias IC, Begnami MDFS, Soares FA, Coimbra FJF. Pancreatic mucinous cystadenoma with serum CA 19-9 over 1,000,000 U/mL: a case report and review of the literature. World J Surg Oncol 2015; 13:78. [PMID: 25888888 PMCID: PMC4345029 DOI: 10.1186/s12957-015-0476-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/21/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The diagnosis of pancreatic cystic neoplasms has become more accurate recently. In some cases, however, doubt remains regarding the lesion's malignant potential. CA 19-9 has long been identified as a reliable biomarker in differentiating pancreatic benign and malignant lesions, especially in non-jaundiced patients. CASE REPORT AND DISCUSSION We report a case of a young female who presented with a mucinous lesion in the tail of the pancreas and a serum CA 19-9 over 1,000,000 U/mL. She was taken to surgery and had a distal pancreatectomy and splenectomy. Pathology reports showed only a mucinous cystadenoma. After 1 year of follow-up, her serum CA 19-9 was normal. Following that, the work-up in these lesions, the role of the biomarker in pancreatic adenocarcinoma and in the differentiation between benign and malignant lesions is discussed.
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Affiliation(s)
- Wilson L Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
| | - Henrique Mantoan
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
| | - Rafael Horácio Brito
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
| | - Héber S C Ribeiro
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
| | - Alessandro L Diniz
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
| | - André Luís Godoy
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
| | - Igor Correia Farias
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
| | | | | | - Felipe J F Coimbra
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, Rua Antonio Prudente 211, Liberdade, CEP 01501-900, São Paulo, Brazil.
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Tyng CJ, Schiavon LHO, Coimbra FJF, Barbosa PNV, Bitencourt AGV, Almeida MFA, Schiavon ACSA, Diniz AL, Guimaraes MD, Chojniak R. Modified preoperative computed tomographic-guided localization of colorectal liver metastases with metallic clips--technical note. Clin Colorectal Cancer 2015; 14:123-7. [PMID: 25600447 DOI: 10.1016/j.clcc.2014.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 11/19/2022]
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da Costa WL, Coimbra FJF, Ribeiro HSC, Diniz AL, de Godoy AL, de Farias IC, Begnami MDFS, Soares FA. Total gastrectomy for gastric cancer: an analysis of postoperative and long-term outcomes through time: results of 413 consecutive cases in a single cancer center. Ann Surg Oncol 2014; 22:750-7. [PMID: 25366586 DOI: 10.1245/s10434-014-4212-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Indexed: 01/19/2023]
Abstract
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 were classified as American Society of Anesthesiologists 2. A curative resection was performed in 336 subjects and a palliative resection was performed in 77 subjects. Overall morbidity was 37.3% and 60-day mortality was 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. In addition, a significant decrease in mortality was observed, from 13 to 4%. With a median follow-up of 74 months among living patients, median survival was 56 months, and 5-year overall survival was 49.2%. Weight loss, lymphadenectomy, tumor size, and T and N stages were prognostic factors in multivariate analysis. CONCLUSIONS Total gastrectomy is a safe and feasible treatment in experienced hands. Advances in surgical technique and perioperative care have improved outcomes through time.
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Affiliation(s)
- Wilson Luiz da Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil,
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Affiliation(s)
- Myrddin Rees
- Basingstoke and North Hampshire Foundation TrustBasingstoke, UK
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Ribeiro HSC, Costa WL, Diniz AL, Godoy AL, Herman P, Coudry RA, Begnami MDFS, Mello CAL, Silva MJB, Zurstrassen CE, Coimbra FJF. Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis. Eur J Surg Oncol 2013; 39:380-5. [PMID: 23351680 DOI: 10.1016/j.ejso.2012.12.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 11/22/2012] [Accepted: 12/07/2012] [Indexed: 12/19/2022] Open
Abstract
AIM The aim of this study was to determine the incidence and prognostic factors of postoperative liver failure in patients submitted to liver resection for colorectal metastases. METHOD Patients with CLM who underwent hepatectomy from 1998 to 2009 were included in retrospective analysis. Postoperative liver failure was defined using either the 50-50 criteria or the peak of serum bilirubin level above 7 mg/dL independently. RESULTS Two hundred and nine (209) procedures were performed in 170 patients. 120 surgeries were preceded by chemotherapy within six months. The overall morbidity rate was 53.1% and 90-day mortality was 2.3%. Postoperative liver failure occurred in 10% of all procedures, accounting for a mortality rate of 9.5% among this group of patients. In multivariate analysis, extent of liver resection, need of blood transfusion and more than eight preoperative chemotherapy cycles were independent prognostic factors of postoperative liver insufficiency. This complication was not related with the chemotherapy regimen used. CONCLUSION We conclude that postoperative liver failure has a relatively low incidence (10%) after CLM resection, but a remarkable impact on postoperative mortality rate. The amount of liver resected, the need of blood transfusion and extended preoperative chemotherapy are independent predictors of its occurrence and this knowledge can be used to prevent postoperative liver failure in a multidisciplinary approach.
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Affiliation(s)
- H S C Ribeiro
- Department of Abdominal Surgery, A.C. Camargo Cancer Hospital, Rua Antonio Prudente, 211 Liberdade, CEP 01501-900, Sao Paulo, Brazil.
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Costa WL, Coimbra FJF, Fogaroli RC, Ribeiro HSC, Diniz AL, Begnami MDFL, Mello CAL, Fanelli MF, Silva MJB, Fregnani JH, Montagnini AL. Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center. Radiat Oncol 2012; 7:169. [PMID: 23068190 PMCID: PMC3542168 DOI: 10.1186/1748-717x-7-169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 10/13/2012] [Indexed: 12/26/2022] Open
Abstract
Background Adjuvant chemoradiotherapy is part of a multimodality treatment approach in order to improve survival outcomes after surgery for gastric cancer. The aims of this study are to describe the results of gastrectomy and adjuvant chemoradiotherapy in patients treated in a single institution, and to identify prognostic factors that could determine which individuals would benefit from this treatment. Methods This retrospective study included patients with pathologically confirmed gastric adenocarcinoma who underwent surgical treatment with curative intent in a single cancer center in Brazil, between 1998 and 2008. Among 327 patients treated in this period, 142 were selected. Exclusion criteria were distant metastatic disease (M1), T1N0 tumors, different multimodality treatments and tumors of the gastric stump. Another 10 individuals were lost to follow-up and there were 3 postoperative deaths. The role of several clinical and pathological variables as prognostic factors was determined. Results D2-lymphadenectomy was performed in 90.8% of the patients, who had 5-year overall and disease-free survival of 58.9% and 55.7%. The interaction of N-category and N-ratio, extended resection and perineural invasion were independent prognostic factors for overall and disease-free survival. Adjuvant chemoradiotherapy was not associated with a significant improvement in survival. Patients with node-positive disease had improved survival with adjuvant chemoradiotherapy, especially when we grouped patients with N1 and N2 tumors and a higher N-ratio. These individuals had worse disease-free (30.3% vs. 48.9%) and overall survival (30.9% vs. 71.4%). Conclusion N-category and N-ratio interaction, perineural invasion and extended resections were prognostic factors for survival in gastric cancer patients treated with D2-lymphadenectomy, but adjuvant chemoradiotherapy was not. There may be some benefit with this treatment in patients with node-positive disease and higher N-ratio.
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Affiliation(s)
- Wilson L Costa
- Department of Abdominal Surgery, Hospital A, C, Camargo, Sao Paulo, Brazil.
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Costa WL, Coimbra FJF, Ribeiro HSC, Diniz AL, de Godoy AL, Begnami M, Silva MJB, Fanelli MF, Mello CAL. Safety and preliminary results of perioperative chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) for high-risk gastric cancer patients. World J Surg Oncol 2012; 10:195. [PMID: 22992263 PMCID: PMC3495866 DOI: 10.1186/1477-7819-10-195] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 07/16/2012] [Indexed: 02/08/2023] Open
Abstract
Background Gastric cancer relapse occurs in about 30% of the patients treated with gastrectomy and D2-lymphadenectomy, mainly as distant or peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with an improvement in survival and lower peritoneal recurrence, albeit with increased morbidity. The aim of this study is to report the preliminary results of the association of perioperative chemotherapy, radical surgery and HIPEC in high-risk gastric patients in a single institution. Methods Treatment protocol was started in 2007 and included patients younger than 65 years old, with good performance status and gastric adenocarcinoma with serosa involvement and lymph node metastases, located in the body or antrum. Patients should receive three preoperative cycles of DCF (Docetaxel 75 mg/m2, Cisplatin 75 mg/m2 and continuous intravenous infusion of 5-Fluorouracil 750 mg/m2 for 5 days), followed by gastric resection with D2-lymphadenectomy, hyperthermic intraperitoneal chemotherapy with Mytomicin C 34 mg/m2 and three more postoperative cycles of DCF. Results Ten patients were included between 2007 and 2011. Their median age was 47 years old and six were male. Nine were staged with cT4 cN + tumors and one as cT3 cN+. Nine patients completed all three preoperative chemotherapy cycles. Eight individuals were treated with a total gastrectomy and the other two had a distal gastrectomy, all having HIPEC. Postoperative morbidity was 50%, with no deaths. Regarding postoperative chemotherapy, only 5 patients completed three cycles. With a median follow-up of 25 months, three relapses were identified and 7 patients remain disease-free, two with more than 4 years of follow-up. Conclusion The association of perioperative systemic and intraperitoneal chemotherapy plus radical surgery is a feasible multimodality treatment, with acceptable morbidity. With a longer follow-up and a larger group of patients, we hope to be able to determine if it also influences survival outcomes and patterns of recurrence. Mini-Abstract The association of perioperative chemotherapy, gastric resection and D2-lymphadenectomy and hyperthermic intraperitoneal chemotherapy proved to be associated with acceptable morbidity. For survival analysis, a longer follow-up is needed.
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Affiliation(s)
- Wilson L Costa
- Department of Abdominal Surgery, Hospital A, C, Camargo, Sao Paulo, Brazil.
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Coimbra FJF, Diniz AL, Ribeiro HS, Costa WL, Lima ENP, Montagnini AL. Ileal loop interposition: an alternative biliary bypass technique. Hepatobiliary Pancreat Dis Int 2010; 9:654-7. [PMID: 21134838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obstructive jaundice is a common condition in advanced digestive cancer. Palliative procedures can improve quality of life and allow patients to attempt a systemic treatment. Bilioenteric anastomosis is still the procedure of choice for patients in many centers. When a surgical bypass is not possible, biliary drainage can be done by placing endoscopic or transparietal stents, which are less durable methods even when an expandable stent is employed. METHODS A 47-year-old male with an excellent clinical status and a previous cholecystectomy and an exploratory laparotomy for advanced gastric cancer was referred with obstructive jaundice. A preoperative CT scan showed a dilated bile duct and a small mass at the distal hepatic hilum. No other signs of metastasis were found. A surgical bilioenteric anastomosis was indicated. At surgery, a distal choledochal obstruction and a mesenteric retraction by a lymph node mass prevented the jejunum to ascend for a bilioenteric anastomosis. Surgically, an alternative bilioenteric bypass was performed by means of an ileal loop interposition between the bile duct and the jejunum. RESULT The recovery of the patient was uneventful and his bilirubin levels normalized after one week. The patient was then referred for systemic chemotherapy. CONCLUSIONS This alternative biliary bypass can be safely and easily performed, and may be a good alternative for patients already referred for surgery because of a better life expectancy and when the jejunum is not an alternative.
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Affiliation(s)
- Felipe J F Coimbra
- Abdominal Surgery Department, Hospital do Cancer AC Camargo, Rua Professor Antonio Prudente 211, Liberdade, Sao Paulo, Brazil.
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Coimbra FJF, Costa WL, Montagnini AL, Diniz AL, Ribeiro HSC, Silva MJB, Begnami MFS. The interaction between N-category and N-ratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil. Eur J Surg Oncol 2010; 37:47-54. [PMID: 21115234 DOI: 10.1016/j.ejso.2010.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 10/22/2010] [Accepted: 11/01/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depth of tumor invasion (T-category) and the number of metastatic lymph nodes (N-category) are the most important prognostic factors in patients with gastric cancer. Recently, the ratio between metastatic and dissected lymph nodes (N-ratio) has been established as one. The aim of this study is to evaluate the impact of N-ratio and its interaction with N-category as a prognostic factor in gastric cancer. METHODS This was a retrospective study in which we reviewed clinical and pathological data of 165 patients who had undergone curative surgery at our institution through a 9-year period. The exclusion criteria included metastases, gastric stump tumors and gastrectomy with less than 15 lymph nodes dissected. RESULTS The median age of the patients was 63 years and most of them were male. Total gastrectomy was the most common procedure and 92.1% of the patients had a D2-lymphadenectomy. Their 5-year overall survival was 57.7%. T-category, N-category, extended gastrectomy, and N-ratio were prognostic factors in overall and disease-free survival in accordance with univariate analysis. In accordance with TNM staging, N1 patients who have had NR1 had 5-year survival in 75.5% whereas in the NR2 group only 33% of the cases had 5-year survival. In the multivariate analysis, the interaction between N-category and N-ratio was an independent prognostic factor. CONCLUSION Our findings confirmed the role of N-ratio as prognostic factor of survival in patients with gastric cancer surgically treated with at least 15 lymph nodes dissected. The relationship between N-category and N-ratio is a better predictor than lymph node metastasis staging.
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Affiliation(s)
- F J F Coimbra
- Department of Abdominal Surgery, Hospital A. C. Camargo, Rua Antonio Prudente, 211 Liberdade, Sao Paulo, Brazil.
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Sallum RAA, Coimbra FJF, Herman P, Montagnini AL, Machado MAC. Modified pharyngogastrostomy by a stapler technique. Eur J Surg Oncol 2006; 32:540-3. [PMID: 16731315 DOI: 10.1016/j.ejso.2006.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Accepted: 02/27/2006] [Indexed: 11/22/2022] Open
Abstract
Pharyngolaryngoesophagectomy is the gold standard treatment for the majority of larynx, pharynx and cervical esophagus advanced tumours. Reconstruction of these pharyngoesophageal defects is complex, and implicates additional time, morbity and mortality to the procedure. Gastric pull up and pharyngogastrostomy with hand sewing technique is the commonest way of doing it. The authors describe a modified technique to execute it using a stapler device.
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Affiliation(s)
- R A A Sallum
- Head of the Esophagus Section of the Abdominal Surgery Department of Hospital do Câncer A C Camargo, São Paulo, Brazil
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Duprat JP, Silva DCP, Coimbra FJF, Lima IAM, Lima ENP, Almeida OM, Brechtbühl ER, Landman G, Scramim AP, Neves RI. Sentinel Lymph Node Biopsy in Cutaneous Melanoma: Analysis of 240 Consecutive Cases. Plast Reconstr Surg 2005; 115:1944-51; discussion 1952-3. [PMID: 15923841 DOI: 10.1097/01.prs.0000165279.99067.79] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to evaluate practical rules for sentinel lymph node biopsy for melanoma and discuss the indications and outcomes of 240 patients. METHODS A prospective, nonrandomized analysis was performed on 240 patients in a referral cancer center. The median patient age was 51 years, and the median Breslow thickness was 1.60 mm. Ulceration was found in 30.4 percent of the cases. The median follow-up was 27.81 months. The sentinel lymph node biopsy was performed in 240 patients with cutaneous melanoma thicker or equal to 1 mm. The operation was performed with preoperative lymphoscintigraphy and postoperative immunohistochemistry. A statistical analysis was performed comparing the need for a gamma probe in each location, the value of the experience, the need for immunohistochemistry, positivity compared with Breslow thickness, reasons for the success of the lymph node localization, and evolution. RESULTS A total of 263 lymph node basins were identified (160 in the axilla, 86 in the inguinal region, and 17 in less common locations, including the popliteal, epitrochlear, and cervical regions). In every lymph node basin, the success of localization was directly related to use of the probe. The success rate for finding the sentinel lymph node increased year by year. Lymph node analysis disclosed positivity of 12.5 percent with hematoxylin and eosin staining and 17.5 percent with immunohistochemistry (excluding the sentinel lymph node not found disclosed 13.2 percent with hematoxylin and eosin and 18.5 percent with HMB45). Immunohistochemistry increased positivity by 40 percent. Positivity was directly related to Breslow thickness (p < 0.001). CONCLUSIONS This study shows the importance of the gamma probe in all lymph node basins but mainly in the axilla and unusual basins, as well as the importance of experience and immunohistochemistry. As a new procedure, it was possible to recognize the pattern of recurrence in the follow-up.
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Affiliation(s)
- João P Duprat
- Department of Cutaneous Oncology, Center for Treatment and Research, Hospital do Câncer A. C. Camargo, São Paulo, Brazil.
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