Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

{"title":"Histological response of gastric adenocarcinomas after chemotherapy in the Tunisian population.","authors":"Dhouha Bacha, Ines Mallek, Sarra Ben-Rejeb, Monia Attia, Lassaad Gharbi, Ahlem Lahmar, Sana Ben-Slama","doi":"10.1590/0102-67202025000032e1901","DOIUrl":"https://doi.org/10.1590/0102-67202025000032e1901","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer is the fifth most common and a leading cause of cancer death. Since 2005, perioperative chemotherapy (CT) has been the standard for non-metastatic gastric adenocarcinomas. Tumor response relies essentially on histological criteria.</p><p><strong>Aims: </strong>The aim of the study was to evaluate tumor regression grade (TRG) after neoadjuvant CT and compare the Mandard and Becker scoring systems.</p><p><strong>Methods: </strong>This 15-year retrospective study included patients with gastric adenocarcinoma treated with neoadjuvant CT and surgery. The TRG was assessed using Mandard and Becker scores, evaluated by area under the curve (AUC) for homogeneity, monotonicity, and discrimination. Tumors were staged by the American Joint Committee on Cancer and classified as the World Health Organization.</p><p><strong>Results: </strong>Forty patients (mean age 62 years; M:F ratio 2.6) were included. Tubular adenocarcinoma was the most common (48%), and 20% were stage IV. Mandard TRG1 and TRG5 each accounted for 15%, with median survivals of 48 and 30.5 months, respectively. For Becker TRG, they were 25.15 months (TRG 1), 24 months (TRG 2), and 54 months (TRG 3). The mean survival was 49.2 months for TRG1 and 39.2 months for TRG5 (Mandard), 50.3 months for TRG1 and 42.2 months for TRG3 (Becker). The positive predictive values for Mandard and Becker were 1.116 and 0.418 at 1 year and 5.719 and 1.820 at 5 years. The linearity values for Mandard and Becker were 0.6 and 0.3 at 1 year and 2.5 and 2.2 at 5 years. The AUC values at 1 year were 0.568 (Mandard), and 0.545 (Becker), and 0.606 for both at 5 years.</p><p><strong>Conclusions: </strong>TRG is an independent survival predictor in gastric cancer, with similar performance between Mandard and Becker scores. Combined with ypTNM staging, it may enhance prognostic accuracy.</p><p><strong>Background: </strong>This 15-year retrospective study compares the prognostic performance of the Mandard and Becker tumor regression grading systems in gastric adenocarcinoma.</p><p><strong>Background: </strong>Both tumor regression grade systems showed moderate and comparable predictive value for 1- and 5-year overall survival.</p><p><strong>Background: </strong>The Mandard score showed slightly better linearity and positive predictive value, but no clear superiority was observed.</p><p><strong>Background: </strong>Combining tumor regression grade classification with ypTNM staging may improve prognostic accuracy in gastric cancer patients treated with neoadjuvant chemotherapy.</p><p><strong>Central message: </strong>Gastric cancer is the 5th most common cancer globally and the 4th leading cause of cancer-related deaths. Since 2005, perioperative chemotherapy has been the standard for non-metastatic gastric adenocarcinomas. Tumor response relies essentially on histological criteria, with many scoring systems, the most used of which are Mandard and Becker, but without consensus.</p","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1901"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANGELITA HABR-GAMA. TRIBUTE TO A REMARKABLE WOMAN AND BRAZILIAN ICON OF GLOBAL COLORECTAL SURGERY. FORMER PRESIDENT OF THE BRAZILIAN COLLEGE OF DIGESTIVE SURGERY (2007-2008).","authors":"Carlos Frederico Sparapan Marques, Fabio Guilherme Campos, Carlos Walter Sobrado","doi":"10.1590/0102-67202025000031e1900","DOIUrl":"10.1590/0102-67202025000031e1900","url":null,"abstract":"","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1900"},"PeriodicalIF":1.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-assisted colonoscopy for colorectal lesion detection: a case-control study on diagnostic accuracy and histopathological agreement.","authors":"Marcio Roberto Facanali Junior, Afonso Henrique da Silva Sousa Junior, Carlos Frederico Sparapan Marques, Adriana Vaz Safatle-Ribeiro","doi":"10.1590/0102-67202025000029e1898","DOIUrl":"10.1590/0102-67202025000029e1898","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI)-assisted colonoscopy has emerged as a tool to enhance adenoma detection rates (ADRs) and improve lesion characterization. However, its performance in real-world settings, especially in developing countries, remains uncertain.</p><p><strong>Aims: </strong>The aim of this study was to evaluate the impact of AI on ADRs and its concordance with histopathological diagnosis.</p><p><strong>Methods: </strong>A matched case-control study was conducted at a colorectal cancer (CRC) referral center, including 146 patients aged 45-75 years who underwent colonoscopy for CRC screening or surveillance. Patients were allocated into two groups: AI-assisted colonoscopy (n=74) and high-definition conventional colonoscopy (n=72). The primary outcome was ADR, and the secondary outcome was the agreement between AI-based lesion characterization and histopathology. Statistical analysis was performed with a significance level of p<0.05.</p><p><strong>Results: </strong>ADR was higher in the AI group (60%) than in the control group (50%), but this difference was not statistically significant (p>0.05). AI-assisted lesion characterization showed substantial agreement with histopathology (kappa=0.692). No significant difference was found in withdrawal time (29 min vs. 27 min; p>0.05), indicating that AI did not delay the procedure.</p><p><strong>Conclusions: </strong>Although AI did not significantly increase ADR compared to conventional colonoscopy, it demonstrated strong histopathological concordance, supporting its reliability in lesion characterization. AI may reduce interobserver variability and optimize real-time decision-making, reinforcing its clinical utility in CRC screening.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1898"},"PeriodicalIF":1.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the recommendations of the II Brazilian Consensus On Gastric Cancer in clinical practice: a multicenter study of the Brazilian Gastric Cancer Association.","authors":"Marcus Fernando Kodama Pertille Ramos, Marina Alessandra Pereira, Alexandre Farias de Albuquerque, Eduardo Freitas Viana, Wilson Luiz Costa Junior, Soraya Rodrigues de Almeida Sanches, Andre Maciel Silva, Ulysses Ribeiro Junior, Andrea Pedrosa Ribeiro Alves Oliveira, Felipe Carvalho Victer, Giovanni Zenedin Targa, Paulo Pimentel Assumpção, Antonio Carlos Weston, João Paulo Ribeiro Neto, Luis Fernando Moreira, Fatima Mrue, Luiz Roberto Lopes, Paulo Kassab, João Odilo Gonçalves Pinto, Leandro Cardoso Barchi, Nora Manoukian Forones","doi":"10.1590/0102-67202025000027e1896","DOIUrl":"10.1590/0102-67202025000027e1896","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Gastric cancer (GC) remains a major global health problem. Despite a decline in its incidence, GC is still the third most lethal cancer worldwide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Multimodal treatment approaches are employed, including chemotherapy (CMT), radiotherapy (RDT), surgery, expanded criteria for endoscopic resection, and increased use of minimally invasive surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The development of clinical guidelines and consensus recommendations to update and guide healthcare professionals involved in GC treatment has gained increasing prominence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preoperative nutritional therapy, indication of D2 lymphadenectomy, and the use of minimally invasive surgery for distal EGC, was notably strong.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Greater attention is warranted regarding the broader implementation of diagnostic laparoscopy and ensuring the retrieval of an adequate number of lymph nodes during D2 lymphadenectomy to optimize staging and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The development of consensus statements and clinical guidelines supports decision-making in clinical practice. However, recommendations formulated by experts may not always reflect real-world clinical practice. In this study, 21 key statements from the 2nd Brazilian Consensus on Gastric Cancer were evaluated across multiple cancer reference centers. It was found that, in 10 of these statements, current clinical practice diverged from the consensus recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Some consensus statements may be revised in future editions to better reflect the realities of clinical practice in the national context. To enhance adherence to the recommendations, broad dissemination of the study results is essential, alongside the implementation of educational initiatives and institutional policies aimed at promoting guideline compliance. These measures may contribute to closing the gap between consensus recommendations and everyday clinical practice, ultimately improving patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The management of gastric cancer has become increasingly complex, highlighting the importance of clinical guidelines to ensure standardized care. The Second Brazilian Consensus on Gastric Cancer was developed to guide clinical practice across the country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The aim of this study was to evaluate the degree of implementation of the 2nd Brazilian Consensus recommendations in cancer reference centers in Brazil.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multicenter study involved 18 cancer centers that prospectively collected data over a one-year period. Notably, 21 key statements from the Consensus were assessed. Adherence was defined as following the recommendation in more than 80% of applicable cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 21 statements, 11 (52.4%) met the predefined adherence threshold. The selective use of","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1896"},"PeriodicalIF":1.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatoduodenectomy and surgical treatment of groove pancreatitis.","authors":"Franz Robert Apodaca-Torrez, Orlando Rondan Zotti, Marcio Apodaca-Rueda, Mariana Araújo Santos, Rogério Aoki Fuziy, Edson José Lobo","doi":"10.1590/0102-67202025000026e1895","DOIUrl":"10.1590/0102-67202025000026e1895","url":null,"abstract":"<p><strong>Background: </strong>Groove pancreatitis is an unusual form of chronic pancreatitis that can be mistaken for a pancreatic head neoplasm.</p><p><strong>Background: </strong>Once the diagnosis is confirmed, clinical management follows the standard recommendations for chronic pancreatitis.</p><p><strong>Background: </strong>Surgery is indicated when clinical treatment fails or when there is diagnostic uncertainty regarding pancreatic neoplasia.</p><p><strong>Background: </strong>Pancreatoduodenectomy is an effective treatment option when performed in high-volume referral centers.</p><p><strong>Background: </strong>Groove pancreatitis (GP) is a rare, segmental form of chronic pancreatitis that primarily affects individuals between 40 and 50 years of age. It has been referred to by various other names, such as paraduodenal pancreatitis, cystic dystrophy of heterotopic pancreas, duodenal dystrophy, duodenal pancreatic hamartoma, paraduodenal wall cyst, and myoadenomatosis. This distinct and sporadic form of pancreatitis (GP) can be classified, depending on the affected segment, into a segmental form - affecting the entire pancreatic head - and a pure form limited to the pancreaticoduodenal groove, with preservation of the remaining pancreatic parenchyma. Its true incidence, as well as its pathophysiological mechanisms, remains unknown.</p><p><strong>Background: </strong>Groove pancreatitis is a rare, segmental form of chronic pancreatitis that, in some cases, may be mistaken for pancreatic head neoplasia, with imaging modalities including endoscopic ultrasound currently playing a key role in its diagnosis. A review of the medical papers indicates that initial treatment should be multidisciplinary, similar to the management of classic chronic pancreatitis. When there is little or no response to conservative and/or endoscopic treatment, surgical intervention is indicated, and pancreatoduodenectomy is a good option, provided it is performed in centers with extensive experience in pancreatobiliary surgery.</p><p><strong>Background: </strong>Groove pancreatitis (GP) is a rare and segmental form of chronic pancreatitis that affects the pancreaticoduodenal sulcus. Its pathophysiology is still not well known, and several etiological factors have been attributed, with chronic alcohol consumption being the most common association. Its treatment still generates controversy. The initial clinical approach followed by endoscopic therapies prevails. Surgery is indicated when these treatment options fail.</p><p><strong>Aims: </strong>The aim of this study was to analyze the clinical, imaging, and surgical treatment data of a series of patients diagnosed with GP.</p><p><strong>Methods: </strong>The clinical, radiological, surgical, and postoperative follow-up data were analyzed, in addition to the histopathological results of chronic pancreatitis, in patients undergoing pancreaticoduodenectomy.</p><p><strong>Results: </strong>A total of eight patients were i","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1895"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation in patients over 70 years old.","authors":"Tércio Genzini, Marina Guitton Rodrigues, Thais Natalia de Almeida, Fernanda Ribeiro Danziere, Luiz Edmundo Pinto da Fonseca, Marcella Costa Genzini, Fernando Kruglensky Lerner, Aloysio Ikaro Martins Coelho, Keli Camila Vidal Grochoski, Marcelo Perosa","doi":"10.1590/0102-67202025000025e1894","DOIUrl":"10.1590/0102-67202025000025e1894","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) in patients aged ≥70 years is feasible with selected donors.</p><p><strong>Background: </strong>Short-term outcomes were comparable to those in younger recipients.</p><p><strong>Background: </strong>Elderly patients had higher intensive care unit (ICU) stay and transfusion needs.</p><p><strong>Background: </strong>Advanced age should not be a contraindication for LT when carefully evaluated.</p><p><strong>Background: </strong>A retrospective analysis of liver transplants was performed, comparing patients over and under 70 years of age. The elderly group was transplanted with careful donor selection and obtained results comparable to those of the younger group.</p><p><strong>Background: </strong>This study aims to show that elderly patients over 70 years of age can have good results after liver transplantation, comparable to patients under 70 years of age, with good donor selection and perhaps additional points to favor their position on the waiting list.</p><p><strong>Background: </strong>Liver transplantation (LT) is increasingly recognized as a treatment option for various diseases affecting a growing elderly population. However, its use in patients over 70 years of age remains controversial in centers with suboptimal outcomes or high waitlist mortality.</p><p><strong>Aim: </strong>The aim of this study was to evaluate the effectiveness of LT as a treatment option for elderly patients aged 70 years or older, in comparison with younger recipients.</p><p><strong>Methods: </strong>This retrospective study was conducted based on medical record data from 309 liver transplant recipients treated by the same surgical team across three hospitals - two located in São Paulo, São Paulo state (SP) and one in Rio Branco, Acre state (AC). Patients were divided into two groups for comparison: those aged up to 69 years (Group I) and those aged 70 years or older (Group II).</p><p><strong>Results: </strong>Donor characteristics were similar between the two groups, except for a higher norepinephrine dose in Group I (p<0.05). Group II showed greater transfusion requirements and longer intensive care unit (ICU) stays (p<0.05), as well as higher rates of malnutrition and comorbidities. Notably, 90-day survival was comparable between the groups.</p><p><strong>Conclusions: </strong>Patients aged 70 years or older can achieve outcomes comparable to those of younger recipients, provided they receive grafts from carefully selected donors. This population should not be excluded from transplant waitlists, and specific allocation policies or scoring adjustments should be considered to ensure equitable access.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1894"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory bowel diseases in Brazil: journey of doctors who care for patients. What is the importance?","authors":"Marcela Maria Silvino Craveiro, Lígia Yukie Sassaki, Eduardo Garcia Vilela, Rogério Saad Hossne","doi":"10.1590/0102-67202025000023e1892","DOIUrl":"https://doi.org/10.1590/0102-67202025000023e1892","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Inflammatory bowel diseases (IBDs), represented by Crohn's disease and ulcerative colitis, are conditions whose epidemiological rates are increasing worldwide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The study of IBDs and the treatment of patients with these conditions are a daily challenge for specialist doctors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Understanding the profile of the doctors who treat these patients and their difficulties during treatment is essential.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many adversities are related to health policies, such as access to medications and complementary tests, which compromises the adequate treatment of these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Inflammatory bowel diseases are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide. It is known that early diagnosis and short start of the correct indicated treatment alter the natural history of the disease, preventing complications; hence, it is necessary to know the profile of the doctors who treat these patients in Brazil and especially to understand the difficulties in care and evaluate them in relation to other variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This study showed the profile of physicians who treat inflammatory bowel disease (IBD) patients, through their registration in the Brazilian Inflammatory Bowel Disease Study Group. In addition to analyzing the physician's profile and their difficulties, the main aspects that hinder both the diagnosis and treatment of the disease, attributed to external factors, were listed. Therefore, more effective public health policies should be planned and expanded, aiming at growth and adaptation focused on IBDs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The aim of this study was to profile the doctors who treat patients with IBDs in Brazil and to understand and analyze the journey and importance of this care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a cross-sectional study that descriptively and inferentially analyzed the pre-existing database of the Brazilian Inflammatory Bowel Disease Study Group and through this observed the reality of care for Crohn's disease and ulcerative colitis, in the country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the descriptive analysis, we found results regarding the physicians' profile such as specialty, number of patients treated with these diseases and their difficulties in accessing medications, complementary exams, and multidisciplinary team. In the statistical analysis regarding the Human Development Index of the states, the significant results were related to workplace, difficulty in accessing medications, and referral to other specialists. Regarding the association of variables with medical demographics, the","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1892"},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive correction of fibrinolysis with epsilon aminocaproic acid detected by thromboelastometry during liver transplantation.","authors":"José Carlos Rodrigues Nascimento, Luiz Henrique Freitas, Daniel Vieira Pinto, Antônia Lima Souza, Cristhyane Costa Aquino, Denise Teixeira Santos, Rogean Rodrigues Nunes","doi":"10.1590/0102-67202025000022e1891","DOIUrl":"https://doi.org/10.1590/0102-67202025000022e1891","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Orthotopic liver transplantation (OLT) is a highly complex procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;OLT can be difficult to control intraoperative bleeding in patients with coagulopathies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;OLT may result in a high need for transfusion of blood products.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Epsilon aminocaproic acid (EACA) can reduce the need for transfusion of Hood products.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;EACA can be safe with regard to complications such as thrombosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A total of 105 patients were assessed for eligibility, and 55 were excluded. The remaining 50 patients were randomized, of which 24 patients were allocated to the intervention group and the other 26 to the saline placebo group. In the analysis of the fibrinolytic and hemostatic coagulation profile by rotational thromboelastometry, fibrinolysis was significantly less frequent in patients treated with epsilon aminocaproic acid (p&lt;0.001) compared to those in the placebo group during the anhepatic phase. In the other analyses using thromboelastometry assays such as extrinsic pathway thromboelastometry (EXTEM) (clotting time [CT], clot formation time, alpha angle, amplitude of clot firmness 10 min after CT [A10], and maximum clot firmness [MCF]) and fibrinogen-specific thromboelastometry (FIBTEM) (A10 and MCF), there was no significant difference nor postoperative complications in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Some studies have shown that epsilon aminocaproic acid (EACA) inhibits the binding of plasminogen to lysine residues on the surface of fibrin and prevents conversion of plasminogen to plasmin and the degradation of glycoprotein Ib receptors, thus preserving platelet function. Although EACA did not reduce blood product transfusion, the drug effectively treated all cases and was not associated with any complications of increased risk of hepatic artery and vein thrombosis or mortality within 3 months after orthotopic liver transplantation (OLT). These results support the safety of EACA as the antifibrinolytic drug of choice in OLT. However, future studies involving larger randomized clinical trials and higher doses are needed to further investigate the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Orthotopic liver transplantation (OLT) is a highly complex procedure, which can be difficult to control intraoperatively in patients with coagulopathies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The aim of this study was to evaluate the prophylactic administration of epsilon aminocaproic acid (EACA) to reduce the need for transfusion of blood products and its relevance for thrombosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients were randomized into two groups: one group received EACA (20 mg/kg/h) before surgical incision until the end of OLT and a control group received a similar volume of 0.9% saline solution. Blood was collected to analyze fibrinolysis and coagulation disorders u","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1891"},"PeriodicalIF":1.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatoduodenectomy with vascular reconstruction versus chemotherapy alone in patients with locally advanced pancreatic cancer: a systematic review.","authors":"Adriano Carneiro da Costa, Vitoria Alessandra Duarte, Fernando Santa Cruz, Mohamed Ali Chaouch, Jayant Kumar, Isabella Reccia, Álvaro Antonio Bandeira Ferraz, Nagy Habib","doi":"10.1590/0102-67202025000021e1890","DOIUrl":"10.1590/0102-67202025000021e1890","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer is still a terrifying condition that has a high mortality rate due to its rapid progression and treatment complexity. However, there is still no consensus on what the gold standard of treatment for locally advanced pancreatic cancer (LAPC) is.</p><p><strong>Aims: </strong>The aim of this study was to review the current evidence-based data on treatment strategies for LAPC, comparing pancreatoduodenectomy with vascular reconstruction (PDVR) and chemotherapy alone (CA).</p><p><strong>Methods: </strong>This systematic review was performed according to the PRISMA 2020 guidelines. Overall survival (OS) was the primary endpoint, while progression-free survival (PFS) was the secondary endpoint. The included studies were published between 2013 and 2023.</p><p><strong>Results: </strong>A total of 16 relevant papers were found in the literature search. The median PFS duration for CA varied from 3.22 to 11.7 months, whereas the median overall survival (mOS) varied from 5.95 to 23.0 months. The mOS ranged from 12.7 to 24.9 months and the median PFS time ranged from 8.5 to 22.5 months for patients submitted to neoadjuvant therapy followed by PDVR.</p><p><strong>Conclusions: </strong>LAPC presents worse outcomes when patients are submitted to CA with gemcitabine only, or when patients undergo upfront PDVR.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1890"},"PeriodicalIF":1.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Siewert II esophagogastric junction cancer: total gastrectomy or esophagectomy?","authors":"Durval Renato Wohnrath, Raphael de Oliveira E Silva, Raphael Leonardo Cunha Araujo","doi":"10.1590/0102-67202025000019e1888","DOIUrl":"10.1590/0102-67202025000019e1888","url":null,"abstract":"<p><strong>Background: </strong>The surgical approach for esophagogastric junction cancers (EJC), Siewert II, has been controversial regarding margin control, reconstruction, and lymphadenectomy extension. Therefore, predicting the need for total/subtotal esophagectomy and proximal gastrectomy (TEPG) or total gastrectomy with distal esophagectomy (TGDE) can be challenging, with each direction usually excluding the other. Historically, complication rates for TEPG are higher, affecting further systemic treatment and long-term outcomes.</p><p><strong>Aims: </strong>The aim of this study was to describe a surgical strategy for approaching tumors such as Siewert II EGJ, with the intraoperative decision to perform total gastrectomy with lymphadenectomy D2 or esophagectomy with lymphadenectomy based on intraoperative frozen sections.</p><p><strong>Methods: </strong>All patients underwent laparotomy, beginning with greater curvature detachment while preserving the right gastroepiploic, right and left gastric arteries; dissection of the esophageal hiatus for node harvesting; and transection of the distal esophagus and its frozen section. TGDE was preferred if the proximal margin of the distal esophagus was negative; TEPG and gastric tube reconstruction were performed through transhiatal access if the margin was positive.</p><p><strong>Results: </strong>Among 38 Siewert II patients, 26 (69%) underwent TGDE and 12 (31%) underwent TEPG, regardless of the trend toward higher complication rates, positive margins, and shorter overall survival in the TEPG group, no statistically significant differences were detected.</p><p><strong>Conclusions: </strong>Although no significant differences in morbidity between the two procedures were noted, type II errors could be a possible cause. This study suggests that unnecessary esophagectomies can be avoided without jeopardizing surgical or oncologic outcomes by opting for a less morbid procedure.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1888"},"PeriodicalIF":1.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}