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

{"title":"Prognostic and predictive value of AXL and C-MET in patients with rectal cancer.","authors":"Carmen Austrália Paredes Marcondes Ribas, Efstathia N Doelken, Sudipta Tripathi, Bülent Polat, Reinhard Lissner, Thomas Böeldicke, Jurandir Marcondes Ribas-Filho, Osvaldo Malafaia, Martin Gasser, Ana Maria Waaga-Gasser","doi":"10.1590/0102-67202025000049e1918","DOIUrl":"10.1590/0102-67202025000049e1918","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer remains a significant clinical challenge with demand for conclusive biomarkers, essential in prognostication and therapy monitoring of neoadjuvant and adjuvant treatment strategies.</p><p><strong>Aims: </strong>The aim of the study was to evaluate AXL and cellular mesenchymal-epithelial transition factor (C-MET) biomarkers for cancer stem cells and to correlate them with clinicopathological characteristics and patient outcome data with respect to neoadjuvant chemoradiotherapy.</p><p><strong>Methods: </strong>Serum levels of soluble surface markers AXL and C-MET were retrospectively analyzed in 164 rectal cancer patients with additional immunofluorescent analyses of their primary tumor tissues.</p><p><strong>Results: </strong>Kaplan-Meier analysis confirmed the prognostic significance of Union for International Cancer Control stages, but with no significant correlation between investigated markers with patient age, gender, or tumor stage. In contrast, tumor tissues demonstrated stage-dependently increased marker expression. While AXL was detected at low levels, C-MET exhibited a bimodal distribution, with elevated levels seen in most patients, particularly post-neoadjuvant therapy and non-significantly in the subgroup with poorer response to neoadjuvant therapy (p=0.074).</p><p><strong>Conclusions: </strong>AXL serum levels in the rectal cancer cohort were significantly different from healthy subjects but did not correlate with tumor stage or survival during and after neoadjuvant/adjuvant therapy. Soluble C-MET levels in the blood, influenced by neoadjuvant chemoradiotherapy, may serve as a predictive marker for treatment response.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1918"},"PeriodicalIF":1.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12815463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013548","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":"Validity of scoring system for palliative care in oncology: CODETM - \"Care of the dying evaluation\". Is it important in assessing the end-of-life process?","authors":"Thayssa de Morais Oliveira, Juliana Nalin Passarini, Dagny Faksvåg Haugen, Catriona Rachel Mayland, Luiz Roberto Lopes","doi":"10.1590/0102-67202025000046e1915","DOIUrl":"10.1590/0102-67202025000046e1915","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced cancer experience a range of distressing symptoms. Palliative care (PC) emerges as an essential area to be implemented by health systems in the care of patients with irreversible diseases and beyond therapeutic possibilities.</p><p><strong>Aims: </strong>To compare the perception of caregivers of patients in palliative care offered by two public hospitals using the CODETM questionnaire; to determine the score obtained by the questionnaire and its usefulness in the evaluation of the palliative care offered.</p><p><strong>Methods: </strong>The post-death questionnaire \"Care of the Dying Evaluation\" (CODETM) was applied to the family members who accompanied the patients in the last days, assessing the perception of the quality of care provided to the patient and the level of support to the family.</p><p><strong>Results: </strong>No statistical difference in demographics. Participants who received palliative care had higher scores in the score, as well as in the ward and ICU unit compared to the emergency unit. The predictive cut-off value for adequate palliative care practice was 97 points, corresponding to 78.6% of the score.</p><p><strong>Conclusions: </strong>There was no statistical difference between the caregivers' perception of the care offered to patients between the two hospitals, being worse in the emergency unit. The cut-off value was 78.6% and was considered adequate and the CODETM questionnaire was a useful tool in the evaluation of palliative care offered by hospitals to patients and can be applied to propose improvements in palliative care. Therefore, there is a need for an instrument that can constantly classify and qualify the care provided to patients and their families in order to offer dignified, comprehensive and humanized care, as proposed by the CODETM questionnaire.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1915"},"PeriodicalIF":1.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985928","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":"Weight loss and self-perceived quality of life following laparoscopic Roux-en-Y gastric bypass: is it important?","authors":"Gustavo Rodrigues Alves Castro, Laís Ducatti Macedo, João Victor Vecchi Ferri, Isabella Benitez Vulcanis, Diancarlos Pereira de Andrade, José Alfredo Sadowski, Eduardo Lemos de Souza Bastos, João Caetano Dallegrave Marchesini","doi":"10.1590/0102-67202025000047e1916","DOIUrl":"10.1590/0102-67202025000047e1916","url":null,"abstract":"<p><strong>Background: </strong>Weight loss (WL) is the most commonly used datum to measure the results of metabolic and bariatric surgery. The amount of WL is generally directly and proportionally associated with the improvement in quality of life (QoL), as the greater the former, the greater the perception of well-being.</p><p><strong>Aims: </strong>To assess the relationship between the amount of weight lost after laparoscopic Roux-en-Y gastric bypass (LRYGB) and self-perceived improvement in quality of life (QoL).</p><p><strong>Methods: </strong>The medical records of patients who underwent LRYGB between January 2017 and December 2019 with a minimum follow-up of 3 years were analyzed. The data obtained in the subgroups made up according to percentage of total weight loss (%TWL), age, and time elapsed since surgery were compared with the self-perceived QoL by the Short Form Survey 36 (SF-36) questionnaire.</p><p><strong>Results: </strong>A total of 95 individuals (71.6% women) with an average age of 45 years and an average postoperative (PO) follow-up of 61.1 months were enrolled. The mean pre- and postoperative weight was 114 kg and 73.4 kg, respectively, and the mean %TWL was 35.6%. According to the comparison between the data from the medical records and the self-perceived QoL assessment, D1 (physical functioning) was the best scoring domain, while D3 (pain) was the worst. There was a significant improvement of the D4 (general health) domain in patients with %TWL greater than 30% (p<0.05), D7 (role emotional), and D8 (mental health) domains in patients older than 45 years (p<0.05) and better results in D7 (role emotional) domain in patients over 5 years after surgery (p<0.05).</p><p><strong>Conclusions: </strong>Greater weight loss and age and longer time after surgery showed important self-perceived improvement in QoL after LRYGB in some assessment domains, both physical and emotional.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1916"},"PeriodicalIF":1.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985986","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":"Preoperative glycemic response to a very low-calorie diet predicts long-term type 2 diabetes remission after bariatric surgery.","authors":"Mariana Fior Frias Thomaz Bortolan, Roberto DE Cleva, Leandro Ferreira, Denis Pajecki, Marco Aurelio Santo","doi":"10.1590/0102-67202025000050e1919","DOIUrl":"10.1590/0102-67202025000050e1919","url":null,"abstract":"<p><strong>Background: </strong>Obesity and type 2 diabetes mellitus are highly prevalent conditions with a significant public health impact, highlighting the need for effective management strategies. Bariatric surgery is widely recognized for promoting sustained weight loss and high rates of type 2 diabetes mellitus remission.</p><p><strong>Aims: </strong>This study investigated the preoperative blood glucose response to a very low-calorie diet as a functional predictor of type 2 diabetes mellitus remission following Roux-en-Y gastric bypass.</p><p><strong>Methods: </strong>198 participants who followed a very low-calorie diet (600 kcal/day) during the preoperative period were included, with glycemic response monitoring.</p><p><strong>Results: </strong>Complete remission of type 2 diabetes mellitus occurred in 66.7% of patients. Two years after surgery, patients with blood glucose levels below 143 mg/dL on the second day of the very low-calorie diet had a higher likelihood (over 70%) of achieving complete remission type 2 diabetes mellitus in the late postoperative period.</p><p><strong>Conclusions: </strong>Preoperative capillary blood glucose levels demonstrated good specificity in predicting remissions. These findings reinforce the clinical utility of early glycemic control as a valuable indicator for predicting the success of surgical treatment for type 2 diabetes mellitus.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1919"},"PeriodicalIF":1.8,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795418","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":"Tumor budding in gastric adenocarcinoma: prognostic value and association with clinicopathological markers.","authors":"Dhouha Bacha, Neirouz Kammoun, Bilel Troudi, Monia Attia, Ahlem Lahmar-Boufaroua, Sana Ben-Slama","doi":"10.1590/0102-67202025000048e1917","DOIUrl":"10.1590/0102-67202025000048e1917","url":null,"abstract":"<p><strong>Background: </strong>The analysis of tumor budding (TB) and its prognostic value in gastric adenocarcinoma (GA) has been the focus of several studies, with inconsistent results. This parameter is not included in gastric prognostic classifications or standardized pathological reports.</p><p><strong>Aims: </strong>To evaluate TB in GA and its prognostic significance through survival analysis, in addition to investigating the association between TB and clinicopathological markers that are considered prognostic factors for this type of cancer.</p><p><strong>Methods: </strong>This retrospective study covers a period of ten years, from January 2008 to December 2017. It included patients who underwent surgery for GA. TB evaluation followed the 2016 consensus guidelines for colorectal cancer, with three grades: Bd1 (0-4 buds), Bd2 (5-9 buds), and Bd3 (10 or more buds). Additionally, a two-grade classification system was employed, distinguishing between low-grade budding (fewer than 10 buds) and high-grade budding (10 or more buds).</p><p><strong>Results: </strong>TB was classified as low-grade in 69% of the cases and high-grade in 31%. High-grade TB was significantly correlated with perineural invasion (HR [hazard ratio]: 2.98, 95%CI [95% confidence interval] 1.04-8.53, p=0.004), stages III and IV (HR 4.04, 95%CI 1.27-12.83, p=0.01), and mortality (HR 3.65, 95%CI 1.24-10.74, p=0.02). It was an independent prognostic factor for recurrence-free survival (RFS) (p=0.005, p<0.05).</p><p><strong>Conclusions: </strong>We have demonstrated that TB prognostic and predictive value in GA is significant, particularly regarding patient survival.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1917"},"PeriodicalIF":1.8,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795458","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":"Predictive factors for histological response to neoadjuvant therapy in gastric adenocarcinomas.","authors":"Dhouha Bacha, Nour Boudrigua, Ines Mallek, Safé Chammem, Monia Attia, Lassaad Gharbi, Ahlem Lahmar, Sana Ben-Slama","doi":"10.1590/0102-67202025000043e1912","DOIUrl":"10.1590/0102-67202025000043e1912","url":null,"abstract":"<p><strong>Background: </strong>Perioperative chemotherapy is the standard curative treatment for resectable gastric adenocarcinoma, significantly improving both overall and recurrence-free survival. The histological response to neoadjuvant therapy is a critical prognostic factor, commonly assessed through grading systems such as Mandard's tumor regression grade (TRG).</p><p><strong>Aims: </strong>The aim of the study was to identify predictive factors for histological response to neoadjuvant therapy in gastric adenocarcinoma.</p><p><strong>Methods: </strong>A retrospective study was performed on patients with gastric adenocarcinoma who underwent surgery following neoadjuvant chemotherapy, from 2015 to 2020. The histological response was evaluated using Mandard TRG, which includes five grades (1-5), based on the proportion of residual viable tumor cells and fibrosis. Grades 1-3 were considered a response, and Grades 4 and 5 were considered no response. Students' t-test, chi-squared test, and multivariate logistic regression were used, with significance set at p<0.05.</p><p><strong>Results: </strong>Forty patients were included (male-to-female ratio 2.64, mean age 63 years). Histological response (TRG 1-3) was observed in 48%, while 52% showed no response (TRG 4-5). Univariate analysis showed significant correlations between histological response and tumor size >38 mm (p=0.03), differentiation (p=0.02), parietal wall invasion, absence of nodal involvement (both p<0.001), pathological tumor, node, and metastasis stage (p<0.001), and absence of vascular and perineural invasion (both p=0.001). Multivariate analysis identified parietal wall invasion (odds ratio=2.351, p=0.022) and absence of lymph node metastases (odds ratio=1.491, p=0.01) as independent predictive factors.</p><p><strong>Conclusions: </strong>Parietal wall invasion and absence of nodal metastases are predictive of histological response to neoadjuvant therapy in gastric adenocarcinoma.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1912"},"PeriodicalIF":1.8,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795467","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":"Standardized approach to small bowel bleeding in a hierarchical healthcare network with varying levels of complexity.","authors":"Rafael Pasqualini de Carvalho, Giovanna Gama-Cunha, Edson Zangiacomi Martinez, José Sebastião Dos Santos","doi":"10.1590/0102-67202025000040e1909","DOIUrl":"10.1590/0102-67202025000040e1909","url":null,"abstract":"<p><strong>Background: </strong>The systematized approach to patients with small bowel bleeding (SBB) can reduce risks and costs for both patients and the Unified Health System (SUS).</p><p><strong>Aim: </strong>Evaluate the evolution of the systematized approach to SBB in a regulated, hierarchically organized healthcare network of varying complexity.</p><p><strong>Methods: </strong>Analysis of the medical records of patients with SBB treated at a tertiary, public, and teaching hospital in two distinct periods: before the implementation of a specialized service and algorithm for SBB (2001-2014, group without algorithm-GSA) and after the establishment of a trained, dedicated team, availability of capsule endoscopy and enteroscopy (2015-2023, group with algorithm-GCA). Demographic, clinical, and care-related data from 184 patient records were collected and entered into the REDCap platform. Additionally, a cost analysis was conducted.</p><p><strong>Results: </strong>Among the 184 patients, 82 (45%) were in the GSA group and 102 (55%) in the GCA group. The average number of specific exams per patient was 7.19 in GSA and 6.37 in GCA (p=0.02, p<0.05). Blood transfusions were performed in 64 patients (78.05%) in GSA and 68 patients (66.67%) in GCA (p=0.05). The average time to reach diagnosis was 309.9 weeks in GSA and 75.37 weeks in GCA (p<0.01). The average hospital stay was 7.57 weeks in GSA and 2.55 weeks in GCA (p<0.01). In GSA, 19 patients (23.2%) died due to SBB, while in GCA only six did (5.9%) (p=0.001, p<0.05). The average cost was higher compared to GCA (p<0.01).</p><p><strong>Conclusions: </strong>The results of organizing a reference service for SBB care support are sufficient to subsidize the planning of services and regional healthcare networks.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1909"},"PeriodicalIF":1.8,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12695083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727530","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":"Gastric sleeve and gastric bypass: changes in weight after two-year follow-up - which is more effective?","authors":"Alexandra Rabello Freire, Flávio Kreimer, Denise Sandrelly Cavalcanti de Lima, Cinthia Katiane Martins Calado, Silvia Alves da Silva, Maria Goretti Pessoa de Araújo Burgos","doi":"10.1590/0102-67202025000045e1914","DOIUrl":"10.1590/0102-67202025000045e1914","url":null,"abstract":"<p><strong>Background: </strong>Bariatric surgery is currently the gold standard for the treatment of obesity. However, weight recurrence varies among the different surgical methods.</p><p><strong>Aims: </strong>To compare changes in weight one and two years after bariatric surgery considering the gastric bypass and gastric sleeve methods.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at a hospital with adults of both sexes followed up for two years after surgery. Anthropometric, sociodemographic, clinical, and lifestyle characteristics were analyzed.</p><p><strong>Results: </strong>A total of 184 patients, predominantly women (82.1%), were assessed (136 submitted to gastric sleeve and 48 to gastric bypass). Good adherence to the multivitamin, but not to diet or physical activity, was verified in both groups. The percentages of weight loss and excess weight loss were higher in the gastric bypass group (one year after surgery: p<0.001 and p=0.010, respectively; two years after surgery: p<0.001 and p<0.001, respectively). Average weight gain was 2.37 kg and higher after gastric sleeve (p=0.042), whereas no difference between methods was found for the percentage of weight recurrence. Weight loss and recurrence at the two-year follow-up were influenced by diet in both groups. The percentage of weight loss was higher after gastric bypass one and two years after surgery. Weight recurrence was higher after the gastric sleeve method, without interfering with the surgical success of the technique.</p><p><strong>Conclusions: </strong>We verified greater efficacy in the gastric bypass technique in terms of weight loss at 12 and 24 months postoperatively. Weight recurrence was found 24 months after both methods, especially in the gastric sleeve group, without constituting surgical failure.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1941"},"PeriodicalIF":1.8,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12695080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727561","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":"Brazilian consensus- and evidence-based recommendations in the diagnosis and treatment of pancreatic exocrine insufficiency in patients after digestive surgeries. Position paper of six brazilian medical societies of surgery.","authors":"Andre Luis Montagnini, Wanderley Marques Bernardo, Paulo Kassab, Claudemiro Quireze Junior, Cassio Virgílio Cavalcante de Oliveira, Alessandro Landskron Diniz, Rodrigo Nascimento Pinheiro, Alexandre Ferreira Oliveira, Pedro Portari Filho, Guilherme de Andrade Gagheggi Ravanini, Nora Manoukian Forones, Marcus Fernando Kodama Pertille, Antonio Carlos Valezi, Anna Carolina Batista Dantas, Maira Andrade Nacimbem Marzinotto, Estela Regina Figueira, José Jukemura, Ulysses Ribeiro Junior, Paulo Herman","doi":"10.1590/0102-67202025000042e1911","DOIUrl":"10.1590/0102-67202025000042e1911","url":null,"abstract":"<p><strong>Background: </strong>Exocrine pancreatic insufficiency (EPI) is a condition characterized by reduced exocrine secretion, leading to decreased food digestion, and digestive tract surgeries can be a cause. Postoperative \"de novo\" EPI is defined as the onset of digestive symptoms following surgeries, which show significant improvement after the initiation of pancreatic enzyme replacement therapy (PERT). The diagnosis of postoperative EPI may be delayed due to mild or nonspecific symptoms, both in pancreatic surgeries and in upper abdominal surgeries.</p><p><strong>Aims: </strong>The aim of this study was to conduct a systematic review on the diagnosis and treatment of \"de novo\" EPI related to digestive surgeries, in collaboration with the development of a consensus among the main surgical societies in Brazil.</p><p><strong>Methods: </strong>The steering committee developed 10 questions related to two areas of interest: diagnosis and treatment. A systematic review was conducted for each of the domains. The evidence was assessed for quality using the GRADEpro tool. Recommendations were formulated for each of the questions. The final report was reviewed by representatives of the surgical societies for the consolidation and approval of the recommendations through a modified Delphi system.</p><p><strong>Results: </strong>\"De novo\" EPI should be considered in case of the onset of postoperative digestive symptoms. Diagnostic methods vary in complexity of execution, with varying sensitivity and specificity in the postoperative condition. Fecal Elastase-1 (FE-1) has limited value in diagnosing EPI in the postoperative setting. PERT can be initiated based on clinical suspicion, and there is no difference in approach regarding the type of surgery performed. PERT should be started at the appropriate dose for the intensity of symptoms and adjusted up or down according to symptom control. Proper treatment of EPI leads to symptom improvement and an increase in quality of life. PERT should be maintained as long as patients have a favorable clinical response.</p><p><strong>Conclusions: </strong>The recommendations encompass the diagnosis and treatment of \"de novo\" EPI and can serve as a basis for the establishment of educational programs led by the participating surgical societies.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1911"},"PeriodicalIF":1.8,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145672674","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":"Global strategies for the diffusion of robotic surgery.","authors":"Francisco Tustumi, Louisa Bolm, Rodrigo Camargo Leão Edelmuth, Felipe Antonio Boff Maegawa, Wellington Andraus, Paulo Herman, Tyler McKechnie, Allan Tsung, Sarah Samreen, Ryan Merkow, Nigel D'Souza, Syed Nabeel Zafar, Giovanna Mennitti Shimoda, Nelson Wolosker, Yoshikuni Kawaguchi, Georgios Tsoulfas, Eduardo Esteban Montalvo-Jave, Vikas Dudeja, Puja Gaur Khaitan, Sajid Khan","doi":"10.1590/0102-67202025000039e1908","DOIUrl":"10.1590/0102-67202025000039e1908","url":null,"abstract":"<p><strong>Background: </strong>The global adoption of robotic surgery has advanced rapidly in high-income countries, yet its diffusion remains limited in resource-constrained settings due to financial, infrastructural, and educational barriers. As surgical technology evolves, there is an urgent need to promote countries' equitable access to robotic platforms worldwide.</p><p><strong>Aims: </strong>The aim of this study was to analyze global strategies employed to promote the diffusion of robotic surgery, with a particular focus on overcoming barriers in resource-limited settings, and to provide practical insights that can guide its equitable and sustainable implementation.</p><p><strong>Methods: </strong>This study is a multinational, policy-oriented integrative review conducted under the guidance of the Research Committee of the Society for Surgery of the Alimentary Tract in the USA (SSAT). The study integrates a bibliometric analysis, a literature review, and expert insights from diverse healthcare environments. Contributions were gathered from SSAT members.</p><p><strong>Results: </strong>Robotic platforms are predominantly concentrated in North America, Western Europe, and Eastern Asia, with the USA hosting nearly 60% of all installations. Research output is similarly skewed, with few countries and institutions producing most clinical trials. Key barriers to diffusion include high costs, lack of infrastructure, limited training capacity, regulatory hurdles, and resistance among surgeons. Facilitators include public-private partnerships, philanthropic support, technology transfer, simulation platforms, and curriculum integration by professional societies.</p><p><strong>Conclusions: </strong>Achieving global equity in robotic surgery requires coordinated action across research, education, clinical practice, policy, and infrastructure. Global cooperation and innovation in implementation strategies can help bridge the current disparities and promote safe, cost-effective surgical care in underserved regions, improving patient outcomes.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1908"},"PeriodicalIF":1.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497569","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}