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

{"title":"Clinicopathologic features and prognostic factors in early- versus late-onset colorectal cancer: a stage-stratified retrospective surgical cohort from the Mekong Delta, Vietnam.","authors":"Kiet Nguyen LE Gia, Nang Van Pham, Tuan Van Nguyen, Doi Van Mai, Hien Van Nguyen, Huan Hoang Lam, Tuan Thanh Tran, Phu Thien Diep Duong, Trinh Vo Thi Anh","doi":"10.1590/0102-672020260000038e1967","DOIUrl":"10.1590/0102-672020260000038e1967","url":null,"abstract":"<p><strong>Background: </strong>Early-onset colorectal cancer (EOCRC), defined as diagnosis before 50 years of age, has increased in incidence globally, but its clinicopathologic profile and prognostic significance remain incompletely characterized, particularly in Southeast Asian populations with limited access to organized screening.</p><p><strong>Aims: </strong>To compare clinicopathologic characteristics and survival outcomes between EOCRC and late-onset colorectal cancer (LOCRC) following curative resection, and to identify independent prognostic determinants in a regional Vietnamese surgical cohort.</p><p><strong>Methods: </strong>This retrospective cohort study included 486 patients with stage I-III colorectal adenocarcinoma who underwent curative laparoscopic resection at a tertiary center in the Mekong Delta between 2016 and 2022.</p><p><strong>Results: </strong>EOCRC (184 patients, 37.9%) was associated with higher rates of poor differentiation, mucinous or signet-ring cell histology, lymphovascular invasion, and perineural invasion compared with LOCRC (all p<0.05). Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) did not differ significantly between groups. In the overall cohort (log-rank p=0.72, 0.15, and 0.96, respectively). On multivariable analysis, postoperative complications were the dominant independent prognostic factor for OS (hazard ratio [HZ] 8.28; 95% confidence interval [CI] 4.87-14.09) and RFS (HZ 4.81; 95%CI 3.03-7.65), whereas age at onset was not independently associated with either outcome. Stage-stratified curves suggested a less favorable survival pattern among patients with stage III EOCRC, particularly for CSS and RFS.</p><p><strong>Conclusions: </strong>Despite a more aggressive histopathologic profile, EOCRC showed comparable survival to LOCRC in the overall cohort. Stage-stratified curves suggested a less favorable survival pattern among patients with stage III EOCRC, while postoperative complications represented the dominant modifiable determinant of outcome.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1967"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889562","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":"Diagnosis, clinical assessment, and staging of hepatocellular carcinoma: a Brazilian multidisciplinary consensus.","authors":"Felipe José Fernández Coimbra, André Luís de Godoy, Paulo Henrique de Sousa Fernandes, Heládio Feitosa Neto, Rodrigo Nascimento Pinheiro, Ilka de Fátima Santana Ferreira Boin, Wellington Andraus, Francisco Tustumi, Paulo Cezar Galvão do Amaral, Carlos Eduardo Brandão Mello, Alexcia Camila Braun, Maria Ignez Braghiroli, Luis César Bredt, Carla Caparroz, Flair José Carrilho, Guilherme Moura Cunha, Alessandro Landskron Diniz, Daniel Neves Forte, José Huygens Parente Garcia, Tércio Genzini, Mauro Monteiro Correia, Cássio Virgílio Cavalcante de Oliveira, Antonio Nocchi Kalil, Agnaldo Soares Lima, Guilherme Lopes Pinheiro Martins, Cristina Melo Rocha, Marcos Roberto de Menezes, Joaquim Maurício da Motta-Leal-Filho, Munir Murad Júnior, Renata D'Alpino Peixoto, Rafael Soares Pinheiro, Marcelo Bruno Rezende, Héber Salvador de Castro Ribeiro, Mario Rino Martins, Duilio Reis da Rocha Filho, Arthur Accioly Rosa, Luiz Arnaldo Szutan, Orlando Jorge Martins Torres, Luiz Augusto Carneiro D'Albuquerque, Ângelo Alves de Mattos, Anelisa Kruschewsky Coutinho, Paulo Herman, Alexandre Ferreira Oliveira","doi":"10.1590/0102-672020260000035e1964","DOIUrl":"10.1590/0102-672020260000035e1964","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with a rising incidence largely driven by chronic liver disease. Accurate diagnosis and appropriate clinical assessment at the time of presentation are essential, as therapeutic strategies and prognosis depend on tumor burden, liver function, portal hypertension, and patient performance status.</p><p><strong>Aim: </strong>To develop evidence-based, multidisciplinary recommendations to guide the diagnosis, clinical assessment, and staging of patients with HCC.</p><p><strong>Methods: </strong>This consensus was developed by 43 experts from surgical oncology, hepatology, clinical oncology, radiology, interventional radiology, pathology, liver transplantation, gastroenterology, radiation oncology, and palliative care, under the coordination of the Brazilian Society of Surgical Oncology and 13 collaborating national medical societies. A scientific steering committee predefined clinically relevant questions addressing radiological and histopathological diagnosis, clinical assessment, diagnostic work-up, management of patients at the time of HCC diagnosis, and staging. These questions were discussed and refined in multidisciplinary meetings and submitted to structured voting rounds.</p><p><strong>Results: </strong>The panel formulated 18 recommendations covering key aspects of HCC evaluation, including standardized application of Liver Imaging Reporting and Data System (LI-RADS®) for imaging-based diagnosis, management of indeterminate lesions, indications for biopsy, histopathological classification and reporting, immunohistochemical markers, assessment of hepatic function and portal hypertension, staging systems, diagnostic work-up, and the role of multidisciplinary care. The recommendations emphasize integration of imaging findings with liver-related factors and clinical context to support individualized decision-making.</p><p><strong>Conclusions: </strong>This multidisciplinary consensus provides practical, evidence-based recommendations for the diagnosis, clinical assessment, and staging of HCC. By promoting standardized diagnostic practices while reinforcing comprehensive patient evaluation and multidisciplinary management, this document aims to improve diagnostic accuracy, optimize treatment selection, and support safe care.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1964"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889524","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":"Can duodenal resection be a valid alternative to pancreatoduodenectomy for nonampullary duodenal tumors?","authors":"Teresa Perra, Alberto Porcu","doi":"10.1590/0102-672020260000036e1965","DOIUrl":"10.1590/0102-672020260000036e1965","url":null,"abstract":"<p><strong>Background: </strong>Pancreatoduodenectomy is still the most common surgical treatment for patients with duodenal tumors. However, in selected cases where duodenal resection is technically feasible, it could represent a valid alternative, reducing the risk of postoperative complications, being a less invasive procedure.</p><p><strong>Aims: </strong>The objective of this study was to evaluate the results of this procedure at our institution.</p><p><strong>Methods: </strong>We collected data from all patients undergoing duodenal resection for oncologic disease between January 2020 and June 2025 at our institution. After a multidisciplinary evaluation, duodenal resection was indicated when the distance between the duodenal tumor and papilla of Vater measured endoscopically was at least 2 cm, and the tumor was operable with radical intent.</p><p><strong>Results: </strong>Eight patients were treated with this procedure. No major postoperative complications were observed. Two patients had postoperative nausea and vomiting, which resolved with antiemetics. Average hospital stay was five days. There has been no recurrence or death to date.</p><p><strong>Conclusions: </strong>Duodenal resection seems a valid alternative to pancreatoduodenectomy for the treatment of duodenal tumors in selected cases. It reduces the risk of postoperative complications, eliminating the risk of complications specific to pancreatoduodenectomy, such as pancreatic and biliary fistulas. It is a less invasive and shorter procedure, less severely compromises the patients general condition, and reduces hospital stay. Further studies are needed to confirm these results and draw generalizable conclusions.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1965"},"PeriodicalIF":1.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889384","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":"Nicolau Gregori Czeczko. Former President of the Brazilian College of Digestive Surgery (2017-2018).","authors":"Jurandir Marcondes Ribas Filho, Osvaldo Malafaia","doi":"10.1590/0102-672020260000020e1949","DOIUrl":"10.1590/0102-672020260000020e1949","url":null,"abstract":"","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1949"},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842351","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":"Improving gastric cancer care in Brazil: the ABCG (Brazilian Gastric Cancer Association) commitment and call to action.","authors":"Andre Maciel da Silva, Marcus Fernando Kodama Pertille Ramos, Antonio Carlos Weston, Paulo Kassab, Ulysses Ribeiro-Junior, Nora Manoukian Forones","doi":"10.1590/0102-672020260000022e1951","DOIUrl":"10.1590/0102-672020260000022e1951","url":null,"abstract":"","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1951"},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842395","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":"Comparative margins between colorectal carcinoma and peritumoral injected methylene blue.","authors":"Priscila Oliveira Cardoso, Andy Petroianu","doi":"10.1590/0102-672020260000023e1952","DOIUrl":"10.1590/0102-672020260000023e1952","url":null,"abstract":"<p><strong>Background: </strong>Removal of malignant tumors with free margins is pivotal in oncological surgery.</p><p><strong>Aims: </strong>To verify the correspondence between the histological growth of colon and rectal adenocarcinomas and how extensively methylene blue diffuses when injected into peritumoral mucosal tissue to understand if the dye margin can guide the correct margin for tumor removal, and also if there is an association between the lymph nodes stained by methylene blue and the presence of metastases.</p><p><strong>Methods: </strong>This study was conducted with 13 patients with colon or rectal adenocarcinoma. Immediately before the operation, all patients underwent colonoscopy and peritumoral methylene blue injection. Radical resection consisted of the removal of the colon or rectum segment beyond the blue-stained margins, in a monobloc, with the meso and regional lymph nodes. Tumor margins, peritumoral lymphatic density, stained margins, and removed lymph nodes were analyzed.</p><p><strong>Results: </strong>In all operative specimens, tumor-free margins were within the blue-stained area. There was no association between the presence of metastases and the dye in the lymph nodes examined.</p><p><strong>Conclusions: </strong>Preoperative peritumoral endoscopic injection of methylene blue spreads the dye beyond the limits of colon and rectal adenocarcinomas, determining reliable free margins for tumor resection, but does not indicate the presence of regional lymph node metastases.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1952"},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842365","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":"Nissen Fundoplication: 70 years of a simple and brilliant idea in the surgical treatment of gastroesophageal reflux disease.","authors":"Fernando Antonio Siqueira Pinheiro, Jean Claude Boulez, Nelson Adami Andreollo, Paulo Kassab","doi":"10.1590/0102-672020260000026e1955","DOIUrl":"10.1590/0102-672020260000026e1955","url":null,"abstract":"<p><p>Rudolf Nissen published his first two cases in 1956, thus inaugurating the era of pathological gastroesophageal reflux surgery. From the 1970s onwards, with Nissen fundoplication increasingly used as the treatment of choice for gastroesophageal reflux and hiatal hernia, minor alterations were proposed. Nissen's greatest legacy: not just an operation, but a way of thinking about surgery as a restless, rigorous, and profoundly patient-centered procedure.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1955"},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842342","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":"Acutely kidney injury in the postoperative period of elective colorectal surgery: assessment of the age influence.","authors":"Leonardo Menezes Guarda, Isaac José Felippe Corrêa-Neto, Gabriela Gambi Robles, Victor Keniti Gomes Nishiyama, Rodrigo Ambar Pinto, Laercio Robles","doi":"10.1590/0102-672020260000011e1940","DOIUrl":"10.1590/0102-672020260000011e1940","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The increase in life expectancy and the development of comorbidities bring a higher rate of complications and mortality in the postoperative period of surgical procedures in general. Among these associations, elective colorectal surgery and acute kidney injury are notable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To analyze risk factors associated with acute kidney injury in the postoperative period of elective colorectal surgeries in patients over 65 years of age. Additionally, to outline the epidemiological, clinical-surgical, and laboratory profile of the study population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A clinical, observational, longitudinal, prospective, and analytical study with a quantitative approach involving 30 patients from January 2023 to April 2024. Data analysis included pre, intra, and post-operative periods, with renal function assessment on the 3rd and 5th days after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall mean age was 70.4 years, 53.3% were female, 46.6% were smokers or former smokers, 63.3% had systemic arterial hypertension, and 23.3% had diabetes mellitus. Ten patients developed acute kidney injury in the postoperative period. The use of angiotensin-converting enzyme inhibitors and postoperative diuresis were significantly associated variables (p=0.039 and 0.034, respectively). The diuresis cutoff value to foretell non-progression to acute kidney injury was 0.5 mL/kg/h, with an accuracy of 88%, sensitivity of 100%, specificity of 77.78%, positive predictive value of 86.67%, and negative predictive value of 100%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In elderly patients undergoing elective colorectal surgery for oncological treatment, the incidence of acute kidney injury was high.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Central message: &lt;/strong&gt;Acute kidney injury, also known as acute renal injury, is a syndrome resulting from an abrupt loss of kidney function due to decreased glomerular filtration rate. Postoperative acute kidney injury is associated with prolonged hospital recovery, increased healthcare costs, and higher mortality following major surgeries, complicating the perioperative period in up to 50% of these patients. Therefore, detecting acute kidney injury in its early stages, even before the onset of symptoms, especially in elderly patients, is essential for improving the management of this condition and reducing postoperative morbidity and mortality in elective colorectal surgery patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Perspectives: &lt;/strong&gt;The increased incidence of acute kidney injury in individuals over 60 years old may be attributed to a combination of factors, including comorbidities, nephrotoxic medications, and structural and functional changes associated with aging. Additionally, high anesthetic risk in elective surgeries, intraoperative complications, and pre-existing chronic kidney disease directly influence the development of acute kidney injury, especially in the elderly. In elderly patients undergoing electi","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1940"},"PeriodicalIF":1.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802065","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":"Career Outcomes and Perceptions of Alumni who completed Postgraduate Education in Sciences in Gastroenterology: insights from a Brazilian Single-Center Survey.","authors":"Gilton Marques Fonseca, Rafaela Maria Zacchi Martucci, José Jukemura, Claudia Pinto Marques Souza Oliveira, Alberto Queiroz Farias, Ulysses Ribeiro Junior, Paulo Herman","doi":"10.1590/0102-672020260000021e1950","DOIUrl":"https://doi.org/10.1590/0102-672020260000021e1950","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postgraduate education is essential for training highly qualified health professionals; however, there is a lack of studies in Brazil evaluating career outcomes of gastroenterology alumni.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To analyze the sociodemographic profile, academic background, career outcomes, and perceived impact of postgraduate training in Sciences, more specifically in Gastroenterology, comparing physicians and non-physicians, as well as physicians with surgical versus clinical training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional study was conducted among alumni who completed master's and doctoral degrees from 2012 to 2024 at Universidade de São Paulo School of Medicine. A 47-item questionnaire collected data on demographics, training, professional practice, academic productivity, and program impact. Statistical comparisons were performed using ꭓ2 or Fisher's exact tests and the Mann-Whitney U test (p&lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 332 eligible alumni, 172 completed the questionnaire (51.8%). The mean age was 43 years; 53.5% were men, and 69.8% were physicians. Postgraduate training was considered fundamental by 51.2% and highly impactful by 37.2, and 74.4% would certainly pursue it again. Physicians were older, had higher scientific output, and more frequently held academic and leadership positions. Non-physicians were predominantly women, received a higher number of scholarships, and more frequently reported positive career changes. Among physicians, those with surgical training had higher income, more academic titles, and were more often based in São Paulo, whereas those with clinical training reported more professional opportunities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Postgraduate training in Sciences in the field of Gastroenterology, had a relevant positive impact on academic and professional development, with differences according to baseline training and professional profile.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Central message: &lt;/strong&gt;Postgraduate education has a relatively recent history in Brazil. In 2011, the Gastrointestinal Surgery and Clinical Gastroenterology programs were officially merged to form the Postgraduate Program in Sciences in Gastroenterology, offering both master's and doctoral degrees. Despite its importance, systematic evaluation of alumni outcomes remains scarce in Brazil, particularly in the field of gastrointestinal surgery and gastroenterology. Most of the data available derive from international experiences or broader surveys in health sciences. Identifying the sociodemographic profile, academic background, career paths, and perceived impact of postgraduate education is crucial for guiding institutional strategies and contributing to the evaluation metrics by the Coordination for the Improvement of Higher Education Personnel.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Perspectives: &lt;/strong&gt;This survey of alumni from a postgraduate program in Sciences in Gastroenterology demonstrates that postgraduate ","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1950"},"PeriodicalIF":1.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802073","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":"Donor age and cold ischemia time combined predict early mortality after long-distance liver procurement.","authors":"Agnaldo Soares Lima, Alexandre Imbs Lima, Bruno Ferreira Russo, Bárbara Buitrago Pereira, Eduardo Nacur Silva, Luís Fernando Magalhães Neves, Ana Flávia Passos Ramos, Rafael Rossi Nominato, João Bernardo Sâncio Rocha Rodrigues, José Clóvis Ligeiro Neto, Marcelo de Medeiros Chaves França","doi":"10.1590/0102-672020260000024e1953","DOIUrl":"https://doi.org/10.1590/0102-672020260000024e1953","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The increasing need to expand the donor pool has led to greater utilization of liver grafts procured at a distance from transplant centers, inevitably prolonging cold ischemia time. Whether long-distance procurement independently affects early outcomes or whether risk is primarily driven by donor-related factors remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;We evaluated the impact of procurement distance on early post-transplant survival and investigated whether the combined effect of donor age and cold ischemia time could define a clinically meaningful risk threshold.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We performed a retrospective cohort study of adult liver transplant recipients from March 2016 to December 2025 at a single tertiary transplant center. Donor, recipient, and procurement variables were analyzed according to procurement location. Early mortality was assessed using Kaplan-Meier analysis and Cox proportional hazards modeling. Among 291 transplants, long-distance procurement was associated with significantly longer cold ischemia time but not with increased 15-day mortality. In multivariable analysis, recipient severity (Model for End-stage Liver Disease-Sodium score) and cold ischemia time were independently associated with early mortality, whereas procurement location and donor age alone were not. A composite variable defined by the sum of donor age and cold ischemia time identified a threshold (≥480) associated with significantly reduced early survival, conferring more than a fivefold increase in 15-day mortality independent of procurement distance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;These findings suggest that the risk associated with distant procurement is not geographic but biological, reflecting the interaction between donor susceptibility and ischemic burden. A simple combined metric may help clinicians balance graft-related risks against recipient urgency when evaluating marginal offers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Central message: &lt;/strong&gt;Long-distance liver procurement increases cold ischemia time but does not worsen early survival after transplantation. In this study, early mortality was driven by recipient severity and ischemic burden, not by procurement distance itself. A simple combination of donor age and cold ischemia time identified grafts at higher risk of early death. This suggests that risk is not geographic, but biological. A straightforward metric may help clinicians better understand graft quality and guide decision-making when evaluating liver offers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Perspectives: &lt;/strong&gt;Deciding whether to accept a liver graft is often challenging, especially when the organ comes from a distant location. Our findings suggest that distance alone should not discourage acceptance. Instead, clinicians should focus on the interaction between donor age and cold ischemia time. A simple combined metric may provide an intuitive way to assess graft-related risk in real time. This approach could help ba","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1953"},"PeriodicalIF":1.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802041","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}