BACKGROUND: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. AIMS:The objective of this study was to evaluate the results of this procedure at our institution. METHODS: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. RESULTS: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. CONCLUSIONS: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.
BACKGROUND: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. AIM:To develop evidence-based, multidisciplinary recommendations to guide the diagnosis, clinical assessment, and staging of patients with HCC. METHODS: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. RESULTS: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. CONCLUSIONS: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.
BACKGROUND:Iatrogenic ureteral injuries (IUI) are rare surgical complications in abdominopelvic surgeries, with an incidence varying between 0.15 and 1.0%. AIMS:To evaluate the incidence of IUI in elective colorectal surgeries performed in a tertiary university hospital. METHODS:This is a retrospective analysis of patients operated from 2004 to 2022, who presented IUI. Demographic data, underlying disease, predisposing factors, surgery access, location of the lesions and their characteristics, diagnosis time, treatment carried out, and follow-up were analyzed. RESULTS:In the period, 2,312 abdominopelvic surgeries were performed, of which 1,998 were open and 314 were laparoscopic, with 19 IUI (0.82%). The mean age was 55.6 years, 57.9% were male, and 89.5% were white. The majority of patients were overweight (52.6%), and 73.7% had a history of abdominal surgery. Primary rectal adenocarcinoma was the most common disease (47.4%), followed by tumor recurrences (21.0%). IUI occurred in 1.91% of laparoscopic surgeries and 0.65% of open surgeries (p=0.053); patients with tumor recurrence presented more IUI than those with primary tumors or benign diseases (p=0.006). They were commonly observed in the left ureter (52.6%) and in the distal portion (89.5%), the main mechanism being the section (57.9%). Intraoperative diagnosis occurred in 12 patients (63.2%). IUI correction was predominant in ureteral reimplantation and end-to-end ureteral anastomosis. Postoperative complications were common (47.4%), and one patient died from causes unrelated to surgery. CONCLUSIONS:IUI presented low incidence in colorectal elective surgeries and were more frequent in surgeries for tumor recurrences, in the left ureter and the distal third. Early diagnosis with repair of the injury provided better results.
BACKGROUND:Obesity is a multifactorial disease with a high prevalence that leads to several comorbidities, posing significant challenges for healthcare systems. Bariatric and metabolic surgery (BMS) has been established as the most effective treatment for patients with obesity; however, in Brazil, limited access remains a critical barrier. AIMS:This study aimed to evaluate the clinical, demographic, and metabolic characteristics of patients with obesity undergoing BMS in the Brazilian Unified Health System and to analyze the relationship between waiting time and comorbidities. METHODS:A retrospective cohort study was conducted involving 1,000 patients with obesity who underwent treatment between July 2022 and June 2024. Clinical, anthropometric, and laboratory variables were analyzed using regression analysis and statistical tests to assess the association between waiting time and comorbidities. RESULTS:A significant correlation was found between prolonged waiting time and an increased number of comorbidities (R²=0.686; p<0.001). Furthermore, the number of comorbidities explained 60% of the variability in waiting time (R²=0.600; p<0.001), with a mean increase of 1.92 years for each additional comorbidity (95%CI 1.82-2.02). Patients on the waiting list for more than 10 years had higher rates of hypertension, type 2 diabetes, and dyslipidemia. Waiting time also had an impact on some metabolic syndrome parameters, including glycated hemoglobin (Hb1Ac) (r=+680, p=0.031), low-density lipoprotein (LDL) (r=+640, p=0.044), and total cholesterol (r=+830, p=0.008). CONCLUSIONS:Prolonged waiting time for bariatric and metabolic surgery is associated with an increased burden of metabolic comorbidities and their consequences.
BACKGROUND: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. AIMS: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.
BACKGROUND:The pathophysiology of necrotizing enterocolitis (NEC) involves changes in intestinal development that hinder its functionality, leading to both metabolic and gene and phenotypic changes. Among the genetic factors the 896A/G polymorphism in the Toll-Like Receptor 4 (TLR4) gene can trigger is an inappropriate and persistent inflammatory response, leading to the progression of lesions and necrosis of the intestinal mucosa, and reduced perfusion of the microvasculature, increasing susceptibility to the disease. AIMS:To determine the prevalence of the 896A/G polymorphism in the TLR4 gene in neonates with and without NEC. METHODS:Case-control study, in which 100 neonates were evaluated, 50 diagnosed with NEC (Case Group) and 50 without the disease (Control Group), of both sexes. DNA was extracted from peripheral blood leukocytes, and the region encompassing the polymorphism was amplified by polymerase chain reaction/restriction fragment length polymorphism. RESULTS:Males were predominant in both groups: Cases (54%) and Controls (56%) (p=1.0000). Moderately and extremely preterm infants were the most frequent in the Case (90%) and Controls (96%) (p=0.6132) groups. Very low birth weight and extremely low birth weight neonates were predominant in the Case Group (60%) and in the Control Group (72%) (p=0.0995). Of the 50 neonates with NEC, 66% responded positively to clinical treatment, and 86% were discharged from hospital. The 896A/G polymorphism in the TLR4 gene was not identified in the 200 alleles analyzed (100%). CONCLUSIONS:The absence of the 896A/G polymorphism in the TLR4 gene in NBs with and without NEC does not exclude the possibility of alterations in this and/or other genes, highlighting the importance of additional studies to elucidate this relationship.
BACKGROUND:Chronic pancreatitis without significant main duct dilation is difficult to treat, as classic drainage procedures are less effective. Endoscopic therapy is often limited by complex anatomy, multiple strictures, stones, and the need for repeated procedures, frequently providing incomplete pain relief. Surgery offers better long-term pain control, but small-duct disease requires alternative strategies. AIMS:To record the case of a 52-year-old man with alcoholic chronic pancreatitis who had progressive abdominal pain requiring opioids. Imaging showed a mildly dilated (6 mm), tortuous pancreatic duct with segmental strictures and a peripancreatic cystic lesion. METHODS:Endoscopic treatment was considered suboptimal, and surgery was indicated. A hybrid laparoscopic pancreaticojejunostomy was performed, combining Izbicki's V-shaped parenchymal excision with a longitudinal Partington-Rochelle anastomosis. The goal was to achieve effective decompression despite the small duct diameter, while preserving a minimally invasive approach. RESULTS:Recovery was uneventful. Oral intake was resumed on the third postoperative day, and discharge occurred on the fifth. At six months, the patient had complete pain relief, a 20% reduction in insulin requirement, and improved control of exocrine insufficiency. CONCLUSIONS:This hybrid laparoscopic technique is feasible and may be an effective alternative for patients with chronic pancreatitis and small-duct disease when standard procedures are unsuitable.
BACKGROUND:The physiological response of the lower esophageal sphincter (LES) to abdominal pressure (AP) plays a key role in the esophagogastric junction (EGJ) integrity. However, in obesity, this interplay remains unclear, particularly in the presence of anatomical alterations. AIMS:This study aims to evaluate the correlation between abdominal pressure and LES basal pressure in obese patients, and to analyze the influence of EGJ morphology on this interaction. METHODS:This retrospective cross-sectional study included 47 obese patients (BMI>35 kg/m2) who underwent high-resolution esophageal manometry. Patients were divided into two groups based on EGJ morphology: normal (Type I) and abnormal (Types II/III, hiatal hernia) and were compared based on clinical and manometric variables. Correlation analyses between AP and LES pressure were performed for the entire sample and stratified by EGJ morphology. RESULTS:No statistically significant correlation was found between AP and LES pressure in the overall sample (rho=0.05; p=0.737). In the subgroup analysis, there was a non-significant trend toward increased LES pressure in patients with normal EGJ morphology (r=0.26; p=0.150) and decreased LES pressure in those with hiatal hernia (r=-0.39; p=0.131). No significant differences in BMI, abdominal circumference, AP, or LES pressure were observed between groups. CONCLUSIONS:In obese individuals, abdominal pressure does not show correlation with LES pressure. However, EGJ morphology may influence sphincteric behavior, with a trend toward LES pressure increase in normal EGJ and reduction in altered morphologies. These findings highlight the multifactorial nature of esophagogastric dysfunction.
BACKGROUND:Local excision (LE) has a limited role in the management of anal squamous cell carcinoma (SCC), typically restricted to carefully selected early-stage tumors. However, in clinical practice, LE is often performed in broader contexts, particularly in patients with large perianal lesions without prior confirmation of invasive carcinoma, in whom diagnostic uncertainty may influence treatment decisions. AIMS:To evaluate oncologic outcomes after LE for anal SCC, with particular emphasis on the role of lesion characteristics, diagnostic uncertainty, and treatment patterns in real-world practice. METHODS:This was a retrospective study of patients with anal SCC who underwent LE as primary treatment and were followed at a tertiary cancer center between 2010 and 2024. Clinical, pathological, and treatment data were collected, including tumor characteristics, margin status, use of adjuvant therapy, and oncologic outcomes. RESULTS:A total of 20 patients with invasive anal SCC were included. The mean tumor size was 3.24 cm (standard deviation ±1.75 cm), with lesions up to 6.9 cm. No patients received chemoradiotherapy before LE. Only two patients met conventional criteria for LE (<2 cm, well or moderately differentiated tumors). Overall, 14 patients (70%) required additional treatment following LE, including chemoradiotherapy or abdominoperineal resection. Among patients initially managed with surveillance, 44% developed local recurrence, even in cases with negative margins. CONCLUSIONS:Outcomes following LE for anal SCC are strongly influenced by patient selection and clinical context. In this real-world cohort, most patients outside established criteria required additional treatment, underscoring the limitations of LE in large perianal lesions. These findings highlight the importance of careful preoperative evaluation and maintaining a high index of suspicion for invasive carcinoma to guide appropriate initial management.
BACKGROUND:Gastric adenocarcinoma remains one of the leading causes of cancer mortality worldwide, according to the International Agency for Research on Cancer. Stage III, as defined by the 8th edition of the American Joint Committee on Cancer Tumor, Node, and Metastasis (TNM) system, comprises a biologically heterogeneous group, resulting in clinicopathological variations that directly impact prognosis and therapeutic decisions. AIMS:To evaluate the clinicopathological features, surgical morbidity and mortality, and overall survival of patients with gastric adenocarcinoma treated at a tertiary center, and to analyze prognostic differences among stage III subgroups. METHODS:This retrospective cohort study included patients treated between 2008 and 2018. Demographic variables, tumor characteristics, TNM staging (8th edition), type of surgical procedure, complications according to the Clavien-Dindo classification, and 30-day mortality were analyzed. Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test, with a significance level of 5%. RESULTS:This retrospective cohort study included patients treated between 2008 and 2018. We analyzed demographic variables, tumor characteristics, TNM staging (8th edition), type of surgical procedure, complications according to the Clavien-Dindo classification, and 30-day mortality. Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test, with a significance level of 5%. CONCLUSIONS:Stage III gastric adenocarcinoma demonstrates marked clinicopathological heterogeneity, which directly impacts morbidity, mortality, and survival. Lymph node involvement is a relevant prognostic determinant.
BACKGROUND:Single-stage outpatient treatment of cholecystocholedocholithiasis is feasible, highlighting the importance of appropriate patient selection, professional training, and healthcare service organization to support this approach. AIM:To identify clinical and procedural factors associated with outpatient management and hospital stay following single-stage laparoendoscopic treatment of cholecystocholedocholithiasis. METHODS:A retrospective cohort study was conducted at hospitals affiliated with the Ribeirão Preto School of Medicine, Universidade de São Paulo (FMRP-USP), between 2019 and 2024. Patients were stratified into three groups according to care setting: outpatient (G1); outpatient with overnight stay (G2); and inpatient (G3). Clinical, surgical, and outcome data were analyzed using logistic regression models, χ2 tests, and Fisher's exact tests (p=0.05). RESULTS:Among 177 patients included, 41 were allocated to G1, 80 to G2, and 56 to G3. Compared with G2, G1 patients had shorter operative time (124.2 vs. 143.8 min; p=0.038), more frequent use of the Rendez-Vous technique (p=0.044), and less frequent use of papillary dilation (p=0.041). Patients in G3 had a higher prevalence of ASA III physical status (p=0.045), higher rates of postoperative complications (p=0.025) and biliary stent use (p=0.001), and lower bile duct clearance rates (p=0.004). CONCLUSIONS:Single-stage outpatient laparoendoscopic treatment of cholecystocholedocholithiasis is safe and effective. Clinical severity, treatment complexity, and failure of bile duct clearance were more strongly associated with inpatient hospitalization, whereas overnight stay among outpatients was not associated with improved postoperative outcomes. The implementation of enhanced recovery protocols and telemedicine-based postoperative assessment strategies may further reduce hospital stay.
Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer and remains the most lethal malignancy of the digestive system. Despite recent advances, surgical treatment remains the only potentially curative option. Most patients are diagnosed with locally advanced or disseminated disease, and chemotherapy is the only indicated treatment. Pancreatic resection rates in centers that do not perform vascular resection are around 15-20% of diagnosed cases, while in specialized centers with vascular expertise, they may reach 30-45%. Ablative therapies have been investigated as local alternatives for unresectable tumors. Radiofrequency ablation (RFA) has proven efficacy in the treatment of hepatic neoplasms, and has recently been explored in PDAC. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) represents a minimally invasive alternative for thermal ablation of pancreatic tumors. Early experience suggests that may serve as a palliative modality for pain or obstruction control, and to facilitate chemotherapy. However, this treatment is considered experimental and requires procedural standardization. Careful patient selection is essential, prioritizing cases without metastatic spread, with tumors accessible by EUS and without extensive vascular invasion. Endoscopic ultrasound-guided radiofrequency ablation should not replace surgery in resectable pancreatic ductal adenocarcinoma. The endoscopic ultrasound-guided radiofrequency ablation should be considered as a palliative option within multidisciplinary protocols. Endoscopic ultrasound-guided radiofrequency ablation is an isolated palliative modality, and considered an option to treat the pancreatic ductal adenocarcinoma.
BACKGROUND: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. AIMS: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. RESULTS: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. CONCLUSIONS: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. CENTRAL MESSAGE: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. PERSPECTIVES: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 balance the risks of marginal grafts against the urgency of transplantation, potentially improving decision-making in daily clinical practice.
BACKGROUND: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. AIMS: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. METHODS: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<0.05). RESULTS: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. CONCLUSIONS: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. CENTRAL MESSAGE: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. PERSPECTIVES:This survey of alumni from a postgraduate program in Sciences in Gastroenterology demonstrates that postgraduate studies have a strong impact on both personal and professional development. Most alumni reported career and academic growth, and the majority would certainly enroll again. Differences between physicians and non-physicians, and between surgical and clinical training, highlight the diverse ways postgraduate education shapes careers. At the same time, limited research funding and the concentration of professionals in large urban centers remain persistent challenges. These findings reinforce the pivotal role of postgraduate education in advancing health sciences while pointing to opportunities for greater equity and improved regional distribution of qualified professionals.
BACKGROUND:Laparoscopic subtotal cholecystectomy is indicated for severe cholecystitis; however, it may lead to complications, including postoperative bile fistulas. AIMS:To evaluate the management, evolution, and risk factors associated with bile fistulas after laparoscopic subtotal cholecystectomy in a hospital in Quito from January 2019 to June 2022. METHODS:A cross-sectional analytical study with a quantitative approach was conducted. A retrospective review of medical records of patients who underwent laparoscopic subtotal cholecystectomy (n=256) was performed. The dependent variable was the occurrence of bile fistulas, while independent variables included sociodemographic data (age, sex) and clinical factors such as comorbidities, nutritional status, cholecystitis severity (Parkland classification), surgical planning, type of cholecystectomy, anesthetic risk (American Society of Anesthesiologists; ASA I-IV), surgical time, intraoperative complications, time of fistula onset, evolution, and postoperative complications. RESULTS:The incidence of postoperative fistulas was 12.9% (n=33). Management strategies included drainage (69.7%) and endoscopic retrograde cholangiopancreatography (ERCP) (30.3%). Spontaneous closure occurred in 60.6%, while 30.3% required therapeutic ERCP and 9.1% needed reoperation. Significant risk factors included surgical time >105 minutes (relative risk [RR]: 2.06; 95% confidence interval [CI] 1.04-4.08), type A cholecystectomy (RR 2.19; 95%CI 1.05-4.57), and choledocholithiasis (RR 2.5; 95%CI 1.34-4.67). Logistic regression confirmed surgical time (odds ratio [OR]: 2.6; 95%CI 1.2-5.8) and choledocholithiasis (OR 3.3; 95%CI 1.4-3.9) as significant predictors (p<0.05). CONCLUSIONS:The incidence of postoperative fistulas observed was comparable to previous reports in the literature, highlighting the importance of early identification and appropriate management. CENTRAL MESSAGE:Type B subtotal cholecystectomies were associated with bile leaks, as were the presence or history of choledocholithiasis and prolonged surgical times, exceeding 105 minutes. Bile leaks were not related to whether a prior ERCP or sphincterotomy were performed, nor to the presence of biliary stents. PERSPECTIVES:There is currently no standardization regarding the optimal timing for ERCP for bile leaks or the amount of bile leakage that should prompt the procedure. A standardized prospective study could help establish evidence-based management criteria.
BACKGROUND:Removal of malignant tumors with free margins is pivotal in oncological surgery. AIMS: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.
BACKGROUND: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. AIMS: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. METHODS: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. RESULTS: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%. CONCLUSIONS:In elderly patients undergoing elective colorectal surgery for oncological treatment, the incidence of acute kidney injury was high. CENTRAL MESSAGE: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. PERSPECTIVES: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 elective colorectal surgery for oncological treatment, the incidence of Stage 1 acute kidney injury was high and associated with postoperative urine output and the non-use of angiotensin-converting enzyme inhibitors.
BACKGROUND:Small-for-size syndrome (SFSS) is a serious complication after partial liver transplantation or extended hepatectomy. Despite advances, the syndrome remains a complex entity with a multifactorial pathophysiology and a lack of standardized therapeutic approaches. AIMS:This study aims to establish a translational model of porcine SFSS, integrating hemodynamic, histopathological, and molecular analyses to quantify the tissue expression of biomarkers to assess liver regeneration. METHODS:Ten liver transplants were performed: eight with small (partial) for size (donors underwent a 70% hepatectomy) and two with whole liver. The recipients were followed until death (euthanasia due to severe morbidity) or for five days. Hemodynamic data, laboratory analyses, and liver tissue biopsies were collected. Immunohistochemistry was performed to assess the expression of TNF-α, IL-1β, NF-κB, and VEGF. Gene expression levels of VEGF, IL-6, IL-10, and NF-κB were quantified using reverse transcription polymerase chain reaction. RESULTS:In the partial group, survival rates were 75% in the immediate postoperative period, 25% at 48 hours, and 12.5% at five days. Immunohistochemistry showed a significant increase in TNF-α and NF-κB proteins after reperfusion and at the end of surgery, respectively. Gene expression analysis showed a significant increase in IL-6 and IL-10 at the end of surgery. CONCLUSIONS:This study represents a methodological advance by performing the first integrated evaluation of protein and gene expression (TNF-α, IL-6, IL-1, IL-10, VEGF, and NF-κB) correlated with hemodynamic, histopathological, and functional parameters in the small-for-size pig model.
