Isolation of Leptospira spp. from a man living in a rural area of the Municipality of Cruz Alta, RS, Brazil

The aim of this study wasto describe the isolation of a pathogenic strain of Leptospira interrogans from the urine sample of a male human living in the rural area of the County of Cruz Alta, Rio Grande do Sul. An aliquot of each urine sample was sown in a Fletcher and Ellinghausen - McCullough - Johnson - Harris (EMJH) media. Samples in which there was growth of spirochetes were sent to the Leptospirosis Laboratory of the Institute of Pathobiology in the National Institute of Agricultural Technology, Buenos Aires, Argentina and were typified by the Multiple Locus of Variable Number Tandem Repeat technique (MLVA). Leptospira interrogans serovar Copenhageni strain Fiocruz L1-130 was isolated, and this is a very important finding that serves as a warning to characterize risk situation of leptospirosis epidemic by a pathogenic strain. Health professionals need to be more committed to the primary health care in Brazil and routinely apply actions of preventive medicine in rural communities in order to get success in the control of leptospirosis and other important zoonoses.O objetivo do presente estudo foi descrever um caso de isolamento de espécie patogênica de Leptospira interrogans em amostra de urina de um humano morador da zona rural do Município de Cruz Alta, Estado do Rio Grande do Sul. De cada amostra de urina, uma alíquota foi semeada nos meios Fletcher e Ellinghausen - McCullough - Johnson - Harris (EMJH). As amostras, nas quais houve crescimento de espiroquetas, foram encaminhadas para o Laboratório de Leptospirose do Instituto de Patobiologia do Instituto Nacional de Tecnologia Agropecuária Buenos Aires, Argentina e foram tipificadas pela técnica Multiple Locus ofVariableNumber Tandem Repeat(MLVA).De um residente do sexo masculino da área rural do município de Cruz Alta, foi isolada Leptospira interrogans sorovariedade Copenhageni cepa Fiocruz L1-130, uma descoberta muito importante e que serve como um alerta por caracterizar uma situação de risco de epidemia de leptospirose por uma cepa patogênica. Os profissionais de saúde precisam ser mais comprometidos com a atenção primária à saúde no Brasil e rotineiramente aplicar ações de medicina preventiva nas comunidades rurais, a fim de obter sucesso no controle da leptospirose e de outras importantes zoonoses.Fil: da Silva, Felipe Jorge. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Pinheiro Silva, Glaucenyra Cecília. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Grune Loffler, Sylvia. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Patobiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Brihuega, Bibiana. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Patobiología; ArgentinaFil: Samartino, Luis Ernesto. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Patobiología; ArgentinaFil: Fernandez Alarcon, Miguel Frederico. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Pereira dos Santos, Carlos Eduardo. Universidade Federal do Mato Grosso do Sul; BrasilFil: Mathias , Luis Antonio. Universidade Estadual Paulista Julio de Mesquita Filho; Brasi

Pesquisa de leptospiras e de anticorpos contra leptospiras em animais e humanos de propriedades rurais nos biomas brasileiros Pantanal e Caatinga

Foi investigada a ocorrência de leptospiras e de sororreatividade para leptospiras em animais e seres humanos de seis propriedades rurais localizadas em dois biomas brasileiros que apresentam condições geoclimáticas distintas: Pantanal – municípios de Miranda (MS), Itiquira (MT) e Poconé (MT) e Caatinga – municípios de Sobradinho (CE), Garanhuns (PE) e Sobral (BA). Em cada uma das propriedades, foram realizadas colheitas de sangue e de urina de animais selvagens de vida livre, animais domésticos e de seres humanos. As colheitas de materiais foram realizadas no período de fevereiro a abril de 2012 no bioma Caatinga e no período de julho a setembro de 2012 no bioma Pantanal. A reatividade sorológica contra Leptospira spp. foi verificada pela técnica de soroaglutinação microscópica (SAM) efetuada com uma coleção de antígenos constituída por 24 sorovares de Leptospira spp. A pesquisa de leptospiras foi efetuada por cultivos de amostras de urina semeadas nos meios Fletcher e de Ellinghausen – McCullough – Johnson – Harris (EMJH). Os cultivos em que houve crescimento de leptospiras foram encaminhados ao Laboratório de Leptospirose do Instituto de Patobiologia, Instituto Nacional de Tecnologia Agropecuária, Buenos Aires, Argentina e as estirpes de leptospiras isoladas foram genotipadas com o emprego da técnica de Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). O procedimento de tipificação empregou os VNTR 4, 7, 9, 10, 19, 23, 31, Lb4 e Lb5, que discriminam estirpes de L. interrogans e L. borgpetersenii. No Pantanal, foram examinados 17 animais selvagens, 65 animais domésticos e dois humanos. Na Caatinga, foram examinados sete animais selvagens, 100 animais domésticos e 26 humanos. Das 84 amostras de sangue examinadas no Pantanal, 47 (55,95%) foram reagentes e, das 133 da Caatinga, 59 (44,36%) foram reagentes. Pelo teste exato de Fisher, considerando-se um nível de significância de 0,05, não houve diferença entre as proporções de animais sororreagentes para Leptospira spp. nos dois biomas avaliados (p = 0,063). Os sorovares predominantes nas reações de SAM foram: 1) Pantanal – Bratislava (animais selvagens, cães e humanos); Grippotyphosa (equinos e bovinos); 2) Caatinga – Copenhageni (humanos e cães), Patoc (equinos e bovinos), Panama (ovinos e caprinos), Patoc, Copenhageni e Australis (animais selvagens). Houve isolamento de quatro estirpes de leptospiras: duas em Sobradinho, BA, L. interrogans sorogrupo Pomona em Cavea aperea e L. interrogans em Euphractus sexcinctus; e duas em Sobral, CE, L. interrogans em Cerdocyon thous e L. interrogans sorogrupo Pomona em Euphractus sexcinctus.The occurrence of Leptospira and of seroreactivity against Leptospira was investigated in animals and humans from six farms located in two Brazilian biomes that have different geoclimatic conditions: Pantanal – municipalities of Miranda (MS), Itiquira (MT) and Pocone (MT) and Caatinga – municipalities of Sobradinho (BA), Garanhuns (PE) and Sobral (BA). Blood and urine samples of wildlife, domestic animals and humans were collected at each property. The samples were collected from February to April 2012 in Caatinga and from July to September 2012 in Pantanal. The serological reactivity against Leptospira spp. was verified by microscopic agglutination technique (MAT) made with a collection consisting by 24 antigens of Leptospira spp. The leptospires research was carried out by urine samples crop sown in Fletcher resources and Ellinghausen – McCullough – Johnson – Harris (EMJH). Crops with growth of leptospires were referred to the Leptospirosis Laboratory of the Institute of Pathobiology, National Institute of Agricultural Technology, Buenos Aires, Argentina and isolated Leptospira strains were genotyped with the technique of Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). The classification procedure employed the VNTR 4, 7, 9, 10, 19, 23, 31, LB4 and LB5, which discriminate strains of L. interrogans and L. borgpetersenii. In Pantanal, 17 wildlife, 65 domestic animals and two humans were examined. In Caatinga, seven wild animals were examined, along with 100 domestic animals and 26 humans. Of 84 blood samples tested in Pantanal, 47 (55.95%) were positive and, of 133 in Caatinga, 59 (44.36%) were reactant. By Fisher’s exact test, considering a 0.05 significance level, there was no difference between the proportions of serum reagent animals against Leptospira spp. in two biome reviews (p = 0.063). The predominant serovars in SAM reactions were: 1) Pantanal – Bratislava (wildlife, dogs and humans), Grippotyphosa (horses and cattle); 2) Caatinga – Copenhageni (humans and dogs), Patoc (horses and cattle), Panama (sheep and goats), Patoc, Copenhageni and Australis (wildlife). Four strains of Leptospira were isolated: two in Sobradinho, BA, L. interrogans serogroup Pomona in Cavea aperea and L. interrogans in Euphractus sexcinctus; and two in Sobral, CE, L. interrogans in Cerdocyon thous and L. interrogans serogroup Pomona in Euphractus sexcinctus

Search of leptospires and of antibodies against leptospires in animals and human beings in farms in Pantanal and Caatinga Brazilian biomes

Foi investigada a ocorrência de leptospiras e de sororreatividade para leptospiras em animais e seres humanos de seis propriedades rurais localizadas em dois biomas brasileiros que apresentam condições geoclimáticas distintas: Pantanal – municípios de Miranda (MS), Itiquira (MT) e Poconé (MT) e Caatinga – municípios de Sobradinho (CE), Garanhuns (PE) e Sobral (BA). Em cada uma das propriedades, foram realizadas colheitas de sangue e de urina de animais selvagens de vida livre, animais domésticos e de seres humanos. As colheitas de materiais foram realizadas no período de fevereiro a abril de 2012 no bioma Caatinga e no período de julho a setembro de 2012 no bioma Pantanal. A reatividade sorológica contra Leptospira spp. foi verificada pela técnica de soroaglutinação microscópica (SAM) efetuada com uma coleção de antígenos constituída por 24 sorovares de Leptospira spp. A pesquisa de leptospiras foi efetuada por cultivos de amostras de urina semeadas nos meios Fletcher e de Ellinghausen – McCullough – Johnson – Harris (EMJH). Os cultivos em que houve crescimento de leptospiras foram encaminhados ao Laboratório de Leptospirose do Instituto de Patobiologia, Instituto Nacional de Tecnologia Agropecuária, Buenos Aires, Argentina e as estirpes de leptospiras isoladas foram genotipadas com o emprego da técnica de Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). O procedimento de tipificação empregou os VNTR 4, 7, 9, 10, 19, 23, 31, Lb4 e Lb5, que discriminam estirpes de L. interrogans e L. borgpetersenii. No Pantanal, foram examinados 17 animais selvagens, 65 animais domésticos e dois humanos. Na Caatinga, foram examinados sete animais selvagens, 100 animais domésticos e 26 humanos. Das 84 amostras de sangue examinadas no Pantanal, 47 (55,95%) foram reagentes e, das 133 da Caatinga, 59 (44,36%) foram reagentes. Pelo teste exato de Fisher, considerando-se um nível de significância de 0,05, não houve diferença entre as proporções de animais sororreagentes para Leptospira spp. nos dois biomas avaliados (p = 0,063). Os sorovares predominantes nas reações de SAM foram: 1) Pantanal – Bratislava (animais selvagens, cães e humanos); Grippotyphosa (equinos e bovinos); 2) Caatinga – Copenhageni (humanos e cães), Patoc (equinos e bovinos), Panama (ovinos e caprinos), Patoc, Copenhageni e Australis (animais selvagens). Houve isolamento de quatro estirpes de leptospiras: duas em Sobradinho, BA, L. interrogans sorogrupo Pomona em Cavea aperea e L. interrogans em Euphractus sexcinctus; e duas em Sobral, CE, L. interrogans em Cerdocyon thous e L. interrogans sorogrupo Pomona em Euphractus sexcinctus.The occurrence of Leptospira and of seroreactivity against Leptospira was investigated in animals and humans from six farms located in two Brazilian biomes that have different geoclimatic conditions: Pantanal – municipalities of Miranda (MS), Itiquira (MT) and Poconé (MT) and Caatinga – municipalities of Sobradinho (BA), Garanhuns (PE) and Sobral (BA). Blood and urine samples of wildlife, domestic animals and humans were collected at each property. The samples were collected from February to April 2012 in Caatinga and from July to September 2012 in Pantanal. The serological reactivity against Leptospira spp. was verified by microscopic agglutination technique (MAT) made with a collection consisting by 24 antigens of Leptospira spp. The leptospires research was carried out by urine samples crop sown in Fletcher resources and Ellinghausen – McCullough – Johnson – Harris (EMJH). Crops with growth of leptospires were referred to the Leptospirosis Laboratory of the Institute of Pathobiology, National Institute of Agricultural Technology, Buenos Aires, Argentina and isolated Leptospira strains were genotyped with the technique of Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). The classification procedure employed the VNTR 4, 7, 9, 10, 19, 23, 31, LB4 and LB5, which discriminate strains of L. interrogans and L. borgpetersenii. In Pantanal, 17 wildlife, 65 domestic animals and two humans were examined. In Caatinga, seven wild animals were examined, along with 100 domestic animals and 26 humans. Of 84 blood samples tested in Pantanal, 47 (55.95%) were positive and, of 133 in Caatinga, 59 (44.36%) were reactant. By Fisher’s exact test, considering a 0.05 significance level, there was no difference between the proportions of serum reagent animals against Leptospira spp. in two biome reviews (p = 0.063). The predominant serovars in SAM reactions were: 1) Pantanal – Bratislava (wildlife, dogs and humans), Grippotyphosa (horses and cattle); 2) Caatinga – Copenhageni (humans and dogs), Patoc (horses and cattle), Panama (sheep and goats), Patoc, Copenhageni and Australis (wildlife). Four strains of Leptospira were isolated: two in Sobradinho, BA, L. interrogans serogroup Pomona in Cavea aperea and L. interrogans in Euphractus sexcinctus; and two in Sobral, CE, L. interrogans in Cerdocyon thous and L. interrogans serogroup Pomona in Euphractus sexcinctus.Fil: Silva, Felipe Jorge da. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Santos, Carlos Eduardo Pereira dos. Universidade Federal do Mato Grosso do Sul; BrasilFil: Silva, Talita Ribeiro. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Silva, Glaucenyra Cecília Pinheiro. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Grune Loffler, Sylvia. Instituto Nacional de Tecnología Agropecuaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Brihuega, Bibiana. Instituto Nacional de Tecnología Agropecuaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Alarcon, Miguel Frederico Fernandez. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Curci, Vera Cláudia Magalhães. Agência Paulista de Tecnologia dos Agronegócios; BrasilFil: Mathias, Luis Antonio. Universidade Estadual Paulista Julio de Mesquita Filho; Brasi

Selection criteria for minimally invasive resection of intrahepatic cholangiocarcinoma-a word of caution: a propensity score matched analysis using the national cancer database

Background While minimally invasive liver resection (MILR) vs. open approach (OLR) has been shown to be safe, the perioperative and oncologic safety for intrahepatic cholangiocarcinoma (ICC) specifically, necessitating often complex hepatectomy and extended lymphadenectomy, remains ill-defined. Methods The National Cancer Database was queried for patients with ICC undergoing liver resection from 2010 to 2016. After 1:1 Propensity Score Matching (PSM), Kruskal-Wallis and chi(2) tests were applied to compare short-term outcomes. Kaplan-Meier survival analyses and Cox multivariable regression were performed. Results 988 patients met inclusion criteria: 140 (14.2%) MILR and 848 (85.8%) OLR resulting in 115 patients MILR and OLR after 1:1 PSM with c-index of 0.733. MILR had lower unplanned 30-day readmission [OR 0.075, P = 0.014] and positive margin rates [OR 0.361, P = 0.011] and shorter hospital length of stay (LOS) [OR 0.941, P = 0.026], but worse lymph node yield [1.52 vs 2.07, P = 0.001]. No difference was found for 30/90-day mortality. Moreover, multivariate analysis revealed that MILR was associated with poorer overall survival compared to OLR [HR 2.454, P = 0.001]. Subgroup analysis revealed that survival differences from approach were dependent on major hepatectomy, tumor size > 4 cm, or negative margins. Conclusion MILR vs. OLR is associated with worse lymphadenectomy and survival in patients with ICC greater than 4 cm requiring major hepatectomy. Hence, MILR major hepatectomy for ICC should only be approached selectively and if surgeons are able to perform an appropriate lymphadenectomy

Western population-based study of oncologic surgical quality and outcomes of laparoscopic versus open gastrectomy for gastric adenocarcinoma

Background While studies have reported improved morbidity of laparoscopic (LG) compared with open gastrectomy (OG), it remains unclear whether comparable oncologic outcomes can be achieved. This study aims at comparing not only short-term outcomes, including 30- and 90-day mortality, but also survival of LG vs OG. Methods The National Cancer Database was searched for adult patients with histologically proven gastric cancer and complete information regarding M0 disease, tumor size, differentiation grade, T stage, nodal status, comorbidities, type of hospital, hospital stay, type of surgery, oncological treatment and survival data were included. Logistic regression analyses were performed to analyze margin status, 30- and 90-day mortality, and 30-day re-admission rate. Linear regression was performed for length of hospital stay and lymph node yield. Kaplan-Meier survival analyses were performed to evaluate median survival. Cox multivariable regression models were created to correct for confounders and identify factors affecting survival. Results A query of the National Cancer Database identified 13,538 patients with complete dataset. A significant regression equation favoring LG for lymph node yield, hospital stay, and unplanned re-admission rate was identified. There was no significant effect of surgical approach on R1 margin rate, 30-day mortality, or 90-day mortality. Median survival was comparable between LG and OG (44.8 vs 40.2 months,p = 0.804). Conclusion LG offers a safe surgical approach to gastric cancer with shorter hospital stay and lower re-admission rates than OG, and also similar and sometimes improved operative oncologic quality parameters (margin, lymph node yield). More importantly, this Western series demonstrates that equivalent long-term outcomes of LG vs. OG are being achieved

Combining Appleby with RAMPS - Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Celiac Trunk Resection

Background Radical Antegrade Modular Pancreatosplenectomy (RAMPS) minimizes the risk of a positive retroperitoneal margin and maximizes lymph node harvest in distal pancreatic cancers.1-7In those with celiac trunk involvement, resection of the celiac trunk (modified Appleby procedure) is a surgical option in which postoperative liver perfusion relies on blood flow via superior mesenteric artery (SMA) and gastroduodenal artery (GDA).8,9 Patient A 66-year-old male was diagnosed with a 3.8 x 2.5 cm pancreatic body adenocarcinoma abutting the celiac trunk. Neoadjuvant FOLFIRINOX was initiated with a uniquely good response. Technique Prior to surgery, a novel preoperative 3D simulation technique accounting for organ displacement during pneumoperitoneum with the goal of optimizing port placement and surgical decision making was employed. At surgery, a RAMPS procedure was performed with the renal vessels and adrenal gland being dissected first (reversed from typical open approach). Following dissection along the SMA towards the celiac axis, desmoplastic reaction enveloping the celiac trunk necessitated its resection. Arterial liver perfusion was confirmed with intraoperative ultrasound. Conclusion L-RAMPS and modified Appleby procedure is a curative option for patients with distal pancreatic cancers that invade the celiac trunk and in whom the tumor biology is well controlled. A preplanned approach with 3D reconstruction accounting for organ displacement due to pneumoperitoneum optimizes surgical decision making and port placement for visual alignment caudally along the SMA

Clinical Prognosticators of Metastatic Potential in Patients with Small Pancreatic Neuroendocrine Tumors

Background While observation of T1(<= 2cm) nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) is an accepted practice, an ill-defined subgroup of patients with T1 tumors develops metastases. This study aimed to identify those patients via clinical factors. Methods Patients from the Surveillance, Epidemiology, and End Results (SEER) registry who were diagnosed with NF-PanNET with size <= 2cm between 1998 and 2014 and who underwent primary tumor resection were identified. Binary logistic regression analyses were performed to evaluate factors associated with pathological nodal and systemic metastatic disease. Results A total of 612 patients with T1 NF-PanNETs were identified. Of those, 72 (11.7%) developed nodal metastasis and 35 (5.7%) distant metastasis (M1). In the multivariable analysis, tumor location in the pancreatic body (OR 1.903, p=0.03) (OR 1.407, p=0.038) or tail (OR 1.258, p=0.04) (OR 1.612, p=0.021); tumor grade III-IV (OR 2.042, p=0.022) (OR 5.379, p <= 0.001); and younger age (OR 0.963, p=0.01) (OR 0.919, p=0.009) were associated with nodal metastases and the presence of M1 disease, respectively. Conclusion While the low metastatic potential of <= 2cm NF-PanNET implies watchful waiting to be an appropriate strategy for most patients, the increased risk of metastatic disease in younger patients with high grade (III-IV) body/tail tumors suggests individualized risk stratification to be optimal

Poorly differentiated hepatocellular carcinoma: resection is equivalent to transplantation in patients with low liver fibrosis

Organ allocation criteria for liver transplantation focus on tumor size and multifocality while tumor differentiation and existing liver damage are omitted. This study analyzes the impact of hepatocellular carcinoma (HCC) grade and liver fibrosis comparing resection (SX) to transplantation (LT). The National Cancer Database was queried between 2004 and 2016 for solitary HCC meeting Milan criteria undergoing SX vs LT. Two groups were created: low fibrosis (LF) vs high fibrosis (HF) and stratified by grade. Cox multivariable regression models, Kaplan–Meier survival analyses and log-rank tests were performed. 1515 patients were identified; 780 had LT and 735 had SX. Median overall survival (mOS) was 39.7 months; LT mOS was 47.9 months vs SX mOS of 34.9 months (P < .001). Multivariate analysis revealed SX, no chemotherapy, longer hospital stays, and age to be associated with worse survival. However, while transplantation conferred survival benefit for well-moderately differentiated tumors, SX vs LT did not impact survival for poorly differentiated HCC in LF patients, independent of tumor size. HCC differentiation and liver fibrosis, but not size, synergistically determine efficacy of SX vs LT. Therefore, current HCC transplantation criteria should incorporate tumor grade or liver fibrosis for optimal organ allocation

Preoperative Chemotherapy for Pancreatic Cancer Improves Survival and R0 Rate Even in Early Stage I

While preoperative chemotherapy for patients with stage II-III pancreatic adenocarcinoma (PDAC) is frequently practiced, its impact on very early PDAC (stage I) remains unclear today. Patients undergoing pancreatectomy for PDAC between 2010 and 2016 were identified in the National Cancer Database. Early-stage patients (IA-IB) with complete oncologic and clinical information and more than 30-day survival were included. The effect of preoperative chemotherapy on margin status was assessed with binary logistic regression. Following correction for confounders, the effect of therapy sequencing was assessed via comparison of preoperative, postoperative, perioperative (pre- and post-operative) chemotherapy, and surgery only using Cox regression. Of 4785 patients, 688 (14.4%) were stage IA, and 4197 (87.7%) IB. The rate of preoperative chemotherapy was only 8.8%. Rate of margin positivity was lower for preoperative chemotherapy (12.3% vs 19.7%). After correcting for confounders, the risk of a positive margin was lower in preoperative chemotherapy (odd ratio [OR] 0.703, p = 0.042). Cox regression showed a significant overall survival advantage for preoperative (hazard ratio [HR] 0.784, p = 0.002), postoperative (HR 0.618, p < 0.001), and perioperative (HR 0.601, p < 0.001) chemotherapy compared with surgery alone. There was no significant difference in survival between chemotherapy groups but a trend towards optimal survival for preoperative chemotherapy. Despite preoperative chemotherapy vs surgery alone resulting in improved R0 rates and overall survival even in stage I PDAC, it is rarely practiced. The results presented here suggest that preoperative chemotherapy should be strongly considered in all patients with resectable PDAC, including very early PDAC

Race, Age, Gender, and Insurance Status: A Comparative Analysis of Access to and Quality of Gastrointestinal Cancer Care

Background Socioeconomics, demographics, and insurance status play roles in healthcare access. Considering the limited resources available, understanding the relative impact of disparities helps prioritize programs designed to overcome them. This study evaluates gastrointestinal cancer care disparity by comparing the impact of different patient factors across oncologic care metrices. Methods A multi-institutional prospectively maintained cancer database was reviewed retrospectively for gastrointestinal cancers (esophagus, stomach, liver, pancreas, colorectal, and hepato-pancreato-biliary) from 2007 to 2017 to assess quality of care provided. Quality of care was defined by clinical course following national guidelines for the respective cancer. This included surgical intervention, chemotherapy, palliative care, and minimal delay to treatment/diagnosis. Logistic regression was used to adjust for confounders and identify factors associated with quality of care. Kaplan-Meier survival curves were compared using log-rank test. Results One thousand seventy-two patients were identified. Survival improved in patients with private insurance compared to government-funded options [median overall survival (mOS) 57.8 vs. 21.2 months; P < .001]. Private insurance also correlated with earlier stage at diagnosis [stages I-II = 50.9% vs. 37.5%, stages III-IV = 37.7% vs. 49.1%, P < .001], increased chemotherapy use [44.2% vs. 37.1%, P < .001], and more surgical intervention [62.4% vs. 48.8%, P < .001]. Outcomes were inferior for Black Americans, including trend towards lower rate of surgical treatment [42% vs. 54%, P = .058] and worse survival in private insurance carriers [mOS 7.8 vs. 57.8 months, P = .021] and those with early stage disease [mOS 39.2 vs. 81.5 months, P = .045] compared to White counterparts. Conclusions Insurance status has the strongest impact on the quality of gastrointestinal oncologic care with negative synergistic negative effect of race for Black Americans. While governmental programs aim to improve equality of care, there remains significant disparity compared to private insurance. Moreover, private insurance doesn't correct disparity for Black Americans, suggesting the need to address racial imbalances in cancer care