Surgical Gastrostomy: Current Indications And Complications In A University Hospital [gastrostomia Cirúrgica: Indicações Atuais E Complicações Em Pacientes De Um Hospital Universitário]

Objective: To analyze the surgical gastrostomies performed at a public University Hospital, their indications and complications. Methods: We conducted a retrospective, nonrandomized review of medical records of patients who underwent surgical gastrostomy from 2007 to 2011; Results:, In the period of studied, 86 patients underwent surgical gastrostomies for enteral nutrition. The Stamm technique was employed in all cases. Men constituted 76 (88%) of the cases and the mean age was 58.4 years, the maximum age being 87 years and the minimum 19. We observed 16 (18.60%) minor complications, 17 (19.76%) serious complications and 8 (9.3%) perioperative deaths. Conclusion: Surgical gastrostomy, while considered a smaller procedure, is not without complications and mortality. The Stamm technique, despite the complications reported, is easy to perform and to handle, as well as safe.406458462Witzel, O., Zur technik der magenfistulaeinlegung (1891) Zbl Chir, 18, pp. 601-604Stamm, M., Gastrostomy: A new method (1894) Med News, 65, p. 324Grant, J.P., Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy (1988) Ann Surg, 207 (5), pp. 598-603Gauderer, M.W., Ponsky, J.L., Izant Jr., R.J., Gastrostomy without laparoscopy: A percutaneous endoscopic technique (1980) J Pediatr Surg, 15 (6), pp. 872-875Kwon, R.S., Banerjee, S., Desilets, D., Diehl, D.L., Farraye, F.A., Enteral nutrition access devices (2010) Gastrointest Endosc, 72 (2), pp. 236-248. , ASGE Technology CommitteeHerman, L.L., Hoskins, W.J., Shike, M., Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel (1992) Gastrointest Endosc, 38 (3), pp. 314-318Möller, P., Lindberg, C.G., Zilling, T., Gastrostomy by various techniques: Evaluation of indications, outcome, and complications (1999) Scand J Gastroenterol, 34 (10), pp. 1050-1054Wollman, B., D'Agostino, H.B., Walus-Wigle, J.R., Easter, D.W., Beale, A., Radiologic, endoscopic, and surgical gastrostomy: An institutional evaluation and meta-analysis of the literature (1995) Radiology, 197 (3), pp. 699-704Ljungdahl, M., Sundbom, M., Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: A prospective, randomized trial (2006) Surg Endosc, 20 (8), pp. 1248-1251Pisano, G., Calò, P.G., Tatti, A., Farris, S., Erdas, E., Licheri, S., Surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible: Indications, results and comparison between the two procedures (2008) Chir Ital, 60 (2), pp. 261-266Martins, F.P., Sousa, M.C.B., Ferrari, A.P., New "introducer" PEG-gastropexy with T fasteners: A pilot study (2011) Arq Gastroenterol, 48 (4), pp. 231-235Ocaña, L.F.O., Crocifoglio, V.A., La gastrostomía laparoscópica como una alternative a la gastrostomía endoscópica percutánea (1995) Rev Gastroenterol Mex, 60 (4), pp. 218-220Bergstrom, L.R., Larson, D., Zinsmeister, A.R., Sarr, M.G., Silverstein, M.D., Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: A population- based study (1995) Mayo Clin Proc, 70 (9), pp. 829-836Nicholson, F.B., Korman, M.G., Richardson, M.A., Percutaneous endoscopic gastrostomy: A review of indications, complications and outcome (2000) J Gastroenterol Hepatol, 15 (1), pp. 21-25Shellito, P.C., Malt, R.A., Tube gastrostomy. Techniques and complications (1985) Ann Surg, 201 (2), pp. 180-185Cox, W.D., Gillesby, W.J., Gastrostomy in postoperative decompression: Indications and methods (1967) Am J Surg, 113 (2), pp. 298-302Cosentini, E.P., Sautner, T., Gnant, M., Winkelbauer, F., Teleky, B., Jakesz, R., Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies (1998) Arch Surg, 133 (10), pp. 1076-1083Rustom, I.K., Jebreel, A., Tayyab, M., England, R.J., Stafford, N.D., Percutaneous endoscopic, radiological and surgical gastrostomy tubes: A comparison study in head and neck cancer patients (2006) J Laryngol Otol, 120 (6), pp. 463-466Grilo, A., Santos, C.A., Fonseca, J., Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting (2012) Arq Gastroenterol, 49 (3), pp. 227-231Zorrón, R., Flores, D., Meyer, C.A.F., Castro, L.M., Madureira, F.A.V., Madureira, F.D., Single-wound gastrostomy: A simple method as an option for endoscopy (2005) Rev Col Bras Cir, 32 (3), pp. 153-15

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Ascites after liver transplantation and inferior vena cava reconstruction in the piggyback technique

3483336333

Barrett's Esophagus Associated To Caustic Stenosis Of The Esophagus [o Esôfago De Barrett Associado à Estenose Cáustica Do Esôfago]

Background - The esophageal stenosis secondary to the ingestion of caustic products is frequent in Brazil, mainly due to an attempt suicide. The Barrett's esophagus is consequence of the chronic gastroesophageal reflux. The literature consulted showed that are a rare association. Casuistic and Methods - From 1981 to 2000 were admitted and treated in the "Gastrocentro" State University of Campinas, SP, Brazil, 120 patients presenting caustic stenosis of the esophagus, and during the follow-up were found nine cases with Barrett's esophagus associated (7,5%). The time of caustic ingestion varied from 4 years to 54 years (mean 29 years), and they were four males and five females, eight whites and one black, with the mean age of 57,7 years (43 to 72 years). Results - All the cases presented dysphagia and the flexible upper endoscopy showed stenotic areas and caustic esophagitis sequels. Three patients referred symptoms of gastroesophageal reflux, but hiatus hernia were found in only one case. The Barrett's esophagus was found in the middle third of the esophagus above the stenotic areas in three cases, and in the distal third in six cases. The dysphagia was treated with periodic esophageal dilatations. Two patients presenting severe symptoms of reflux were submitted to modified Nissen fundoplication by videolaparoscopy, with good results. Conclusions - The Barrett's esophagus in these patients could be associated to the caustic ingestion, because it is not situated in the distal third of the esophagus, as commonly found in reflux esophagitis. Its is very important the follow-up and biopsies of the Barrett's esophagus, due to the possibility of malignancy.403148151Andreollo, N.A., Miquelino, M., Lopes, L.R., Trevisan, M.A.S., Brandalise, N.A., Leonardi, L.S., Incidência e epidemiologia do epitélio de Barrett no Gastrocentro/UNICAMP (1997) Arq Gastroenterol, 34, pp. 22-26Andreollo, N.A., Lopes, L.R., Nogutti, R., Brandalise, N.A., Leonardi, L.S., Tratamento conservador das estenoses benignas do esôfago através de dilatações. Análise de 500 casos (2001) Rev Assoc Med Bras, 47, pp. 236-243Bremner, C.G., Bremner, R.M., Malignant degeneration of Barrett's esophagus: Current concepts on the pathogenesis of Barrett's esophagus (1995) Dis Esophagus, 8, pp. 79-85Cornet, A., Barbier, J., Grenier, G., Elhadad, A., Breaute, H., Carnot, F., Caustic burn and adenocarcinoma of the esophagus (1976) Sem Hop, 52, pp. 1999-2003Fisher, D.R., Preston, D.F., Robinson, R.G., Ginsberg, B.W., Barrett's esophagus complicating by ingestion. Demonstration by pertechnetate scintigraphy (1983) Clin Nucl Med, 8, pp. 550-552Gumaste, V.V., Dave, P.B., Ingestion of corrosive substances by adults (1992) Am J Gastroenterol, 87, pp. 1-5Ishioka, S., Estenoses benignas do esôfago (1994) Endoscopia Digestiva, pp. 85-99. , Sociedade Brasileira de Endoscopia Digestiva - SOBED, editor. Rio de Janeiro: MedsiKikendall, J.W., Caustic ingestion injuries (1991) Gastroenterol Clin North Am, 20, pp. 847-857Lopes, L.R., Brandalise, N.A., Andreollo, N.A., Leonardi, L.S., Tratamento cirúrgico videolaparoscópico da doença do refluxo gastroesofagiano: Técnica de Nissen modificada - Resultados clínicos e funcionais (2001) Rev Assoc Med Bras, 47, pp. 141-148Pera, M., Duranceau, A., Malignant degeneration of Barrett's esophagus: Epidemiology of Barrett's esophagus and esophageal adenocarcinoma (1995) Dis Esophagus, 8, pp. 86-92Phillips, R.W., Wong, R.K.H., Barrett's esophagus. Natural history, incidence, etiology and complications (1991) Gastroenterol Clin North Am, 20, pp. 791-815Postlethwait, R.W., Chemical burns of the esophagus (1979) Surgery of the Esophagus, p. 287. , Postlethwait RW. New York: Appleton Century CroftsProvenzale, D., Kemp, J.A., Arora, S., Wong, J.B., A guide for surveillance of patients with Barrett's esophagus (1994) Am J Gastroenterol, 89, pp. 670-680Reid, B., Barrett's esophagus and esophageal adenocarcinoma (1991) Gastroenterol Clin North Am, 20, pp. 817-833Sampliner, R.E., Jaffe, P., Malignant degeneration of Barrett's esophagus: The role of laser ablation and photodynamic therapy (1995) Dis Esophagus, 8, pp. 104-108Salo, J.A., Malignant degeneration of Barrett's esophagus: The role of laser ablation and anti-reflux surgery (1995) Dis Esophagus, 8, pp. 109-110Spechler, S.J., Sperber, H., Doos, W., Schimmel, E.M., The prevalence of Barrett's esophagus in patients with chronic peptic esophageal strictures (1983) Dig Dis Sci, 28, pp. 769-774Spechler, S.J., Schimmel, E.M., Dalton, J.W., Doos, W., Trier, J.S., Barrett's epithelium complicating lye ingestion with sparing of the distal esophagus (1981) Gastroenterology, 81, pp. 580-583Talbert, J.T., Estenoses cáusticas do esôfago (1999) Tratado de Cirurgia. 15 Ed., pp. 732-737. , Sabiston DC Jr, Lyerly HK, editores. Rio de Janeiro: Guanabara KooganTolentino, M.M., Faifer, J.G., Trentini, E.A., Doença do refluxo gastroesofágico (1998) Gastroenterologia Essencial, pp. 62-74. , Dani R, editor. Rio de Janeiro: Guanabara KooganTucker, J.A., Yarington, C.T., The treatment of caustic ingestion (1979) Otolaryngol Clin North Am, 12, pp. 343-35

Neoadjuvant Chemoradiotherapy And Surgery Compared With Surgery Alone In Squamous Cell Carcinoma Of The Esophagus [radioterapia E Quimioterapia Neoadjuvantes E Cirurgia Comparado Com A Cirurgia No Tratamento Do Carcinoma Epidermoide Do Esôfago]

Context - Despite progress in recent years in methods of diagnosis and surgical treatment of esophageal cancer, there is still controversy about the benefits from neoadjuvant chemoradiotherapy. Objective - To analise the survival of patients submitted to esophagectomy for squamous cell carcinoma of the esophagus with or without neoadjuvant chemoradiotherapy. Method - A retrospective, non-randomized study conducted using the medical charts of patients operated for squamous cell carcinoma of the esophagus at the School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil between 1979 and 2006. The Kaplan-Meier analysis was used to calculate survival curves and the log-rank test to compare data in each group. The significance level was settled as 5%. Results - A total of 123 patients were evaluated in this study, divided into three groups: I - 26 (21.2%) patients submitted to esophagectomy alone; II - 81 (65.8%) patients submitted to neoadjuvant radiotherapy plus esophagectomy and III - 16 (13%) patients submitted to neoadjuvant chemoradiotherapy plus esophagectomy. A statistically significant survival was recorded between the groups (log rank = 6.007; P = 0.05), survival being greatest in the group submitted to neoadjuvant chemoradiotherapy, followed by the group submitted to neoadjuvant radiotherapy compared to the group submitted to esophagectomy alone as the initial treatment of choice. Conclusion - Radiotherapy and chemotherapy neoadjuvants in patients with squamous cell carcinoma of the esophagus offers benefits and increases survival.502101106Almhanna, K., Strosberg, J.R., Multimodality approach for locally advanced esoph-ageal cancer (2012) World J Gastroenterol, 18, pp. 5679-5687Ancona, E., Ruol, A., Santi, S., Merigliano, S., Sileni, V.C., Koussis, H., Zaninotto, G., Peracchia, A., Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esopagheal squamous cell carcinoma: Final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone (2001) Cancer, 91, pp. 2165-2174Bosset, J.F., Gignoux, M., Triboulet, J.P., Tiret, E., Mantion, G., Elias, D., Lozach, P., Sahmoud, T., Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus (1997) N Engl J Med, 337, pp. 161-167(2012) Rio De Janeiro, , http://www.inca.gov.br/estimativa/2012/, Brasil. Ministério da Saúde, National Institute of Cancer (INCA): Incidence of cancer in Brazil [Internet]Conteduca, V., Sansonno, D., Ingravallo, G., Marangi, S., Russi, S., Lauletta, G., Dam-Macco, F., Barrett's esophagus and esophageal cancer: An overview (2012) Int J Oncol, 41, pp. 414-424de Barros, S.G., Ghisolf, E.S., Luz, L.P., Barlem, G.G., Vidal, R.M., Wolff, F.H., Magno, V.A., Prolla, J.C., High temperature "matè" infusion drinking in a population at risk for squamous cell carcinoma of the esophagus (2000) Arq Gastroenterol, 37, pp. 25-30Denlinger, C.E., Reed, C.E., Contemporary management of esophageal malignancy (2012) Surg Clin North Am, 92, pp. xvii-xviiiEl-Nakadi, I., Van Laethem, J.L., Houben, J.J., Gay, F., Closset, J., van Houtte, P., Danhier, S., Gelin, M., Squamous cell carcinoma of the esophagus: Multimodal therapy in locally advanced disease (2002) World J Surg, 26, pp. 72-78Fiorica, F., Di Bona, D., Schepis, F., Licata, A., Shahied, L., Venturi, A., Falchi, A.M., Cammà, C., Preoperative chemoradiotherapy for oesophageal cancer: A systematic review and meta-analysis (2004) Gut, 53, pp. 925-930Greer, S.E., Goodney, P.P., Sutton, J.E., Birkmeyer, J.D., Neoadjuvant chemoradio-therapy for esophageal carcinoma: A meta-analysis (2005) Surgery, 137, pp. 172-177Hölscher, A.H., Bollschweiler, E., Choosing the best treatment for esophageal cancer: Criteria for selecting the best multimodal therapy (2012) Recent Results Cancer Res, 196, pp. 169-177Le Prise, E., Etienne, P.L., Meunier, B., Maddern, G., Ben Hassel, M., Gedouin, D., Boutin, D., Launois, B., A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus (1994) Cancer, 73, pp. 1779-1784Liao, Z., Zhang, Z., Jin, J., Ajani, J.A., Swisher, S.G., Stevens, C.W., Ho, L., Komaki, R., Esophagectomy after concurrent chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients (2004) Int J Radiat Oncol Biol Phys, 60, pp. 1484-1493Makary, M.A., Kiernan, P.D., Sheridan, M.J., Tonnesen, G., Hetrick, V., Vaughan, B., Graling, P., Elster, E., Multimodality treatment for esophageal cancer: The role of surgery and neoadjuvant therapy (2003) Am Surg, 69, pp. 693-700Malaisrie, S.C., Untch, B., Aranha, G.V., Mohideen, N., Hantel, A., Pickleman, J., Neo-adjuvant chemoradiotherapy for locally advanced esophageal cancer: Experience at a single institution (2004) Arch Surg, 139, pp. 532-538Malthaner, R.A., Wong, R.K., Rumble, R.B., Zuraw, L., Members of the Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: A systematic review and meta-analysis (2004) BMC Med, 2, p. 35Marin, F.A., Lamônica-Garcia, V.C., Henry, M.A., Burini, R.C., Grade of esophageal cancer and nutritional status impact on postsurgery outcomes (2010) Arq Gastroenterol, 47, pp. 348-353Morgan, M.A., Lewis, W.G., Crosby, T.D., Escofet, X., Roberts, S.A., Brewster, A.E., Harvard, T.J., Clark, G.W., Prospective cohort comparison of neoadjuvant chemo-radiotherapy versus chemotherapy in patients with oesophageal cancer (2007) Br J Surg, 94, pp. 1509-1514Pinotti, H.W., Subtotal esophagectomy by transmediastinal tunnel without thora-cotomy (1977) Rev Assoc Med Bras, 23, pp. 395-398Ramos, A.C., Araujo, M.R., Lopes, L.R., Andreollo, N.A., Role of the vitamin C in diethylnitrosamine-induced esophageal cancer in Wistar rats (2009) Acta Cir Bras, 24, pp. 183-188Schena, M., la Rovere, E., Solerio, D., Bustreo, S., Barone, C., Daniele, L., Buffoni, L., Ricardi, U., Neoadjuvant che-mo-radiotherapy for locally advanced esophageal cancer: A monocentric study (2012) Tumori, 98, pp. 451-457Sugimachi, K., Yaita, A., Ueo, H., Natsuda, Y., Inokuchi, K., A safer and more reliable operative technique for esophageal reconstruction using a gastric tube (1980) Am J Surg, 140, pp. 471-474Talsma, K., van Hagen, P., Grotenhuis, B.A., Steyerberg, E.W., Tilanus, H.W., van Lanschot, J.J., Wijnhoven, B.P., Comparison of the 6th and 7th Editions of the UICC-AJCC TNM Classification for Esophageal Cancer (2012) Ann Surg Oncol, 19, pp. 2142-2148Tercioti, V., Lopes, L.R., Coelho-Neto, J.S., Andreollo, N.A., New aspects of the neo-adjuvant therapy in esophageal squamous cell carcinoma: A review of medical literature (2009) ABCD Arq Bras Cir Dig, 22, pp. 33-40Urba, S.G., Orringer, M.B., Turrisi, A., Iannettoni, M., Forastiere, A., Strawderman, M., Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma (2001) J Clin Oncol, 19, pp. 305-313Urschel, J.D., Vasan, H., A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer (2003) Am J Surg, 185, pp. 538-543van Hagen, P., Hulshof, M.C., van Lanschot, J.J., Steyerberg, E.W., Van Berge Henegou-Wen, M.I., Wijnhoven, B.P., Richel, D.J., van der Gaast, A., CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer (2012) N Engl J Med, 366, pp. 2074-2084Worni, M., Martin, J., Gloor, B., Pietrobon, R., D'Amico, T.A., Akushevich, I., Berry, M.F., Does surgery improve outcomes for esophageal squamous cell carcinoma? An analysis using the surveillance epidemiology and end results registry from 1998 to 2008 (2012) J Am Coll Surg, 215, pp. 643-651Zhang, X., Watson, D.I., Jamieson, G.G., Bessell, J.R., Devitt, P.G., Neoadjuvant chemo-radiotherapy for esophageal carcinoma (2005) Dis Esophagus, 18, pp. 104-10

Local Effectiveness And Complications Of Neoadjuvant Therapy In Esophageal Squamous Cell Carcinoma: Radiotherapy Versus Chemoradiotherapy [eficácia Local E Complicações Da Terapêutica Neoadjuvante No Carcinoma Epidermóide Do Esôfago: Radioterapia Versus Radioterapia Associada à Quimioterapia]

Objective: To evaluate tumor responses to neoadjuvant therapy, according to the histopathological findings of surgical specimens of patients operated and treated for squamous cell carcinoma of the middle third and distal esophagus. Methods: We conducted a retrospective nonrandomized study including 97 patients distributed as follows: Group I - 81 (83.5%) underwent neoadjuvant radiation therapy, and group II - 16 (16.5%) underwent neoadjuvant radiotherapy and chemotherapy. A third group of 26 patients undergoing esophagectomy alone was used for comparison of postoperative complications. The characteristics of each patient (age, gender and race), tumor site, staging, and histological evaluation of treatment modalities were reviewed and analyzed. Tumor response to neoadjuvant therapy was evaluated by histopathology of the specimen. Results: There was no statistically significant differences regarding race, gender, age, staging and postoperative complications in patients in the three groups. Patients undergoing radiotherapy and neoadjuvant chemotherapy showed more satisfactory tumor reduction, with improved local efficacy when compared to the group only submitted to neoadjuvant radiotherapy. Conclusion: The study suggests that radiotherapy combined with chemotherapy was more efficient in reducing tumor site when compared to the group treated with radiotherapy. In addition, neoadjuvant therapy did not increase the postoperative complications when compared to patients undergoing surgery alone.384227231(2007) Coordenação De Prevenção E Vigilância De Câncer, , http://bvsms.saude.gov.br/bvs/publicacoes/estimativa_incidencia_cancer_2008.pdf, Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Insti-tuto Nacional de Câncer, Estimativas 2008: Incidência de câncer no Brasil. Rio de Janeiro: INCA, acessado em 25-02-2008Zacherl, J., Sendler, A., Stein, H.J., Ott, K., Feith, M., Jakesz, R., Current status of neoadjuvant therapy for adenocarcinoma of the distal esophagus (2003) World J Surg, 27 (9), pp. 1067-74Pearson, J.G., The present status and future potential of radiotherapy in the management of esophageal cancer (1977) Cancer, 39 (2 SUPPL.), pp. 882-90Urba, S.G., Orringer, M.B., Turrisi, A., Iannettoni, M., Forastiere, A., Strawderman, M., Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma (2001) J Clin Oncol, 19 (2), pp. 305-13Ancona, E., Ruol, A., Santi, S., Merigliano, S., Sileni, V.C., Koussis, H., Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: Final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone (2001) Cancer, 91 (11), pp. 2165-74Kesler, K.A., Helft, P.R., Werner, E.A., Jain, N.P., Brooks, J.A., Dewitt, J.M., A retrospective analysis of locally advanced esophageal cancer patients treated with neoadjuvant chemoradiation therapy followed by surgery or surgery alone (2005) Ann Thorac Surg, 79 (4), pp. 1116-21Berger, A.C., Farma, J., Scott, W.J., Freedman, G., Weiner, L., Cheng, J.D., Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival (2005) J Clin Oncol, 23 (19), pp. 4330-4337Sobin, L.H., Wittekind, C., International Union Against Cancer (2002) TNM Classification of Malignant Tumours, , 6 th ed. New York: Wiley-LissPinotti, H.W., Subtotal esophagectomy by transmediastinal tunnel without thoracotomy (1977) AMB Rev Assoc Med Bras, 23 (11), pp. 395-398McKeown, K.C., Total three-stage oesphagectomy for câncer of the esophagus (1976) Br J Surg, 63 (4), pp. 259-62Donington, J.S., Miller, D.L., Allen, M.S., Deschamps, C., Nichols, F.C., Pairolero, P.C., Tumor response to induction chemoradiation: Influence on survival after esophagectomy (2003) Eur J Cardiothorac Surg, 24 (4), pp. 631-636. , discussion 636-7Malaisrie, S.C., Untch, B., Aranha, G.V., Mohideen, N., Hantel, A., Pickleman, J., Neoadjuvant chemoradiotherapy for locally advanced esophageal cancer (2004) Arch Surg, 139 (5), pp. 532-538. , discussion 538-9Danilo, G., Corsi, P.R., Frimm, C.E., Fava, J., Câncer do esôfago: Compli-cações pós-operatórias imediatas e letalidade hospitalar (2004) Rev Col Bras Cir, 31 (1), pp. 2-9Bosset, J.F., Gignoux, M., Triboulet, J.P., Tiret, E., Mantion, G., Elias, D., Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus (1997) N Engl J Med, 337 (3), pp. 161-167Walsh, T.N., Noonan, N., Hollywood, D., Kelly, A., Keeling, N., Hennessy, T.P., A comparison of multimodal therapy and surgery for esophageal adenocarcinoma (1996) N Engl J Med, 335 (7), pp. 462-467Tercioti, V., Lopes, L.R., Coelho Neto, J.S., Andreollo, N.A., Aspectos atuais da terapêutica neoadjuvante no carcinoma epidermoide do esôfago. Revisão da literatura (2009) ABCD Arq Bras Cir Dig, 22 (1), pp. 33-40Tepper, J., Krasna, M.J., Niedzwiecki, D., Hollis, D., Reed, C.E., Goldberg, R., Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781 (2008) J Clin Oncol, 26 (7), pp. 1086-92Jones, D.R., Detterbeck, F.C., Egan, T.M., Parker, L.A., Bernard, S.A., Tepper, J.E., Induction chemoradiotherapy followed by esophagectomy in patients with carcinoma of the esophagus (1997) Ann Thorac Surg, 64 (1), pp. 185-91. , duscussion 191-2Hennequin, C., Gayet, B., Sauvanet, A., Blazy, A., Perniceni, T., Panis, Y., Impact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus (2001) Int J Rad Oncol Biol Phys, 49 (3), pp. 657-64Makary, M.A., Kiernan, P.D., Sheridan, M.J., Tonnesen, G., Hetrick, V., Vaughan, B., Multimodality treatment for esophageal cancer: The role of surgery and neoadjuvant therapy (2003) Am Surg, 69 (8), pp. 693-700. , discussion 700-2Reynolds, J.V., Muldoon, C., Hollywood, D., Ravi, N., Rowley, S., O'Byrne, K., Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer (2007) Ann Surg, 245 (5), pp. 707-16Yano, M., Inoue, M., Shiozaki, H., Preoperative concurrent chemotherapy and radiation therapy followed by surgery for esophageal cancer (2002) Ann Thorac Cardiovasc Surg, 8 (3), pp. 123-30Kleinberg, L., Forastiere, A.A., Chemoradiation in the management of esophageal cancer (2007) J Clin Oncol, 25 (26), pp. 4110-4117Hyngstrom, J.R., Posner, M.C., Neoadjuvant strategies for the treatment of locally advanced esophageal cancer (2010) J Surg Oncol, 101 (4), pp. 299-30

Esophagogastric Junction Adenocarcinoma: Multivariate Analyses Of Surgical Morbi-mortality And Adjuvant Therapy.

In recent years the literature has recorded a progressive increase in the prevalence of adenocarcinoma of the esophagogastric junction. Several factors can interfere with the morbidity and mortality of surgical treatment. Non-randomized retrospective study of prognostic factors of operated patients by adenocarcinoma of esophagogastric junction, with or without post-operative chemotherapy and radiotherapy. Medical records were reviewed from patients treated at university hospital in the period of 1989 and 2009, to obtain data about pre and postoperative treatment. Cox's univariate and multivariate regression analysis of risk factors for prognostic of these patients were done with level of significance of 5 %. Were reviewed 103 patients distributed as: 1) 78 (75.7%) patients without adjuvant therapy, and 2) 25 (24.3%) with it. All patients underwent surgical resection with curative intent. Cox's multivariate regression analysis of all patients showed that: lymphnode invasion N2 had greater risk of death in 5.9 times; broncopneumonia, in 11.4 times; tumoral recurrence during clinical following greater in 3.8 times. Tumoral recurrence, lymphnode metastasis and broncopneumonia in the postoperative period were factors of bad prognosis and contributed significantly to increase morbimortality and decrease global survival.25422923