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

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