Does adjuvant therapy associated with esophagectomy improve survival in patients with esophagogastric junction adenocarcinoma?

777

Surgical gastrostomy: current indications and complications in a university hospital

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.OBJETIVO: revizar as indicações e as complicações observadas após a realização de gastrostomias cirúrgicas em pacientes internados em um hospital universitário público de ensino. MÉTODOS:estudo retrospectivo não randomizado de revisão dos prontuários médicos dos pacientes submetidos à gastrostomia cirúrgica nos últimos cinco anos, sobre as indicações e complicações. RESULTADOS: no período de 2007 a 2011, 86 pacientes foram submetidos à gastrostomias cirúrgicas para nutrição enteral. A técnica operatória utilizada foi a de Stamm na totalidade dos casos. Os homens constituíram 76 (88%) dos casos e a média de idade foi 58,4 anos, a idade máxima 87 anos e a mínima de 19 anos. Foram observadas 16 (18,60%) complicações consideradas menores, 17 (19,76%) complicações graves e oito (9,3%) óbitos peri-operatórios. CONCLUSÃO: as gastrostomias cirúrgicas, embora consideradas procedimentos de menor porte, não são isentas de complicações e mortalidade. A técnica operatória de Stamm, apesar das complicações relatadas, é de fácil execução, manuseio e oferece segurança.45846

ARE THERE ADVANTAGES IN DOUBLE TRANSIT RECONSTRUCTION AFTER TOTAL GASTRECTOMY IN PATIENTS WITH GASTRIC CANCER? A SYSTEMATIC REVIEW

ABSTRACT BACKGROUND: Curative treatment for gastric cancer involves tumor resection, followed by transit reconstruction, with Roux-en-Y being the main technique employed. To permit food transit to the duodenum, which is absent in Roux-en-Y, double transit reconstruction has been used, whose theoretical advantages seem to surpass the previous technique. AIMS: To compare the clinical evolution of gastric cancer patients who underwent total gastrectomy with Roux-en-Y and double tract reconstruction. METHODS: A systematic review was carried out on Web of Science, Scopus, EmbasE, SciELO, Virtual Health Library, PubMed, Cochrane, and Google Scholar databases. Data were collected until June 11, 2022. Observational studies or clinical trials evaluating patients submitted to double tract (DT) and Roux-en-Y (RY) reconstructions were included. There was no temporal or language restriction. Review articles, case reports, case series, and incomplete texts were excluded. The risk of bias was calculated using the Cochrane tool designed for randomized clinical trials. RESULTS: Four studies of good methodological quality were included, encompassing 209 participants. In the RY group, there was a greater reduction in food intake. In the DT group, the decrease in body mass index was less pronounced compared to preoperative values. CONCLUSIONS: The double tract reconstruction had better outcomes concerning body mass index and the time until starting a light diet; however, it did not present any advantages in relation to nutritional deficits, quality of life, and post-surgical complications

Retrospective study of results of neo-adjuvant therapy of esophgeal carcinoma in the survival of the operated patients in the College of Medicine of UNICAMP

Orientadores: Nelson Adami Andreollo, Luiz Roberto LopesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A neoplasia de esôfago é a oitava neoplasia mais incidente no Brasil, mantendo alta letalidade a despeito da melhora do tratamento cirúrgico nas últimas décadas. Os tratamentos utilizados dividem-se em: I) paliativos (sondas para nutrição enteral, próteses endoscópicas, gastrostomia, jejunostomia, derivação esôfago-gástrica, quimioterapia, radioterapia) e; II) curativos (esofagectomias isoladas, terapias neo-adjuvantes e terapias adjuvantes). Sendo assim, estratégias de tratamento neo-adjuvante tornam-se objeto de estudo. O objetivo do trabalho é avaliar em estudo retrospectivo não-randomizado a morbidade, a mortalidade e a sobrevida dos pacientes operados na Faculdade de Ciências Médicas da UNICAMP no período de 1979 a 2006, divididos em três grupos: I) esofagectomia; II) radioterapia neo-adjuvante seguido de esofagectomia; e III) radioterapia-quimioterapia neo-adjuvante seguido de esofagectomia. Na análise dos resultados, os grupos não diferem significativamente quanto ao sexo, cor, idade, alguns sintomas pré-operatórios (pirose, tabagismo), complicações pós-operatórias, mortalidade, N patológico, grau de diferenciação histológica e estadiamento; os grupos diferem significativamente em relação a outros sintomas (disfagia, dor retroesternal, etilismo), localização tumoral, T patológico e resposta tumoral. As conclusões mostram diferenças de sobrevida entre os grupos após a exclusão dos óbitos peri-operatórios, com benefício estatisticamente significativo para a terapêutica neo-adjuvanteAbstract: Neoplasm of esophagus cancer is the eighth highest incidence in Brazil, maintaining a high mortality rate despite the improvement of surgical treatment in recent decades. Treatments are divided into: I) palliative (nasogastric tube for enteral nutrition, prosthetics, endoscopic gastrostomy, jejunostomy, esophageal-gastric bypass, chemotherapy, radiotherapy) and; II) radical (esophagectomy isolated, neo-adjuvant therapy and adjuvant therapy) . Thus, neoadjuvant treatment strategies become the object of study. The objective is to evaluate with a non-randomized retrospective study morbidity, mortality and survival of patients operated in the Faculty of Medical Sciences of Campinas in the period 1979-2006, divided into three groups: I) esophagectomy; II) neoadjuvant radiotherapy followed by esophagectomy, and III) neoadjuvant radiotherapy and chemotherapy followed by esophagectomy. Results show that groups did not differ significantly regarding gender, race, age, some preoperative symptoms (heartburn, smoking), postoperative complications, mortality, N pathological, histological grade and stage; groups differ significantly for other symptoms (dysphagia, retrosternal pain, alcoholism), tumor location, T and pathological tumor response. Findings show differences in survival between groups after the exclusion of perioperative deaths, with statistically significant benefit for neoadjuvant therapyMestradoCirurgiaMestre em Cirurgi