Guilherme Pinto Bravo Neto

Lymph node metastasis in early gastric cancer

OBJECTIVE to evaluate the incidence of lymph node metastasis in early gastric cancer, identifying risk factors for its development. METHODS we conducted a prospective study of patients with gastric cancer admitted to the Section of the Esophago-Gastric Surgery of the Surgery of Service HUCFF-UFRJ, from January 2006 to May 2012. RESULTS the rate of early gastric cancer was 16.3%. The incidence of nodal metastases was 30.8% and occurred more frequently in patients with tumors with involvement of the submucosa (42.9%), in those poorly differentiated (36.4%), in tumors larger than 2 cm (33.3%) and in type III ulcerated lesions (43.8%). CONCLUSION the incidence of lymph node metastases in patients was very high and suggests that one should keep the radicality of resection in early gastric cancer, particularly in relation to D2 lymphadenectomy, recommended for advanced gastric cancer. Conservative resections, with lymphadenectomies smaller than D2, should be performed only in selected cases, well-studied as for the risk factors of lymph node metastasis. Despite the small number of cases did not permit to relate the rate of lymph node metastasis to the risk factors considered, we noted a strong tendency for the occurrence of these metastases in the poorly differentiated, type III, larger than 2 cm tumors, and in the Lauren diffuse types.

Lesão iatrogênica da via biliar principal em colecistectomia videolaparoscópica

BACKGROUND: The aim of this study was to analyze the incidence, morbidity and mortality of iatrogenic biliary tract injury during laparoscopic cholecystectomies in a teaching hospital. METHODS: Retrospective study at Hospital Universitario Clementino Fraga Filho of the Universidade Federal do Rio de Janeiro from January 1992 to December 2003. Total and partial injuries, the time to recognize them and types of repair were reviewed. RESULTS: During the studied period, 1589 patients underwent laparoscopic cholecystectomies with four biliary tract injuries (0.25%), all of them occuring in the recent years. CONCLUSION: The incidence of iatrogenic biliary tract injury in our series was similar to the literature and very similar to the open procedure.

Ressecções gástricas menores com linfadenectomia modificada em câncer gástrico precoce com linfonodo sentinela negativo

OBJECTIVE To study the sentinel lymph node in early gastric cancer as a diagnostic method of unsuspected lymph node metastasis, which may allow the performance, in those with negative lymph nodes, of smaller gastric resections with limited lymphadenectomy. METHODS We studied seven patients with early gastric cancer treated at the Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, from September 2008 to May 2011, who underwent sentinel lymph node exams, performed by intraoperative peritumoral endoscopic injection of patent blue dye. RESULTS We found an average of three sentinel nodes per patient. The frozen biopsy of lymph nodes was negative for metastases, which allowed the realization of atypical gastric resection in three cases and antrectomy with BI reconstruction in four. The performed lymphadenectomy was modified D1. There was no operative mortality. The duration of postoperative follow-up ranged from five to 37 months, without evidence of recurrence. One patient developed a second early tumor 13 months after the initial surgery and underwent total gastrectomy. CONCLUSION The sentinel lymph node in early gastric cancer proved to be an effective method for the evaluation of nodal metastases in seven patients and allowed for smaller gastric resections and limited lymphadenectomies. These minor procedures reduce the risk of postoperative complications, maintaining, on the other hand, the oncological radicality that is required in the treatment of gastric cancer.OBJECTIVE: To study the sentinel lymph node in early gastric cancer as a diagnostic method of unsuspected lymph node metastasis, which may allow the performance, in those with negative lymph nodes, of smaller gastric resections with limited lymphadenectomy. METHODS: We studied seven patients with early gastric cancer treated at the Hospital Universitario Clementino Fraga Filho, Federal University of Rio de Janeiro, from September 2008 to May 2011, who underwent sentinel lymph node exams, performed by intraoperative peritumoral endoscopic injection of patent blue dye. RESULTS: We found an average of three sentinel nodes per patient. The frozen biopsy of lymph nodes was negative for metastases, which allowed the realization of atypical gastric resection in three cases and antrectomy with BI reconstruction in four. The performed lymphadenectomy was modified D1. There was no operative mortality. The duration of postoperative follow-up ranged from five to 37 months, without evidence of recurrence. One patient developed a second early tumor 13 months after the initial surgery and underwent total gastrectomy. CONCLUSION: The sentinel lymph node in early gastric cancer proved to be an effective method for the evaluation of nodal metastases in seven patients and allowed for smaller gastric resections and limited lymphadenectomies. These minor procedures reduce the risk of postoperative complications, maintaining, on the other hand, the oncological radicality that is required in the treatment of gastric cancer.

Ressecção de metástase hepática de sarcomas de partes moles

OBJETIVO: Avaliar os resultados do tratamento cirurgico de pacientes portadores de metastases hepaticas de sarcomas de partes moles, com enfase na identificacao de fatores prognosticos e estudo de sobrevida. METODO: Foi realizada analise retrospectiva de pacientes submetidos a resseccoes hepaticas por sarcomas de partes moles metastaticos para figado no Instituto Nacional de Câncer - MS entre 1992 e 2002. Fatores demograficos, caracteristicas do tumor primario e dos tumores metastaticos, intervalo de surgimento de metastases, tipo de resseccao e resultados de sobrevida global e livre de doenca, considerados a partir da operacao para o tumor metastatico foram considerados. Os dados obtidos foram analisados estatisticamente atraves dos softwares SPSS versao 8 e EpiInfo 2002.. RESULTADOS: O tumor primario era localizado no trato gastrintestinal em cinco pacientes, no retroperitonio em quatro e nos dois restantes no utero e no musculo deltoide. Leiomiossarcoma foi a linhagem histologica em 10 casos e dermatofibrossarcoma no caso restante, com grau de diferenciacao tumoral G2 em seis casos e G3 em cinco. A extensao da resseccao hepatica foi a segmentectomia em cinco pacientes, a lobectomia em quatro e as resseccoes maiores em dois pacientes. Dois pacientes tiveram resseccoes extra-hepaticas associadas. A resseccao foi completa em sete pacientes, persistindo doenca residual macroscopica em quatro pacientes. Pela analise multivariada a sobrevida foi afetada pela radicalidade da resseccao, com 49 meses para as cirurgias completas e 15 meses para as incompletas (p< 0,05) e pelo grau de diferenciacao tumoral, com 49 meses para os tumores G2 e 15 meses para os G3 (p< 0,0447). CONCLUSOES: As resseccoes hepaticas para metastases de sarcomas de partes moles podem aumentar a sobrevida destes pacientes, particularmente quando completas e para tumores de baixo grau de diferenciacao.

Complicações pós-operatórias em pacientes submetidos à abdominoplastia isolada e combinada à outras cirurgias do abdome

BACKGROUND: The association of abdominoplasty with other surgeries of the abdominal wall and cavity is an attractive approach although it has been a matter of controversies.Our objective is to evaluate the morbidity and mortality of these procedures. METHODS: We studied retrospectively 75 patients with indication for abdominoplasty. Thirty nine of them were submitted to abdominoplasty alone (group 1) and 36 were associated with other abdominal surgeries (group2), as hernioplasties, hysterectomies or cholecystectomies. RESULTS: The complications were seroma (group 1: 2.56%, group 2: 25%), epidermolisis (group 1: 12.82%, group 2: 5.55%), suture dehiscence (group 1: 5.12%, group 2: 5.55%), wound infection (group 1: 0%, group 2: 8.33%) and haematoma (group 1: 0%, group 2: 5.55%). There was statistical difference only in the presence of seroma (p=0.009). CONCLUSION: There was no significant increase in morbidity and mortality when abdominoplasty was combined to other abdominal surgeries compared to isolated abdominoplasty.

Câncer de coto gátrico em ratos: papel da associação de Helicobacter pylori e refluxo êntero-gástrico

BACKGROUND: Gastric carcinogenesis is still under investigation. Our objective is to evaluate a possible relationship between H.pylori and entero-gastric reflux in the genesis of epithelial neoplasias after Billroth II gastrectomy in rats. METHODS: Twenty male Wistar rats were divided into two groups. Group I rats underwent laparotomy and group II had a Billroth II gastrectomy performed. After nine months, survivors were killed and their stomachs analysed for quantification of H.pylori and for pre-neoplastic and neoplastic changes of the epithelium. RESULTS: Group II animals had a significant higher percentage of colonization by H.pylori and their epithelium had more pathological changes that ranged from a higher number of mitotic cells to invasive carcinoma. CONCLUSION: The percentage of glandular involvement by H.pylori increases with entero-gastric reflux after partial gastrectomy and is associated to the development of gastric stump cancer in rats.

Considerations about gastric cancer proteomics.

The frequency of molecular studies aimed to analyze promoter methylation of tumor suppressor genes and global proteomics in gastric carcinogenesis is increasing. Nonetheless, only a few considered the different types of stomach cells, the tumor location and the influence of Helicobacter pylori and Epstein Barr virus infection (EBV). Molecular differences relating to anatomical and histological tumor areas were also recently described. The authors propose a molecular classification of gastric cancer, dividing it into four subtypes: tumors positive for EBV; microsatellite unstable tumors; genomically stable tumors and tumors with chromosomal instability. RESUMO A frequência de estudos moleculares visando a analisar os promotores de metilação de genes supressores de tumor e proteômica globais na carcinogênese gástrica está aumentando. No entanto, apenas alguns consideraram os diferentes tipos de células do estômago, a localização do tumor e a influência da infecção por Helicobacter pylori e pelo vírus Epstein-Barr (EBV). Diferenças moleculares relacionadas com áreas tumorais anatômicas e histológicas também foram recentemente descritas. Os autores propõem uma classificação molecular de câncer gástrico, dividindo-o em quatro subtipos: tumores positivos para o EBV; tumores microssatélite instáveis; tumores genomicamente estáveis ​​e tumores com instabilidade cromossômica.

Sentinel Lymph Node Navigation Surgery for Early Gastric Cancer: Is It a Safe Procedure in Countries with Non-Endemic Gastric Cancer Levels? A Preliminary Experience.

Purpose Early diagnosis of gastric cancer is still the exception in Western countries. In the East, as in Japan and Korea, this disease is an endemic disorder. More conservative surgical procedures are frequently performed in early gastric cancer cases in these countries where sentinel lymph node navigation surgery is becoming a safe option for some patients. This study aims to evaluate preliminary outcomes of patients with early gastric cancer who underwent sentinel node navigation surgeries in Brazil, a country with non-endemic gastric cancer levels. Materials and Methods From September 2008 to March 2014, 14 out of 205 gastric cancer patients underwent sentinel lymph node navigation surgeries, which were performed using intraoperative, endoscopic, and peritumoral injection of patent blue dye. Results Antrectomies with Billroth I gastroduodenostomies were performed in seven patients with distal tumors. The other seven patients underwent wedge resections. Sentinel basin resections were performed in four patients, and lymphadenectomies were extended to stations 7, 8, and 9 in the other 10. Two patients received false-negative results from sentinel node biopsies, and one of those patients had micrometastasis. There was one postoperative death from liver failure in a cirrhotic patient. Another cirrhotic patient died after two years without recurrence of gastric cancer, also from liver failure. All other patients were followed-up for 13 to 79 months with no evidence of recurrence. Conclusions Sentinel lymph node navigation surgery appears to be a safe procedure in a country with non-endemic levels of gastric cancer.

Hepatectomia direita no tratamento da metástase hepática do carcinoma colorretal

OBJETIVO: As metastases hepaticas do carcinoma colorretal, constituem-se, atualmente, em doenca potencialmente curavel, atraves dos diversos tipos de resseccoes hepaticas, entre as quais se sobressai a hepatectomia direita. Os objetivos deste trabalho sao analisar a evolucao pre, per e pos-operatoria de pacientes submetidos a hepatectomia direita por metastases hepaticas do adenocarcinoma colorretal, seu prognostico e a exequibilidade de re-resseccao nos casos de recidiva tumoral hepatica. METODO: Cinquenta e sete pacientes submetidos a hepatectomia direita por metastases hepaticas do carcinoma colorretal com intencao curativa, entre 1990 e 2000, no Hospital Beaujon, Clichy-Franca, foram analisados retrospectivamente. O periodo de seguimento pos-operatorio foi de 33±25 meses. RESULTADOS: Nao houve mortalidade operatoria. Em 29,8% dos casos houve necessidade de transfusao e o indice de complicacoes pos-operatorias foi de 57,9%. Metastases maiores que 5cm foram observadas em 59% dos pacientes e 78,5% apresentavam mais de uma lesao. A sobrevida de cinco anos foi de 43% e a sobrevida livre de doenca no mesmo periodo foi de 23%.Recidiva hepatica do tumor foi observada em 19,3% dos pacientes e destes, 45,5% foram submetidos a re-resseccao hepatica tambem sem mortalidade. CONCLUSOES: A hepatectomia direita e um procedimento seguro para o tratamento das metastases hepaticas do carcinoma colorretal confinadas no lobo direito do figado, com baixa mortalidade e morbidez aceitavel nos pacientes estudados. A sobrevida de cinco anos encontra-se dentro da media observada na literatura. As re-resseccoes hepaticas mostraram-se exequiveis em cerca de metade dos casos de recidiva.

Comparing intestinal versus diffuse gastric cancer using a PEFF-oriented proteomic pipeline

Gastric cancer is the fifth most common malignant neoplasia and the third leading cause of cancer death worldwide. Mac-Cormick et al. recently showed the importance of considering the anatomical region of the tumor in proteomic gastric cancer studies; more differences were found between distinct anatomical regions than when comparing healthy versus diseased tissue. Thus, failing to consider the anatomical region could lead to differential proteins that are not disease specific. With this as motivation, we compared the proteomic profiles of intestinal and diffuse adenocarcinoma from the same anatomical region, the corpus. To achieve this, we used isobaric labeling (iTRAQ) of peptides, a 10-step HILIC fractionation, and reversed-phase nano-chromatography coupled online with a Q-Exactive Plus mass spectrometer. We updated PatternLab to take advantage of the new Comet-PEFF search engine that enables identifying post-translational modifications and mutations included in neXtProts PSI Extended FASTA Format (PEFF) metadata. Our pipeline then uses a text-mining tool that automatically extracts PubMed IDs from the proteomic result metadata and drills down keywords from manuscripts related with the biological processes at hand. Our results disclose important proteins such as apolipoprotein B-100, S100 and 14-3-3 proteins, among many others, highlighting the different pathways enriched by each cancer type. SIGNIFICANCE Gastric cancer is a heterogeneous and multifactorial disease responsible for a significant number of deaths every year. Despite the constant improvement of surgical techniques and multimodal treatments, survival rates are low, mostly due to limited diagnostic techniques and late symptoms. Intestinal and diffuse types of gastric cancer have distinct clinical and pathological characteristics; yet little is known about the molecular mechanisms regulating these two types of gastric tumors. Here we compared the proteomic profile of diffuse and intestinal types of gastric cancer from the same anatomical location, the corpus, from four male patients. This methodological design aimed to eliminate proteomic variations resulting from comparison of tumors from distinct anatomical regions. Our PEFF-tailored proteomic pipeline significantly increased the identifications as when compared to previous versions of PatternLab.