Valdir Tercioti Junior

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.OBJETIVO: avaliar por meio de um estudo retrospectivo nao randomizado as respostas tumorais a terapeutica neoadjuvante, conforme os achados histopatologicos das pecas cirurgicas dos pacientes operados e tratados por carcinoma espinocelular do terco medio e distal do esofago. METODOS: Foram incluidos no estudo 97 pacientes assim distribuidos: grupo I 81 (83,5%) submetidos a radioterapia neoadjuvante; e grupo II 16 (16,5%) submetidos a radioterapia e quimioterapia neoadjuvantes. Um terceiro grupo de 26 pacientes submetidos a esofagectomia exclusiva foi utilizado na comparacao das complicacoes pos-operatorias. As caracteristicas de cada paciente (idade, sexo e raca), o local do tumor, o estadiamento, e a avaliacao histologica das modalidades de tratamento foram revisadas e analisadas. A resposta tumoral a terapeutica neoadjuvante foi avaliada com estudos histopatologicos da peca cirurgica. RESULTADOS: Nao houve diferencas estatisticas significativas quanto a cor, sexo, idade, estadiamento e complicacoes pos-operatorias nos pacientes dos tres grupos analisados. Os pacientes submetidos a radioterapia e quimioterapia neoadjuvante apresentaram reducao tumoral mais satisfatoria, com melhor eficacia local, quando comparado ao grupo submetido apenas a radioterapia neoadjuvante. CONCLUSAO: o estudo sugere que a radioterapia associada a quimioterapia apresentou maior eficacia local na reducao tumoral em comparacao com o grupo tratado com radioterapia; alem disso, a terapeutica neoadjuvante nao elevou as complicacoes pos-operatorias em comparacao aos pacientes submetidos a cirurgia exclusiva.

Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

OBJECTIVE to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. METHODS twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. RESULTS the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. CONCLUSION the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life.

Obstructive Gastric Pseudotumor Caused by Cytomegalovirus in an AIDS Patient: A Case Report and Review of Surgical Treatment

Patient: Male, 27 Final Diagnosis: Obstructive gastric pseudotumor Symptoms: Dyspepsia • weight loss Medication: Ganciclovir Clinical Procedure: Infectious diseases treatments and surgical treatment Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Cytomegalovirus (CMV) is a common opportunistic pathogen in patients with HIV. It is also a major cause of gastrointestinal ulcers in patients with acquired immunodeficiency syndrome (AIDS). CMV pseudotumor in the stomach is a rare cause of digestive tract obstruction. Case Report: In this study we report a male patient infected with HIV in 2002. In 2014 he evolved C3 stage AIDS with prepyloric gastric ulcer which provoked deformity and pseudotumoral aspect of the gastric outlet. Endoscopic biopsy confirmed CMV infection. He underwent Roux-en-Y gastroenteroanastomosis with good recovery. Conclusions: CMV infection should be considered as an agent in gastric lesions in HIV-infected patients. Roux-en-Y gastroenteroanastomosis is a surgical option for this group of patients, allowing improvements in quality of life and decreasing risks of perioperative complications.

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.OBJETIVO: revizar as indicacoes e as complicacoes observadas apos a realizacao de gastrostomias cirurgicas em pacientes internados em um hospital universitario publico de ensino. METODOS:estudo retrospectivo nao randomizado de revisao dos prontuarios medicos dos pacientes submetidos a gastrostomia cirurgica nos ultimos cinco anos, sobre as indicacoes e complicacoes. RESULTADOS: no periodo de 2007 a 2011, 86 pacientes foram submetidos a gastrostomias cirurgicas para nutricao enteral. A tecnica operatoria utilizada foi a de Stamm na totalidade dos casos. Os homens constituiram 76 (88%) dos casos e a media de idade foi 58,4 anos, a idade maxima 87 anos e a minima de 19 anos. Foram observadas 16 (18,60%) complicacoes consideradas menores, 17 (19,76%) complicacoes graves e oito (9,3%) obitos peri-operatorios. CONCLUSAO: as gastrostomias cirurgicas, embora consideradas procedimentos de menor porte, nao sao isentas de complicacoes e mortalidade. A tecnica operatoria de Stamm, apesar das complicacoes relatadas, e de facil execucao, manuseio e oferece seguranca.