RESUMEN
BACKGROUND: : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. AIM: : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. METHODS: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS: : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. CONCLUSION: : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.
Asunto(s)
Neoplasias Gástricas , Brasil , Consenso , Gastrectomía , Humanos , Escisión del Ganglio Linfático , Neoplasias Gástricas/cirugíaRESUMEN
ABSTRACT Background : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. Aim : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. Methods: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. Conclusion : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.
RESUMO Racional: O II Consenso Brasileiro de Câncer Gástrico da Associação Brasileira de Câncer Gástrico ABCG (Parte 1) foi recentemente publicado. Nesta ocasião inúmeros especialistas que atuam no tratamento desta doença expressaram suas opiniões diante declarações apresentadas. Objetivo: Apresentar as Diretrizes da ABCG (Parte 2) quanto às indicações de tratamento cirúrgico, técnicas operatórias, extensão de ressecção e terapia combinada. Métodos: Para formulação destas diretrizes os autores realizaram extensa e atual revisão referente a cada declaração presente no II Consenso, utilizando as bases Medline/PubMed, Cochrane Library e SciELO, inicialmente com os seguintes descritores: câncer gástrico, gastrectomia, linfadenectomia, terapia combinada. Ainda, cada declaração foi classificada de acordo com o nível de evidência e grau de recomendação. Resultados: Das 43 declarações presentes neste estudo, 11 (25,6%) foram classificadas com nível de evidência A, 20 (46,5%) B e 12 (27,9%) C. Quanto ao grau de recomendação, 18 (41,9%) declarações obtiveram grau de recomendação 1, 14 (32,6%) 2a, 10 (23,3%) 2b e um (2,3%) 3. Conclusão: O complemento das diretrizes aqui presentes possibilita que cirurgiões e oncologistas que atuam no combate ao câncer gástrico possam oferecer o melhor tratamento possível, de acordo com as condições locais disponíveis.
Asunto(s)
Humanos , Neoplasias Gástricas/cirugía , Brasil , Consenso , Gastrectomía , Escisión del Ganglio LinfáticoAsunto(s)
Neoplasias Gástricas/epidemiología , Adulto , Anciano , Brasil , Humanos , Incidencia , Persona de Mediana EdadRESUMEN
BACKGROUND: The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented. AIM: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients. METHODS: To forge these Guidelines, the authors carried out an extensive and current review regarding each statement present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases with the following descriptors: gastric cancer, staging, endoscopic treatment and follow-up. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS: Of the 24 statements, two (8.3%) were classified with level of evidence A, 11 (45.8%) with B and 11 (45.8%) with C. As for the degree of recommendation, six (25%) statements obtained grade of recommendation 1, nine (37.5%) recommendation 2a, six (25%) 2b and three (12.5%) grade 3. CONCLUSION: The guidelines presented here are intended to assist professionals working in the fight against gastric cancer with relevant and current information, granting them to be applied in the daily medical practice.
Asunto(s)
Endoscopía del Sistema Digestivo , Estadificación de Neoplasias , Neoplasias Gástricas , Brasil , Consenso , Estudios de Seguimiento , Humanos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugíaRESUMEN
BACKGROUND: Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. AIM: This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. METHODS: Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. RESULTS: Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. CONCLUSION: The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
Asunto(s)
Neoplasias Gástricas , Brasil , Consenso , Humanos , Sociedades MédicasRESUMEN
The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented. Aim: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients. Methods: To forge these Guidelines, the authors carried out an extensive and current review regarding each statement present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases with the following descriptors: gastric cancer, staging, endoscopic treatment and follow-up. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results: Of the 24 statements, two (8.3%) were classified with level of evidence A, 11 (45.8%) with B and 11 (45.8%) with C. As for the degree of recommendation, six (25%) statements obtained grade of recommendation 1, nine (37.5%) recommendation 2a, six (25%) 2b and three (12.5%) grade 3. Conclusion: The guidelines presented here are intended to assist professionals working in the fight against gastric cancer with relevant and current information, granting them to be applied in the daily medical practice.
O II Consenso Brasileiro de Câncer Gástrico da Associação Brasileira de Câncer Gástrico (ABCG) foi recentemente publicado. Nesta ocasião, inúmeros especialistas que atuam no tratamento desta doença expressaram sua opinião diante declarações apresentadas. Objetivo: Apresentar as Diretrizes da ABCG (Parte 1) quanto ao diagnóstico, estadiamento, tratamento endoscópico e seguimento dos pacientes com câncer gástrico. Métodos: Para formulação destas Diretrizes os autores realizaram extensa e atual revisão referente a cada declaração presente no II Consenso, utilizando as bases Medline/PubMed, Cochrane Library e SciELO com os seguintes descritores: câncer gástrico, estadiamento, tratamento endoscópico e seguimento. Ainda, cada declaração foi classificada de acordo com o nível de evidência e grau de recomendação. Resultados: Das 24 declarações, duas (8,3%) foram classificadas com nível de evidência A, 11 (45,8%) B e 11 (45,8%) C. Quanto ao grau de recomendação, seis (25%) declarações obtiveram grau de recomendação 1, nove (37,5%) grau 2a, seis (25%) 2b e três (12,5%) 3. Conclusão: As diretrizes aqui presentes têm a finalidade de auxiliar os profissionais que atuam no combate ao câncer gástrico com informações relevantes e atuais, permitindo que sejam aplicadas na prática médica diária.
Asunto(s)
Humanos , Neoplasias Gástricas/diagnóstico , Endoscopía/métodos , Estadificación de Neoplasias/métodos , Estudios de Seguimiento , Conferencia de ConsensoAsunto(s)
Humanos , Adulto , Persona de Mediana Edad , Anciano , Neoplasias Gástricas/epidemiología , Brasil , IncidenciaRESUMEN
ABSTRACT Background: Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. Aim: This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. Methods: Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. Results: Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. Conclusion: The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
RESUMO Racional: Desde a publicação do primeiro Consenso Brasileiro sobre Câncer Gástrico em 2012 realizado pela Associação Brasileira de Câncer Gástrico (ABCG), novos conceitos sobre o diagnóstico, estadiamento, tratamento e seguimento foram incorporados. Objetivo: Promover uma atualização aos profissionais que atuam no combate ao câncer gástrico (CG) e fornecer diretrizes quanto ao manejo dos pacientes portadores desta afecção. Métodos: Cinquenta e nove especialistas responderam 67 declarações sobre o diagnóstico, estadiamento, tratamento e prognóstico do CG com cinco alternativas possíveis: 1) concordo plenamente; 2) concordo parcialmente; 3) indeciso; 4) discordo e 5) discordo fortemente. Foi considerado consenso a concordância de pelo menos 80% da soma das respostas "concordo plenamente" e "concordo parcialmente". Este artigo apresenta apenas as respostas dos especialistas participantes. Os comentários sobre cada declaração, assim como uma revisão da literatura serão apresentados em publicações futuras. Resultados: Das 67 declarações, houve consenso em 50 (74%). Em 10 declarações, houve concordância de 100%. Conclusão: O tratamento do câncer gástrico evoluiu consideravelmente nos últimos anos. Este consenso reúne princípios consolidados nas últimas décadas, novos conhecimentos adquiridos recentemente, assim como perspectivas promissoras sobre o manejo desta doença.
Asunto(s)
Humanos , Neoplasias Gástricas , Sociedades Médicas , Brasil , ConsensoRESUMEN
BACKGROUND: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment. AIM: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality. METHODS: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile. RESULTS: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007). CONCLUSION: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.
Asunto(s)
Músculo Esquelético/anatomía & histología , Evaluación Nutricional , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Periodo Posoperatorio , Pronóstico , Estudios Prospectivos , PulgarRESUMEN
ABSTRACT Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment Aim: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality Methods: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile Results: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007) Conclusion: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.
RESUMO Racional: A desnutrição é muito prevalente em pacientes com câncer gástrico e aumenta o risco de morbidade e mortalidade. A espessura do músculo adutor do polegar (APMT) aparece como uma importante medida objetiva, rápida, barata e não invasiva para avaliar o compartimento muscular. Objetivo: O objetivo deste estudo foi comparar a APMT e outros métodos de avaliação nutricional e correlacionar esses métodos com a mortalidade pós-operatória. Métodos: Quarenta e quatro pacientes, 29 homens e 15 mulheres; média (SD) de 63 anos (10,2) e variando de 34 a 83 anos, que foram submetidos a 9 (20,5%) gastrectomias parciais e 34 (77,3%) totais por câncer de estômago (Estágio II a IIIa) e avaliados no pré operatório por Avaliação Subjetiva Global Produzida Pelo Paciente (PG-SGA), antropometria e perfil laboratorial. Resultados: APMT melhor predisse morte (p<0,001) em ambas mãos, dominante e não-dominante, e se correlacionou bem com albumina (p=0,039) e PG-SGA (p=0,007). Conclusão: APMT permitiu claramente determinar a desnutrição e prever o risco de morte em pacientes com câncer gástrico.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/mortalidad , Evaluación Nutricional , Músculo Esquelético/anatomía & histología , Tamaño de los Órganos , Periodo Posoperatorio , Pronóstico , Pulgar , Estudios ProspectivosRESUMEN
OBJECTIVES: to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. METHODS: we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA), classical anthropometry, current weight and height, percentage of weight loss (%WL) and body mass index (BMI). We also measured the thickness of the thumb adductor muscle (TAM) in both hands, dominant hand (TAMD) and non-dominant hand (TAMND), as well as the calculated the prognostic nutritional index (PNI). The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC). RESULTS: of the 44 patients studied, 29 (66%) were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval) of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. CONCLUSION: PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.
Asunto(s)
Gastrectomía , Evaluación Nutricional , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
ABSTRACT Objectives: to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. Methods: we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA), classical anthropometry, current weight and height, percentage of weight loss (%WL) and body mass index (BMI). We also measured the thickness of the thumb adductor muscle (TAM) in both hands, dominant hand (TAMD) and non-dominant hand (TAMND), as well as the calculated the prognostic nutritional index (PNI). The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC). Results: of the 44 patients studied, 29 (66%) were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval) of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. Conclusion: PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.
RESUMO Objetivos: determinar o método de avaliação nutricional que melhor prediz a mortalidade em 90 dias de pacientes submetidos à gastrectomia por câncer gástrico. Métodos: estudo prospectivo de 44 pacientes portadores de câncer gástrico, estágios II a IIIa, dos quais nove foram submetidos à gastrectomia parcial, 34 à gastrectomia total e um à esôfago-gastrectomia. Todos os pacientes foram avaliados nutricionalmente através do mesmo protocolo, até 72h da admissão hospitalar. Os parâmetros utilizados foram a Avaliação Subjetiva Global Produzida Pelo Paciente (ASG-PPP), antropometria clássica, incluindo peso e altura atuais, porcentagem de perda ponderal (%PP) e índice de massa corporal (IMC). A espessura do músculo adutor do polegar (MAP) em ambas mãos, mão dominante (MAPD) e mão não-dominante (MAPND) também foram realizadas, assim como o cálculo do índice nutricional prognóstico (IPN). O perfil laboratorial incluiu níveis séricos de albumina, eritrócitos, hemoglobina, hematócrito, leucócitos e contagem total de linfócitos (CTL). Resultados: dos 44 pacientes estudados, 29 (66%) eram desnutridos pelo método subjetivo, sendo 15 grau A, 18 grau B e 11 grau C. Os casos com ASG-PPP grau B e com MAPD 10,2±2,9 mm foram significativamente associados à maior mortalidade. As curvas ROC (intervalo de confiança de 95%) de ambas ASG-PPP e espessura da MAPD fidedignamente predisseram mortalidade em 30 e 90 dias. Nenhum método laboratorial permitiu prever a mortalidade em 90 dias. Conclusão: a ASG-PPP e a espessura da MAPD podem ser utilizados como parâmetros pré-operatórios para risco de morte em pacientes submetidos à gastrectomia por câncer gástrico.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Gástricas , Neoplasias Gástricas/mortalidad , Evaluación Nutricional , Gastrectomía , Periodo Posoperatorio , Estudios Prospectivos , Persona de Mediana EdadRESUMEN
BACKGROUND: Morbid obesity is a state of insulin resistance combined with excess of visceral fat, which contributes to the development of metabolic syndrome (MetS). Nonsurgical treatment of obesity usually improves MetS, but there is no ultimate resolution and weight regain is common. Surgical options like Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) result in a significant and sustained weight loss accompanied by improvement of MetS. The aim of this study was to compare the weight loss and improvement of MetS parameters between degree II and III obese patients with MetS undergoing RYGB or SG in a period of 12 months. METHODS: Analysis of medical records of 102 patients diagnosed with MetS (63 undergoing RYGB and 39 undergoing SG) in a reference center (CTO ISCMPA) between 2010 and 2013. RESULTS: After 1-year follow-up, an excess weight loss (EWL) of 77.2 ± 22.5% and of 63.4 ± 20.1% (p = 0.033) was observed in the RYGB and SG groups, respectively. The rate of MetS resolution was very similar (87.3 and 84.6%, respectively; p = 0.971). The percentage of patients with type 2 diabetes was 3.3% for RYGB and 15.4% for SG (p = 0.025). Fasting blood glucose levels followed the same trend with mean values reaching 87.6 ± 16.9 mg/dl in the RYGB group and 97.7 ± 35.5 mg/dl in the group undergoing SG (p = 0.023). CONCLUSIONS: Among the patients studied, both surgical techniques were safe and effective for MetS resolution in 12 months. However, RYGB was more effective for EWL and improvement of some parameters related to glucose metabolism.
Asunto(s)
Gastrectomía , Derivación Gástrica , Laparoscopía , Síndrome Metabólico/complicaciones , Obesidad Mórbida , Gastrectomía/efectos adversos , Gastrectomía/métodos , Gastrectomía/estadística & datos numéricos , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Derivación Gástrica/estadística & datos numéricos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugíaAsunto(s)
Humanos , Masculino , Femenino , Relaciones Médico-Paciente , Internet , Conducta en la Búsqueda de InformaciónRESUMEN
OBJECTIVES: the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). METHODS: two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. RESULTS: at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 - 1.4). CONCLUSION: in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS.
Asunto(s)
Derivación Gástrica/métodos , Síndrome Metabólico/terapia , Obesidad Mórbida/terapia , Adulto , Índice de Masa Corporal , Brasil , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Obesidad/metabolismo , Estudios Retrospectivos , Resultado del Tratamiento , Circunferencia de la Cintura , Pérdida de PesoRESUMEN
Summary Objectives: the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). Methods: two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. Results: at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 - 1.4). Conclusion: in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS. .
Resumo Objetivo: o objetivo deste estudo foi avaliar a eficácia do bypass gástrico em Y de Roux (BGYR), em comparação a um tratamento não cirúrgico (grupo NC), como instrumento para induzir remissão da síndrome metabólica (SMet) em pacientes com obesidade graus 2 e 3 (Ob2, 3). Métodos: duzentos e cinquenta e oito pacientes com Ob2,3 foram selecionados para análise retrospectiva em estudos de caso e controle. SMet foi definida como descrita pela Federação Internacional de Diabetes. Dos pacientes, 129 foram submetidos ao BGYR (grupo C), e 129 formaram o grupo NC. Resultados: antes dos tratamentos, os grupos C e NC não diferiram em IMC, idade, sexo feminino e prevalência de SMet (p>0,05). No grupo C, houve uma redução no IMC de 38,1% (p<0,001), circunferência da cintura de 28,6% (p<0,001), glicemia de jejum de 10,5% (p<0,001), LDL colesterol sérico de 21,9% (p<0,001) e em 85% dos casos de SMet (p<0,001). As diferenças observadas no grupo NC foram uma diminuição nos níveis de triglicérides, de 4,12% (p=0,047), e na pressão arterial diastólica, de 5,9% (p=0,031). No grupo NC, 98,6% dos pacientes persistiram com SMet. O número necessário para tratar (NNT) com a cirurgia, para resolver um caso de SMet, foi de 1,2 (IC 95%: 1,1 - 1,4). Conclusão: em um mundo real, no Sul do Brasil, em comparação ao tratamento NS e após 1 ano de observação, BGYR foi altamente eficaz para diminuir a prevalência de SMet. .
Asunto(s)
Adulto , Femenino , Humanos , Derivación Gástrica/métodos , Síndrome Metabólico/terapia , Obesidad Mórbida/terapia , Índice de Masa Corporal , Brasil , Estudios de Casos y Controles , Estudios de Cohortes , Obesidad/metabolismo , Estudios Retrospectivos , Resultado del Tratamiento , Circunferencia de la Cintura , Pérdida de PesoRESUMEN
Introdução: O adenocarcinoma de estômago é a quarta neoplasia mais incidente no mundo e a segunda causa de morte relacionada ao câncer. O objetivo deste estudo é determinar o perfil epidemiológico e patológico dos pacientes intervidos cirurgicamente por adenocarcinoma gástrico e sua sobrevida relacionada à classificação TNM. Métodos:Estudo de coorte histórica de 216 pacientes submetidos à gastrectomia por adenocarcinoma gástrico. Foram analisados dados epidemiológicos, patológicos e a sobrevida. Resultados: A média de idade foi de 61,84 anos. Foram 76 (35,2%) pacientes do gênero feminino e 140 (64,8%), masculino. Quanto à localização, 79 (36,6%) no antro, 45 (20,8%) na cárdia, 70 (32,4%) no corpo. Em relação à diferenciação celular, 5 (2,3%) bem diferenciados, 71 (32,9%) moderadamente diferenciados, 133 (61,6%) pouco diferenciados e 7 (3,2%) eram indeterminados. O estadiamento clínico demonstrou 11 (5,1%) pacientes com estádio 0, com sobrevida de 100%; 23 (10,6%) no estádio I, com sobrevida de 82%; 55 pacientes (25,5%), com sobrevida de 60% no estádio II; 101 pacientes (46,7%), com sobrevida de 25% no estádio III e 26 pacientes (12%), com sobrevida de 15% no estádio IV. Em relação às complicações pós-operatórias, 52,3% dos pacientes não tiveram complicações e 7,9% (17 pacientes) com óbito no período pós-operatório. Conclusões: Aproximadamente 70% das neoplasias eram distais, enquanto cerca de 30% eram proximais. A grande parte dos pacientes era de estádios mais avançados, o que conferiu um pior prognóstico, refletindo a necessidade de uma revisão das políticas públicas para câncer gástrico do Brasil, visando aprimorar o diagnóstico e tratamento, melhorando o prognóstico desses pacientes.
Introduction:The gastric adenocarcinoma is the fourth most frequent cancer worldwide and the second leading cause of cancer-related death. The aim of this study is to determine the epidemiological and pathological profile of gastric adenocarcinoma patients and their survival regarding the TNM classification. Methods: A historical cohort study of 216 patients undergoing gastrectomy for gastric adenocarcinoma. Epidemiological, pathological and survival data were analyzed. Results: The mean age was 61.84 years. There were 76 (35.2%) females and 140 (64.8%) males. Regarding location, 79 (36.6%) cases were in the antrum, 45 (20.8%) in the cardia, and 70 (32.4%) in the body. Regarding cell differentiation, 5 cases (2.3%) were well differentiated, 71 (32.9%) moderately differentiated, 133 (61.6%) poorly differentiated, and 7 (3.2%) were indeterminate. Clinical staging showed 11 (5.1%) patients with stage 0 with a survival rate of 100%, 23 (10.6%) in stage I with a survival rate of 82%, 55 patients (25.5%) in stage II with a survival rate of 60%,101 patients (46,7%) in stage III with a survival rate of 25% and 26 patients (12%) in stage IV with a survival rate of 15%. Regarding postoperative complications, 52.3% of the patients had no complications and 7.9% (17 patients) died in the postoperative period. Conclusions: Approximately 70% of tumors were distal, while approximately 30% were proximal. The majority of patients had more advanced stages, which conferred a worse prognosis, reflecting the need for a revision of public policies for gastric cancer in Brazil, aiming to improve the diagnosis and treatment and determining a better prognosis for these patients.
Asunto(s)
Humanos , Adenocarcinoma , Epidemiología Analítica , Estómago , Neoplasias Gástricas/prevención & controlRESUMEN
Context Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe) deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis. Objective The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis. Methods A total of 250 liver biopsies were conducted in the transoperation of the surgeries. Results Steatosis was present in 226 (90.4%) of the samples, 76 (30.4%) being classified as mild; 71 (28.4%) as moderate and 79 (31.6%) as intense. Nonalcoholic steatohepatitis was diagnosed in 176 (70.4%) cases, where 120 (48.4%) were mild; 50 (20%) were moderate, and 6 (2.4%) cases were intense. Fibrosis was referred to in 108 (43.2%) biopsies, 95 of which (38%) were mild; 2 (0.8%) were moderate; 7 (2.8%) were intense, and cirrhosis was diagnosed in 4 (1.6%) cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (rs = 0.460; P<0.001) and between the degree of this activity and the degree of fibrosis (rs = 0.583; P<0.001). Only 13 (5.2%) samples showed Fe deposits. Conclusion There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease. .
Contexto A doença hepática gordurosa não alcoólica engloba um espectro de alterações histopatológicas que abrangem desde a esteatose simples até a esteato-hepatite não alcoólica. Trabalhos sugerem que depósitos de ferro (Fe) no fígado estão envolvidos na fisiopatologia da esteato-hepatite não alcoólica. Objetivo Determinar a prevalência de esteatose simples e de esteato-hepatite não alcoólica nos pacientes com obesidade mórbida, submetidos à cirurgia bariátrica e estabelecer uma correlação dos achados anatomopatológicos com a presença de fibrose hepática. Método Foram analisadas 250 biópsias hepáticas realizadas no transoperatório das cirurgias. Resultados A esteatose esteve presente em 226 (90,4%) das amostras, sendo 76 (30,4%) classificadas como leves; 71 (28,4%), como moderadas e, 79 (31,6%) como intensas. A esteato-hepatite não alcoólica esteato-hepatite não alcoólica foi diagnosticada em 176 (70,4%) dos casos, nos quais 120 (48,4%) eram de grau leve; 50 (20%) moderado e, 6 (2,4%) intenso. A fibrose foi referida em 108 (43,2%) biópsias, das quais 95 (38%) eram leves; 2 (0,8%), moderadas; 7 (2,8%) intensas e, em 4 (1,6%) casos, foi diagnosticado cirrose. Observou-se uma correlação entre o grau de esteatose e o nível de atividade inflamatória (rs = 0,460; P<0,001) e entre o grau dessa atividade com o de fibrose (rs = 0,583; P<0,001). Apenas 13 (5,2%) amostras apresentaram depósitos de Fe. Conclusão Existe uma prevalência elevada de esteato-hepatite não alcoólica nesses pacientes e uma correlação positiva dos graus de esteato-hepatite não alcoólica com a intensidade da fibrose. A baixa prevalência de depósitos de Fe encontrada torna questionável que a presença deste ...