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Introducción. El cáncer gástrico en Colombia es la segunda neoplasia más común en hombres y la cuarta en mujeres. En los últimos años se han descrito ampliamente los beneficios del abordaje laparoscópico en el cáncer gástrico frente a sangrado, recuperación postoperatoria y complicaciones, sin afectar los resultados oncológicos. Métodos. Estudio observacional retrospectivo de pacientes llevados a gastrectomía laparoscópica en la Clínica Universitaria Colombia durante un período de diez años, entre 2013 y 2023. Se describieron los resultados perioperatorios en cuanto a estancia hospitalaria, sangrado operatorio, duración del procedimiento, complicaciones, causas de reintervención y mortalidad en los primeros 30 días. Resultados. Se incluyeron 418 pacientes, 58,9 % hombres, con una edad promedio de 60,8 años. Se documentó un tiempo quirúrgico promedio de 228,7 minutos, con un sangrado de 150 ml. La media de ganglios linfáticos resecados fue de 26,1 ± 11,4. La estancia hospitalaria en promedio fue de 4 ± 4 días, y se registraron complicaciones en 104 sujetos, con una tasa promedio de 24 %, de las cuales 29 (27,4 %) obtuvieron una clasificación Clavien-Dindo IIIB. Conclusiones. La gastrectomía por laparoscopia en un centro de alto volumen y con cirujanos experimentados en Colombia, tiene resultados perioperatorios similares a lo reportado en la literatura mundial. Aún se requiere de estudios de mayor fuerza de asociación para establecer recomendaciones sobre el uso rutinario de este abordaje en patología maligna avanzada.

Introduction. Gastric cancer in Colombia is the second most common neoplasm in men and the fourth in women. In recent years, the benefits of the laparoscopic approach in gastric cancer against bleeding, postoperative recovery com and complications have been widely described, without affecting oncological results. Methods. Retrospective observational study of patients undergoing laparoscopic gastrectomy at the Clínica Universitaria Colombia over a period of ten years, between 2013 and 2023. Perioperative results were described in terms of hospital stay, operative bleeding, duration of the procedure, complications, causes of reintervention, and mortality in the first 30 days. Results. 418 patients were included, 58.9% men, with an average age of 60.88 years. An average surgical time of 228.7 minutes was documented, with a blood loss of 150 ml. The mean number of lymph nodes resected was 26.1 ± 11.4. The average hospital stay was 4 ± 4 days, and complications were recorded in 104 subjects, with an average rate of 24%, of which 29 (27.4%) obtained a Clavien-Dindo IIIB classification. Conclusions. Laparoscopic gastrectomy in a high-volume center and with experienced surgeons in Colombia has perioperative results similar to those reported in the world literature. Studies with greater strength of association are still required to establish recommendations on the routine use of this approach in advanced malignant pathology.

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ABSTRACT Background: Diet is one of the most important modifiable risk factors for the incidence of gastric cancer. Objective: To carry out an exploratory analysis on the dietary patterns of individuals with gastric adenocarcinoma (AdG) in the Central Brazil region. Methods: This is a case-control study carried out from April 2019 to July 2022, in three reference centers for cancer treatment in Goiânia-GO. The cases were patients diagnosed with AdG, the control 1 dyspeptic patients submitted to upper digestive endoscopy and the control 2 patients without gastric complaints. In the three groups, patients aged 18 to 75 years and of both sexes were recruited. To assess food consumption, a Food Frequency Questionnaire validated for the Brazilian population was used. Dietary patterns were identified by Exploratory Factor Analysis (EFA), using principal component analysis as the extraction method, followed by Varimax rotation. Results: The commonality values in the EFA for the foods/food groups consumed by the cases and controls were above 0.30 for all variables. The variance explained by the model was 66.7% for cases, 60.3% for control 1 and 59.7% for control 2. Three eating patterns were identified in cases, control 1 and control 2 that explained 34, 87%, 35.41% and 33.25% respectively of the total variance. The first pattern ("healthy") was characterized by the consumption of vegetables, fruits, meat and cheese; the second ("unhealthy") for sausages, pizzas, snacks, ketchup, sweet drinks and instant noodles and the third ("prudent") rice, beans, meat and fried fish and pasta. Conclusion: This study identified three dietary patterns among patients with AdG and controls in the Central Brazil region. According to the identified patterns, it will be possible to establish a relationship between diet and other epidemiological measures aimed at the prevention of gastric cancer.

RESUMO Contexto: A dieta é um dos fatores de risco modificáveis mais importante para a incidência de câncer gástrico. Objetivo: Realizar uma análise exploratória sobre os padrões alimentares de indivíduos com adenocarcinoma gástrico (AdG) na região Brasil central. Métodos: Este é um estudo de caso-controle realizado no período de abril de 2019 a julho de 2022, em três centros de referência para o tratamento para câncer em Goiânia-GO. Os casos foram pacientes diagnosticados com AdG, o controle 1 pacientes dispépticos submetidos a endoscopia digestiva alta e o controle 2 pacientes sem queixas gástricas. Nos três grupos foram recrutados pacientes de 18 a 75 anos e de ambos os sexos. Para avaliar o consumo alimentar foi utilizado um Questionário de Frequência Alimentar validado para a população brasileira. Os padrões alimentares foram identificados por Análise Fatorial Exploratória (AFE), utilizando a análise de componentes principais como método de extração, seguida pela rotação Varimax. Resultados: Os valores de comunalidade na AFE para os alimentos/grupos alimentares consumidos pelos casos e controles ficaram acima de 0,30 para todas as variáveis. A variância explicada pelo modelo foi de 66,7%, para casos, 60,3% para o controle 1 e 59,7% para o controle 2. Foram identificados três padrões alimentares nos casos, controle 1 e controle 2 que explicaram 34,87%, 35,41% e 33,25% respectivamente da variância total. O primeiro padrão ("saudável") foi caracterizado pelo consumo de vegetais, frutas, carne e queijos; o segundo ("não saudável") por embutidos, pizzas, snacks, ketchup, bebidas doces e macarrão instantâneo e o terceiro ("prudente") arroz, feijão, carnes e peixes fritos e massas. Conclusão: Esse estudo identificou três padrões alimentares entre os pacientes com AdG e os controles na região Brasil central. De acordo com os padrões identificados, será possível estabelecer uma relação entre a dieta e outras medidas epidemiológicas destinadas à prevenção do câncer gástrico.

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Background: The assessment of health-related quality of life (QoL) has improved the treatment of gastric cancer. Aiming to compare the influence of skilled surgeons in general hospitals versus specialized hospitals in cancer in Brazil, this study evaluated the relationship between quality of life and types of hospitals (general or cancer) in treating patients with gastric adenocarcinoma operated by surgeons with specific training in Surgical Oncology. Methods: This was a cross-sectional study involving 104 patients. Inferential analyses were used to compare two Brazilian general hospitals and a cancer center, evaluating scores of the SF-36 and FACT-Ga QoL questionnaires (Kruskal-Wallis test, Mann-Whitney test); gender, smoking, and Helicobacter pylori tests status (Pearson's Chi-Square test); ethnicity, alcoholism, location of the tumor in the stomach, Lauren's histological types, and type of surgery (Fisher's exact test), number of lymph nodes resected by Surgical Oncologists [Analysis of Variance (ANOVA) with a Fixed Factor], and comparative survival analysis (Log-Rank test). Results: Patients treated at a cancer hospital had higher scores of the FACT-Ga (FACT-G total score, P=0.023; physical well-being, PWB, P=0.006; and functional well-being, FWB, P=0.011). The mean scores of the SF-36 questionnaire showed similar behavior but without reaching a significant difference. Patients operated by Surgical Oncologists at the cancer hospital had better scores in emotional well-being FACT-Ga domain (EWB, P=0.034 and P=0.047) compared to those operated by Surgical Oncologists in general hospitals. There was no significant difference in survival among the three hospitals (P=0.214). Conclusions: In this study, it was possible to suggest the relationship between QoL assessment scores with the centralization of care at specialized cancer hospital in the treatment of patients with gastric adenocarcinoma undergoing surgery with curative intent in Brazil.

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Introducción. El diagnóstico adecuado de los tumores de la unión esofagogástrica es esencial para el tratamiento de estos pacientes. La clasificación propuesta por Siewert-Stein define las características propias, factores de riesgo y estrategias quirúrgicas según la localización. El objetivo de este estudio fue describir las características de los pacientes con adenocarcinoma de la unión esofagogástrica tratados en nuestra institución. Métodos. Estudio retrospectivo, descriptivo, de corte longitudinal, que incluyó los pacientes con diagnóstico de adenocarcinoma de la unión esofagogástrica intervenidos quirúrgicamente en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre enero de 2012 y mayo de 2017. Resultados. Se operaron 59 pacientes (84,7 % hombres), con una edad media de 62,5 años. En su orden de frecuencia los tumores fueron tipo II (57,6 %), tipo III (30,7 %) y tipo I (11,9 %). El 74,6 % recibieron neoadyuvancia y se realizó gastrectomía total en el 73 % de los pacientes. La concordancia diagnóstica moderada con índice Kappa fue de 0,56, difiriendo con la endoscópica en 33,9 %. El 10,2 % de los pacientes presentó algún tipo de complicación intraoperatoria. La supervivencia a tres años en los tumores tipo II fue del 89,6 % y del 100 % en aquellos con respuesta patológica completa. Conclusión. Es necesario el uso de diferentes estrategias para un proceso diagnóstico adecuado en los tumores de la unión esofagogástrica. En esta serie, los pacientes Siewert II, aquellos que recibieron neoadyuvancia y los que obtuvieron una respuesta patológica completa, tuvieron una mejor supervivencia a tres años

Introduction: Proper diagnosis of gastroesophageal junction tumors is essential for the treatment of these patients. The classification proposed by Siewert-Stein defines its own characteristics, risk factors and surgical strategies according to the location. This study describes the characteristics of patients with adenocarcinoma of the esophagogastric junction treated at our institution. Methods. Retrospective, descriptive, longitudinal study, which includes patients diagnosed with adenocarcinoma of the esophagogastric junction who underwent surgery at the National Cancer Institute in Bogotá, Colombia, between January 2012 and May 2017. Results. Fifty-nine patients (84.7% men) were operated on, with a mean age of 62.5 years. In their order of frequency, the tumors were type II (57.6%), type III (30.7%) and type I (11.9%). 74.6% received neoadjuvant therapy and total gastrectomy was performed in 73% of the cases. The moderate diagnostic concordance with the Kappa index was 0.56, differing from the endoscopic one in 33.9%. 10.2% of the patients presented some type of intraoperative complication. Three-year survival in type II tumors was 89.6% and 100% in those with complete pathologic response. Conclusion. The use of different strategies is necessary for an adequate diagnostic process in tumors of the esophagogastric junction. In this series, Siewert II patients, those who received neoadjuvant therapy, and those who obtained a complete pathological response had a better three-year survival

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Introducción: La úlcera gástrica perforada es la complicación ulcerativa más frecuente después del sangrado y la más grave de todas. A medida que se desarrolla el proceso inflamatorio la lesión gástrica evoluciona pasando por los siguientes estadíos: gastritis superficial, gastritis atrófica crónica, metaplasia intestinal, displasia y finalmente cáncer. En este proceso de evolución natural de la enfermedad radica la importancia de realizar una biopsia durante el abordaje quirúrgico de la úlcera gástrica perforada. Objetivos: Determinar la prevalencia de neoplasia en úlceras gástrica perforada en el servicio de Cirugía General del Hospital Central del Instituto de Previsión Social en el periodo 2015-2020. Materiales y métodos: Se llevó a cabo un estudio observacional descriptivo de corte transversal con datos retrospectivos. Resultados: Se incluyeron 50 pacientes sometidos a cirugía por úlcera gástrica perforada. El promedio de edad fue 67,1 ±17,1 años, el 60% correspondían al sexo masculino; en el 94% se realizó reavivamiento de bordes y en el 6% antrectomía. Con respecto al diagnóstico anatomopatológico, en el 90% se confirmó proceso infamatorio, la prevalencia de neoplasia fue del 6% y en el total de los pacientes postoperados por úlcera gástrica perforada se constató un 46% de mortalidad. Conclusión: La prevalencia de neoplasia fue mínima en los pacientes sometidos a cirugía por úlcera gástrica perforada. Se identificó un alto porcentaje de mortalidad en los pacientes postoperados por úlcera gástrica perforada. El promedio de edad fue 67,1 años y predominó el sexo masculino. El procedimiento quirúrgico más frecuente fue el reavivamiento de bordes y el diagnóstico anatomopatológico más prevalente fue proceso inflamatorio.

Introduction: Perforated gastric ulcer is the most frequent ulcerative complication after bleeding and the most serious of all; as inflammation progresses, gastric lesion evolves, beginning with superficial gastritis, then chronic atrophic gastritis, intestinal metaplasia, dysplasia, and finally cancer; hence the importance of performing a biopsy in the surgical approach of perforated gastric ulcer. Objectives: To determine the prevalence of neoplasia in perforated gastric ulcers in the General Surgery service of the Hospital Central del Instituto de Previsión Social in the period 2015-2020. Materials and methods: An observational descriptive cross-sectional study with retrospective data was carried out. Results: 50 patients who underwent surgery for perforated gastric ulcer were included. The average age was 67.1 ± 17.1 years, 60% were male; 94% underwent edge revival and 6% antrectomy. Regarding the anatomopathological diagnosis, 90% confirmed the inflammatory process, the prevalence of neoplasia was 6%, and in the total number of postoperative patients for perforated gastric ulcer, 46% mortality was confirmed. Conclusion: The average age was 67.1 years and the male sex predominated. The most frequent surgical procedure was edge revival and the most prevalent pathological diagnosis was inflammatory process. The prevalence of neoplasia was minimal in patients undergoing surgery for perforated gastric ulcer. A high percentage of mortality was identified in postoperative patients for perforated gastric ulcer.

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Introdução: O tratamento com intuito curativo do adenocarcinoma gástrico ainda tem como principal modalidade a cirurgia que, dependendo da localização do tumor e subtipo histológico, determinará a extensão da ressecção a ser realizada, se gastrectomia subtotal ou total. Objetivo: O objetivo deste estudo foi avaliar a qualidade de vida dos pacientes pós cirurgia no período de 30, 90 e 180 dias. Material e métodos: Trata-se de um estudo observacional prospectivo, em que foram entrevistados 50 pacientes diagnosticados com adenocarcinoma gástrico e submetidos a gastrectomia subtotal ou total, com o intuito curativo, no Departamento de Cirurgia Abdominal do A.C.Camargo Câncer Center durante o período de 2020 a 2022. Foram utilizados o QLQ-C30 e QLQ-STO22, questionários para avaliar a qualidade de vida destes pacientes pós cirurgia, e, como complemento, a escala Karnofsky de avaliação das condições de performance status. Resultados: Foram incluídos neste estudo 50 pacientes, sendo a maior frequência do sexo feminino, com idade mediana em 54 anos. Dentre os resultados mais relevantes, destacam-se que, para os primeiros 30 dias de pós-operatório, os pacientes submetidos a GST apresentaram mais constipação e os pacientes submetidos a GT apresentaram mais diarreia. No período de 30 dias do pós-operatório, os pacientes submetidos a via de acesso minimamente invasiva apresentaram menos náuseas e/ou vômitos quando comparados a via aberta / minimamente invasiva com conversão. Já no período de 90 dias de pós-operatório, os pacientes submetidos a GT apresentaram mais sintomas relacionados a disfagia e os pacientes submetidos a GST apresentaram mais sucesso de retorno ao convívio social. Ainda para os primeiros 90 dias, os pacientes submetidos a via minimamente invasiva apresentaram menos dor quando comparados a via aberta / minimamente invasiva com conversão. Após 180 dias, os dois procedimentos se tornam bastante semelhantes em termos de qualidade de vida, porém, vale destacar que os pacientes submetidos a via minimamente invasiva apresentaram menos queixas relacionadas a vida/convívio social e com relação a dificuldade financeira. Conclusão: Avaliar qualidade de vida sempre será uma tarefa complexa, pois envolve não somente a subjetividade do paciente, como também aspectos temporais. No presente estudo, identificamos diferenças significativas com relação a qualidade de vida dos pacientes submetidos a gastrectomias oncológicas, principalmente quando comparamos GST com GT, com resultados em termos de reabilitação alimentar a curto prazo favoráveis a GST e melhor qualidade de vida referida pelos pacientes submetidos a via minimamente invasiva com relação a menos náuseas, vômitos e dor a curto prazo. No longo prazo, os pacientes submetidos a via minimamente invasiva apresentaram melhor função/convívio social. Tais diferenças parecem causar menos impacto em termos de qualidade de vida após 6 meses do pós-operatório.

Introduction: Treatment with curative intent for gastric adenocarcinoma still has surgery as its main modality, which, depending on the location of the tumor and histological subtype, will determine the extent of the resection to be performed, whether subtotal or total gastrectomy. Objective: The aim of this study was to evaluate patients' quality of life after surgery in the period of 30, 90 and 180 days. Material and methods: This was a prospective observational study, in which 50 patients with gastric adenocarcinoma who underwent subtotal or total gastrectomy, with curative intent, were treated at the Department of Abdominal Surgery at A.C.Camargo Cancer Center during the period from 2020 to 2022. The QLQ-C30 and QLQ-STO22 were used to assess the quality of life of these patients after surgery, and, as a complement, the Karnofsky scale for assessing performance status conditions. Results: A total of 50 patients were included in this study, most frequently female, with a median age of 54 years. Among the most relevant results, it is noteworthy that, for the first 30 postoperative days, patients who had a GST had more constipation, and patients with GT had more diarrhea. In the first 30 postoperative days, patients treated through a minimally invasive procedure had less nausea and/or vomiting when compared to the open/minimally invasive with conversion surgery. For the first 90 days after surgery, patients in the GT group had symptoms more related to dysphagia and patients in the GST one had more success in returning to social life. Furthermore, in the first 90 days, patients treated with a minimally invasive procedure had less pain when compared to the open one. After 180 days, the two procedures become very similar in terms of quality of life, however, it is worth mentioning that the patients treated with a minimally invasive procedure had fewer complaints related to life/social interaction and with regard to financial difficulties. Conclusions: Assessing quality of life will always be a complex task, as it involves the patient's subjectivity and temporal aspects. In the present study, we identified significant differences regarding the quality of life of patients submitted to oncological gastrectomies, especially when comparing GST with GT, with better results in terms of short-term nutritional rehabilitation favorable to GST and better quality of life reported by patients who underwent minimally invasive surgery with regards to less short-term nausea, vomiting, and pain. In the long term, patients undergoing the minimally invasive approach had better function/social interaction. Such differences seem to cause less impact in terms of quality of life 6 months after the operation.

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Resumen Introducción: la infección por Helicobacter pylori tiene una alta prevalencia y distribución a nivel mundial. Por su asociación con el desarrollo de adenocarcinoma gástrico, las actualizaciones sobre su prevalencia son de interés para el médico internista o gastroenterólogo, así como para la generación de políticas públicas. Este estudio midió la prevalencia de H. pylori y evaluó su asociación con hallazgos endoscópicos e histopatológicos en adultos con indicación de endoscopia de vías digestivas altas (EVDA). Metodología: estudio de cohorte analítica para describir la prevalencia de H. pylori y evaluar factores de riesgo asociados a esta infección en pacientes adultos sometidos a EVDA ambulatoria por cualquier indicación médica en la unidad de endoscopia de un hospital universitario de cuarto nivel de complejidad entre junio y diciembre de 2020. Se describen hallazgos endoscópicos, histopatológicos y la prevalencia de H. pylori. Para explorar los factores de riesgo se usó la prueba chi cuadrado (χ2) para evaluar diferencias en las proporciones y las pruebas t de Student y U de Mann-Whitney para las variables continuas según su distribución. Resultados: 613 pacientes cumplieron los criterios de selección y fueron incluidos en el análisis. La indicación más frecuente de EVDA fue dispepsia. La prevalencia de H. pylori fue de 38,5% (intervalo de confianza [IC] 95%: 34,7%-42,4%). Conclusión: H. pylori es un tema de gran interés en las patologías gastrointestinales. La búsqueda endoscópica debe ser en el antro y cuerpo. Su presencia fue mayor en pacientes con esófago normal, gastritis nodular folicular, úlcera duodenal e inflamación aguda al estudio histológico. Se requieren más estudios que complementen el comportamiento epidemiológico local.

Abstract Introduction: Helicobacter pylori infection has a high prevalence and distribution worldwide. Due to its association with the development of gastric adenocarcinoma, updates on its prevalence are of interest to the internist or gastroenterologist and policymaking. This study measured the prevalence of H. pylori and evaluated its association with endoscopic and histopathological findings in adults with an indication for upper GI endoscopy (EGD). Materials and methods: This analytical cohort study describes the prevalence of H. pylori and assesses risk factors associated with this infection in adult patients undergoing outpatient EGD for any medical indication in the endoscopy unit of a quaternary care university hospital between June and December 2020. Endoscopic and histopathological findings and the prevalence of H. pylori are described. To explore the risk factors, the chi-square (χ2) test was used to evaluate differences in proportions and the Student's t and Mann-Whitney U tests for continuous variables according to their distribution. Results: 613 patients met the selection criteria and were included in the analysis. The most frequent indication for EGD was dyspepsia. The prevalence of H. pylori was 38.5% (95% confidence interval [CI]: 34.7-42.4%). Conclusion: H. pylori is a topic of great interest in gastrointestinal pathologies. The endoscopic search should take place in the antrum and body. Its presence was most common in patients with a normal esophagus, follicular nodular gastritis, duodenal ulcer, and acute inflammation upon the histological study. More studies are required to complement the local epidemiological behavior.

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ABSTRACT Background: Endoscopic treatment of precancerous lesions and early gastric cancer has been widely accepted in recent years. Endoscopic submucosal dissection (ESD), following established indication criteria, can lead to cure of the disease in more than 90% of cases. Objective: This study aimed to analyze the use of ESD in patients with early gastric cancer and precancerous lesions, as well as the results of the procedure, its complications and effectiveness in controlling the disease. Methods: This is a retrospective cohort study composed of 41 patients aged from 53 to 87 years (mean age: 65 years; 58.53% male) who were analyzed from 2008 to 2019. The variables collected from the medical records were: comorbidities, classification of the lesion regarding resection criteria, type of resection, histology, degree of invasion, resection margin, complications, disease recurrence. Statistical analysis was performed using the Kruskal-Wallis test, the McNemar's test, and the Mann-Whitney test, with 5% statistical significance (P<0.05). Results: The most frequent site of the lesion was the gastric antrum and the predominant presentation by the Japanese or Paris classification was the one with depressed components in 56.09%. Adenocarcinoma occurred in 75.6% of the biopsies, and the remainder were adenomas without neoplasia. En-bloc resection occurred in 97.57% of cases, and compromise of the safety margin occurred in one patient. The main pre-existing comorbidity was liver cirrhosis in 29.26% of cases. There was a significant increase in post- ESD adenocarcinoma compared to pre-resection diagnosis. The mean follow-up time was 38.4 months, with one recurrence (2.43%) and two metachronous lesions (4.87%). Complications during and after the procedure occurred in three patients (7.31%), being due to bleeding (two cases) and perforation (one case). There was one death due to a cardiac event not directly related to the procedure. Conclusion: Endoscopic submucosal dissection proved to be a safe procedure, with a low complication and recurrence rate. Its recommendation must occur within the established criteria; however, it can be indicated for patients outside the criteria, if there is a high risk for surgical treatment.

RESUMO Contexto: O tratamento endoscópico das lesões pré-cancerosas e do câncer gástrico precoce tem sido amplamente aceito nos últimos anos. A dissecção endoscópica da submucosa (submucosectomia), obedecendo a critérios estabelecidos de indicação, pode levar a cura da doença em mais de 90% dos casos. Objetivo: Este estudo teve como objetivo analisar o uso da dissecção submucosa endoscópica em pacientes com câncer gástrico precoce e lesões pré-cancerosas, bem como os resultados do procedimento, suas complicações e eficácia no controle da doença. Métodos: Foram analisados 41 pacientes, com idade variando de 53 a 87 anos (média de 65 anos), sendo 58,53% do sexo masculino, no período de 2008 a 2019, sendo este estudo do tipo coorte retrospectivo. As variáveis coletadas dos prontuários foram: comorbidades, classificação da lesão quanto aos critérios de ressecção, tipo de ressecção, histologia, grau de invasão, margem de resseção, complicações, recidiva de doença. A análise estatística foi feita com o uso do teste de Kruskal-Wallis, teste de McNemar e teste de Mann-Whitney, com significância estatística de 5% (P<0,05). Resultados: O local mais frequente da lesão foi o antro gástrico e a apresentação predominante pela classificação japonesa ou de Paris foram os com componentes deprimidos em 56,09%. O adenocarcinoma ocorreu em 75,6% das biópsias e o restante foram adenomas sem neoplasia. A ressecção em bloco ocorreu em 97,57% dos casos, e o comprometimento da margem de segurança ocorreu em um paciente. A principal comorbidade pré-existente foi a cirrose hepática em 29,26% dos casos. Houve um aumento significativo de adenocarcinoma após dissecção endoscópica da submucosa em comparação ao diagnóstico pré ressecção. O tempo médio de seguimento foi de 38,4 meses, sendo registrado uma recidiva (2,43%) e duas lesões metacrônicas (4,87%). As complicações durante e após o procedimento ocorreram em 3 (7,31%) pacientes, sendo por sangramento (dois casos) e perfuração (um caso). Houve um óbito por evento cardiológico, não relacionado diretamente com o procedimento. Conclusão: A ressecção endoscópica da submucosa mostrou ser procedimento seguro, com baixa taxa de complicação e de recidiva. A sua indicação deve ser dentro dos critérios estabelecidos, entretanto, pode ser indicada em pacientes fora de critérios, se há alto risco para o tratamento cirúrgico.

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BACKGROUND: Gastric cancer (GC) with microsatellite instability (MSI) is a less aggressive disease and associated with resistance to 5-fluorouracil (5-FU)-based chemotherapy (CMT). Thymidylate synthase (TS) is inhibited by 5-FU, and another potential mediator of therapeutic resistance to 5-FU. Therefore, we aimed to analyze the association between MSI and TS expression in GC, and its impact on disease outcomes. METHODS: We retrospectively evaluated GC who underwent D2-gastrectomy. MSI and TS were analyzed by immunohistochemistry. We also investigated p53 expression, PD-L1 status, and tumor-infiltrating lymphocytes (CD4 and CD8). RESULTS: Out of 284 GC, 60 (21.1%) were MSI. Median TS-score for all cases was 16.5. TS expression was significantly higher in MSI compared to microsatellite-stable (MSS; p < 0.001). Considering both status, GC were classified in four groups: 167 (58.8%) MSS + TS-low; 57 (20.1%) MSS + TS-High; 24 (8.5%) MSI + TS-low; and 36 (12.7%) MSI + TS-high. MSI + TS-high group had less advanced pTNM stage, higher CD8+T cells levels (p < 0.001) and PD-L1 positivity (p < 0.001). Normal p53 expression was related to MSI GC (p < 0.001). Improved survival was observed in MSI + TS-high, but no survival benefit was seen with CMT. CONCLUSION: MSI GC was associated with high TS levels, which may explain therapeutic resistance to 5-FU. Additionally, MSI + TS-high showed better survival, but without improvement with CMT.

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Resumen Objetivo: Generar recomendaciones basadas en la evidencia, para la prevención primaria y secundaria, el tratamiento de las lesiones preneoplásicas y el diagnóstico temprano del cáncer gástrico en población adulta, con el propósito de reducir la carga de la enfermedad. Materiales y métodos: El grupo desarrollador estuvo integrado por profesionales de la salud y tomadores de decisiones. Se construyeron preguntas clínicas contestables y se realizó la graduación de los desenlaces. Se elaboró la búsqueda de la información en MEDLINE; EMBASE y CENTRAL, siendo actualizada el 18 de octubre de 2018. La pesquisa también abarcó otras fuentes de información como la Revista Colombiana de Gastroenterología y la lectura en "bola de nieve" de las referencias incluidas. Se contactó a expertos en la materia con el objetivo de identificar estudios relevantes no publicados. Para la construcción de las recomendaciones, se realizó un consenso acorde con los lineamientos propuestos por la metodología GRADE, sopesando los beneficios, los efectos adversos derivados de la intervención, las preferencias de los pacientes y el potencial impacto de las intervenciones sobre los costos. Resultados: Se presenta la versión corta de la "Guía de práctica clínica para la prevención primaria, secundaria y diagnóstico temprano de cáncer gástrico", junto con su evidencia de soporte y respectivas recomendaciones. Conclusiones: Como recomendación central para la implementación, se recomienda erradicar la infección por H. pylori en los pacientes con o sin factores de riesgo, como estrategia de prevención de las condiciones precursoras de cáncer gástrico. La Guía deberá actualizarse en tres años.

Abstract Objetive: Generate recommendations for primary and secondary prevention, treatment of gastric preneoplastic lesions, and early diagnosis of gastric cancer in the adult population, to increase the detection of gastric cancer in early stages. Material and methods: The developer group was made up of health professionals, decision-makers, and a representative of the patients. Answerable clinical questions were constructed and outcomes were graded. The search for information in MEDLINE was carried out; EMBASE and CENTRAL, being updated on October 18, 2018. The search also covered other sources of information such as the Colombian Journal of Gastroenterology and the "snowball" reading of the references included. Experts in the field were contacted to identify studies. For the construction of the recommendations, a consensus was made according to the guidelines proposed by the GRADE methodology, weighing the benefits, the adverse effects derived from the intervention, the preferences of the patients, and the potential impact of the interventions on costs. Results: The short version of the "Clinical practice guidelines for the primary, secondary, and early diagnosis of gastric cancer" is presented together with its supporting evidence and respective recommendations. Conclusions: As a central recommendation for implementation, it is recommended to eradicate H. pylori infection in patients with or without risk factors in whom it is detected to prevent gastric cancer precursor conditions. The Guide will need to be updated in three years.

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Abstract Stomach cancer is the second leading cause of death by cancer worldwide and is even more pronounced in South America. In Brazil, it is estimated that an increase in the number of cases due to this cancer occurred in the biennium 2018-2019. In this study, we investigated the expenditures of the State Health Department of Goiás on hospitalizations and treatment of gastric cancer for the Unified Health System (SUS) from 2008-2016. This is a cross-sectional, descriptive, and analytical study based on secondary data from the Unified Health System computing department (DATASUS) and the System of Management of the Table of Procedures, Medications, Orthosis, Prosthesis, and Special Materials of SUS through CONECTA-SUS related to International Classification of Diseases-10/C16 (ICD-10/C16) procedures for gastric neoplasms. A total of I$ 5,697,958.20 was spent on gastric tumor in the last nine years in Goiás, I$ 4,492,916.67 (0.3%) on hospitalizations, and I$ 1,997,120.91 on treatment. This study presents a current and relevant estimate of the costs of gastric cancer patients in Goiás. Moreover, we provide information on the extent of the cancer issue to public health. Our analysis offers components for service management and studies that reduce resource allocation in more rational ways

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In Brazil, gastric cancer is the third most common type of cancer among men and fifth among women, with an estimated 13360 new cases among men and 7870 among women each year during the 2020-2022 period. This study presents reflections and attempts to add knowledge to the theme of quality of life (QoL) in patients with gastric adenocarcinoma and describes some of its characteristics in three regions of Brazil, with an evaluation of the disease's impacts in various dimensions of life, as reported by the patients themselves. We performed a narrative review of the literature and a data analysis of studies on QoL in Brazilian patients treated for gastric adenocarcinoma from three different cities in three geographic regions: Brasília (the midwest), Jaú (the southeast), and Macapá (the north).

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Resumen Introducción: El cáncer gástrico, a nivel mundial, tiene una incidencia variable y es una de las causas más frecuentes de muerte. En Ecuador ocupa el segundo lugar de muerte en los hombres y la cuarta en las mujeres por cáncer gástrico. Objetivos: Establecer las características sociodemográficas, clínicas, histológicas y endoscópicas, y determinar una correlación entre la localización e histología en una población de pacientes con cáncer gástrico en el Hospital de Especialidades de Guayaquil, Dr. Abel Gilbert Pontón. Materiales y métodos: Estudio de prevalencia analítico y prospectivo. Se incluyeron las endoscopias digestivas altas de consulta externa y emergencia con signos de sospecha de cáncer gástrico realizadas en el Hospital de Especialidades de Guayaquil, Dr. Abel Gilbert Pontón, Ecuador, entre enero de 2018 y diciembre de 2019. Resultados: En el estudio se incluyeron 62 pacientes con diagnóstico de adenocarcinoma gástrico, el sexo masculino representó el 72,6 % en relación con el sexo femenino, con el 27,4 %; el rango de edad fue entre los 27 y 95 años, el promedio de edad es de 60,96 ± 15,1 y la edad de mayor presentación fue de 60 a 70 años. El síntoma que predominó fue el dolor, en un 98,4 %, y la pérdida de peso, en un 64,5 %; su localización más frecuente fue el antro (50,0 %), su morfología de mayor presentación es el Borrmann tipo III y, con respecto al tipo histológico, se encontró el tipo intestinal (64,5 %) y el difuso (29,0 %). El tipo intestinal se presentó en edad más avanzada en un 60 %-69 %, fue más frecuente en el cuerpo (71,4 %) y su localización fue más proximal, en comparación con el tipo difuso, que se presentó más en edad temprana (27-39 años), fue más frecuente en el antro (32,3 %) y su localización fue más distal. Conclusiones: El cáncer gástrico se diagnostica en estadios avanzados, más en hombres que en mujeres y se puede afirmar que en nuestro hospital la localización del cáncer gástrico tipo intestinal se presentó en edades avanzadas, más frecuentemente a nivel proximal y en la clasificación del cáncer gástrico avanzado Borrmann tipo III, lo cual podría tener influencia en el tratamiento y pronóstico. Además, los resultados obtenidos justifican la implementación de programas de detección oportuna y tratamiento de esta grave enfermedad.

Abstract Introduction: Gastric cancer is one of the most common causes of death worldwide, with a varying incidence. In Ecuador, it is the second leading cause of death in men and the fourth in women. Objectives: To establish the socio-demographic, clinical, histological, and endoscopic characteristics of patients with gastric cancer and to determine the correlation between location and histology in this population treated at the Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón. Materials and methods: Analytical and prospective prevalence study. Outpatient and emergency upper gastrointestinal endoscopies with signs of suspected gastric cancer performed at the Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón - Ecuador between January 2018 through December 2019 were included. Results: The study included 62 patients diagnosed with gastric adenocarcinoma. 72.6% were male and 27.4% were female; the age range was between 27 and 95 years, with an average of 60.96 ± 15.1 years, the age of onset being between 60 and 70 years. Pain was the most frequent symptom in 98.4% of cases, followed by weight loss in 64.5%. The antrum was the most common site of cancer (50.0%), and Borrmann type III was the most common morphology. Intestinal cancer was found in 64.5% of cases, while diffuse gastric cancer was found in 29.0%. Intestinal cancer was more common in older ages (60-69%) and the most frequent site of presentation was the body of the stomach (71.4%) with a proximal location. In contrast, diffuse gastric cancer was more frequent in younger patients aged between 27-39 years, more often in the antrum (32.3%) at a more distal location. Conclusions: Gastric cancer is more often found in men and is usually diagnosed in advanced stages. Intestinal gastric cancer was most commonly seen at advanced ages in our hospital, most frequently at the proximal site and in the Borrmann type III according to the classification of advanced gastric cancer, affecting its treatment and prognosis. The results obtained support the implementation of programs to diagnose and treat this severe disease in a timely manner.

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Resumen A través del presente reporte se describe un caso de gastritis enfisematosa, una rara condición clínica consistente en la invasión de la pared gástrica por microorganismos productores de gas. Puede resultar en una situación fatal debido a lo inespecífico de su clínica y a lo tórpido de su evolución. En este caso se describe a un paciente anciano de 77 años, con alta fragilidad, quien cursaba con un cuadro de gastritis enfisematosa que no respondió a manejo médico y requirió gastrectomía de urgencia. Adicionalmente, cursaba con un adenocarcinoma gástrico ulcerado infiltrante, que previamente no había sido diagnosticado, como probable factor condicionante y desencadenante.

Abstract This report describes a case of emphysematous gastritis, a rare clinical condition consisting of invasion of the gastric wall caused by gas-producing bacteria. It can lead to fatal outcomes due to the unspecific nature of the symptoms and its torpid course. The following is the case of a highly fragile 77-year-old male patient, who presented with symptoms of emphysematous gastritis that did not respond to medical treatment and required emergency gastrectomy. In addition, the patient had an infiltrating ulcerated gastric adenocarcinoma, which had not previously been diagnosed and was a probable conditioning and triggering factor.

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Introducción. Se conoce como escudo de Blumer al engrosamiento neoplásico del fondo de saco de Douglas, palpable al tacto rectal como una protrusión en forma de resalte, presente en pacientes afectados por carcinomas con infiltración difusa. A pesar de haber sido descrito hace más de un siglo, se trata de un proceso diagnosticado infrecuentemente y con escasa mención en la literatura científica. Es preciso tener un alto nivel de sospecha clínica para correlacionar los síntomas pélvicos con la presencia de un tumor, habitualmente gástrico. Casos clínicos. Presentamos dos pacientes con hallazgo de escudo de Blumer, asociado a cáncer gástrico difuso, uno como diagnóstico primario de enfermedad metastásica y otro como recidiva de la enfermedad, meses después de ser operado. Ambos casos presentan un complejo proceso diagnóstico, en el que prima la sospecha clínica, apoyado sobre pruebas de imagen como tomografía computarizada y resonancia nuclear magnética, ya que tanto las biopsias obtenidas por endoscopia, como las biopsias intraoperatorias fueron negativas. Discusión. En el escudo de Blumer, las células tumorales infiltran el fondo de saco de Douglas de forma difusa por debajo de la serosa, sin necesidad de que existan implantes macroscópicamente visibles en el peritoneo visceral. La infiltración tumoral puede afectar extrínsecamente al recto, causando una estenosis del mismo, lo que produce sintomatología pélvica inespecífica, como tenesmo rectal y proctalgia. Por lo tanto, este ominoso proceso debe ser sospechado en pacientes con sintomatología pélvica, que presenten o hayan presentado cáncer gástrico

Introduction. The neoplastic thickening of the cul-de-sac of Douglas is known as "Blumer's shelf". It is palpable on rectal examination as a protrusion in the form of a projection, and it presents in patients affected by carcinomas with diffuse infiltration. Despite being described more than a century ago, it is a rare process with little mention in the scientific literature. A high level of clinical suspicion is required to correlate pelvic symptoms with the presence of a typically gastric tumor.Clinical cases. We present two patients with a Blumer's shelf finding associated with diffuse gastric cancer, one as a primary diagnosis of metastatic disease and the other as a recurrence of the disease, months after being operated on. Both cases present a complex diagnostic process, in which clinical suspicion prevails, supported by imaging tests such as computed tomography and magnetic resonance imaging, since both endoscopic biopsies and intraoperative biopsies were negative.Discussion. In Blumer's shelf, tumor cells infiltrate the cul-de-sac of Douglas in a diffuse and subserous manner, without the need for macroscopically visible implants in the visceral peritoneum. Tumor infiltration can extrinsically affect the rectum, causing its stenosis, which produces nonspecific pelvic symptoms such as rectal tenesmus and proctalgia. Therefore, this ominous process should be suspected in patients with pelvic symptoms, who present or have presented gastric cancer

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Resumen La lipomatosis gástrica es una enfermedad infrecuente caracterizada por múltiples lesiones tumorales benignas (lipomas), que acorde a su tamaño pueden producir una variedad de síntomas. Por lo general, la enfermedad es documentada incidentalmente en estudios imagenológicos que se realizan para estudiar otras enfermedades y los hallazgos patológicos contribuyen a tener una certeza en el diagnóstico de esta patología. Por el momento, no hay un tratamiento definido para las masas pequeñas y asintomáticas, mientras que para las masas grandes (> 3-4 cm) o sintomáticas se sugiere la resección quirúrgica de las lesiones.

Abstract Gastric lipomatosis is a rare disease characterized by multiple lipomas, benign tumors which can produce a variety of symptoms according to their size. In general, the disease is incidentally documented in imaging studies done to study other diseases. Pathological findings can contribute to the certainty of diagnosis. At the moment, there is no definite treatment for small, asymptomatic masses, but surgical resection is suggested for masses that are larger than 3 or 4 cm and for those that are symptomatic.

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OBJECTIVES: This study aimed to evaluate the effect of preoperative immunonutrition on the rate of postoperative complication and survival of patients with gastric cancer. METHODS: A retrospective cohort was formed after data collection of patients hospitalized with gastric cancer. Postoperative complications classified according to the Clavien-Dindo classification system, length of hospital stay, readmissions, and rates of survival at 6 mo, 1 y, and 5 y were analyzed. A χ2 or Fisher's exact test, Student or Mann-Whitney t test, and Kaplan-Meier and Cox regressions were used in the statistical analysis. RESULTS: A total of 164 patients were included in the study, with 56 patients assigned to the immunonutrition group and 108 to the conventional group. There were no significant differences in postoperative complications between the immunonutrition and conventional groups (51.8% versus 58.3%; P = 0.423). The most frequent complications were fistula and surgical wound infection. Length of hospital stay did not differ between the groups (median of 7.0 d: P = 0.615) and the presence of readmissions did not differ either (12.5% versus 15.7%; P = 0.648). In the multivariate Cox regression, in a pooled model for group, age, sex, body mass index, Charlson comorbidity index, staging, neoadjuvant chemotherapy, and type of surgery, there was a significant difference in survival rates at 6 mo (P = 0.011), 1 y (P = 0.006), and 5 y (P < 0.001). CONCLUSIONS: Preoperative immunonutrition in patients with gastric cancer did not reduce postoperative complications or length of hospital stay. More studies are needed to confirm the benefit of immunonutriton supplementation for overall survival when associated with other protective factors.

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ABSTRACT Introduction: Pathologists currently face a substantial increase in workload and complexity of their diagnosis work on different types of cancer. This is due to the increased incidence and detection of neoplasms, associated with diagnostic subspecialization and the advent of personalized medicine. There are numerous treatments available for different types of cancer, and the diagnosis must be dispensed quickly and accurately for each case. Deep learning is a tool that has been used in daily life, including image detection, and there is growing interest in its application in Medicine and especially in Pathology, where it has a revolutionary potential. Objective: In this article, we present deep learning, in particular convolutional neural networks, as a potential technique for the analysis of digitized images of histopathological slides, detecting identifiable patterns in an automated manner, introducing the possibility of applying this technology as an auxiliary tool in the diagnosis of neoplasms, especially in gastric cancer, the object of this preliminary study. Method: From a database of digitized images of histopathological slides representative of gastric cancer, we identified three morphological patterns of neoplasia, as well as non-neoplastic tissue patterns, with which we train a convolutional neural network algorithm, designed to identify and categorize similar images within these standards, in an automated manner. Results: The results of identification and automatic classification in the defined categories were satisfactory, with ROC curves above 0.9. Conclusion: The results show the potential application of convolutional neural networks for digitized slides of gastric cancer, in accordance with international literature findings.

RESUMEN Introducción: Los patólogos enfrentan actualmente un aumento sustancial de su trabajo diagnóstico en diferentes tipos de cáncer. Eso ocurre debido al incremento de la incidencia y de la detección de neoplasias, además de la subespecialización diagnóstica y del advenimiento de la medicina personalizada. Hay numerosos tratamientos disponibles para diferentes tipos de cáncer, y el diagnóstico debe ser realizado con celeridad y precisión para cada caso. El aprendizaje profundo es una herramienta que ha sido empleada en el día a día, incluso en la detección de imágenes, y hay creciente interés en su aplicación en Medicina, especialmente en Patología, área en la que presenta potencial revolucionario. Objetivo: En este artículo presentamos el aprendizaje profundo, en especial las redes neuronales convolucionales, como una técnica potencial para el análisis de imágenes digitalizadas de portaobjetos histopatológicos, detectando patrones identificables de forma automatizada, introduciendo la posibilidad de empleo de esa tecnología como herramienta auxiliar en el diagnóstico de neoplasias, principalmente en el adenocarcinoma gástrico, objeto de este estudio preliminar. Métodos: A partir de una base de datos de imágenes digitalizadas de portaobjetos histopatológicos representativos de adenocarcinoma gástrico, identificamos tres patrones morfológicos de la neoplasia, así como patrones de tejidos no neoplásicos, con los cuales entrenamos un algoritmo de red neuronal convolucional, creado para identificar y categorizar imágenes semejantes dentro de eses patrones, de modo automatizado. Resultados: Los resultados de identificación y clasificación automática en las categorías definidas se mostraron satisfactorios, con curvas ROC por encima de 0,9. Conclusión: Los resultados muestran el potencial de aplicación de las redes neuronales convolucionales en portaobjetos digitalizados de adenocarcinoma gástrico, en conformidad con la literatura internacional.

RESUMO Introdução: Os patologistas enfrentam atualmente um aumento substancial na carga e na complexidade de seu trabalho diagnóstico em diferentes tipos de câncer. Isso ocorre devido ao aumento da incidência e da detecção de neoplasias, além da subespecialização diagnóstica e do advento da medicina personalizada. Existem inúmeros tratamentos disponíveis para diferentes tipos de câncer, e o diagnóstico deve ser dado com celeridade e precisão para cada caso. A aprendizagem profunda é uma ferramenta que vem sendo empregada no dia a dia, inclusive na detecção de imagens, e há crescente interesse em sua aplicação na Medicina, especialmente na Patologia, área em que apresenta potencial revolucionário. Objetivo: Neste artigo, apresentamos a aprendizagem profunda, em específico as redes neurais convolucionais, como uma potencial técnica para a análise de imagens digitalizadas de lâminas histopatológicas, detectando padrões identificáveis de forma automatizada, introduzindo a possibilidade de aplicação dessa tecnologia como ferramenta auxiliar no diagnóstico de neoplasias, principalmente no adenocarcinoma gástrico, objeto deste estudo preliminar. Métodos: A partir de um banco de dados de imagens digitalizadas de lâminas histopatológicas representativas de adenocarcinoma gástrico, identificamos três padrões morfológicos da neoplasia, bem como padrões de tecidos não neoplásicos, com os quais treinamos um algoritmo de rede neural convolucional, criado com a finalidade de identificar e categorizar imagens similares dentro desses padrões, de forma automatizada. Resultados: Os resultados de identificação e classificação automática nas categorias definidas mostraram-se satisfatórios, com curvas ROC acima de 0,9. Conclusão: Os resultados evidenciam o potencial de aplicação das redes neurais convolucionais em lâminas digitalizadas de adenocarcinoma gástrico, consoantes com a literatura internacional.

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ABSTRACT Noncutaneous melanoma is a rare clinical entity, and their primary or secondary nature is often difficult to establish. Few cases of primary gastric melanoma have been described in the literature. We report a case of a 55-year-old male patient with dyspepsia complaints. Esophagogastroduodenoscopy revealed a polypoid mass with blackened areas at the greater curvature of the gastric body, which was histologically compatible with melanoma; positive immunohistochemistry for S100, melan-A, and vimentin. The extensive dermatological exam did not identify a primary lesion.

RESUMEN El melanoma extracutáneo es una entidad clínica rara, y es difícil identificar su naturaleza primaria o secundaria. Hay pocos casos de melanoma gástrico primario descritos en la literatura. Reportamos el caso de un paciente masculino, de 55 años de edad con síntomas dispépticos. La esofagogastroduodenoscopia reveló lesión polipoidea con zonas ennegrecidas en la curvatura mayor del cuerpo gástrico, histológicamente compatible con melanoma; inmunohistoquímica positiva para S100, melan-A y vimentina. El examen dermatológico completo no identificó lesión primaria.

RESUMO Melanoma extracutâneo é uma entidade clínica rara, e sua natureza primária ou secundária é difícil de ser estabelecida. Poucos casos de melanoma gástrico primário são descritos na literatura. Relatamos o caso de um paciente do sexo masculino, 55 anos, com queixas dispépticas. A esofagogastroduodenoscopia revelou lesão polipoide com áreas enegrecidas na grande curvatura do corpo gástrico, histologicamente compatível com melanoma; imuno-histoquímica positiva para proteína S100, melan-A e vimentina. O exame dermatológico extenso não identificou lesão primária.

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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.

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