Predicting overall and major postoperative morbidity in gastric cancer patients.

BACKGROUND: Postoperative complications after gastric cancer resection vary in different series and they might have a significant impact in long-term outcomes. Our aim was to build a prediction rule on gastric cancer patients' overall and major morbidity risks. METHODS: This retrospective study included 1223 patients from a single center who were resected between 1992 and 2016. Overall and major morbidity predictors were identified through multiple logistic regression. Models' performances were assessed through discrimination, calibration, and cross-validation, and nomograms were constructed. RESULTS: The mean age was 61.3-year old and the male gender was more frequent (60%). The most common comorbidities were hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD). A D2-distal gastrectomy was the most frequent procedure and 87% of all lesions were located in the middle or distal third. Age, COPD, coronary heart disease, chronic liver disease, pancreatic resection, and operative time were independent predictors of overall and major morbidity. The extent of resection and splenectomy was associated with overall events and HTN with major ones. Both models were very effective in predicting events among patients at higher risk. CONCLUSIONS: The overall and major morbidity models and nomograms included clinical- and surgical-related data that were very effective in predicting events, especially for high-risk patients.

Comparative analysis of basaloid and conventional squamous cell carcinomas of the esophagus: prognostic relevance of clinicopathological features and protein expression.

Basaloid squamous cell carcinoma (BSCC), a variant of squamous cell carcinoma (SCC), is a rare and aggressive epithelial malignancy which has been reported in only 0.1-11 % of primary esophageal carcinomas. In this study, a comparison of clinicopathological features and protein expression between esophageal BSCC (EBSCC) and conventional esophageal SCC (ESCC) cases from Brazil was performed in order to find factors that can be relevant to better characterize EBSCC. The expression of HER2, epidermal growth factor receptor (EGFR), Ki-67, and cyclins (A, B1, and D1) in 111 cases (95 ESCC and 16 EBSCC) was evaluated by immunohistochemistry using tissue microarray. When the clinicopathological data were compared, no significant difference was found between the two histological types. Although the difference is not significant (p = 0.055), the EGFR expression was more frequent in the conventional ESCC than in the EBSCC group. Our results indicate that the clinicopathological profiles of conventional ESCC and EBSCC are similar and provide no indicators for differences in prognosis between these two groups.

Tratamento curativo do câncer gástrico em um centro de referência: análise crítica dos resultados pós-operatórios / Curative treatment of gastric cancer in a referral center: critical analysis of the postoperative results

Introdução: A cirurgia para câncer gástrico está associada à significante morbidade o que pode atrasar o tratamento adjuvante dos pacientes que necessitam. Objetivo: O objetivo deste estudo foi identificar os fatores prognósticos associados às taxas de morbi-mortalidade pós-operatória. Métodos: Trata-se de um estudo retrospectivo com 298 doentes com CG submetidos à ressecção cirúrgica em um centro de tratamento oncológico no período de 2007 a 2013. Fatores preditivos de complicações gerais, clínicas e cirúrgicas e também de mortalidade foram identificados. Resultados: A maioria dos doentes deste estudo eram homens (58,1%) com mediana de idade de 62 anos e submetidos à gastrectomia total (46,1%). Complicações pós-operatórias foram encontradas em 122 casos (40,9%). A pneumonia foi a principal complicação clínica (8,1%) e a infecção de ferida operatória (9,1%) e abscesso intracavitário (7,7%) foram as complicações cirúrgicas mais prevalentes. A taxa de mortalidade pós-operatória foi de 5,7%. Idade maior que 70 anos, perda de peso ao diagnóstico, extensão da ressecção gástrica e tempo cirúrgico prolongado foram fatores associados à maior morbidade. Pacientes com idade maior que 70 anos, presença de DPOC e com transfusão sanguínea intraoperatória apresentaram maior taxa de complicações clínicas. Maiores complicações gerais ocorreram com maior frequência nos pacientes com DPOC e submetidos a longo tempo cirúrgico. Já a classificação ASA III/IV juntamente com a ressecção multivisceral foram fatores associadas à mortalidade pós-operatória. Conclusão: Pacientes com idade maior que 70 anos, diagnóstico prévio de DPOC, classificação ASA III/IV, submetidos a longo tempo cirúrgico e transfundidos no intraoperatório apresentaram alto risco de morbidade e mortalidade após cirurgia curativa para câncer gástrico.

Introduction: Surgery for gastric cancer (GC) is still associated with significant postoperative morbidity, which may delay adjuvant treatment. The aim of this study was to identify prognostic factors associated with postoperative morbidity and mortality for GC patients surgically treated. Methods: This is a retrospective study with 298 GC patients who underwent curative GC resection in a single cancer center between 2007 and 2013. Predictors for general, clinical and surgical postoperative complications, major and minor ones and also for mortality rates were identified. Results: Most patients in the study were male (58.1%), median age of 62 years old and underwent a total gastrectomy (46.3%). Postoperative complications were found in 122 cases (40.9%). Pneumonia was the main clinical complication (8.1%) followed by wound infection (9.1%) and intracavitary abscess (7.7%). Postoperative mortality rate was 5.7%. Age, extension of gastric resection, operative time and weight loss were associated with higher postoperative morbidity. Age over 70 years old, operative time duration and chronic obstructive pulmonary disease (COPD) were related to clinical complications, while operative time and blood transfusion led to the surgical ones. Major clinical complications were related to COPD, longer operative times; meanwhile, patients with ASA classification III/IV and multivisceral resections had higher mortality rates. Conclusion: Patients at older age, with COPD, ASA III/IV, longer operative time and multivisceral resections were at higher risk of postoperative morbidity and mortality after curative resection for gastric cancer.