Prognostic Impact of Pathology, Cytoreduction, and Tumor Markers in Pseudomyxoma Peritonei.

INTRODUCTION: The pathologic classification of pseudomyxoma peritonei is controversial. This study aimed to standardize the histopathological evaluation of pseudomyxoma peritonei and identify the clinicopathological factors associated with survival. METHODS: A pathologic review was performed to systematize the pathology report and verify the relationship between clinical features and survival. Terminology was based on the World Health Organization and Peritoneal Surface Oncology Group International definitions. Preoperative serum levels of carcinoembryonic antigen, CA19-9, and CA-125 were evaluated to determine their association with overall survival (OS) and ability to predict CC0-1 cytoreduction. RESULTS: Among 109 patients with carcinomas resulting from primary appendiceal neoplasms, 72 had pseudomyxoma peritonei of appendiceal origin and underwent debulking surgery. CC0-1 cytoreduction and CC2-3 cytoreduction were achieved in 61% and 39% of patients, respectively. Patients in the CC0-1 and CC2-3 groups had an OS of 122.80 and 32.92 mo, respectively. The histologic grade was associated with CC0-1 cytoreduction; however, it did not influence OS. Patients with CC0-1 cytoreduction, acellular mucin, and low-grade lesions had better disease-free survival. Higher preoperative CA19-9 levels were associated with poor OS. Normal carcinoembryonic antigen values were associated with 100% sensitivity for predicting CC0-1. CA19-9 levels of 625 U/mL were associated with a low possibility of predicting CC0-1. CONCLUSIONS: Histologic grades are associated with disease-free survival when CC0-1 cytoreduction is achieved. Normal preoperative CA19-9 levels were associated with a better OS. CC0-1 cytoreduction is the main determinant of longer survival.

Surgical Management of Malignant Intestinal Obstruction: Outcome and Prognostic Factors.

Background: Malignant intestinal obstruction is a frequent complication in advanced stages cancer patients. The prognosis is poor, with mean survival rate beneath 3 months. Clinical treatment, endoscopic or surgical procedures are options for malignant intestinal obstruction management. There is no generally accepted management strategy. Objectives: To evaluate prognostic factors of patients with malignant intestinal obstruction who underwent surgical treatment. Methods: A retrospective analysis was performed including patients of a single institution with diagnosis of malignant intestinal obstruction. Demographic data, in-hospital stay, postoperative complications, and overall survival were assessed. Logistic regression was used to evaluate associated prognostic factors. Results: Two hundred thirty-three surgeries were performed due to suspicion for malignant intestinal obstruction over a seven-year period. This diagnosis was confirmed in 210 operations (90.1%). The main causes of malignant obstruction were colorectal (49.5%) and gynecological cancer (21.9%). The rate of severe complications was 11.42%. In-hospital mortality rate was 40.95% (CI 95%: 34.16-47.74%). Functional status impairment,high serum urea, and low albumin levels were associated to higher mortality rate. Conclusion: Malignant intestinal obstruction implies poor prognosis, with high in-hospital mortality rate and severe postoperative complications. The decision regarding management of malignant intestinal obstruction must be multimodal and individualized, according to individual prognostic factors.

Nós e suturas em vídeo-cirurgia: orientações práticas e técnicas / Nodes and sutures in video-surgery: technique and practice guidelines

INTRODUÇÃO: A realização de suturas e nós é das mais difíceis manobras cirúrgicas em videolaparoscopia. A habilidade de realizá-las durante os procedimentos videolaparoscópicos determinou grande expansão nas indicações laparoscópicas, bem como permitiu aos cirurgiões realizarem procedimentos de maior complexidade com mais segurança. O treinamento deve seguir as mesmas orientações do ensino de procedimentos básicos. Para tanto, meios podem ser encontrados no comércio ou serem confeccionados pelo cirurgião. OBJETIVO: Dar atualização aos nós e técnicas de suturas usadas em videocirurgia. MÉTODOS: Descreve-se as técnicas mais práticas e usadas em nosso meio com figuras demonstrativas de como realizá-las. CONCLUSÃO: Existe uma lacuna importante da literatura científica na descrição e demonstração das diferentes técnicas de sutura em videocirurgia, como também existem muitas modalidades técnicas para a confecção de nós cirúrgicos. O seu conhecimento é importante para permitir ao cirurgião a escolha adequada nas diferentes situações e estratégias cirúrgicas existentes. A sistematização técnica dos nós e suturas em videocirurgia torna o procedimento mais fácil e seguro e deve ser cada vez mais divulgado.

INTRODUCTION: The completion of sutures and knots are the most difficult surgical maneuvers at laparoscopy. The ability to perform them during videolaparoscopy allowed surgeons to perform procedures of greater complexity with more security. The training should follow the same guidelines as the teaching of basic procedures. For this purpose, means may be found in trade or being prepared by a surgeon. AIM: To update techniques used in laparoscopic suturing. METHODS: Are described the techniques used with figures to demonstrate how to accomplish them. CONCLUSION: There is a significant gap in the scientific literature describing and illustrating the different suturing techniques in laparoscopic surgery, and there are many technical details for making surgery knots. Their knowledge is important to allow the surgeon to choose appropriately in different situations and surgical strategies what to use. The systematic technique of knots and sutures in laparoscopic surgery makes the procedure easier and safer and should be increasingly disseminated.

Estenose de anastomose bolsa ileal-anal: tratamento por ressecçäo com uso de grampeador: (relato de Caso) / Stenosis of the ileal-anal pouch anastomosis: treatment for the ressection with staplers using: (report of case)

As estenoses de anstomoses anais e retais são prevenidas e tratadas em sua grande maioria pela dilatação digital ou instrumental e retotomias. Estensores recidivantes e refratárias podem ser tratadas por procedimentos mais complexos ou por uma série de outras abordagens como grampeadores, balões dilatadores, ressectoscópios urológicos, staple cutter, uretrótomo etc. com bons resultados. Apresentamos uma nova aplicação do grampeador no tratamento de estenose de anastomose bolsa ileo-anal, de execução simples e eficiente.