Epidemiological profile in a tertiary admission unit of spine diseases / Perfil epidemiológico em uma unidade de internação terciária de doenças da coluna vertebral / Perfil epidemiológico en una unidad de internación terciaria de patologias de la columna vertebral

ABSTRACT: Introduction: In March 2020, WHO officially decreed that the world was going through a pandemic, that of Covid-19. In May 2022, in Brazil, the end of measures to deal with the pandemic was decreed. In 2022, there was a movement to return to normal care in the provision of care. Objective: In the present study, we carried out a retrospective descriptive analysis of the epidemiological scenario of the ward of the Spine Group at the Hospital das Clínicas of the Faculty of Medicine of the Universidade de São Paulo (HC-FMUSP). Method: Data analysis was performed from information gathered in patients' medical records. Results: In the analyzed period, there were 152 consultations in hospitalization, with the main cause being spinal trauma. Of all the cases, only 23.68% were scheduled on an elective basis, which despite being a lower than expected number, was shaped by the demands of urgent care channeled to the service in question. Conclusion: Despite a higher number of cases hospitalized in the post-pandemic period, there is still the expectancy of more elective cases to be treated in the future. Level of Evidence III; Retrospective Case Series Study.

RESUMO: Introdução: Em março de 2020, a OMS decretou oficialmente que o mundo atravessava uma pandemia, a Covid-19. Em maio de 2022, no Brasil, decretou-se o fim das medidas de enfrentamento à pandemia. No ano de 2022, houve um movimento de retorno à normalidade assistencial na prestação de atendimentos. Objetivo: No presente estudo, realiza-se uma análise retrospectiva descritiva do cenário epidemiológico da enfermaria do Grupo de Coluna Vertebral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Método: A análise dos dados foi efetuada a partir do levantamento de prontuários médicos. Resultados: No período analisado, houveram 152 atendimentos em regime de internação, com a principal causa sendo o traumatismo da coluna vertebral. De todos os casos, apenas 23,68% foram casos agendados em regime eletivo, o que apesar de ser um número abaixo do esperado, foi moldado pelas demandas dos atendimentos de urgência canalizados ao serviço em questão. Conclusão: Apesar do aumento de atendimentos no período pós pandemia, há espaço para maior retomada do volume de casos eletivos no futuro. Nível de Evidência III; Estudo Retrospectivo de Série de Casos.

RESUMEN: Introdución: En marzo de 2020, la OMS decretó oficialmente que el mundo atravesaba una pandemia, la del Covid-19. En mayo de 2022, en Brasil, se decretó el fin de las medidas para enfrentar la pandemia. En el año 2022, hubo un movimiento para volver a la atención normal en la prestación de cuidados. Objetivo: En el presente estudio, realizamos un análisis descriptivo retrospectivo del escenario epidemiológico de la sala del Grupo de Columna Vertebral del Hospital das Clínicas de la Facultad de Medicina de la Universidade de São Paulo (HC-FMUSP). Método: El análisis de los datos se realizó con acceso al prontuario médico de los pacientes. Resultados: En el período analizado, hubo 152 consultas en hospitalización, siendo la principal causa trauma espinal. Del total de casos, solo el 23,68% fueron programados de forma electiva que, a pesar de ser un número inferior al esperado, estuvo condicionado por las demandas de atención urgente canalizadas al servicio en cuestión. Conclusión: A pesar del aumento de asistencias en el período postpandemia, hay espacio para una mayor recuperación futura en el volumen de casos electivos. Nivel de Evidencia III; Estudio Retrospectivo de Serie de Casos.

High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes.

PURPOSE: To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base. METHODS: Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure. RESULTS: A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63). CONCLUSION: Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.

EXTRA-ABDOMINAL DESMOID TUMOR: ANALYSIS OF 23 CONSECUTIVE CASES IN A SINGLE INSTITUTION.

OBJECTIVE: Extra-abdominal desmoid tumor (EDT) is a rare condition, caused by proliferation of fibroblasts. Despite being a benign tumor, it is locally aggressive and has unpredictable clinical behavior. The objective of this study is to present the clinical outcomes of patients with EDT treated surgically between 1995 and 2016. METHODS: This is a retrospective series of 23 patients with histopathological diagnosis of EDT that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the institute's clinical and pathology reports. RESULTS: A total of 223 medical records with histopathological reports were evaluated. Only 23 cases of EDT were included in the present study. The mean age was 22.5 years. Twelve (52.2%) patients had the tumor on the lower limbs, seven (30.4%) on the upper limbs and four (17.4%) cases were reported on the back. Five (21.7%) patients had tumors measuring less than 5 cm, while eighteen (78.3%) patients had tumors measuring more than 5 cm. All patients underwent surgery as the definitive treatment in our institute. Twelve (52.2%) cases presented negative margins (NM) and eleven (47.8%) cases had positive margins (PM). Local recurrence (LR) occurred in eleven (47.8%) patients. CONCLUSION: Impairment of the surgical margin was the only prognostic factor found for LR of EDT. Level of Evidence IV, Case Series.

OBJETIVO: O tumor desmoide extra-abdominal (TDE) é raro, formado por proliferação de fibroblastos. Apesar de ser um tumor benigno, é localmente agressivo e tem comportamento clínico imprevisível. O objetivo desta pesquisa é apresentar os resultados clínicos obtidos nos pacientes com TDE, tratados cirurgicamente entre 1995 e 2016. MÉTODOS: Trata-se de uma série retrospectiva de 23 pacientes com diagnóstico anatomopatológico de TDE, tratados cirurgicamente no serviço de oncologia ortopédica de nosso hospital. A informação foi obtida dos relatos clínicos e patológicos do instituto. RESULTADOS: Um total de 223 prontuários com relato anatomopatológico foi revisado. Apenas 23 casos de TDE foram incluídos no presente estudo. A média de idade foi de 22,5 anos. Doze (52,2%) casos se localizaram nos membros inferiores, sete (30,4%) casos nos membros superiores e quatro (17,4%) casos se localizaram no dorso. Cinco (21,7%) casos tinham tamanho < 5 cm e 18 (78,3%) casos tinham tamanho > 5 cm. Todos os pacientes receberam tratamento cirúrgico como terapia definitiva no instituto. Doze (52,2%) casos apresentaram margens livres (ML) e onze (47,8%) casos tinham margens comprometidas (MC). A recorrência local (RL) ocorreu em onze (47,8%) pacientes. CONCLUSÃO: O comprometimento da margem cirúrgica foi o único fator de prognóstico encontrado para a RL do TDE. Nível de Evidência IV, Série de Casos.

Extra-abdominal desmoid tumor: analysis of 23 consecutive cases in a single institution / Tumor desmoide extra-abdominal: análise de 23 casos consecutivos em uma única instituição

ABSTRACT Objective: Extra-abdominal desmoid tumor (EDT) is a rare condition, caused by proliferation of fibroblasts. Despite being a benign tumor, it is locally aggressive and has unpredictable clinical behavior. The objective of this study is to present the clinical outcomes of patients with EDT treated surgically between 1995 and 2016. Methods: This is a retrospective series of 23 patients with histopathological diagnosis of EDT that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the institute's clinical and pathology reports. Results: A total of 223 medical records with histopathological reports were evaluated. Only 23 cases of EDT were included in the present study. The mean age was 22.5 years. Twelve (52.2%) patients had the tumor on the lower limbs, seven (30.4%) on the upper limbs and four (17.4%) cases were reported on the back. Five (21.7%) patients had tumors measuring less than 5 cm, while eighteen (78.3%) patients had tumors measuring more than 5 cm. All patients underwent surgery as the definitive treatment in our institute. Twelve (52.2%) cases presented negative margins (NM) and eleven (47.8%) cases had positive margins (PM). Local recurrence (LR) occurred in eleven (47.8%) patients. Conclusion: Impairment of the surgical margin was the only prognostic factor found for LR of EDT. Level of Evidence IV, Case Series.

RESUMO Objetivo: O tumor desmoide extra-abdominal (TDE) é raro, formado por proliferação de fibroblastos. Apesar de ser um tumor benigno, é localmente agressivo e tem comportamento clínico imprevisível. O objetivo desta pesquisa é apresentar os resultados clínicos obtidos nos pacientes com TDE, tratados cirurgicamente entre 1995 e 2016. Métodos: Trata-se de uma série retrospectiva de 23 pacientes com diagnóstico anatomopatológico de TDE, tratados cirurgicamente no serviço de oncologia ortopédica de nosso hospital. A informação foi obtida dos relatos clínicos e patológicos do instituto. Resultados: Um total de 223 prontuários com relato anatomopatológico foi revisado. Apenas 23 casos de TDE foram incluídos no presente estudo. A média de idade foi de 22,5 anos. Doze (52,2%) casos se localizaram nos membros inferiores, sete (30,4%) casos nos membros superiores e quatro (17,4%) casos se localizaram no dorso. Cinco (21,7%) casos tinham tamanho < 5 cm e 18 (78,3%) casos tinham tamanho > 5 cm. Todos os pacientes receberam tratamento cirúrgico como terapia definitiva no instituto. Doze (52,2%) casos apresentaram margens livres (ML) e onze (47,8%) casos tinham margens comprometidas (MC). A recorrência local (RL) ocorreu em onze (47,8%) pacientes. Conclusão: O comprometimento da margem cirúrgica foi o único fator de prognóstico encontrado para a RL do TDE. Nível de Evidência IV, Série de Casos.

Simplified technique for reconstruction of the digestive tract after total and subtotal gastrectomy for gastric cancer / Técnica simplificada de reconstrução do trato digestivo após gastrectomia para câncer gástrico

BACKGROUND: Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. AIM - To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. METHODS - In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. RESULTS - The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. CONCLUSION - The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method. .

RACIONAL: Cada vez mais a cirurgia laparoscópica está sendo aplicada no tratamento cirúrgico do câncer gástrico. A reconstrução do trato gastrointestinal totalmente feita por laparoscopia também tem sido um desafio para aqueles que desenvolveram este procedimento. OBJETIVO: Descrever reconstrução simplificada após gastrectomia total ou subtotal para o câncer gástrico por laparoscopia e os resultados de sua aplicação em uma série de casos. MÉTODOS: Nos últimos quatro anos, 75 pacientes foram operados com câncer gástrico e dois com GIST. Trinta e quatro eram mulheres e 43 homens. A idade variou de 38 a 77 anos com média de 55 anos. Nos dois pacientes com GIST em um foi realizada gastrectomia total e no outro gastrectomia subtotal. Nos outros 75 pacientes foram aplicados 21 gastrectomias totais e 54 subtotais. Em todos os cânceres, a gastrectomia foi completada com linfadenectomia D2 com pelo menos 37 linfonodos retirados. Foi utilizada nas operações modificação técnica laparoscópica proposta pelos autores consistindo em anastomose latero-lateral esôfago jejunal em GT e de modo semelhante na GST e restabelecimento da continuidade digestiva também no abdômen superior. RESULTADOS: O intra-operatório e a evolução pós-operatória imediata transcorreu sem intercorrências, exceto por um caso de sangramento devido à abertura de clipe, sendo necessária re-intervenção. O tempo operatório foi de cerca de 300 minutos, não havendo diferença entre GT e GST. O número de nódulos linfáticos retirados variou de 28 a 69, com média de 37. O estadiamento pós-operatório mostrou um caso em T4 N2 M0; 13 em T2 N0 MO; 27 em T2 N1 M0; 24 em T3 N1 M0; e 10 em T3 N2 M0. Como complicação, em apenas ...

Simplified technique for reconstruction of the digestive tract after total and subtotal gastrectomy for gastric cancer.

BACKGROUND: Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. AIM: To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. METHODS: In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. RESULTS: The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. CONCLUSION: The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method.

Resultados da gastrectomia D2 para o câncer gástrico: dissecção da cadeia linfática ou ressecção linfonodal múltipla? / Results of D2 gastrectomy for gastric cancer: lymph node chain dissection or multiple node resection?

RACIONAL: A literatura oriental é notável por apresentar taxas de sobrevida para o tratamento cirúrgico do adenocarcinoma gástrico superiores àquelas apresentadas nos países ocidentais. OBJETIVO: Analisar o resultado a longo prazo após a gastrectomia D2 por câncer gástrico. MÉTODOS: Duzentos e setenta e quatro pacientes foram submetidos à gastrectomia com dissecção linfonodal D2 como tratamento exclusivo. Os critérios de inclusão foram: 1) remoção dos linfonodos de acordo com dissecção linfática padronizada Japonesa, 2) operação potencialmente curativa descrita no prontuário como dissecção D2 ou mais linfonodos; 3) invasão tumoral da parede gástrica restrita ao órgão (T1-T3); 4) ausência de metástases à distância (N0-N2/M0); 5) mínimo de cinco anos de acompanhamento. Dados clinicopatológicos incluíam sexo, idade, localização do tumor, classificação de Borrmann do tumor macroscópico, o tipo de gastrectomia, as taxas de mortalidade, tipo histológico, classificação e estadiamento TNM de acordo com a UICC TNM 1997. RESULTADOS: Gastrectomia total foi realizada em 77 casos (28,1%) e subtotal em 197 (71,9%). O tumor foi localizado no terço superior em 28 casos (10,2%), no terço médio em 53 (19,3%), e no terço inferior em 182 (66,5%). Borrmann foi atribuído cinco casos (1,8%) como BI, 34 (12,4%) BII, 230 (84,0%) BIII e 16 (5,9%) BIV. Os tumores foram histologicamente classificados como Laurén tipo intestinal em 119 casos (43,4%) e como o tipo difuso em 155 (56,6%). De acordo com a UICC TNM foram câncer gástrico precoce (T1) foi diagnosticada em 68 casos (24,8%); 51 (18,6%) T2 e 155 (56,6%) T3. Nenhum envolvimento linfonodal (N0) foi observado em 129 casos (47,1%), enquanto 100 (36,5%) eram N1 (1-6 linfonodos) e 45 (16,4%) N2 (7-15 gânglios linfáticos). O número médio de linfonodos dissecados foi de 35. A sobrevida em cinco anos para os estádios de I a III B foi de 70,4%. CONCLUSÃO: Cirurgiões digestivos devem ser estimulados a realizarem gastrectomias ...

BACKGROUND: Eastern literature is remarkable for presenting survival rates for surgical treatment of gastric adenocarcinoma superior to those presented in western countries. AIM: To analyze the long-term result after D2 gastrectomy for gastric cancer. METHODS: Two hundred seventy four underwent gastrectomy with D2 lymph node dissection as exclusive treatment. The inclusion criteria were: 1) lymph node removal according to Japanese standardized lymphatic chain dissection; 2) potentially curative surgery described in medical records as D2 or more lymph node dissection; 3) tumoral invasiveness of gastric wall restricted to the organ (T1 - T3); 4) absence of distant metastasis (N0-N2/M0); 5) a minimum of five years follow-up. Clinical pathological data included sex, age, tumor location, Borrmann's macroscopic tumor classification, type of gastrectomy, mortality rates, hystological type, TNM classification and staging according to UICC TNM 1997. RESULTS: Total gastrectomy was performed in 77 cases (28.1%) and subtotal gastrectomy in 197 (71.9%). The tumor was located in the upper third in 28 cases (10.2%), in the middle third in 53 (19.3%), and in the lower third in 182 (66.5%). Among patients that had their Borrmann's classification assigned, five cases (1.8%) were BI, 34 (12.4%) BII, 230 (84.0%) BIII and 16 (5.9%) BIV. Tumors were histologically classified as Laurén intestinal type in 119 cases (43.4%) and as diffuse type in 155 (56.6%). According to UICC TNM 1997 classification, early gastric cancer (T1) was diagnosed in 68 cases (24.8 %); 51 (18.6%) were T2, and 155 (56.6%) were T3. No lymph node involvement (N0) was observed in 129 cases (47.1%), whereas 100 (36.5%) were N1 (1-6 lymph nodes), and 45 (16.4%) were N2 (7-15 lymph nodes).The median number of lymph nodes dissected was 35. The overall long-term (five-year) survival rate, for stages I to IIIb was 70.4%. CONCLUSION: Digestive surgeons must be stimulated in performing D2 gastrectomies ...

Forma aguda da doença enxerto contra o hospedeiro após transplante de fígado: Existe opção terapêutica para as formas refratárias ao tratamento com esteróides? / Acute graft versus host disease after liver transplantation: Do we have an option for treatment of steroid-refractory forms?

Background: Acute graft-versus-host disease (GVHD) usually occurs by 8 weeks after liver transplantation (LT) usually is an uncommon complication but has both high mortality and major diagnostic challenge in addition most of them are associated with resistance to steroid therapy. Objective: Discuss the pathogenesis, treatment and long-term results of Acute Graft versus Host Disease after Liver Transplantation. Methods: A PubMed search was performed to identify all reported cases of GVHD following LT. The medical subject heading GVHD disease was used in combination with LT, including adults (19 + years) and children. The bibliographies of the articles found though PubMed were then searched for further reports of GVHD. Results: We reviewed 102 cases of acute GVHD, 96 (94.1%) adults and 6 (5.8%) children. After treatment 24 (25%) adults and 3 (50%) children were alive only. As faras the treatment of GVHD is concern the therapy used in adults and in children patients was respectively : anti-thymocyte globulin + prednisolone – 19 (19.5%); interleukin-2 receptor blocker – 17 (17.5%); OKT3 – 12 (12.3%); cyclosporine – 9 (9,2% ); others – 39 (40.2%) and in children anti-thymocyte globulin – 1 (20%);anti-thymocyte globulin + prednisolone – 1 (20%); prednisolone – 1 (20%); anti-thymocyte globulin + prednisolone + interleukin-2 receptor blocker-1 (20%); not mentioned – 1.There was no standard treatment of acute GVHD for both children and adults. Conclusion: Although acute GVHD following LT is rare complication and mortality is still very high, there is no consensus for the treatment ofsteroid-refractory forms. Further researches are needed to providenew approach for treating effectively such condition.

Introdução: A forma aguda da doença do enxerto contra o hospedeiro ocorre geralmente até oito semanas após o transplante de fígado, é rara, porém tem mortalidade alta e constitui-se emum grande desafio terapêutico principalmente naqueles casos quesão resistentes ao tratamento com corticóides. Objetivo: Discutir a patogênese, tratamento e resultados a longo prazo da Forma Aguda da Doença Enxerto contra o Hospedeiro após Transplante de Fígado. Métodos: Fizemos uma pesquisa na base de dados do PubMed procurando identificar todos os casos de doença Enxerto contra o Hospedeiro após Transplante de Fígado incluindo adultos com mais de 19 anos e crianças. Resultados: Revisamos 102 casos desta doença e encontramos 96 (94,1%) adultos e 6 (5,8%) crianças. Após o tratamento, 24 (25%) adultos e 3 (50%) crianças estavam vivos. Com relação ao tratamento da doença do enxerto contra o hospedeiro em adultos e crianças encontramos respectivamente: globulina anti-timocítica + prednisolona – 19 (19,5%); bloqueador do receptor da interleucina 2 – 17 (17,5%); OKT3 – 12 (12,3%); ciclosporina – 9 (9,2%); outros – 39 (40,2%) e em crianças globulina anti-timocítica – 1 (20%); globulina antitimocítica + prednisolona – 1 (20%); prednisolona – 1 (20%); globulina anti-timocítica + prednisolona + bloqueador do receptor da interleucina 2 -1 (20%); não mencionado – 1. Conclusão: Pesquisas devem ser aprofundadas nos mecanismos que desencadeiam esta patologia. Não existe consenso para o tratamento da doença do enxerto contra o hospedeiro após o transplante de fígado naqueles doentes que são refratários ao uso de esteróides.

Results of D2 gastrectomy for gastric cancer: lymph node chain dissection or multiple node resection?

BACKGROUND: Eastern literature is remarkable for presenting survival rates for surgical treatment of gastric adenocarcinoma superior to those presented in western countries. AIM: To analyze the long-term result after D2 gastrectomy for gastric cancer. METHODS: Two hundred seventy four underwent gastrectomy with D2 lymph node dissection as exclusive treatment. The inclusion criteria were: 1) lymph node removal according to Japanese standardized lymphatic chain dissection; 2) potentially curative surgery described in medical records as D2 or more lymph node dissection; 3) tumoral invasiveness of gastric wall restricted to the organ (T1-T3); 4) absence of distant metastasis (N0-N2/M0); 5) a minimum of five years follow-up. Clinical pathological data included sex, age, tumor location, Borrmann's macroscopic tumor classification, type of gastrectomy, mortality rates, hystological type, TNM classification and staging according to UICC TNM 1997. RESULTS: Total gastrectomy was performed in 77 cases (28.1%) and subtotal gastrectomy in 197 (71.9%). The tumor was located in the upper third in 28 cases (10.2%), in the middle third in 53 (19.3%), and in the lower third in 182 (66.5%). Among patients that had their Borrmann's classification assigned, five cases (1.8%) were BI, 34 (12.4%) BII, 230 (84.0%) BIII and 16 (5.9%) BIV. Tumors were histologically classified as Laurén intestinal type in 119 cases (43.4%) and as diffuse type in 155 (56.6%). According to UICC TNM 1997 classification, early gastric cancer (T1) was diagnosed in 68 cases (24.8 %); 51 (18.6%) were T2, and 155 (56.6%) were T3. No lymph node involvement (N0) was observed in 129 cases (47.1%), whereas 100 (36.5%) were N1 (1-6 lymph nodes), and 45 (16.4%) were N2 (7-15 lymph nodes).The median number of lymph nodes dissected was 35. The overall long-term (five-year) survival rate, for stages I to IIIb was 70.4%. CONCLUSION: Digestive surgeons must be stimulated in performing D2 gastrectomies to avoid wasting the only treatment to gastric adenocarcinoma that has proven to be efficient up to this days. It must be emphasized that standardized lymph nodes dissection according to tumor location is more important that only the number of removed nodes.