Case Report: Abdominal Wall Reconstruction in a High-Risk Patient With Incisional Hernia and Complications From Oncological Treatment.

Introduction: A high risk patient with evisceration underwent to abdominal wall reconstruction without mesh or drains. We present a case of a 62 years-old female patient with a significant medical history of Wilson's disease-related hepatopathy Child-Pugh class B classification, sequelae of a stroke, and relevant surgical background including total hysterectomy, oophorectomy, and Hartmann's procedure for ovarian neoplasm stage 3. The patient developed a large incisional hernia in the midline incision while undergoing Bevacizumab (Avastin) treatment for clinical oncology. During an attempt at skin closure due to erosion and necrosis, there was progressive deterioration leading to evisceration. We opted for abdominal wall reconstruction by transposing the hernia sac without using mesh and employing hemostatic powder (Arista) to mitigate the risk of bleeding in a high-risk patient due to recent bevacizumab use and hepatopathy. The patient had a favorable postoperative course without any other intervention in abdominal wall. Patient developed worsening hepatic function with the presence of ascites, constipation, and disorientation. On the 6th day postoperative, a tomography was performed, which showed colonic distension without obstructive factors and a slight amount of supra-aponeurotic fluid. The patient was discharged on the 10th day postoperative after improvement of the condition with clinical treatment. The patient has been progressing under outpatient follow-up for 5 months, with a resumption of chemotherapy cycles and no evidence of hernia recurrence. Conclusion: Further studies and long-term follow-up are necessary to evaluate the efficacy and safety of hernia sac transposition as a mesh-free technique and the use of hemostatic powder without drains in high-risk patients. However, our case highlights the potential feasibility of these approaches in carefully selected cases.

FUCA2 and TSTA3 expression in gastric cancer: candidate biomarkers of malignant transformation.

INTRODUCTION: Aberrant fucosylation is closely related to malignant transformation, cancer detection, and evaluation of treatment efficacy. The fucosylation process requires GDP-L-fucose, fucosyltransferases, and fucosidases. In gastric cancer (GC), fucosylation alterations were associated with tumor formation, metastasis inhibition, and multi-drug resistance. It is not clear whether tissue-specific transplantation antigen P35B (TSTA3) and alpha-L-fucosidase 2 (FUCA2) have any effect on the development of GC. MATERIALS AND METHODS: We used immunohistochemistry to assess the expression of TSTA3 and FUCA2 in 71 gastric adenocarcinoma samples and their relationship with clinicopathological parameters. RESULTS: TSTA3 expression was associated with lower histological grade I and II (P = 0.0120) and intestinal type Lauren classification (P = 0.0120). TSTA3 immunopositivity could predict Lauren's classification. Analysis of mRNA expression in GC validation cohorts corroborates the significant TSTA3 association with histological grade observed in our study. However, no associations were found between TSTA3 staining and overall survival. FUCA2 expression was markedly increased in GC tissues compared with non-tumoral tissues (P < 0.0001) and was associated with surgical staging III and IV (P = 0.0417) and advanced histological grade tumor states (P = 0.0125). CONCLUSIONS: Alterations of FUCA2 and TSAT3 immunoexpression could lay the basis for future studies using cell glycosylation as a biomarker for the planning of therapeutic strategy in primary gastric cancer.

Immunopositivity for Siglec-15 in gastric cancer and its association with clinical and pathological parameters.

The sialic acid-binding immunoglobulin-type lectin Siglec-15 is a promising target to cancer immunotherapy in several tumor types. The present study aimed to investigate Siglec-15 expression in gastric cancer (GC) patient tissue and to evaluate its clinical value. Siglec-15 expression was evaluated by immunohistochemistry with 71 patients. Siglec-15 staining was observed in tumor cells of 53 (74.64%) patients, with significant association with histologic classification and angiolymphatic invasion (p<0.05). Immunohistochemistry analysis also detected Siglec-15 in tumor-associated stroma cells (macrophages/myeloid cells). There was no significant association with outcomes parameters. Siglec-15 expression in well differentiated histological GC tissues and in the tumor microenvironment are potential targets to be further investigated as a novel prognostic factor for GC.

Overexpression of UDP-Glucose 4-Epimerase Is Associated with Differentiation Grade of Gastric Cancer.

The UDP-glucose 4-epimerase (GALE) is a glycosyltransferase, which acts on protein and lipid glycosylation in normal and neoplastic cells. This study is aimed at investigating the differential tissue expression of GALE and its possible association with clinical-pathological parameters and the outcome of gastric adenocarcinoma patients. Seventy-one patients were evaluated in relation to GALE expression by immunohistochemistry. Our results showed that 48 (67.6%) patients were GALE positive and 23 (32.4%) negative. Positive staining was present on well-differentiated and moderate-differentiated histological grade of gastric adenocarcinomas (p < 0.0001). There was no significant association with outcome parameters (p > 0.05). Besides that, our results corroborated with the validation cohort analysis, where the expression of GALE mRNA was also associated with the histological grade (p < 0.001). These results suggest a possible use of this enzyme as a biomarker for well and moderately differentiated tumors.

MicroRNA expression profiling provides novel insights into immune-related pathways involved in gastric cancer.

Gastric cancer is one of the most common cancers, and an increasing number of studies have found that microRNAs (miRNAs) play essential roles in gastric cancer progression; however, the roles of specific miRNAs involved in the immune response to this disease remain unclear. We compared the miRNA expression in tissues from primary gastric cancer patients and healthy controls to find miRNAs dysregulated in gastric cancer and used bioinformatics tools to determine potential roles of these miRNAs in the immune system. We evaluated 25 primary gastric cancer tissues and five healthy gastric tissues. Quantitative real-time polymerase chain reaction was performed for a set of miRNAs, followed by the prediction of their target genes and functional enrichment analysis of these targets. Analysis of a microarray dataset showed that the miRNA miR-196a-5p was significantly upregulated, while miR-374a-5p and miR-375 were downregulated in gastric cancer patients. In addition, miR-374-5p was significantly downregulated in patients with metastasis compared with its expression levels in non-metastatic patients (p = 0.03). Bioinformatics analysis suggested that the pathways regulated by these differentially expressed miRNAs were related to the immune response, cell adhesion, and cell migration. Most importantly, this study provides a new insight into the potential use of multiple miRNAs to find distinct pathways of immune regulation in gastric cancer.

Análise da expressão de microRNAs, receptores OX40 e CD40L, e do agregado de plaquetas-leucócitos no câncer gástrico / Analysis of the expression of microRNAs, OX40 and CD40L receptors, and platelets-leukocytes aggregation in gastric cancer

O prognóstico dos portadores de câncer gástrico tem melhorado pouco nas últimas décadas e o melhor entendimento das vias moleculares e as interações imunes no microambiente tumoral podem revelar novas possibilidades de tratamento. O ambiente tumoral é composto por células do sistema imune, que refletem a tentativa desse sistema em promover uma resposta antitumoral. Complexas interações entre células e mediadores imunes no microambiente tecidual regulam o crescimento de tumores, progressão, metástase e angiogênese. O entendimento das alterações da imunidade na população com câncer gástrico (CG) permitirá a intervenção terapêutica para melhorar a resposta à cirurgia e à quimioterapia. Objetivo: comparar a expressão de miRNA em tecidos de pacientes com câncer gástrico e controles saudáveis para encontrar miRNAs desregulados no câncer gástrico e usar ferramentas de bioinformática para determinar a possível influência desses miRNAs no sistema imunológico. Avaliar a formação de agregados plaquetas-leucócitos circulantes, bem como os níveis de ativação plaquetária (CD62p+, CD40L) desses conjugados a leucócitos em pacientes com CG. Quantificar a expressão de moléculas costimulatórias da resposta imune (OX40) em linfócitos T de pacientes com CG. Métodos: é um estudo do tipo corte transversal, exploratório e translacional realizado no Hospital de Câncer de Pernambuco, Laboratório de Pesquisa Translacional do Instituto de Medicina Integral Prof. Fernando Figueira e Centro Internacional de Pesquisa (CIPE) do AC Camargo entre 2015 a 2018. Foram avaliados 83 pacientes com câncer gástrico e 69 controles. Foram determinados os níveis de expressão de microRNAs no tecido tumoral gástrico em comparação aos da mucosa gástrica normal por técnica de reação em cadeia da polimerase (qPCR - TaqMan). Foram realizadas as análises dos niveis linfócitos T e B, OX40, CD40L e de agregado de plaquetas no sangue periférico por citometria de fluxo. Resultados: As análises revelaram um miRNA mais expresso (miR-196a-5p) e dois significativamente menos expressos (miR-374a-5p e miR-375) em comparação ao grupo controle. Pacientes com estádio IV (metástatico) apresentaram uma diminuição significativa na expressão do miR-374-5p quando comparados aos pacientes não metastáticos (p=0.03). Com uso de plataformas de bioinformática, foram observadas várias vias que sofrem influência dos microRNAs desregulados e que interagem com genes envolvidos com a resposta imune celular, moléculas de adesão celular e migração celular. Foram encontrados níveis elevados de expressão de OX40 em linfócitos T, monócitos e neutrófilos de pacientes com neoplasia gástrica (p<0.0001), entretanto, os níveis de OX40 foram reduzidos nos grupos com neoplasia estádio III/IV quando comparados ao estádio I/II. Observamos níveis elevados de agregados de plaquetas-linfócitos T e plaquetas-linfócitos B no sangue de pacientes GC com estágio IV quando comparados com os estágios I, II e III, e grupo controle (p <0,05). Níveis reduzidos de agregados plaquetas-linfócitos totais com expressão de CD40L foram observados no estádio IV da doença (p<0,05). Níveis elevados de plaquetas ativadas e agregados de plaquetas-monócitos ativados (CD62p+) foram observados em pacientes GC quando comparados ao grupo controle (p<0,05). Conclusão: Os resultados deste estudo permitem concluir que existem alterações de mecanismos moleculares (miRNA) e celulares envolvidos na regulação e ativação da resposta imune, sendo associadas à progressão e metástase no GC

The prognosis of gastric cancer patients has not been improved in the last decades and the the understanding of the molecular immune pathways and how immune interactions happens on tumoral microenvironment, open new possibilities of treatment. The tumor environment is infiltrated by cells of the immune system, which reflect an antitumor response. Complex interactions between microenvironmental cells and mediators regulate tumor growth, progression, metastasis and angiogenesis. The knowledge of the immunity in the population with gastric cancer will allow therapeutic intervention to improve the response to surgery and the chemotherapy. Objective: our primary goal was to compare the miRNA expression in tissues from primary gastric cancer patients and healthy controls to find miRNAs dysregulated in gastric cancer and used bioinformatics tools to determine potential roles of these miRNAs in the immune system. We conducted a secondary analysis to evaluate the formation of circulating platelet-leucocyte conjugates as well as the CD40L levels conjugate to leucocytes in GC and finally, samples were analysed for levels of costimulatory molecules related to the immune response (OX40) in GC. Methods: A cross-sectional, translational and exploratory study carried out at the Hospital de Cancer de Pernambuco, Translational Research Laboratory of the Instituto de Medicina Integral Prof. Fernando Figueira and AC Camargo International Research Center (CIPE) from 2015 to 2018, involving 83 patients with gastric cancer and 69 controls. Expression levels of microRNAs in gastric tumor tissue and normal gastric mucosa were determined by polymerase chain reaction technique (qPCR - TaqMan). Analyzes of T and B lymphocytes, OX40, CD40L and platelet aggregate levels were performed in peripheral blood by flow cytometry. Results: The results revealed a more express miRNA (miR-196a-5p) and two significantly less expressed (miR-374a-5p and miR-375) compared to the control group. Patients with stage IV (metastasis) showed a significant decrease in miR-374-5p expression when compared to non-metastatic patients (p = 0.03). Bioinformatics analysis suggested that the pathways regulated by these differentially expressed miRNAs were related to the immune response, cell adhesion, and cell migration. High levels of OX40 expression were found in T lymphocytes, monocytes and neutrophils of patients with gastric neoplasia (p <0.0001); however, OX40 levels were reduced in groups with stage III / IV neoplasia when compared to stage I / II. We observed higher levels of platelet-T lymphocyte aggregate (P-T lymp) and platelet-B lymphocyte aggregate (P-B lymp) in the peripheral blood (PB) of GC patients with stage IV when compare with stages I-II-III, and control group (p<0,05). Reduced levels of CD40L+ Platelet-total lymphocyte (P-lymp) were observed at stage IV of the disease (p<0.05). High levels of CD62p+ platelets and CD62p+ platelets-monocyte aggregate were observed GC patients when compare to control group (p<0.05). Conclusion: The results of this study allow us to conclude that there are alterations of molecular mechanisms (miRNA) and cellular mechanisms involved in the regulation and activation of the immune response and associated to the progression and metastasis in GC

A PHASE II TRIAL EXPLORING THE EXTENSIVE INTRA-OPERATIVE PERITONEAL LAVAGE (EIPL) AS A PROPHYLACTIC STRATEGY FOR PERITONEAL RECURRENCE IN LOCALLY ADVANCED GASTRIC CANCER: reporting postoperative morbidity and mortality after early closure.

BACKGROUND: The Extensive Intraoperative Peritoneal Lavage (EIPL) has been proposed as a practical prophylactic strategy to decrease the risk of peritoneal metastasis in gastric cancer. OBJECTIVE: To explore the safety and efficacy of the EIPL in our locally advanced gastric cancer patients. METHODS: This study is an open-label, double-center, single-arm phase II clinical trial developed at two tertiary hospitals from Recife (Pernambuco, Brazil). RESULTS: The study protocol was prematurely closed due to slow accrual after only 16 patients had been recruited to participate. Eight of them were excluded of the protocol study during the laparotomy, whereas four cases were also excluded from the per-protocol analysis. Two patients had died in hospital before 30 days and six were alive with no evidence of cancer relapses after a follow-up ranging from five to 14,2 months (median of 10.6 months). In the intention-to-treat analysis, three of eight patients suffered of gastrointestinal leakages and two of them had died. On a per-protocol basis, two of four patients presented this type of postoperative complication and one of them had died. All deaths occurred as a somewhat consequence of gastrointestinal leakages. CONCLUSION: We could not make any conclusion about the safety and efficacy of the EIPL, but the possibility of this approach might increase the rate of gastrointestinal leakage is highlighted.

Surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy / Tratamento cirúrgico do câncer de endométrio em estágio clínico precoce sem linfadenectomia radical.

Objective: the main aim of this study was to describe the authors’ experience with the surgical treatment of endometrial cancer without systematic lymphadenectomy. Methods: a retrospective cohort study was carried out on a subset of patients suffering of clinically early-stage endometrial carcinoma who underwent hysterectomy and salpingo-oophorectomy without systematic (radical) lymph nodes dissection at our centers from June, 2002, to November, 2011. Descriptive statistics were explored as medians (interquartile range) or frequencies (percentages), as appropriated, and the Kaplan–Meier method was applied for survival estimation. Results: eighty-three patients who underwent surgical treatment with no lymph node dissection (n = 20; 24.1%) or with only a sampling procedure (n=63; 75.98%) were selected for analysis. Among these patients, 27 (32.53%) underwent surgery alone and 56 (67.46%) received some adjuvant treatment. Postoperative complications occurred in five patients (6.02%). Over a median follow-up of 27.4 months (Q25 = 13.7 – Q75 = 46.5), 15 (18.07%) patients suffered from relapses and 11 deaths occurred as result of disease recurrence. Cumulative 1, 2 and 3-year disease- free survivals were 97.32, 91.18 and 78.02%, respectively. Conclusion: on a case-by-case basis, the surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy did not seem to decrease survival outcomes and presented low rates of surgical morbidity in our experience, but was also related to a high rate use of adjuvant therapy. .

Objetivo: descrever a experiência dos autores com o tratamento cirúrgico do câncer de endométrio em estádio precoce sem linfadenectomia radical. Métodos: realizou-se estudo de coorte retrospectivo envolvendo um subgrupo de pacientes com câncer de endométrio em estágio clínico precoce tratadas com histerectomia e salpingo-ooforectomia sem linfadenectomia radical, em dois centros pernambucanos, de junho de 2002 a novembro de 2011. As variáveis foram descritas como mediana (intervalo interquartílico) ou frequências (percentuais), utilizando- se o método de Kaplan-Meier para a estimativa das taxas de sobrevivência. Resultados: oitenta e três pacientes submetidas a tratamento cirúrgico sem dissecção linfonodal (n = 20, 24,1%) ou com dissecção apenas por amostragem (n = 63; 75,98%) foram selecionadas para análise. Entre essas pacientes, 27 (32,53%) foram tratadas somente com cirurgia e 56 (67,46%) receberam tratamento adjuvante. Cinco pacientes apresentaram complicações pós-operatórias (6,02%). Durante o acompanhamento mediano de 27,4 meses (Q25 = 13,7 - Q75 = 46,5), 15 (18,07%) pacientes apresentaram recorrência, dentre as quais 11 faleceram em decorrência da recidiva neoplásica. Observou-se sobrevivência cumulativa proporcional livre de doença em um, dois e três anos de 97,32, 91,18 e 78,02%, respectivamente. Conclusão: em um contexto de indicação caso-a-caso, o tratamento cirúrgico do câncer de endométrio em estádio precoce sem linfadenectomia radical parece não ter prejudicado a sobrevivência e apresentou baixas taxas de morbidade cirúrgica em nossa experiência, mas também foi acompanhado de elevada utilização de terapia adjuvante. .

Surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy.

OBJECTIVE: the main aim of this study was to describe the authors' experience with the surgical treatment of endometrial cancer without systematic lymphadenectomy. METHODS: a retrospective cohort study was carried out on a subset of patients suffering of clinically early-stage endometrial carcinoma who underwent hysterectomy and salpingo-oophorectomy without systematic (radical) lymph nodes dissection at our centers from June, 2002, to November, 2011. Descriptive statistics were explored as medians (interquartile range) or frequencies (percentages), as appropriated, and the Kaplan-Meier method was applied for survival estimation. RESULTS: eighty-three patients who underwent surgical treatment with no lymph node dissection (n = 20; 24.1%) or with only a sampling procedure (n=63; 75.98%) were selected for analysis. Among these patients, 27 (32.53%) underwent surgery alone and 56 (67.46%) received some adjuvant treatment. Postoperative complications occurred in five patients (6.02%). Over a median follow-up of 27.4 months (Q25 = 13.7 - Q75 = 46.5), 15 (18.07%) patients suffered from relapses and 11 deaths occurred as result of disease recurrence. Cumulative 1, 2 and 3-year disease- free survivals were 97.32, 91.18 and 78.02%, respectively. CONCLUSION: on a case-by-case basis, the surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy did not seem to decrease survival outcomes and presented low rates of surgical morbidity in our experience, but was also related to a high rate use of adjuvant therapy.

Qual a importância do número de linfonodos pélvicos dissecados para o estadiamento locorregional do câncer de colo uterino? / How important is the number of pelvic lymph node retrieved to locorregional staging of cervix cancer?

OBJETIVO: Avaliar a importância do número de linfonodos pélvicos dissecados para o estadiamento locorregional de pacientes portadoras de câncer do colo uterino com estadiamento FIGO IA2 a IB2, submetidas a tratamento cirúrgico radical. MÉTODOS: Estudo de corte transversal incluindo pacientes submetidas à histerectomia radical tipo II de Piver e linfadenectomia pélvica, em dois centros pernambucanos, entre janeiro de 2001 e dezembro de 2008. Utilizou-se análise da área sob curva ROC como medida-resumo do desempenho do número de linfonodos dissecados para a predição do acometimento metastático linfonodal pélvico. Adicionalmente, também se avaliou a relação entre essas variáveis, usando a regressão logística e o teste exato de Fisher. RESULTADOS: A avaliação anatomopatológica incluiu 662 linfonodos dissecados (mediana=9, q25=6 - q75=13) de 69 pacientes. A avaliação da área sob curvas ROC revelou AUC=0,642 para a predição do estadiamento linfonodal pélvico pelo número de linfonodos dissecados. AUCs de 0,605 e 0,526 foram observadas quando se classificaram as pacientes, utilizando-se 10 e 15 linfonodos como pontos de corte, respectivamente. Por regressão logística, evidenciou-se odds-ratio de 0,912 (IC95%=0,805-1,032; p=0,125). A dissecção de ≥10 ou ≥15 linfonodos não se associou ao achado anatomopatológico de comprometimento metastático dos linfonodos pelo teste de Fisher (p=0,224 e p=0,699, respectivamente). CONCLUSÃO: O número de linfonodos dissecados não se correlacionou com comprometimento metastático linfonodal pélvico nessa casuística, o que sugere que a dissecção de um maior número de linfonodos não incremente o estadiamento locorregional do câncer de colo uterino.

OBJECTIVE: To explore how important is the number of pelvic lymph nodes dissected for the nodal staging in FIGO IA2-IB2 cervical cancer, submitted to radical surgical treatment. METHODS: A cross-sectional study was carried out on patients who underwent Piver class II radical hysterectomy and pelvic lymphadenectomy, in two centers in the state of Pernambuco, from January, 2001 to December, 2008. The analysis of the area under the ROC curve was adopted as a summary-measure of discriminatory power of the number of nodes dissected in predicting the pelvic nodal status. Additionally, we also confirm our findings using logistic regression and the Fisher's exact test. RESULTS: The postoperative pathological study included 662 pelvic lymph nodes dissected (median per-patient=9, q25=6 - q75=13) from 69 patients. The ROC curve analysis revealed AUC=0.642, for the discriminatory value of the number of nodes dissected in predicting the pelvic nodal status. Similar findings were found after categorization using 10 and 15 lymph nodes as cut-offs (AUC=0.605 and 0.526, respectively). Logistic regression revealed odds ratio of 0.912 (95%CI=0.805-1.032; p=0.125) for the predictive value of the number of nodes dissected, and a number of nodes ≥10 or ≥15 lymph nodes was not significantly associated with the nodal status by the Fischer's exact test (p=0.224 and p=0.699, respectively). CONCLUSION: The number of pelvic lymph nodes dissected did not correlate with pelvic lymph node metastatic involvement. This study suggests that dissection of a greater number of lymph nodes does not increase locoregional nodal staging in cervical cancer.

How important is the number of pelvic lymph node retrieved to locorregional staging of cervix cancer?

OBJECTIVE: To explore how important is the number of pelvic lymph nodes dissected for the nodal staging in FIGO IA2-IB2 cervical cancer, submitted to radical surgical treatment. METHODS: A cross-sectional study was carried out on patients who underwent Piver class II radical hysterectomy and pelvic lymphadenectomy, in two centers in the state of Pernambuco, from January, 2001 to December, 2008. The analysis of the area under the ROC curve was adopted as a summary-measure of discriminatory power of the number of nodes dissected in predicting the pelvic nodal status. Additionally, we also confirm our findings using logistic regression and the Fisher's exact test. RESULTS: The postoperative pathological study included 662 pelvic lymph nodes dissected (median per-patient=9, q25=6 - q75=13) from 69 patients. The ROC curve analysis revealed AUC=0.642, for the discriminatory value of the number of nodes dissected in predicting the pelvic nodal status. Similar findings were found after categorization using 10 and 15 lymph nodes as cut-offs (AUC=0.605 and 0.526, respectively). Logistic regression revealed odds ratio of 0.912 (95%CI=0.805-1.032; p=0.125) for the predictive value of the number of nodes dissected, and a number of nodes ≥10 or ≥15 lymph nodes was not significantly associated with the nodal status by the Fischer's exact test (p=0.224 and p=0.699, respectively). CONCLUSION: The number of pelvic lymph nodes dissected did not correlate with pelvic lymph node metastatic involvement. This study suggests that dissection of a greater number of lymph nodes does not increase locoregional nodal staging in cervical cancer.

Lymph node dissection for gastric cancer: a critical review.

Gastric cancer is one of the most common neoplasms and an important cause of cancer-related death worldwide. Efforts to reduce its high mortality rates are currently focused on multidisciplinary management. However, surgery remains a cornerstone in the management of patients with resectable disease. There is still some controversy as to the extent of lymph node dissection for potentially curable stomach cancer. Surgeons in eastern countries favor more extensive lymph node dissection, whereas those in the West favor less extensive dissection. Thus, extent of lymph node dissection remains one of the most hotly discussed aspects of gastric surgery, particularly because most stomach cancers are now often comprehensively treated by adding some perioperative chemotherapy or chemo-radiation. We provide a critical review of lymph nodes dissection for gastric cancer with a particular focus on its benefits in a multimodal approach.

Class II radical hysterectomy for stage I-IIA cervix cancer: prognostic factors associated to recurrence and survival in a northeast Brazil experience.

BACKGROUND: The main aim of this study was describe the author's experience with class II radical hysterectomy and pelvic lymphadenectomy to treat stage I-IIA cervix cancer and reexamine some prognostic factors associated with disease recurrence and patient survival in this data from northeast Brazil. METHODS: A cross-sectional study was carried out on patients treated at our Centers from January 2001 to December 2008. Statistical analyses were performed using conventional methods. RESULTS: Eighty-eight patients were selected to analysis. Over the 7.3-year follow-up, 80 (91%) patients were alive and 8 (9%) disease recurrences were observed. Overall 1-, 2-, and 5-year patients survival was 96.5%, 95.3%, and 84%, respectively. Recurrence was associated to tumor size ≥1 cm (P = 0.021) and compromised vaginal margin (P = 0.020). Lower survivals were associated to tumor size ≥1 cm (P = 0.038), compromised vaginal margin (P < 0.001), and lymph node metastasis (P = 0.024). Postoperative complications (n = 11) included wound infection (5.7%), partial wound dehiscence (3.4%), and bladder atony (3.4%). CONCLUSIONS: Class II radical hysterectomy has provided appropriated disease control of cervix cancer with low morbidity in our experience. Furthermore, tumor size and compromised vaginal margin were significantly associated to recurrence. These factors and lymph node metastasis were also associated to lower 5-year survival according to our analysis.

Autonomização gástrica prévia a faringolaringoesofagectomia total minimamente invasiva com pull-up gástrico para tratamento de câncer de esôfago cervical / Minimally invasive gastric autonomization before total pharyngolaryngoesophagectomy with gastric pull up for the treatment of cervical esophageal cancer

O câncer de esôfago cervical é uma doença rara. O melhor tratamento é o cirúrgico, porém com muitas complicações. Portanto, sugerimos, demonstrando dois casos operados, um acesso minimamente invasivo (laparoscópico e/ou toracoscópico) com faringolaringectomia total e autonomização do tubo gástrico previamente, com o intuito de diminuir a incidência de fistula.

The cervical esophagus cancer is a rare disease. The best treatment is the surgical one. However, it can present many complications. Therefore, we suggest, demostrating two operated cases, a minimally invasive access (laparoscopic and/or thorascopic) with total pharyngolaryngectomy and autonomization of the gastric tube previously in order to decrase the incidence of leak.