BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 2): UPDATE ON TREATMENT.

Background: : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented.

Aim: : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment.

BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 1): AN UPDATE ON DIAGNOSIS, STAGING, ENDOSCOPIC TREATMENT AND FOLLOW-UP.

Background: The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented.

Aim: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients.

Predictive factors for short gastric vessels division during laparoscopic total fundoplication.

Objective: to determine clinical variables that can predict the need for division of the short gastric vessels (SGV), based on the gastric fundus tension, assessing postoperative outcomes in patients submitted or not to section of these vessels.

Methods: we analyzed data from 399 consecutive patients undergoing laparoscopic fundoplication for gastroesophageal reflux disease (GERD). The section of the SGV was performed according to the surgeon evaluation, based on the fundus tension.

Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil.

Background: In Brazil, gastric cancer is the fourth most common malignancy among men and sixth among women. The cause is multivariate and the risks are well known. It has prognosis and treatment defined by the location and staging of the tumor and number of lymph nodes resected and involved.

Helicobacter pylori has no influence on distal gastric cancer survival.

Context: There is some evidence that Helicobacter pylori correlates with distal gastric cancer genesis. However, few studies analyzed the survival related to H. pylori infection.

Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones.

Background: Gallstones have been frequently diagnosed after Roux-en-Y gastric bypass (RYGBP). Gallbladder stasis associated with duodenal exclusion may play a role in their pathogenesis.

Methods: Gallbladder emptying was studied before and on the 30th and 31st postoperative days (POD) after RYGBP in 20 morbidly obese patients.

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation.

Purpose: Evaluate short results after fundoplication procedure, concerning the division of short gastric vessels.

Methods: A prospective randomization of 90 patients with indication for hiatoplasty and total fundoplication with fundus mobilization was performed. They were divided into two groups: no SGV division (group A, n= 46) and with SGV division (Group B, n=44), although in both groups the gastric fundus was mobilized to perform a floppy valve.

Effects of increased intra-abdominal pressure on the healing process after surgical stapling of the stomach of dogs.

Purpose: To assess the initial healing after surgical stapling of the stomach using a linear cutting stapler and creating pneumoperitoneum (12-14 mmHg) for 60 minutes or 120 minutes, and compare it with the healing of a staple line not submitted to increased pressure.

Methods: A total of 30 dogs were divided into three groups of 10 animals each: Group I (control group - surgical stapling), Group II (surgical stapling and increased intra-abdominal pressure for 60 minutes) and Group III (surgical stapling and increased intra-abdominal pressure for 120 minutes). All dogs were maintained under general anesthesia for two hours after surgical stapling.

[Electromanometry and acid pHmetry of 24 hours in postoperative evaluation of the hiatoplasty and total antireflux wrap laparoscopic].

Background: The electromanometry and 24-hour esophageal pHmetry has been proposed as objective method in postoperative evaluation of antireflux surgery.

Aim: Prospective evaluation of the results of cruroplasty and total fundoplication in the treatment of non-complicated gastroesophageal reflux disease based on comparative results of pre and post operative manometry and pHmetry findings.

Methods: Fifty-nine consecutive individuals with typical symptoms of gastroesophageal reflux disease were prospectively studied.

Incidence of regurgitation after the banded gastric bypass.

Background: Frequent regurgitation is a common complication following Roux-en-Y gastric bypass (RYGBP). This study investigated the risk of becoming a chronic regurgitator, by considering silicone ring size and lower esophageal sphincter (LES) function, and their relationship with weight loss.

Methods: 80 morbidly obese patients were randomly selected to undergo surgery using ring length of 62 mm (40 patients, group A) or 77 mm (40 patients, group B), with 6 months' postoperative follow-up.

Obesity and symptomatic achalasia.

Weight loss is a frequent finding in achalasia because of the difficulty in swallowing. Although manometric findings compatible with achalasia have been found in morbidly obese patients, all of them were asymptomatic. The authors report a case of symptomatic achalasia and morbid obesity in a 38-year-old woman.

Safety of cystic duct clipping in healthy and cirrhotic livers: a cadaveric study.

Background And Objectives: Biliary leakage through the cystic duct stump due to clip dislodgement has been a concern since the advent of the laparoscopic cholecystectomy. The authors proposed a cadaveric model to test the safety of cystic duct clipping in a hypertensive biliary tract in healthy and cirrhotic livers.

Methods: Twenty fresh cadavers were studied (5 cirrhotic, 15 healthy).

Short esophagus or bad dissected esophagus? An experimental cadaveric study.

Short esophagus is defined as the inability to reduce the gastroesophageal junction below the diaphragm. One of the factors responsible for this inability can be inadequate esophageal mobilization. We evaluated esophageal lengthening achieved by means of dissection in a cadaveric model.

Forensic autopsy costs in the city of São Paulo.

Context: Modern medical practice involves cost analysis of therapeutic and diagnostic procedures. There are no papers dealing with this theme in relation to forensic autopsies in our country.

Objective: Analysis of direct costs of forensic autopsies.

Anatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese Society for Diseases of the Esophagus.

Purpose: Extended mediastinal lymphadenectomy is gaining popularity in the treatment of esophageal cancer, but lymph node nomenclature and classification is still not standardized. The normal mediastinal lymph node distribution according to the classification of the Japanese Society for Esophageal Diseases has never been studied.

Methods: We dissected 20 fresh adult cadavers to examine the mediastinal lymph nodes.

[Oximetry of stomach: comparative study between proximal gastric vagotomy and anterior lesser curve seromyotomy with posterior truncal vagotomy in chronic duodenal ulcer].

Unlabelled: Delayed gastric emptying of solid food is greater after proximal gastric vagotomy (PGV) than after anterior lesser curve seromyotomy with posterior truncal vagotomy (ASPTV) and may be due to the hypoxia in the gastric wall and mainly in the gastric pacemaker.

Purpose: To verify if operative devascularization of the lesser curve and the gastric fundus could affect the entire stomach and particularly the pacemaker area.

Methods: Measures of intraoperative oxyhemoglobin saturation (SpO2) were taken by pulse oximetry on the anterior gastric wall in 20 patients with chronic duodenal ulcer, randomly allocated in two groups of 10 individuals for surgical treatment, by PGV or ASPTV.

Synchronous advanced gastric adenocarcinoma and advanced esophageal squamous cell carcinoma.

Context: Synchronous associations of esophageal and gastric cancers are not a common finding, especially with differing histological types and both tumors in advanced forms. A case with such an association is presented, in which an unusual therapy was proposed: palliative gastrectomy and esophageal intubation.

Case Report: A 75-year-old white man was referred to our service complaining of malaise and weight loss for one year and dysphagia and vomiting for 2 months.