Background: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients. Aim: In the second module of this consensus, management of resectable liver metastases was discussed. Method: Concept of synchronous and metachronous metastases was determined, and both scenarius were discussed separately according its prognostic and therapeutic peculiarities. Results: Special attention was given to the missing metastases due to systemic preoperative treatment response, with emphasis in strategies to avoid its reccurrence and how to manage disappeared lesions. Conclusion: Were presented validated ressectional strategies, to be taken into account in clinical practice.

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In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization.

Results Results Results Results: Of the 123 patients studied, 68 underwent gastrectomy, 52 (42.3%) with curative intent and 16 (13%) palliative resection, while 55 (44.7%) had disease not subject to resection. Three postoperative deaths followed the curative resection, constituting a mortality rate of 5.76%. In nine (17.3%) patients there were technical complications, and esophagojejunal fistula seven cases, the most frequent. All technical complications and deaths occurred after total gastrectomy, which was the most commonly performed curative resection type in this series. The most common pattern of recurrence was peritoneal carcinomatosis. The location of the tumor, lymph node metastasis, lymphatic invasion and pathological staging were considered significant prognostic factors. The median survival time was 29 months, with a rate of five-year survival of 33% in patients undergoing curative resection. Conclusion Conclusion Conclusion Conclusion Conclusion: The curative resection of B IV gastric adenocarcinoma had a positive impact on survival of patients with the disease in stages IB, II and III, with up to 15 lymph nodes (pN2) and localized type.

PURPOSE: Investigate if alpha-tocopherol has a protective effect on intestinal mucosa after obstruction and to evaluate the potential relations between lipid peroxidation and bacterial translocation. METHODS: Ten rats were submitted to a sham laparotomy and six served as control group. A small bowel obstruction was done in sixteen animals and among them eight were pretreated with alpha-tocopherol. Forty-eight hours later, mesenteric lymph node, spleen, liver and blood cultures and also samples from ileal mucosal were obtained, Thiobarbituric acid reactive substances (TBARS) levels were determined and intestinal histological assessment was performed. RESULTS: Bacterial translocation was significantly increased in the obstructed rats compared with the control, sham and antioxidant pretreated groups (p< 0,05). TBARS (nmol/100mg) in untreated obstructed rats increased from 49,0 ± 13,3 in control group to 128,8 ± 40 after 48 hours of intestinal obstruction and achieved 72,3 ± 24,6 in alpha-tocopherol group (p< 0,05). Bacterial adherence to the intestinal epithelial cells surface and mucosal necrosis were significantly increased in the obstructed compared with nonobstructed rats. CONCLUSION: Alpha-tocopherol reduce the deleterious effects of the TBARS over the intestinal mucosal suggesting that in such circumstances there might be an association between bacterial translocation and lipid peroxidation after an intestinal occlusion.