Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

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.

RESUMO: Objetivo: Avaliar a factibilidade e os resultados de uma técnica pouco invasiva para a pesquisa do linfonodo sentinela (LFNsn) com o uso do corante vital azul patente. Método: A pesquisa do LFNsn foi realizada em 12 pacientes portadores de adenocarcinoma gástrico que não apresentavam linfonodos suspeitos de metastases durante o estadiamento clínico pré-operatório. Injetou-se nos quatro quadrantes do tumor, 0,5 ml de corante vital azul patente. Os linfonodos que se coraram de azul foram classificados como LFNsn e foram obtidos após a gastrectomia com linfadenectomia D2. Utilizou-se a coloração HE para avaliação anatomopatológica dos LFNsn, e nos casos com LFNsn negativo para HE, foi realizada imuno-histoquímica com pan-citoqueratinas AE1/AE3. Resultados: Dos 12 pacientes, oito eram mulheres, com média de idade de 64,5 (48-87) anos. Identificaram-se em média 3,25 (2-6) LFNsn por paciente. A factibilidade da técnica foi de 100%. A acurácia do método foi de 91,6% . Em 11 de 12 casos foi possível predizer as características linfonodais regionais pela concordância da análise anatomopatológica entre os LFNsn e não sentinelas(LFNñsn). Conclusão: A pesquisa do linfonodo sentinela em câncer gástrico é factível com o uso da técnica do corante azul patente. O método mostrou ser promissor como técnica minimamente invasiva para estadiar tumores gástricos, nesta casuística inicial (Rev. Col. Bras. Cir. 2007; 34(6): 367-373 Os três métodos para se realizar a pesquisa do linfonodo sentinela em câncer gástrico utilizam: o corante isolado, o radiotraçador isolado e a combinação de ambos 11,13 . A principal indicação para pesquisa do linfonodo sentinela em câncer gástrico parece ser em tumores precoces T1, devido às baixas probabilidades de metástases para linfonodos 5,[15][16][17][18] . No entanto, nenhuma publicação relata restrição do seu uso em tumores avançados (T2,T3), apenas deve-se ter idéia de que quanto maior o grau de invasão tumoral maiores as chances de casos com LFNsn falso negativo 12 .Os dois tumores nos quais é realizada a pesquisa do LFNsn, com resultados satisfatórios, são o melanoma e o câncer de mama [19][20][21] . A técnica da pesquisa do linfonodo sentinela caracteriza-se principalmente em poder predizer com um alto percentual de acerto quais são as características dos demais linfonodos regionais, sendo importantíssima para estadiar estes tumores [22][23][24] .Para avaliar a factibilidade e os resultados de uma técnica pouco invasiva para a pesquisa do linfonodo sentinela (LFNsn) com o uso do corante vital azul patente, decidimos realizar um estudo clínico em pacientes portadores de câncer gástrico em nosso meio. MÉTODOO estudo foi realizado em 12 pacientes portadores de adenocarcinoma gástrico no Hospital de Clínicas de Porto Alegre e em casos privados do autor, no período de junho de 2002 a dezembro de 2004.Os critérios de inclusão foram os seguintes: adenocarcinoma gástrico localizado no fundo, corpo ou antro, lesões T1,T2 e T3, linfonodos regionais sem evidência de metástases no estadiamento clín...

Background: Partial hepatectomy is a surgical intervention of the liver that can trigger its regenerative process, where the residual lobes deflagrate a compensatory hyperplasia, causing its restoration almost to the original volume. Nevertheless, depending on the extent of liver damage its regeneration might be impaired. The low-power laser has been studied with beneficial results. Aim: To investigate the possible functional and mutagenic damage arising from the use of low-power laser used in liver regeneration after partial hepatectomy. Methods: Fifteen male adult Wistar rats were hepatectomizated in 70% and laser irradiated or not with dose of 70 J/cm2, 650 nm, 100 mW, directly on the remaining liver, during the perioperative period. These animals were divided into four groups: G1 (control, 7 days); G2 (laser, 7 days); G3 (control, 14 days); G4 (laser, 14 days). Were analyzed the liver weight; number of hepatocytes; deposition of collagen fibers; liver function tests: serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transferase, bilirubin and micronucleus test in peripheral blood erythrocyte. Results: The liver weight was greater in G3 and G4 (p=0.001 and p=0.002) compared to other groups. The deposition of collagen fibers in G1 was statistically higher than the other groups (p=0.01). In tests of liver function and micronucleus test was not found significant differences between the studied groups. Conclusion: Low-power laser stimulation did not cause loss of liver function or mutagenic damage.

Introduction: Postoperative recovery of patients undergoing surgical procedures has been a focus of attention in recent years. Positive results from the Enhanced Recovery Based on the favorable results of the Enhanced Recovery After Surgery (ERAS) protocol, the ACERTO (Aceleração da Recuperação Total pós-operatória) protocol was designed in Brazil. This protocol defines some perioperative routines, such as nutritional therapy, decreased preoperative fasting period, early postoperative feeding, decreased venous hydration, among others, with favorable impact on postoperative recovery. The aim of this study was to compare the response of patients undergoing surgical procedures following or not a pilot protocol for accelerating postoperative recovery. Methods: A case-control study nested in a cross-sectional study reviewing medical records of patients hospitalized for colectomy, rectosigmoidectomy, pancreatectomy, and hepatectomy procedures between 2016 and 2017. The patients were divided into intervention and control group. Main endpoints analyzed were: length of postoperative hospital stay, hospitalization outcomes, rate of readmission within 30 days, and hospital costs. Results: 76 patients were enrolled (30 in intervention group and 46 in control group). The median length of in-hospital stay was 6.5 days for the intervention group and 13.5 days for the control group (p =0.0001). Rate of readmission within 30 days was 5.3 times lower in the intervention group in comparison to control group (p=0.02). Cost analysis showed a median per-patient cost of R$ 15.493,91 in the intervention group compared to a median per-patient cost of R$ 25.929,19 in the control group (p=0.0036). Conclusion: Patients who underwent the intervention of the postoperative recovery acceleration multimodal protocol presented shorter hospital stay, lower readmission rate at 30 days and lower hospital costs when compared to patients in the control group.