EJSO Supplement For BSSO 2015 Congress

EJSOEuropean Journal of Surgical Oncology
the Journal of Cancer Surgery
Aims and Scope

The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles,
editorials, debates and correspondence.
The Editors welcome submissions on clinical research and all other aspects of surgical oncology which advance the care of patients with
cancer, including surgical quality control, epidemiology, preventative aspects of surgical oncology, as well as translational research relevant to surgical oncology practice.
Editor-in-Chief
Riccardo A. Audisio
University of Liverpool,
St. Helens Teaching Hospital, UK
Virgilio Sacchini, USA

Peter A. van Dam, Belgium
Lynda Wyld, UK
Editorial Advisory Board

Sven Mahner, Germany
Andrea Mariani, USA
Christophe Pomel, France
Colorectal Cancer
Chairman of the Editorial Advisory
Board
Graeme Poston
University Hospital Aintree,
Liverpool, UK
Ex Officio - BASO ~ the Association

for Cancer Surgery
Rachel Hargest
Cardiff University School of Medicine,
Cardiff, UK
Ex-Officio - European Society for

Surgical Oncology
Marjut Leidenius
Helsinki University Central Hospital,
Helsinki, Finland
Breast Cancer
Associate Editors
Tibor Kovacs
Guy's and St Thomas's Hospitals NHS
Foundation Trust,
London, UK
Marjut Leidenius
Helsinki University Central Hospital,
Helsinki, Finland
Associate Editors
Head and Neck Surgery
Harm Rutten
University of Maastricht, Maastricht,
The Netherlands
Anna Martling, Karolinska Institute,
Stockholm, Sweden
Associate Editor
Domenico D'Ugo, Italy

Jose Guillem, USA
Brendan Moran, UK
Paris P Tekkis, UK
Giampaolo Ugolini, Italy
Jun W. Um, South Korea
Andrew Zbar, Israel
Massimo Maranzano, UK
Vincent Vander Poorten, Belgium
Endocrine Cancer
Gerard Doherty, USA
Quan-Yang Duh, USA
Andrea Frilling, UK
Robert Hardy, UK
Michael T. Stang, USA
Geoffrey Thompson, USA
Geriatric Surgery
Associate Editor
Tanir M. Allweis, Israel

Itamar Ashkenazi, Israel
Allan Corder, UK
Oreste D. Gentilini, Italy
Stephen R. Grobmyer, USA
Kieran Horgan, UK
Shigeru Imoto, Japan
Niels Kroman, Denmark
Thorsten Khn, Germany
Gurdeep Singh Mannu, UK
Jerome Pereira, UK
Gbor Pley, UK
Isabel Rubio, Spain
Ponnandai S. Somasundar
Roger Williams Medical Center,
Providence, RI, USA

Barbara L. van Leeuwen, Netherlands
Brian Badgwell, USA
Alfons J. M. Balm
Netherlands Cancer
Institute, Amsterdam,
Netherlands
Hepatopancreatobiliary Surgery
Associate Editors
Roberto Biffi
European Institute of Oncology,
Milan, Italy
Hassan Z. Malik
University Hospital
Aintree NHS Trust,
Liverpool, UK

Richard Charnley, UK
Serge Evrard, France
Thomas Gruenberger, Austria
Omar Sherif Omar, Egypt
Franco Orsi, Italy
Jean-Nicolas Vauthey, USA
Melanoma and Limb Perfusion

Associate Editors
Odysseas Zoras
University of Crete, Heraklion,
Crete, Greece

Gynecologic Surgery
Associate Editor
Gabriella Ferrandina
Catholic University of the Sacred Heart,
Campobasso, Italy
Valerie Francescutti, USA

James H. Muchmore, USA
Brian M. Parrett, USA
Schlomo Schneebaum, Israel
John Thompson, Australia
Neurosurgery
Thoracic Surgery
Associate Editor
Associate Editor
Zvi Ram
The Tel Aviv Sourasky Medical Center
Michael Shackcloth
Liverpool Heart and Chest
Hospital NHS Foundation Trust,
Liverpool, UK

Lorenzo Bello, Italy
Hugues Duffau, France
Alfredo Quiones-Hinojosa, USA
Nader Sanai, USA
Colin Watts, UK

Clemens Aigner, Austria
Raja Flores, USA
Babu Naidu, UK
Pediatric Surgery
Upper Gastrointestinal Surgery
Associate Editor
Associate Editor
Kenneth W. Gow
Seattle Children's Hospital,
Seattle, WA, USA
Franco Roviello
University of Siena, Siena, Italy
Lorenzo Ferri, Canada

Michael Hallissey, UK
Arnulf Hlscher, Germany
Eduardo Linhares Riello de Mello, Brazil
Christophe Mariette, France
Alberto Ruol, Italy
Jan J. B. van Lanschot, Netherlands
Rebecka L. Meyers, USA
Peritoneal Surface Malignancy

Associate Editor
Olivier Glehen
Central Hospital Lyon South,
Lyon, France

Marcello Deraco, Italy
Dominique Elias, France
Jesus Esquivel, USA
Pompiliu Piso, Germany
Francois Quenet, France
Beate Rau, Germany
Vic Verwaal, Netherlands
Urologic Surgery
Associate Editor
Brian Birch
Southampton General Hospital,
Southampton, UK
Valery E. Lemmens, Netherlands

Eva Morris, UK
Medical Oncology
Laura Biganzoli, Italy
Fortunato Ciardiello, Italy
Elizabeth Comen, USA
Demetris Papamichael, Cyprus
Nicholas Pavlidis, Greece
George Pentheroudakis, Greece
Per Pfeiffer, Denmark
Monica Ramello, Italy
John Souglakos, Greece
Christopher Steer, Australia
Juan Valle, UK
Nuclear Medicine
Marianne Aznar, Denmark
John Buscombe, UK
Francesco Giammarile, France
Domenico Rubello, Italy
Nutrition
Federico Bozzetti, Italy
Paula Ravasco, Portugal
Pathology
Theo de Reijke, Netherlands

Steven Joniau, Belgium
Massimo Maffezzini, Italy
Andrea Minervini, Italy
Karim Touijer, USA
Associate Editor
Anesthesia
Radiation Therapy
Daniel Perez
University Clinic of Hamburg-Eppendorf,
Hamburg, Germany
Irwin Foo, UK
Claudia Spies, Germany
Fady B. Geara, Lebanon

Rob Glynne-Jones, UK
Youlia Kirova, France
Philip Poortmans, Netherlands
Suresh Senan, Netherlands
Alponse G. Taghian, USA
Robotic Surgery, Simulation and

New Technologies

Rajesh Aggarwal, USA
Pierre Allemann, Switzerland
Basic Science
Sarcomas
Elisa Giovannetti, Netherlands

Nadia Zaffaroni, Italy
Associate Editor
Sylvie Bonvalot
Institut Gustave Roussy, Paris, France

Robert Ashford, UK
Anant Desai, UK
Nicola Fabbri, USA
Marco Fiore, Italy
Frank E. Johnson, USA
Piotr Rutkowski, Poland
Sergio Sandrucci, Italy
Maria Foschini, Italy

Sally Hales, UK
Elena Provenzano, UK
Angelo P. Dei Tos, Italy
Radiology
Cost Effectiveness
Gina Brown, UK
Robin Wilson, UK
Katherine S. Virgo, USA
Epidemiology and Biostatistics

Sarah C. Darby, UK
Guy D. Eslick, Australia
Gemma Gatta, Italy
Past Editors:
T. Lehnert (20102013)
D. A. Rew (20032009)
I. Taylor (19942003)
I. Burn (19881994)
H. White (19841988)
EJSO VOLUME 41 SUPPLEMENT 1 15 OCTOBER 2015
Abstracts of the XII Congress of the Brazilian

Society of Surgical Oncology - BSSO
Salvador, Bahia, Brazil, October 14th - 17th, 2015
Publication information: EJSO (ISSN 0748-7983). For 2015, volume 41

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EJSO VOLUME 41 SUPPLEMENT 1 15 OCTOBER 2015
Contents
It is necessary to go beyond...
Leonaldson Castro, BSSO President
Claudio de Almeida Quadros, 2015 BSSO/LASSO Congress
Riccardo A. Audisio, EJSO Editor-in-Chief, ESSO President
Hector Martnez-Sad, LASSO President
vi
vii
viii
ix
Congress Organizing Committee
Best Abstracts Selection Committee
NUMACO/SBEO Multidisciplinary Program
GT5 Logistic Team
Brazilian Society of Surgical Oncology (BSSO)

Board of Directors 2014-2105
Regional BSSO Organizations
Membership
Past Presidents
Speakers 2015
xi
xii
xiii
xiv
xiv
Abstracts of the XII Congress

Breast cancer
Cancer of the esophagus and stomach
Cancer of the liver, pancreas and biliary ducts
Colorectal and anal cancer
General oncology
GIST and neuroendocrine tumors
Gynecologic oncology
HIPEC
Melanoma and sarcomas
Neoplasms of the head and neck and chest
NUMACO
Urologic cancer
S89
S99
S118
S136
S154
S170
S175
S199
S204
S226
S236
S247
Author index
S252
CONGRESS
OF THE BRAZILIAN SOCIETY
OF SURGICAL ONCOLOGY
14 - 17
OCTOBER|2015
Congress of the Latin American Society of Surgical Oncology

II NUMACO Congress
XV Brazilian Congress of Oncology Nursing
BAHIA OTHON
PALACE HOTEL
SALVADOR - BAHIA - BRAZIL
THE SURGEON AS A PROGNOSTIC FACTOR IN CANCER TREATMENT

It is necessary to go beyond...
The Brazilian Society of Surgical Oncology,
BSSO, was founded in May 1988, in Rio de Janeiro city, by a group of 22 fearless surgeons,
mostly from the Brazilian National Cancer
Institute, led by Dr. Ary Frauzino Pereira and
'U 0DUFRV 0RUDHV ZKR ZLOO EHFRPH WKH UVW
BSSO Member Emeritus, during the 2015 BSSO
Congress, with the mission of advancing the
science and practice of surgical oncology for
the care of cancer patients in Brazil.
It has been a personal privilege to serve as
president of BSSO over the past two years,
continuing the strategic restructuring plan
initiated by Dr. Jose Humberto Simoes Correa
(2010-2011 year) who reviewed the bylaws
allowing the Society to become truly national.
His successor, Dr. Ademar Lopes (2012-2013
\HDUUVW3UHVLGHQWRI%662RXWVLGHWKHVWDte of Rio de Janeiro, kept this key element
enabling a growing number of new members,
culminating in the 2013 BSSO Congress in
So Paulo with about 1,500 participants.
As a result, this allowed us to consolidate BSSO
DVDOHDGLQJVFLHQWLFVRFLHW\LQVXUJLFDORQFRlogy in Brazil and focus our efforts on its internationalization through intersocietal collaboration (Figure 1). In March 2014, in Phoenix, AZ,
we met with the Board of Society of Surgical
Oncology, SSO - President at that time, Dr. V.
Suzanne Klimberg; former Presidents Dr. Charles M. Balch and Dr. Mitchell Posner; the current
President, Dr. Jeffrey A. Drebin; and the Executive Director Eileen Widmer, resulting in the
start of a fruitful partnership. The SSO offered
us to join its 2015 International Career Development Exchange program, being selected Dr.
Marcy Junqueira Piedade. The BSSO participation is guaranteed in this SSO program for the
years 2016 and 2017. Furthermore, generously
and fruit of our partnership, the SSO allows
BSSO members become an international SSO
member with differentiated rates of contribution. On that same occasion, during the 67th
SSO Annual Cancer Symposium, we lead conversations with our Latin American peers with
the intention of creating the Latin American
Society of Surgical Oncology, LASSO, a kind
of federation of Latin American National Societies of Surgical Oncology, to share solutions in
WKHHOGRIVXUJLFDORQFRORJ\WRRXUFRPPRQ
problems, since we have similar socioeconomic
aspects. Today, in 2015 BSSO Congress, the
LASSO becomes a reality and Dr. Hector MartiQH]6DLGLVLWVUVW3UHVLGHQW
Audisio, current President, and Carine LeFRT &KLHI 2SHUDWLRQV 2IFHU HQFRXUDJHG
and approved the design of this partnership.
Today, in the second year of partnership, any
compliant BSSO member can become an international member of ESSO, just by a simple
application. A small annual fee paid by BSSO
to ESSO, dispense our members any payment for membership in the ESSO.
The BSSO is very grateful to the SSO and ESSO
IRUDOORZLQJ%662EHDQDIOLDWHRIWKHPDQG
IRUJLYLQJXVLQGLVSHQVDEOHVXSSRUWWRIXOOORXU
mission to provide high-level medical education to our associates. On the basis of fraternal
partnership with these organizations leaders in
the world, we want to advance, develop comPRQ VFLHQWLF DFWLYLWLHV VXFK DV FRQVHQVXV
courses, guidelines, multicenter studies, and
HYHQEHDEOHWRDOVRXVHWKHLURXWVWDQGLQJRIFLDOMRXUQDOVDVWKH%662RIFLDOMRXUQDO
Despite an era of personalized medicine, molecular diagnostics and targeted therapy, surgery will continue to be the backbone of control and cure for most solid tumors. The effect
of specialized surgeons on reducing operative
morbidity and mortality and lowering costs
has been reported in many studies of different cancer types. So, the central theme of our
Congress is the surgeon as a prognostic factor
in cancer treatment, organized superbly by Dr.
Claudio Quadros and his team. I must admit
that the choice of my brilliant former resident
of surgical oncology for President of this Congress, Dr. Claudio Quadros, was perhaps the
surest one of my choices as BSSO President
these last 2 years. This memorable Congress
would not be possible without the institutional
support of myriad institutions leaders in the
treatment of cancer around the world, such
as MD-Anderson Cancer Center led by Ms.
Karen Francis, Memorial Sloan-Kettering Can600
cer Center led by Dr. Murray Brenan, City of

Hope led by Dr. Yuman Fong, Cleveland Clinic
led by Dr. Stephen Grobmyer, Cancer Centers
of America led by Dr. Jesus Esquivel, IRCAD
Latin America led by Dr. Armando Melani, the
Indian Society of Surgical Oncology led by Dr.
M.Vijayakumar and Virginia Mason led by Dr.
Flvio Rocha.
One of the most important reports on the
status of cancer in Latin America and the
Caribbean, including Brazil, led by Dr. Paul
E. Goss, published in The Lancet 2013; 14, 5:
391-436, points to the frightening estimated
1.7 million cases of cancer will be diagnosed in
2030, and more than 1 million cancer deaths
will occur annually in this region due to inadequate funding; inequitable distribution of
resources and services; inadequate numbers,
training, and distribution of health-care personnel and equipment; lack of adequate care for
many populations based on socioeconomic, geographic, ethnic, and other factors; and current
systems geared toward the needs of wealthy,
urban minorities at a cost to the entire population. A clear example of this chaotic scenario is
the result of BSSO survey led by Dr. Reni Moreira
and sent this year to 466 BSSO members, getWLQJUHVSRQVHWKDWFRQUPVWKHGLVtribution disparity and unequal access of Brazilians to a surgical oncologist: 60.6% (203) works
in cities formerly over 1 million people, although
these big urban centers represent a minority
of Brazilian cities, only 0.31%. This burgeoning
cancer problem threatens to cause widespread
suffering and economic peril to the countries of
Latin America.
Therefore, the BSSO need to follow along, go
much further, in order to ensure the best care
for all Brazilians with cancer. This Congress is
an example that we are walking on this path
correctly.
574
537
500
422
400
391
300
277
213
239
184
200
169
144
In the same direction, we began an important partnership with the European Society
of Surgical Oncology, ESSO. It was in Liverpool, UK, in October 2014, where Dr. Graeme
Poston, President at that time, Dr. Riccardo
100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Fig 1: Evolution of BSSO Membership
Leonaldson Castro,
MD, PhD
BSSO President
CONGRESS
II NUMACO Congress
14 - 17
OCTOBER|2015
BAHIA OTHON
PALACE HOTEL

I would like to take the opportunity of having so many colleagues from all over the world joined in our 2015 BSSO/
LASSO Congress to share some thoughts about cancer
care.
Cancer is a major public health problem in Latin America
and in Brazil it is the second leading cause of death. All
the innovations in cancer treatment during the last decades
GLGQRWVLJQLFDQWO\UHGXFHFDQFHUPRUWDOLW\UDWHVLQ/DWLQ
American countries. This makes us consider that advances
in cancer treatment have not yet made our Latin American
cancer patients die less, because access to acceptable medical treatment is still a privilege. Generally speaking, Latin
$PHULFDQ FRXQWULHV EHQHW IURP WZR SDWKZD\V RI FDQFHU
care: patients with private medical insurance get the best
treatment available and poor patients of the public health
systems struggle to have simple endoscopies performed
to have their gastrointestinal tumors diagnosed. There are
some public cancer centers that are exceptions to this logic and provide excellent cancer care. Still, numerous Latin American patients dye of preventable virus induced
tumors, as cervix, head & neck and anal canal cancer, or
caused by inadequate habits as ultraviolet skin exposure,
tabacco use and excess in alcohol consumption. Patients
also dye because their tumors are being detected at an advanced stage. We know that prevention and early cancer
detection measures saves lives but these measures are not
undertaken in Latin America where, in the majority of the
countries, there is no effective public health cancer screening program. The available public cancer centers are not
VXIFLHQWWRWUHDWWKHODUJHQXPEHURIORZLQFRPHFDQFHU
patients, causing delays in cancer diagnosis and treatment,
when we know how a delayed diagnosis often results into
poor cancer outcomes. And what do Oncological Surgeons
have to do with this? In my opinion, a lot! We should understand that we are not going to have an effective impact
in cancer treatment only with our surgical scalpels. When
basic aspects of cancer treatment are not being provided
to the entire population we should engage our Societies in
pointing out discrepancies and proposing solutions. And us
as individuals should support politicians engaged in providing better public health systems.
Nowadays we operate with robots, with small incisions but
the fundaments of curative intent oncological surgical treatment are the same: free surgical margins, adequate lymphadenectomies, R0 and en bloc resections. We should not
let technology change our fundaments, trying to reduce the
importance of them so we could use technology. But instead, we shall use all the fascinating aspects of technology to
better treat our patients with less pain and minus morbidity
using the same oncological principles that we have used
to try to achieve the best disease free survival as possible.
Despite all the advances with targeted clinical oncological
therapy and better radiotherapy techniques, no patient with
solid tumors survives cancer treatment if they do not have
adequate surgical treatment. And adequate surgical treat-
ment requires adequate surgical training through residency

programs in cancer centers and continuous medical education. These are the main reasons for us to spend so much
effort in organizing this Latin American Surgical Oncological
Congress and having its theme as: the surgeon as a prognostic factor in cancer treatment. If our 2015 BSSO/LASSO
Congress provides us with better ways of teaching the young
surgical oncologists and enhance our surgical skills with techniques and approaches to better treat our cancer patients, all
the efforts to organize this meeting were worthwhile.
I would like to express my gratitude to the European Society of Surgical Oncology - ESSO President Prof. Riccardo Audisio, who enabled the abstracts of our 2015 BSSO/
LASSO to be published in this European Journal of Surgical
Oncology - EJSO Supplement, and provided us with the learning possibility with the ESSO Colorectal Cancer Surgical
Course. We also thank the Society of Surgical Oncology
662LQWKHQDPHRI3UHVLGHQW-HIIUH\'UHELQWKDWTXDOLHG
our meeting with the Best of SSO Program and awarded
the two best abstracts with the SSOs International Career Program. The President of the Society of Gynecologic
Oncology SGO, Prof. Robert Coleman, also should be
thanked for sharing knowledge through the presentation
of the best of the SGO Congress. These attitudes stimulate
VFLHQWLFDFWLYLWLHVVKDUHVNQRZOHGJHDQGWHFKQLTXHVWKDW
certainly will make us treat better our cancer patients.
The reason that this Congress has so many international
speakers was through the support of Institutions and Cancer Centers that provided the trip of their faculties. I would
like to thank each one them for believing that meetings like
the 2015 BSSO/LASSO provide continuous medical education which will result into lives saved and teaches us how
to become a better Surgical Oncologist. Thank you: MD
Anderson Cancer Center, Memorial Sloan Kettering Cancer
Center, City of Hope, ESSO, Cleveland Clinic, Cancer Treatment Centers of America, SSO, SGO, Indian Association of
Surgical Oncology IASO, IRCAD Latin America and Virginia Mason. Financial support was essential to turn into reality this dream, I would like to thank very much each one
of the private companies listed in the back cover of this
EJSOs Supplement.
Be welcomed and enjoy our Brazilian hospitality! Thank you
for coming!
Claudio de Almeida
Quadros, MD, PhD
President - 2015 BSSO/
LASSO Congress.
CONGRESS
II NUMACO Congress
14 - 17
OCTOBER|2015
BAHIA OTHON
PALACE HOTEL
There is no doubt that oncological progress has been substantial over the last decades: what we had been awaiting
for such a long time is now taking place! Genetic information has to be taken into account. Tumor characterization
entails better comprehension of how it progresses: patterns of spread and recurrence are better predicted. Diagnosis
and staging are being revolutionized with advanced imaging and new technologies including liquid biopsy; this will
impact on the way we follow-up cancer patients. In essence, the whole trajectory of patients care, from prevention
and early diagnosis to plans of surveillance after treatment,
are being reviewed and updated every day.
While this universe of knowledge is rapidly expanding, the
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SURJUHVV FRQQHFWLRQV DUH PRUH HIFLHQW IDVWHU DQG UHOLDble. The spread of information is accurate and instant. The
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and clinical application. A rapid turnover encourages cliniFDO VFLHQWLVWV WR UHO\ RQ TXDOLHG SXEOLFDWLRQV DQG QHZV LV
spread world-wide. Journals are rarely printed any more,
while their electronic version are instantly delivered to the
most remote places as centers of excellence. Useful information is made available in a timely way and at a very low
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advancements in patient care.
On the other hand, progress generates questions and
spawns debate. And what a better opportunity than a
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questions, test opinion-leaders, establish links and set up
the network for boosting progress? This will generate the
momentum to move one more step forward and experiment new hypothesis.
EJSO is extremely proud of assisting the community of
cancer surgeons and celebrates its advancements. We are
proud to play an active part at he 2015 BSSO/LASSO Congress and to host the Abstracts submitted to this founding
event of the South American convention.
We wish to congratulate the proactive role of Professor
Claudio Quadros in establishing the XII Congress of the
Brazilian Society of Surgical Oncology BSSO and the foundation Congress of the Latin American Society of Surgical
Oncology. We welcome the entire community of cancer
surgeons in San Salvador de Bahia and wish you all a successful and joyful event.
Prof. Riccardo A.
Audisio, MD, FRCS
EJSO Editor-in-Chief
ESSO - President
CONGRESS
II NUMACO Congress
14 - 17
OCTOBER|2015
BAHIA OTHON
PALACE HOTEL

Latin-America has an area of approximately 19,197,000 km2 (7,412,000 sq mi), almost 13% of the earths land surface area,
divided in 26 countries and joined by the
romance language: mostly Spanish and
Portuguese. According to World Bank
data in 2014, lives almost 521.9 million people with a Gross National Income (GNI)
of almost 10,000 USD and $4.764 trillion
USD of Gross Domestic Product (GDP).
Arizona. In this meeting, we had the opportunity to discuss with

other Latin-American surgical leaders and under the support of the
Society of Surgical Oncology of United States (SSO), the necessity
to advance in a federation of Latin-American Societies of surgeons
dedicated to treat cancer in the region with the similarities in education, population, language, health problems and development. In
this paramount meeting were represented surgeons of the Brazilians Society of Surgical Oncology (Leonaldson Castro and Claudio
Quadros), Mexican Society of Oncology (Hctor Martinez-Said),
Mexican Society of Mastology (Enrique Bargallo), Chile (Agusto
Len) and the President (Suzanne Klimberg) and past presidents
of the Society of Surgical Oncology (Mitchell Posner & Charles
Balch). Few months after, during the development of the congress
The Best of SSO Meeting 2014, in Cancun, Mexico, sponsored by
the Instituto Nacional de Cancerologia Mexico, Mexican Society
of Oncology, and the SSO, we convene a surgical leaders of Guatemala, Honduras, Panama, Colombia, Ecuador, Chile and Brazil to
establish the emerging plan of LASSO. Several meetings in Houston, Bogota, Panama, Mexico City, and Manta, served as initial plan
to develop this Federation and set up the Congress of the Brazilian
6RFLHW\RI6XUJLFDO2QFRORJ\DVWKHUVW&RQJUHVVRI/$662XQGHU
the principle: The Surgeon as a prognostic factor in Cancer Treatment.
With nearly 1,100,000 new cases of cancer per year, malignant tumors represents one the leading mortality causes in the majority
of our countries, with 600,000 deaths related. Although breast
tumors are the leading cancer cause in our region (Mexico, Brazil,
and Argentina for example); our women are still being affected by
preventable and easily detected tumors, like cervical cancer. In the
case of men, Prostate, Lung, and colorectal are the main malignant
diseases, with poor tobacco control and prevention programs.
Claudio Quadros, Mitchell Posner, Charles M. Balch, Suzanne Klimberg, Leonaldson Castro,
Hector Martnez-Said, Enrique Bargallo-Rocha, Augusto Leon y Nicolas Droppelman.
The mission of the Latin America Society of Surgical Oncology is to

improve multidisciplinary patient care by advancing the science, education and practice of cancer surgery in Latin America and the main
objective is to align educational surgical path through the region to
ensure standardization of capabilities and skills developed to become
surgeons experts in cancer. Our values are: Patient Care (Advocate
for the cancer patient through integrity and ethical conduct), Lifelong
Learning, Discovery, Quality and Leadership.
To date several Societies and Cancer Institutes of Mexico, Guatemala,
Honduras, Costa Rica, Panama, Colombia, Ecuador, Argentina, Per, Brasil y Chile, lay the foundation of the Latin-American Society of Surgical
Oncology (LASSO), a society for surgeons who treat cancer patients.
The Latin-American Society of Surgical Oncology (LASSO) is the

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providers (mostly surgical related) dedicated to advancing and
promoting the science, education and treatment of cancer. Was
conceptualized in March 2014 during the 67th Annual Cancer Symposium of the Society of Surgical Oncology celebrated in Phoenix,
Dr. Hctor
Martnez-Sad
President,
Latin American Society of
Surgical Oncology - LASSO
CONGRESS
II NUMACO Congress
14 - 17
OCTOBER|2015
BAHIA OTHON
PALACE HOTEL
CONGRESS ORGANIZING
COMMITTEE
NUMACO/SBEO
MULTIDISCIPLINARY
PROGRAM
CLAUDIO DE ALMEIDA
QUADROS
2015 BSSO/LASSO Congress
President and Coordinator
RIWKH6FLHQWLF3URJUDP
CELENA FRIEDRICH
President of the Multidisciplinary Team in the
Support of Surgical Oncology - NUMACO
CRISTIANE VAUCHER
EMERSON PRISCO
2015 BSSO/LASSO Congress Treasurer
BEST ABSTRACTS
SELECTION COMMITTEE
President of the Brazilian Society of Nurses

in Oncology - SBEO
GT5 LOGISTIC TEAM
ADALBERTO RIOS
ROBERTO DURAN
Coodinator
Director - GT5 Group
HERBERT IVES BARRETTO

ALMEIDA
Operational Manager - GT5 Group
THALES PAULO BATISTA
Project Manager - GT5 Group
PEDRO XAVIER
ANA PAULA C. RIBEIRO
CONGRESS
II NUMACO Congress
14 - 17
OCTOBER|2015
BAHIA OTHON
PALACE HOTEL
BRAZILIAN SOCIETY OF SURGICAL ONCOLOGY - BSSO

BSSO - BOARD
OF DIRECTORS
2014-2015
LEONALDSON DOS SANTOS

CASTRO/RJ
President
FELIPE JOS FERNANDEZ

COIMBRA/SP
LUIS FERNANDO MAZZINI/ES
Vice-President
Coordinator for International Relations
JOS WILSON MOURO/CE
AUDREY TEIKO TSUNODA/SP
General Secretary
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PAULO HENRIQUE
ZANVETTOR/BA
RENI CECLIA MOREIRA/MG
1 Secretary
RAFAEL OLIVEIRA
ALBAGLI/RJ
2 Secretary
JOS HUMBERTO SIMES

CORREA/RJ
1 Treasurer
CLAUDIO DE ALMEIDA
QUADROS/BA
2 Treasurer
Commission Coordinator of Specialist Title

Committee
SAMUEL AGUIAR JNIOR/SP

Coordinator of the Medical Residency
Commission
EDUARDO MIRANDA
BRANDO/PE
Coordinator of Professional Defense
Commission
WESLEY PEREIRA ANDRADE/SP

Commission Coordinator of Journal,
Bulletin and Internet
CONGRESS
II NUMACO Congress
14 - 17
OCTOBER|2015
BAHIA OTHON
PALACE HOTEL
BRAZILIAN SOCIETY OF SURGICAL ONCOLOGY - BSSO

REGIONAL BSSO ORGANIZATIONS
FERNANDO AUGUSTO
DE VASCONCELLOS SANTOS
Regional Minas Gerais - President
RODRIGO NASCIMENTO
PINHEIRO
JOS WILSON MOURO

DE FARIAS
Regional Cear - President
EDUARDO ZANELLA
CORDEIRO
Regional Braslia - President
Regional Santa Catarina - President
MRIO RINO MARTINS
GIOVANNI ZENEDIN
TARGA
Regional Pernambuco - President
Regional Paran - President
SAMUEL AGUIAR JNIOR
MANOEL JESUS PINHEIRO

COELHO JUNIOR
Regional So Paulo - President
Regional Amazonas - President
GERALDO JOS
DE SOUSA NASCIMENTO
ERLON KLEIN
Regional Bahia - President
Regional Mato Grosso do Sul - President
LUIZ FERNANDO MAZZINI

GOMES
JORGE S. LYRA
Regional Esprito Santo - President
Regional Maranho - President
ANTONIO NOCCHI KALIL
Regional Alagoas (In development)

President
ALDO VIEIRA BARROS

Regional Rio Grande do Sul - President
BRAZILIAN
SOCIETY
OF SURGICAL
ONCOLOGY
MEMBER BENEFITS
Join BSSO ... Share the Expertise.
We invite you to join the Brazilian Society of Surgical Oncology - BSSO, one of the countrys
most respected surgical organizations. BSSO is the surgical home for academic and community-based physicians involved in the surgical treatment of cancer patients in Brazil.
BSSO membership is open to surgeons, physicians, surgical residents, scientists and other heDOWKFDUHSURYLGHUV180$&2WKDWDUHVLJQLFDQWO\LQYROYHGLQRQFRORJLFSDWLHQWFDUH
MEMBERSHIP BENEFITS
Become a BSSO member and you will:
take part of a national network of over 600 members dedicated to provide the best care
for cancer patients;
take part at BSSO Committees;
KDYHDSHUVRQDOL]HGPHPEHUVKLSFHUWLFDWH
attend the BSSO Congress at reduced rates;
be listed in the online membership directory Find a Surgical Oncologist Near You;
EHLQYLWHGWRVSHFLFWHDFKLQJFRXUVHVDWDGYDQWDJHRXVUHJLVWUDWLRQUDWHV
EHQHW IURP UHGXFHG DSSOLFDWLRQ IHHV DW PDMRU RQFRORJLFDO LQWHUQDWLRQDO VRFLHWLHV DV WKH
Society of Surgical Oncology - SSO and Society of Gynecological Oncology SGO, and
even be a member without additional costs of the European Society of Surgical Oncology
- ESSO;
apply to the SSO International Career Development Exchange program;
receive regular updates on BSSO activities and projects in surgical oncology.
take part of the Latin American Society of Surgical Oncology LASSO.
www.sbco.org.br
BRAZILIAN SOCIETY OF SURGICAL ONCOLOGY PAST PRESIDENTS

ARY FRAUZINO
PEREIRA (in memorian)
MARCOS FERNANDO
OLIVEIRA MORAES
GERALDO MATOS
DE S (in memorian)
1986-1988
1989-1999
2000-2002
ODILON DE SOUZA
FILHO
EDUARDO LINHARES
RIELLO DE MELLO
JOS HUMBERTO
SIMES CORRA
2003-2005
2006-2008
2009-2011
LEONALDSON DOS
SANTOS CASTRO
ADEMAR LOPES
2011-2012
2013-2015
SPEAKERS - BSSO 2015

DANIEL CHERQUI
Professor of visceral and digestive
surgery and liver transplantation,
Hepatobiliary Center, Paul Brousse
Hospital, France.
DOMINIQUE ELIAS
FLVIO ROCHA
Chef du Depart de Chirurgie, Gustave

Roussy, France.
Liver/Pancreatic Surgery, Virginia

Mason, Med Center, USA.
FEDERICO AUCEJO
HENRI BISMUTH
Surgical Director Liver Tumor

Clinic, Cleveland Clinic, USA.
Institut Hpatobiliaire Henri Bismuth, France.
ALEXANDER M. M.
EGGERMONT
JAE KIM
Chief or Thoracic Surgery, City of
Hope, USA.
Director General of the Gustave

Roussy Cancer Center, France.
JESUS ESQUIVEL
JULIO GARCIA AGUILAR
National Director for HIPEC Research,

Cancer Treatment Centers of America,
USA.
Chief of Colorectal Surgery, Memorial Sloan Kettering Cancer

Center, New York, USA.
KEVIN ROGGIN
MRIO M. LEITO JR.
Program Director, General Surgery Residency; Associate Program Director, Surgical Oncology
Fellowship, University of Chicago
Medicine, USA.
Director of the Gynecologic Oncology

Fellowship Program and Co-Director
of the Robotic Surgery Program of the
Memorial Sloan Kettering Cancer Center,
New York, USA.
MASARU MIYAZAKI
Chairman, Department of General
Surgery; Director of the Universitys
Hospital, Chiba University, Japan.
President, Society of Japan Hepatobiliary-Pancreatic Surgery.
HCTOR MARTNEZ SAD

Head of the Melanoma Clinic, National
Cancer Institute, Mexico.
MICHAEL FRUMOVITZ
Director, Gynecologic Oncology
Fellowship Program, The University
of Texas MD Anderson Cancer Center,
Houston, USA.
MITCHELL POSNER
Chief of Surgical Oncology, University
of Chicago, USA.

PANKAJ VASHI
MURRAY BRENNAN
NORA JASKOWIAK
Vice President for International

Programs, Memorial Sloan Kettering
Cancer Center, New York, USA.
Surgical Director, Breast Cancer,

University of Chicago, USA.
PRAJNAN DAS
Program Director of the Residency
and Fellowship in Radiation Oncology,
Radiotherapy Division, The University
of Texas MD Anderson Cancer Center,
Houston, USA.
ERNEST HAN
Director of Ovarian Cancer Research,
City of Hope Cancer Center, California,
USA.
AUGUSTO LEN
Chief of the Surgical Oncology
Program, School of Medicine,
Catholic University of Chile.
Lead National Medical Director,

National Director Gastroenterology/Nutrition/Metabolic Support,
Cancer Treatment Centers of
America, USA.
MATTHEW WALSH
STEPHEN GROBMYER
Chairman, General Surgery, Cleveland

Clinic, USA.
Section Head, Surgical Oncology,

Cleveland Clinic, USA.
YUMAN FONG
Chair of the Department of
Surgery, Associate Director for International Relations, City of Hope
Cancer Center, California, USA.
CHARLES BALCH
Editor-in-Chief of Annals of Surgical
Oncology.
GEORGE J. CHANG
Chief of Colon and Rectal Surgery,
Director of Clinical Operations, Minimally Invasive and New Technologies
in Oncologic Surgery, The University
of Texas MD Anderson Cancer Center, Houston, USA.
DANIEL COIT
Surgical Oncologist, Memorial
Sloan Kettering Cancer Center
MSKCC, USA.
EMLIO VICENTE
RICHARD SULLIVAN
GEERARD BEETS
Director, General and Digestive

Surgery Service Madrid Sanchinarro University Hospital, Clara Campal Oncological Center, Spain.
Professor of Cancer & Global Health

at Kings College London (KCL) and
founding director of the Institute of
Cancer Policy.
Medical Director, Oncology Center;

Vice Chairman, Department of
Surgery, Maastricht Universitys
Medical Center , Amsterdam,
Netherlands.
ENRIQUE BARGALLO
President of the Indian Association of

Surgical Oncology. Vice Chancellor,
Yenepoya University, Mangalore,
Karnataka, India.
JEFFREY DREBIN
Chair of the Department of Surgery,
Univ. Pennsylvania Medicine. SSO
President.
MRIO RIETJENS
Director, Division of Reconstructive Surgery, European Institute of
Oncology, Milan, Italy.
RICCARDO AUDISIO
President of the European Society
of Surgical Oncology ESSO, Editor-in-Chief of the European Journal of
Surgical Oncology EJSO, President
of the British Association of Surgical
Oncology BASO.
Chief, Department of Breast Surgery,

National Cancer Institute, Mexico.
MARK WAKABAYASHI
M. VIJAYAKUMAR
PARIS TEKKIS
Chief Division, Gynecologic Oncology

Department of Surgery, City of Hope
Cancer Center, California, USA.
Professor of Colorectal Surgery,

The Royal Marsden, England.
ROBERT COLEMAN
T. SUBRAMANYESHWAR
RAO
President of the Society of Gynecologic Oncology SGO; Professor, Department of Gynecologic Oncology,
University of Texas, The MD Anderson
Cancer Center, Houston, USA.
Medical Director & Chief Surgical

Oncologist, Indo american Cancer
Hospital, India.

SUZANNE KLIMBER
THEO WIGGERS
TIBOR KOVACS
Chairman of the Department of Surgical Oncology, University Medical

Center, Groningen, Netherlands.
Surgical Oncologist and Oncoplastic

Breast Surgeon at Guys and St. Thomas NHS Foundation Trust, London.
VIC VERWAAL
YUKIHIDE KANEMITSU
MARCELLO DERACO
HIPEC and colorectal surgeon Catharina Hospital Eindhoven, Netherlands.
Chief of Colorectal Surgery Division,

National Cancer Center, Tokyo, Japan.
Surgical Oncologist, Departm

Peritoneal Malignancies, Sarc
and Melanoma, National Can
Institute of Milan, Italy.
TIMOTHY PAWLIK
LUC SOLER
C. PALANIVELU
Chief of the Division of Surgical

Oncology, Program Director of
the Surgical Oncology Fellowship,
Director of the Johns Hopkins Medicine Liver Tumor Center, USA.
Head of the Research and Deve

ment team in computer science
Robotics, IRCAD. Professor, Univ
Strasbourg I Digestive and Endo
Surgery, France.
GEM Hospital, India.
Chairman of the Muriel Balsa

Kohn Chair in Breast Surgica
cology at the University of A
sas for Medical Sciences, US
BARRY W. FEIG
Surgical Oncologist. Chief of the Surgical Sarcoma Section and Professor of
the Department of Surgical Oncology,
The University of Texas MD Anderson
Cancer Center, Houston, TX, USA.
FRANOISE VAN HOVE

Nurse in Hepato Biliary Institute of
Professor Henri Bismuth, France.
www.congresso2015sbco.com.br
Almost a quarter century

fighting cancer in Brazil
The Cancer Foundation is a non-profit institution founded in 1991 that raises funds and manages them
in order to fight cancer.
Our work has helped to save thousands of lives. We undertake and support actions involving prevention
early detection, medical assistance, palliative care, education, research and treatment.
The Cancer Foundation is in charge of the administrative and financial management of the Nationa
Register of Volunteer Bone Marrow Donors (Redome), the third largest in the world, with over 3 million
registered volunteers. It further manages the project for expanding the Brazilian Network of Public
Umbilical Cord and Placenta Blood Banks (BrasilCord Network).
We also play an important role in campaigning for the creation of tobacco-restricting regulations in
Brazil, such as the recently enacted Federal Anti-Smoking Law.
Cancer is a serious threat to peoples health and must be fought. For the last 24 years, it has been a
relentless battle for us.
ccancer.org.br
ffacebook.com/fundacaodocancer
linkedin.com/company/fundao-do-cncer
ttwitter.com/fdocancer
instagram.com/fdocancer
with you, for life
Available online at www.sciencedirect.com
ScienceDirect
EJSO 41 (2015) S89S258
www.ejso.com
Abstracts of the XII Congress of the Brazilian Society of Surgical Oncology - BSSO
Salvador, Bahia, Brazil, October 14th - 17th, 2015
Breast cancer
029318
Performance of a new autologous blood-derived marker versus
technetium-99 in sentinel lymph-node biopsy in breast cancer
Furtado, G.P.1, Pinheiro, L.G.P.1, Vasques P.H.D.1, Pinheiro, A.C.1,
Vasconcellos, A.A.1, Bezerra, J.L.M.1
1
Saul Goldenberg Experimental Surgery Laboratory, Department of
Surgery, Faculty of Medicine, Federal University of Cear, Fortaleza,
Brazil
gabriel.pinheiro@msn.com
Introduction: With sentinel-node biopsy, it is possible to stage most
cases of breast cancer. Some methods used are controversial, so the study
of new markers is important.
Objectives: To compare identification by sentinel lymph-node biopsy
rates of an autologous blood-derived marker versus the radioactive marker
technetium-99 (Tc99).
Methods: Between October 2011 and September 2013, we studied
15 women with breast cancer (T1/T2); the women were under the age of
70 years and had clinically negative axillae. We excluded patients with
inflammatory breast cancer, those with palpable axillary lymph nodes,
and those who were pregnant. For the preparation of the autologous blood
marker, 24 h before surgery 10 mL of blood were collected from the patient
in Vacutainer tubes and fractionated by centrifugation (2000 rpm, 22C for
10 min); the three phases were separated. Under laminar flow, the top and
middle phases were discarded and the bottom phase was diluted with physiological saline and again centrifuged at 3800 rpm for 3 min. Two phases
appeared; the top was discarded, the volume discarded being replaced with
redistilled water, followed by further centrifugation at 3800 rpm for 3 min.
The preparation was finalized by the injection of 4 mL subareolar tissue.
After 24 h, the patient underwent magnetic resonance imaging (MRI)
and preoperative injection with Tc99; they were then sent to the surgical
center, where they were anesthetized and operated. The biopsy used the
gamma probe to identify the sentinel node with Tc99 and evaluated whether
Tc99 scored differently from the autologous blood marker; the intensity of
staining was also evaluated.
Results: The identification rate using Tc99 was 100% (15/15); 100%
(15/15) of the cases were also identified with the autologous marker. The
concordance rate was 100%. In marking intensity rate with the autologous
marker, 53% (8/15) stained intensely, 27% (4/15) moderately, 20% (3/15)
lightly, and 0 were unstained (0/15).
Conclusions: The performance of the autologous marker is demonstrated to be effective, safe, and without side effects when compared to
Tc99. In addition, the autologous marker presented a magnetic signal to
MRI, opening new perspectives for axillary study in breast cancer, either by
imaging or as a magnetic signal.
029255
Association between alcohol consumption and breast cancer
development
Portela, L.F.S.1, Machado, C.A.C.2, Canguss, R.C.3, Landeiro, L.G.C.3,
Bertrand, S.A.B.1, Pinto, R.M.O.1
1
Escola Bahiana de Medicina e Sade Pblica, Brazil; 2Ncleo da Mama,
Brazil, 3Ncleo de Oncologia da Bahia, Brazil
laisfranciele2@gmail.com, cesaracmachado@hotmail.com,
landeiro@hotmail.com
Introduction: Some studies have suggested a modest association and
dose/response relationship between alcohol consumption and breast cancer,
with an intake of 10 g/day being a factor that enhances the development
of this neoplasm. Evidence shows that alcohol increases estrogen levels, a
known risk factor for the disease. Others have suggested that alcohol may
increase the risk of breast cancer by a co-carcinogenic action, increasing
capillary permeability of the cell membrane to real carcinogens, or by
the action of derivatives of alcohol metabolism such as acetaldehyde
responsible for changes in the DNA, also related with disease development.
Objectives: To identify the association between alcohol consumption
and the development of breast cancer in a patient population of Salvador,
Bahia.
Methods: This is a casecontrol study in a population of Salvador,
Bahia, Brazil, with 69 patients in the case group diagnosed with ductal
breast carcinoma and 71 controls; data were collected between December
2012 and May 2014. Sample calculation was performed with n = 140
patients, using the program Winpepi, presuming a difference of 5% between
groups and with an acceptable difference of 10%. The chi-square test was
performed to evaluate the correlation between categorical variables and the
Student t-test between continuous variables.
Results: When analyzing the association between alcohol intake and
breast cancer, an odds ratio of 0.99 was obtained (CI95% 0.5241.890), P =
0.988. In relation to alcohol consumption >10 g/day and breast cancer, an
odds ratio of 1.579 was obtained (CI95% 0.6243.995), P = 0.332. Among
the cases, alcoholic average intake was 3.66 8.6 g/day, and among the
controls the average was 3.71 7.4 g/day (P = 0.890).
Conclusions: Although published data suggest an association between
alcohol consumption and breast cancer, in this study there was no statistical
significance between alcohol intake or alcohol consumption >10 g/day and
a greater risk of developing breast cancer.
S90
029247
Association between diabetes mellitus and increased risk of breast
cancer: a casecontrol study
Azevedo, C.F.1, Grangeiro, G.O.1, Santos I.P.1, Machado, M.C.M.1,
Crusoe, N.S.D.R.1, Machado, C.A.C.2
1
Academician of Medicine on Escola Bahiana de Medicina e Sade
Pblica (EBMSP), Salvador, Brazil, 2Clinic of Mastology Ncleo da
Mama, Salvador, Brazil
camiazevedo@hotmail.com, gustavomaia_06@hotmail.com,
irlania.dossantos@gmail.com, cissa.mathias@gmail.com,
nathaliacrusoe@gmail.com, cesaracmachado@hotmail.com
Introduction: Diabetes has been linked to increased risk of breast
cancer. There is no clear explanation for this relationship, but some studies
suggest that diabetes can cause an inflammatory state in the body, facilitating carcinogenesis. Furthermore, insulin has a mitogenic effect and can
stimulate cancer cell proliferation.
Objective: To evaluate whether diabetes is related to an increased risk
of breast cancer.
Methods: This is an analytical casecontrol study, with data collected
between 2012 and 2015, in a population of Salvador, Bahia. The case
group consisted of patients with ductal carcinoma, while the control group
consisted of patients free of malignancy or premalignant breast injury. The
diagnosis of diabetes was confirmed by fasting plasma glucose and glycated
hemoglobin, or it could be self-reported in patients who used antidiabetic
medications. Statistical tests were performed using Software Statistical
Package for Social Sciences (SPSS), P values < 0.05 being considered
statistically significant.
Results: A total of 492 patients were involved in the study (case =
130, control = 362). Of these patients, 41 (8.3%) had diabetes. The mean
age was 52 years (1786 years); 46% of the patients considered themselves
brown, 18.9% black and 34.3% white. Most patients were college graduates (60.2%, and 20% were also postgraduates). In the case group the incidence of diabetes was 14%, while in the control group the incidence was
6.4%. Diabetes was associated with an increase of 2.39 in the risk of breast
cancer (95%CI 1.2444.592). The chi-square test rejected the null hypothesis (7.178, Asym. sig 0.007).
Conclusion: Patients with a diagnosis of diabetes appear to be at
higher risk of developing breast cancer. A limitation of the study is that no
distinction was made between diabetes type I and type II.
029222
Association between hypertension and breast cancer in patients from
Salvador, Bahia
Silva, L.A.1, Bertrand, S.A.B.1, Kruschewsky, M.M.1, Matos, J.R.1,
Silva, P.C.C.1, Landeiro, L.C.G.2
1
Academician of Medicine on Escola Bahiana de Medicina e Sade
Pblica (EBMSP), Salvador, Brazil, 2Clinical Oncologist of Ncleo de
Oncologia da Bahia (NOB), Salvador, Brazil.
laisalmeidas@hotmail.com,
bertrand.susanne@gmail.com, mkruschewsky@uol.com.br,
jeu_jess@hotmail.com, paula.92@gmail.com, landeiro@hotmail.com
Introduction: Breast cancer is the second most common malignant
neoplasia worldwide and the main cause of cancer mortality among women
in Brazil. Hypertension is also a leading cause of morbidity and mortality.
Studies that evaluated the association between breast cancer and hypertension have shown discordant results. There is the hypothesis that the association between these chronic diseases may be associated with other risk
factors such as high body mass index and metabolic syndrome. Then, to
date, it is unclear whether hypertension is associated with an increased risk
of developing breast cancer.
ABSTRACTS
Objective: This study aims to evaluate whether hypertension is related
to increased risk of breast cancer.
Methods: This is an analytical casecontrol study, with data collected
between 2012 and 2015, in a population of Salvador, Bahia. The case group
consists of patients with ductal carcinoma, while the control group consists
of patients free of malignancy or premalignant breast injury. Sample calculation was performed with n = 492 patients through the program SPSS. The
presence of hypertension was defined as blood pressure 140/90 mmHg
measured by one of the sub-investigators, or reported use of antihypertensive medication. The staff were trained in blood pressure measurement
techniques, according to the VI Brazilian Guidelines on Hypertension.
Blood pressure was measured with an aneroid sphygmanometer, calibrated
by a mercury manometer. Statistical analysis included X2 test achievement
for evaluation of correlation between categorical variables.
Results: Mean age was 55 years between cases and 50.8 years between
controls. In controls, the proportion of non-hypertensive and hypertensive
patients was 60.77% (299) and 39.22%, respectively. Among cases, 49.2%
of patients (64) were not hypertensive and 50.8% (66) were hypertensive.
There were significantly more hypertensive patients among cases than
among controls (OR = 1.908; 95%CI 1.2712.864; Asymp. sig. = 0.002).
Conclusions: The results show a correlation between the presence of
breast cancer and hypertension.
029280
Association between obesity and ductal breast carcinoma in a
population of patients in Salvador
Bertrand, S.A.B.1, Cruso, N.S.D.R.1, Rio, J.A.1, Canguss, R.C.2,
Landeiro, L.C.G.2, Machado, C.A.C.3
1
Escola Bahiana de Medicina e Sade Pblica, Brazil, 2Ncleo de
Oncologia da Bahia, Brazil, 3Ncleo da Mama, Brazil
bertrand.susanne@gmail.com, nathaliacrusoe@gmail.com,
juliana_a_rio@gmail.com, renatacosta@nob-ba.com.br,
landeiro@hotmail.com, cesaracmachado@hotmail.com
Introduction: In recent decades there has been a significant increase
in the prevalence of obesity. According to Ministrio da Sade, about 15%
of the Brazilian population is obese (body mass index 30 kg/m). The
highest concentration of fat cells leads to endocrinemetabolic consequences harmful to the human body. There are significant increases in serum
concentration of insulin, release of inflammatory cytokines, and increased
peripheral conversion of estrogens. All these changes may be related to the
emergence of malignancies, including breast cancer. Therefore, obesity is a
risk factor for the development of cancer and also affects survival in women
with breast cancer.
Objective: The aim of this study is to evaluate the possible correlation
between anthropometric data and breast cancer at a private oncology clinic.
Methods: This was a cross-sectional study including 492 female
patients with pathological diagnosis of invasive ductal carcinoma. Excluded
from the study were patients with insufficient/non-existent anthropometric
data; with a history of prior cancer except non-melanoma skin cancer; with
no previous clinical data of the systemic treatment and without immunohistochemical report. Regarding the anthropometric data body mass index was
analyzed and divided into normal, overweight and obese. Analyses were
conducted with IBM Statistical package for the Social Sciences software
(SPSS, Chicago, IL, EUA) 20.0.
Results: Mean age was 55 years among cases and 50.8 years among
controls. In controls, the proportion of obese people was 17.7% (64).
Among cases, 29.9% of patients (39) were obese. The MannWhitney test
revealed statistical significance (Asymp. Sig = 0.012).
Conclusion: The results show a correlation between the presence of
breast cancer and obesity.
ABSTRACTS
029286
Association between obesity and molecular subtypes of ductal breast
carcinoma in a population of patients in Salvador
Paixo, M.P.S.1, Cruso, N.S.D.R.1, Rio, J.A.1, Almeida, J.M.C.1,
Landeiro, L.C.G.2, Machado, C.A.C.3
1
Escola Bahiana de Medicina e Sade Pblica, Brazil, 2Ncleo de
Oncologia da Bahia, Brazil, 3Ncleo da Mama, Brazil
mirellinha6@hotmail.com, nathaliacrusoe@gmail.com,
juliana_a_rio@hotmail.com, jhon.mascarenhas@hotmail.com,
landeiro@hotmail.com, cesaracmachado@hotmail.com
Introduction: Breast cancer is the most common cancer in women
worldwide. The influence of obesity on the development of this disease
is still controversial. Knowledge of molecular subtypes of ductal breast
cancer (luminal A, luminal B, triple-negative and HER2+) is recent and can
be useful in the planning of treatment and determination of prognosis of
affected patients. Although some subtypes present positive estrogens receptors, there is evidence in the literature showing a relationship between them
and obesity.
Objective: To evaluate correlation between anthropometric data
and the emergence of specific molecular subtypes of ductal carcinoma in
patients at private clinics.
Methods: This was a cross-sectional study including female patients
with a pathological diagnosis of invasive ductal carcinoma. Excluded from
the study were patients with insufficient/non-existent anthropometric data;
with a history of prior cancer except non-melanoma skin cancer; with no
previous clinical data of the systemic treatment and without immunohistochemical report. The subtype classification was: luminal A, luminal B,
HER2+ and triple-negative. The anthropometric body mass index data
were analyzed. Analyses were conducted with IBM Statical package for
the Social Sciences software (SPSS, Chicago, IL, EUA) 20.0.
Results: Of the 492 women analyzed, there were 130 cases. The
median age was 52 years (range 1786 years). In relation to molecular
subtypes, 31 patients were excluded for not having such data. Regarding
the luminal subtype A, 50% were obese; in luminal B subtype, this value
was 24.13%; in triple negative it was 33.33%, and in HER-2 the percentage
overweight was 26.66%. The KruskalWallis test was performed and
showed that P = 0.274, showing no statistical significance, and the evaluation of the Chi-square linear by linear association showed P = 0.473.
Conclusion: No relationship was shown between obesity and molecular subtypes of ductal carcinoma.
029101
Breast carcinomas associated with lung and mediastinal carcinoid
tumors: a five-case report
Silva, F.P.A.1, Camaro, W.R.1, Iyeyasu, H.1, Bevilacqua, J.L.B.1, Curi, C.1
1
AC Camargo Cancer Center, So Paulo, Brazil
feperez01@gmail.com, wrcamarco@msn.com, hiroiyeyasu@hotmail.com,
jose.bevilacqua@accamargo.org.br, ccuri@hotmail.com
Introduction: Carcinoid tumors are differentiated malignant neuroendocrine tumors which represent 2% of lung cancers. It has been reported
that they increase the risk of developing other tumors.
Objective: To report five cases of breast carcinomas associated with
lung/mediastinal carcinoid tumors.
Methods: We identified five patients with carcinoma of the breast
associated with lung/mediastinal carcinoid tumors treated at our Institution
between 1998 and 2014.
Results: Case 1: LMAF, 66 years old, invasive lobular carcinoma
(ILC) of the left breast, luminal A. At staging, a pulmonary node in the
left upper lobe was biopsied and identified as carcinoid tumor. The patient
submitted to a left breast quadrantectomy with sentinel lymph node (SLN)
S91
investigation, and pulmonary segmentectomy. Invasive lobular carcinoma,
01/02 positive SLN, and typical carcinoid tumor with no pulmonary lymph
node involvement were identified. Case 2: CCG, 45 years old, right node
identified during silicone breast implant change. An invasive lobular carcinoma of the breast, luminal B, was identified. A pulmonary node in the
middle lobe revealed a typical carcinoid tumor, in addition to bone metastasis of the breast and another invasive lobular carcinoma, luminal A, in the
left breast. The subject is undergoing chemotherapy. Case 3: LO, 68 years
old, focal asymmetry in left breast, biopsy and resection, treated with
radiochemotherapy for ductal carcinoma. At follow-up, mediastinal node
biopsy revealed atypical carcinoid tumor with progression to the lungs
and bones. Subject died. Case 4: TCS, 72 years old, node in left breast,
submitted to radical modified mastectomy and chemotherapy. At followup, a left pulmonary node was identified, biopsy revealed atypical carcinoid tumor. Currently free of disease. Case 5: JAMF, 53 years old, biopsy
revealed a ductal carcinoma of the left breast. Mediastinal lymph-node
biopsy confirmed carcinoid tumor and malignant paraganglioma. Subject
submitted to palliative care.
Conclusion: There may be an association between pulmonary/mediastinal carcinoid tumors and hormonal breast carcinomas. Further studies are
necessary to confirm this.
029107
Case report: metaplastic carcinoma of heterologous differentiation
area (chondroid and bone) of the breast cancer
Falco, A.C.A.1, Perez, F.1, Tregnago, A.1, Bevilacqua, J.L.B.1, Curi, C.1,
Hirofumi,Y.1
1
AC Camargo Cancer Center, So Paulo/SP, Brazil
carolanacleto_falcao@hotmail.com, feperez01@gmail.com,
tregnago.aline@gmail.com, jose.bevilacqua@accamargo.org.br,
carla.curi22@gmail.com
Introduction: Metaplastic carcinoma of the breast (MCB) is a rare
and aggressive subtype of breast carcinoma and occurs in 0.025% of
tumors. It usually manifests itself as a large, rapidly growing palpable mass,
with high potential for distant metastases however, without lymph-node
involvement. Histological manifestation is heterogeneous and may be of
epithelial and/or mesenchymal elements, in addition to two or three other
subclasses which may also coexist in the tumor. Immunohistochemistry is
compatible with triple-negative status. Treatment varies according to tumor
size, immunohistochemistry and metastases; however, standard treatment
is mastectomy, radiotherapy and chemotherapy. Although there are many
reports on MCB, understanding of it remains limited.
Objectives: Case report of uncommon metaplastic carcinoma of the
breast.
Methods: The case was SERW, a 60-year-old postmenopausal woman
with three pregnancies, three births, no familial history of malignancies,
and with previous breast implants (9 years ago). Upon physical examination, we detected a nodule in the lower medial quadrant of the right breast
measuring 12 x 12 x 8 mm; core biopsy showed a metaplastic carcinoma of
mesenchymal differentiation.
Results: Negative staging for distant metastases; MRI demonstrated
biopsy of the liver corresponding to an adenoma. In March 2015, the
patient underwent a simple mastectomy and sentinel lymph-node investigation. Pathological analysis: metaplastic carcinoma of heterologous
differentiation area (chondroid and bone), histologic grade III, nuclear
grade 3, mitosis index of 17 cells by 10 high-power magnification fields
(score 3).There was a tumor extension of 2.3 x 1.9 cm, ductal carcinoma
in situ, free of invasions, of a solid type, with a 0.3 cm cancerous lobe in
isolated foci of the upper medial quadrant. Margins were free of disease
and there were no positive lymph nodes. Immunohistochemistry: triplenegative status compatible with invasive metaplastic carcinoma, expressive
S92
of basiloid markers. Currently, the subject is on chemotherapy treatment
with no evidence of disease.
Conclusion: We report a rare case of metaplastic carcinoma of the
breast with multidisciplinary treatment.
029315
Comparative analysis of histological grade between primary tumors
and axillary metastasis in breast cancer cases
Pinheiro, A.C.1, Aquino, R.G.F., Pinheiro, L.G.P., Oliveira, A.L. de S.,
Feitosa, L.M.C., Furtado, G.P.
1
GEEON-UFC, Cear, Brazil
agostinhocpinheiro@gmail.com
Introduction: The histological study of breast cancer and its metastases are very usuful when analysing the stage of the disease in each patient.
However, some differences are found when comparing the results between
the primary tumor and its axillary metastasis.
Objectives: To establish the histological grade of axillary metastasis
in cases of invasive ductal breast cancer and to compare the results to the
findings in the primary tumors.
Methods: This was a cross-sectional study evaluating 69 cases of invasive ductal breast cancer, with their respective axillary metastases, coming
from the mastology center of Assis Chanteaubriand Maternity (Ceara,
Brazil). The primary tumor and the metastatic lymph nodes were submitted
to histological processing and, then each of their histological, tubular and
nuclear grades, besides their mitotic index, were determined on the basis of
the ScarffBloomRichardson classification.
Results: The histological grades were, mostly, higher in the primary
tumors, among which 52.2% were classified as grade III. When compared
to primary tumors, the axillary mestastases showed a higher frequency of
histological grade 3 (66.7%), tubular grade (85.5%), nuclear grade (58%)
and mitotic index (58%). The tubular formation was lower on axillary
mestastasis (P = 0.04).
Conclusions: The axillary implants showed a more disorganized tissue
morphology, with less tubular formation when compared to primary breast
tumors. However, the difference in histological grades between the axillary
metastases and the primary breast tumors wasnt seen as significant in these
samples.
028314
Comparison of hospital stay and daily ICU in patients undergoing
conservative and non-conservative breast surgery in oncology in
Brazil
Loula, M.D.S.1, Souza, M.O.1, Santos, A.C.S.1, Barbosa, F.R.A.O.1,
Felicio, S.J.O.1, Peixoto, E.1
1
Escola Bahiana de Medicina e Sade Pblica, Salvador, Brazil
marilialoula@gmail.com, mari19.oliveira@gmail.com,
anacarlasantana13@outlook.com, fernandaranielle@hotmail.com,
saulo-felicio@hotmail.com, edipeima@gmail.com
Introduction: Breast cancer is the second most frequent cancer among
women, and the curative therapy is surgery. The most common surgeries
are segmentectomy/quadrantectomy/setorectomies and simple and radical
mastectomy.
Objectives: To compare hospital stay and ICU use in surgery for the
treatment of breast cancer in SUS.
Methods: The data were obtained from DATASUS page and tabulated by the TabWin program. We selected: RADICAL MASTECTOMY
C/LYMPHADENECTOMY AXILLARY; SIMPLE MASTECTOMY
and SEGMENTECTOMY/QUADRANTECTOMY/SETORECTOMY
OF BREAST, all in oncology. For each selected procedure, data were
ABSTRACTS
obtained as daily presence in the ICU by region and hospital stay by age
group.
Results: Held in Oncology were 8134 segmentectomies/quadrantectomies/setorectomies (SQS) of breast, 7693 radical mastectomies with axillary lymphadenectomy, and 1055 simple mastectomies in SUS in 2014.
Among these procedures carried out daily in ICU was radical mastectomy
with axillary lymphadenectomy with 225 procedures (2.9%) daily in the
ICU, followed in proportion by simple mastectomy with 28 procedures
(2.65%) with the ICU and by SQS of the breast with 32 (0.39%). The
hospital stay of most patients undergoing simple and radical mastectomy
was 2 days, surpassing the SQS, where the majority of patients (42.88%)
stayed only 1 day. In radical mastectomy with axillary lymphadenectomy
the age group with the highest performance of the procedure was 65 years
(28.86%), similar to simple mastectomy, in which 28.86% of the procedures were performed on patients 65 years. But in the SQS, most of the
procedures (26.31%) were performed in patients aged 4554 years.
Conclusions: The segmentectomy/quadrantectomy/setorectomy
of the breast was the most common procedure and the one with shorter
hospital stay, followed by the simple and radical mastectomy. The same
was observed for the use of ICU in proportion to the number of procedures
performed.
028907
Diagnostic performance of preoperative 18F-FDG PET/CT
for assessing pathological tumor response after neoadjuvant
chemotherapy for patients with breast cancer
Andrade, W.P.1, Baiocchi Neto, G.2, Lima, E.N.P.2, Soares, F.A.2,
Osrio, C.A.B.T.2, Bitencourt, A.G.V.2
1
Instituto de OncoMastologia, So Paulo, Brazil, 2A. C. Camargo Cancer
Center, So Paulo, Brazil
wesley.andrade@hotmail.com
Introduction: Breast cancer is the most common malignant neoplasm
in women all over the world, and its treatment is based on surgery even
for advanced disease. The best strategy for LABC treatment is neoadjuvant chemotherapy (NAC). A 65% complete pathological response rate
(pCR) may be obtained after new recent improvements in NAC efficacy
due the use of new drugs; this has implied increased pCR rates, and with
high pCR rates, theoretically, surgery may not be required for patients
whose tumors have been completely eradicated by NAC for optimum local
control. Currently, the challenge is to develop a diagnostic tool capable of
precisely predicting pCR after NAC to try to omit surgery. In this scenario,
PET/CT is a fairly recent imaging tool that may be potentially used after
NAC. Theoretically, a negative PET/CT after NAC should correspond also
to pCR.
Objective: To analyze the role of PET/CT after NAC as a method to
predict pathological response for patients with breast cancer and to correlate
the results with the other pathological variables in the surgical specimen.
Methods: We performed a prospective study that included 73 patients
with either LABC or unfavorable tumor/breast size index that were
submitted to NAC followed by surgery. The surgical specimens were evaluated with the RCB (residual cancer burden) protocol.
Results: Between February 2010 and June 2013, 73 patients entered
the protocol. Median age was 41 years (range 2676) and median primary
tumor size was 55 mm (range 21200). Local staging was: cT2 (39.7%),
cT3 (35.6%), cT4b (17.8%) and cT4d (6.8%). After NAC, complete clinical
response (cCR) was 45.2% (33/73), metabolic complete response (mCR)
61.6% (45/73), and pCR (ypT0 ypN0) was 27.4% (20/73). Seventy patients
were suitable for the RCB protocol, and we found RCB 0 (ypT0-is ypN0)
in 38.6% (27/70), RCB I in 4.3% (3/70), RCB II in 30% (21/70), and RCB
III in 27.1% (19/70). We correlated the PET/CT results with pCR (ypT0
ypN0) and still found a 62% rate of residual tumor in 45 patients who had
ABSTRACTS
mCR, with sensitivity of 85%, specificity of 47%, positive predictive value
of 38%, negative predictive value of 89%, and accuracy of 58%.
Conclusion: PET/CT use after NAC in breast cancer treatment was
not able to accurately predict the absence of residual tumor (complete
pathological response). We found high false-positive response rates, where
even after a negative PET/CT performed after NAC, 62% patients still had
residual tumor.
029235
Granular cell tumor of the breast: a case report
Zanini, L.A.G.1, Cagnacci, R.N.1, Bevilacqua,J.L.1, Petribu, E.F.1,
Fraianella,L.1, Vivas, D.V.1
1
Department of Mastology, AC Camargo Cancer Center, So Paulo, Brazil
lgzanini@hotmail.com,
recagnacci@gmail.com, jose.bevilacqua@accamargo.org.br,
epetribu@gmail.com,lilianfraianella@ig.com.br,drvivasoncologia@gmail.com
Introduction: Granular cell tumors are predominantly benign mesenchymal lesions derived from Schwann cells. They usually appear in the
oropharynx and rarely affect the breast, accounting for 5% of the cases.
They may present as nodules that simulate an invasive carcinoma, requiring
the exclusion of this differential diagnosis. Being a benign lesion, treatment
is simple, consisting of excision with free surgical margins.
Objectives: To report a case of breast granular cell tumor and review
the literature.
Case report and results: We report the case of a 74-year-old asymptomatic female patient. Screening mammography and breast ultrasound
identified a 15 mm breast nodule, classified as BIRADS 4. MRI later
corroborated the suspicion. Percutaneous biopsy showed fibroadipose
tissue with an intense epithelioid cell infiltrate as well as some lymphoid
aggregates, suggestive of granular cell tumor. Due to this unusual result
and the suspicious characteristics of the nodule, excisional biopsy was
indicated. The final pathological examination confirmed the diagnosis of
granular cell tumor, and it was excised with free surgical margins.
Conclusions: Although rare in the breast, proper diagnosis of these
tumors is important because they can mimic malignancy and can lead to
more extensive treatment than is necessary. Excisional biopsy with free
margins is considered the gold standard for definitive diagnosis and treatment. Being a benign lesion, axillary staging and other treatment modalities are unnecessary. Experienced pathologists are important for diagnosing
these lesions.
029310
Hemosiderin: an organic iron as marker in the lymph-node staging of
breast cancer in MRI
Pinheiro, A.C.1, Pinheiro, L.G.P., Vasques
P.H.D., Furtado, G.P., Lima, L.M., Filho, L.C.O.
1
GEEON-UFC, Cear, Brazil
agostinhocpinheiro@gmail.com
Introduction: Early detection and treatment in the initial phase
of breast cancer are important measures. With sentinel-node biopsy, its
possible to ensure means for proper staging of the illness and the therapeutic approach. However, there are some methods that are controversial,
such as the use of vital blue dye which may cause severe hypersensitivity
reactions. Because of this, it is important to study new markers.
Objectives: To evaluate the role of hemosiderin as a marker in the
staging of breast cancer in MRI.
Methods: This was an observational clinical study prospective,
non-randomized from October 2011 to September 2013; 14 women with
breast cancer from the mastology service of Walter Cantidio University
S93
Hospital, aged <70 years with early-stage (T1/T2) and clinically negative axilla, were the subjects. Blood (10 mL) collected from the patients
24 hours before surgery underwent threefold dilution and centrifugation,
leading to complete hemolysis; a homogeneous solution hemosiderin base
was thus obtained. Four millilitres of the solution was injected subareolarly
in the patients breast. On average 2 hours before surgery, the patient underwent MRI of the bilateral breasts and armpits. After examination, technetium-99 was injected subareolarly for sentinel lymph-node identification
and the patient was referred to the operating room, anesthetized and operated by the conventional approach to sentinel-node biopsy.
Results: 100% (14/14) were observed in the studied lymphangiography breast side. The identification rate of axillary lymph nodes (LA)
contrasted with MRI by hemosiderin was 100% (14/14) in the exams. In
contrast, the average LA with MRI was 1.5 lymph nodes. In two cases
(2/4 cases) of positive axillary lymph-node histopathology, the MRI image
suggested neoplastic colonization of marked lymph node.
Conclusions: Hemosiderin identifies the anatomical image lymphatic
system, the armpit lymph nodes and internal mammary, revealing an efficient contrast which is secure; this opens the prospect of the assessment of
axillary state imaging.
028858
HER-2-positive breast cancer: analysis of 55 cases
Esteves, F.V.C.S.1, Furtado, L.B.1, Nascimento, M.F.C.L.1, Lima, R.K.B.1,
Moura, L.N.M.1, Vieira, S.C.2
1
Department of General Clinic, Federal University of Piau, UFPI,
Teresina, Brazil, 2Oncology Clinic, Oncocenter, Teresina, Brazil
flaviavanessaesteves@hotmail.com,
luanbf93@gmail.com, mathfernando@outlook.com,
rayssakarla16@hotmail.com,du-loren@hotmail.com,sabas.vieira@uol.com.br
Introduction: The clinical behavior of triple-negative breast cancer
is typically more aggressive than other tumors in the breast, with lower
survival rates similar to HER-2-positive patients.
Objectives: To assess the epidemiology and clinical aspects in patients
with triple-negative breast tumor.
Methods: Observational, retrospective, and descriptive methods
involving breast cancer patients with triple-negative breast cancer treated in
clinic at Teresina-PI between the years 2001 and 2010. The aspects evaluated were: age, family history, histopathology, treatment, subsequent events
and social factors.
Results: Of the 18 patients analyzed, 16.67%, 33.33% and 50.00%
were, respectively, 40 years, between 40 and 60 years and >60 years
of age. Regarding family history of breast cancer, one had a first-degree
relative and three had second-degree relatives. In matters of histological
aspects, tumor size averaged 2.69 cm; there was one isolated case of metaplastic tumor and another of Pagets disease of the breast. Of the rest,
83.33% were infiltrating ductal carcinoma; 66.67% were grade 3; 63.63%
had negative lymph-node status, and 36.36% positive; 38.89% were stage
IV; 11.11% were treated with hormone therapy (100%, tamoxifen), 61.11%
used chemotherapy and 55.56% radiotherapy. None of the patients in stage
IV relapsed or died, but 22.22% of the remainder did so. None reported
alcoholism or smoking, but 11.11% had diabetes mellitus and 33.33% had
arterial hypertension.
Conclusion: There was a predominance of women over 60 years of
age, with infiltrating ductal carcinoma grade 3 and with a bad prognosis
(death, relapse or stage IV), with negative lymph-node status, treated with
radiotherapy and chemotherapy only. Social factors were not evaluated.
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029320
Invasive ductal carcinoma: correlation of pathological findings and
age in cases
Furtado, G.P.1, Aquino, R.G.F.1, Pinheiro, L.G.P.1, Oliveira, A.L.S.1,
Oliveira, B.M.K.1, Barros, K.S.1
1
Saul Goldenberg Experimental Surgery Laboratory, Department of
Surgery, Faculty of Medicine, Federal University of Cear, Fortaleza,
Brazil
gabriel.pinheiro@msn.com
Introduction: Breast cancer, as other neoplasias, is a disease originating from an uncontrollable multiplication of abnormal cells; it is the
most common malign tumor and the major cause of death by cancer among
women worldwide after skin cancer. In Brazil, the scenario is the same,
mostly because of late diagnosis, which leads to a worse prognosis. This is
a longstanding issue that deserves a thorough study.
Objectives: To analyze the morphological characteristics of the breast
invasive ductal carcinomas in women above and below 50 years of age.
Methods: 302 cases of ductal carcinoma from the service of
Mastology of the Walter Cantidio University Hospital, from 2005 to 2014,
aged 50 years and >50 years were studied. The following morphological
characteristics were analyzed: major diameter of the tumor, presence of
axillary metastasis and histological grade.
Results: The average age of the patients was 55.6 years. The average
size of the tumors was 3.4 cm; 40% of the tumors had a diameter 2 cm and
60% >2 cm. Histologically, 23.7% were grade I, 32.1% grade II and 42%
grade III. Of the cases, 66% presented axillary metastasis and 34% did not.
Women above 50 years of age presented more grade III tumors (P = 0.002)
and had tumors more than 2 centimeters in diameter (P < 0.001). The presence of metastasis predominated in both age groups when analyzed separately (P < 0.001).
Conclusions: Women above 50 years of age presented larger tumors
with more undifferentiated morphology. Women aged 50 years old
presented less well differentiated tumors. There was no morphological
difference between the two groups when compared with each other.
029323
Latissimus dorsi and pectoralis major advancement flaps a new
option to prevent axillary retraction after axillary lymphadenectomy
Andrade, W.P.1
1
Instituto de OncoMastologia, So Paulo, Brazil
Introduction: Classically, the standard axillary lymphadenectomy
may cause soft tissue retraction in the axillary scar. With the advent of new
knowledge about cancer biology, personalized therapy and surgical techniques, patients have achieved higher cure rates and are living longer and
better. One example is the current scenario of treatment of breast cancer in
which, through oncoplastic surgery techniques, the surgeon can minimize
esthetic defects. In selected cases it is possible to improve esthetic results
during oncological procedures. From this perspective, surgery may offer
patients treatments with minor changes in quality of life, preserving body
self-image. In this scenario, we perceive that patients were satisfied with
breast surgery but were unsatisfied with axillary surgery because retraction
in the axillary area reduces shoulder motion besides causing poor esthetic
outcomes. To try to solve this problem we have developed a new technique
to minimize the axillary retraction.
Objective: To describe a new technique with the latissimus dorsi and
pectoralis major advancement flaps.
Methods: The technique consists in performing, at the end of axillary
dissection, an advancement of the latissimus dorsi (LD) muscle and pectoralis major (PM) muscle (advancement muscle flap). In this technique, we
ABSTRACTS
find the anterior border of the LD and the subcutaneous tissue is separated
from the LD for about 5 cm toward the back and about 58 cm distally.
After this, we find the lateral border of the PM, and the breast tissue is separated from the PM for about 35 cm toward the breast and about 58 cm
distally. We mobilize both muscle flaps and make a suture with a U-stitch
to close the axillary region with both muscles. With this we create a muscle
shield between the skin flap and the thoracic wall (medially) and the axillary vein (superiorly) to avoid or minimize the axillary retraction. We insert
a drain as usual and perform the axillary skin closure.
Results: This technique was performed with good functional and
cosmetic results and to the great satisfaction of patients.
Conclusion: This technique provides esthetic and functional gain for
the patients.
029084
Lymph-node positivity in ten or more dissected pieces: clinical and
epidemiological aspects
Esteves, F.V.C.S.1, Guimares, R.B.1, Albuquerque, D.M.G.1,
Nascimento, M.F.L.C.1, Lima, R.K.B.1, Vieira, S.C.2
1
flaviavanessaesteves@hotmail.com, ruggeriguimaraes@gmail.com,
dennyse_13@hotmail.com, mathfernando@outlook.com,
rayssakarla16@hotmail.com, sabas.vieira@uol.com.br
Introduction: Lymph-node status is more an expression than a determinant of poor prognosis, and it is widely observed that most patients with
positive status have a lower overall survival than those with negative status.
Objective: To assess the epidemiology and clinical aspects of patients
with breast cancer patients presenting ten or more positive lymph nodes.
were used with breast cancer patients having ten or more positive lymph
nodes treated in clinic at Teresina-PI between the years 2001 and 2010.
The aspects evaluated were: age, family history, histopathology, adopted
therapy, biomarkers and subsequent events.
Results: Nine patients attended. The average age was 59.78 years,
ranging from 36 to 85 years of age. Only one patient had a family history
of breast cancer. The average tumor size of the major axis was 4.28 cm,
the largest of these was 8 cm and the lowest 2 cm. Histologically, 66.67%
were infiltrating ductal carcinoma, 11.11% were mucinous carcinoma, and
22.22% infiltrating lobular carcinoma; 25%, 37.50% and 37.50% were,
respectively, grades 1, 2 and 3 degrees of differentiation. As for treatment, 88.89% underwent chemotherapy, 66.67% radiotherapy and 77.78%
tamoxifen. Regarding biomarkers, HER-2 was negative (eight registered)
in 75.00%; Ki-67 was positive in 55.56% (60.00%, 60.00%, 40.00%,
10.00%); the estrogen receptor (ER) was positive in 100.00% (eight registered) and the progesterone receptor (PR) was positive in 75.00% (eight
recorded). Subsequently, 44.44% evolved with distant metastases, 22.22%
with death, 11.11% with relapse and 11.11% with paraneoplastic syndrome.
Conclusion: The positive lymph node status in 10 or more lymph
nodes was more common in women 60 years of age, without a family
history, with infiltrating ductal carcinoma, grade 2 or 3, treated with chemotherapy, radiotherapy and tamoxifen; HER-2 was negative in 75.00%,
Ki-67 in 55.56%, ER in 100.00% and PR positive in 75.00%.
ABSTRACTS
029225
Malignant phyllodes tumor of the breast with epithelial cells in a
young woman
Carvalho, L.H.1, Moreira, R.P.1, Abade, B.1, Botaro, V.1, Lombardi, W.1
1
Santa Casa de Araraquara, Araraquara/SP, Brazil
luishenc@ig.com.br, raquelpmoreira@hotmail.com, brabade@gmail.com,
penelope_vivi@yahoo.com.br, wellom@terra.com.br
Introduction: Phyllodes tumor is an uncommon tumor which is
biphasic, composed of epithelial and stromal elements; it occurs mainly
in middle-aged to elderly women, but can occur at any age. The epithelial
part is mostly benign, but it has been shown that both the stroma and the
epithelium can exhibit distinct molecular changes, suggesting that both are
part of the malignant neoplastic process.
Objectives: This study reports on a young woman (22 years old) with
malignant epithelial change within a malignant phyllodes tumor, probably
a metaplastic carcinoma that arose from a phyllodes tumor.
Methods: NV, female, 22, was referred to the Oncology Department
50 days after lumpectomy, with a palpable mass of 6.0 x 6.0 cm in the right
breast. Biopsy showed a phyllodes tumor which was histologically malignant, high grade, with a positive margin. Immunohistochemistry revealed
cytokeratin expression, P63 protein, S100 protein, CD34 and desmin. The
case was sent to Mount Signal Medical Center, New York, USA; the diagnosis was a malignant phyllodes tumor with a malignant epithelial component. The case was treated with a total mastectomy and intraoperative
frozen sentinel lymph node. The new biopsy showed a histologically malignant high grade with a carcinomatous malignant epithelial component.
Results: The patient was referred to adjuvant radiotherapy and chemotherapy. During the radiotherapy local disease progression occurred, with
a palpable mass at the sternum and a left supraclavicular lymph node.
Chemotherapy was conducted with ifosfamide 1.8 mg/m2 D1 to D5 and
doxorubicin 25 mg/m2 D1 to D3, every 21 days, for 5 cycles. The response
to treatment was poor.
Conclusions: The incidence of breast carcinoma in phyllodes tumor is
about 12%, and most are infiltrating ductal carcinoma and lobular carcinoma in situ, especially in the fifth or sixth decades of life. According to the
literature, this is the youngest patient case reported with malignant association between phyllodes tumor and malignant breast carcinoma.
028851
Metastatic breast cancer of kidney. A case report.
Filho, R.L.M.1, Morais, R.A.1, Carvalho, A.M.1, Caldeira, J.R.F.1,
Paloschi, J.R.A.1, Joioso, A.1
1
Amaral Carvalho Hospital, Brazil
raulfilho_26@hotmail.com, rafaelamoraisgo@hotmail.com,
andremcar@gmail.com, jrfcaldeira@gmail.com, jaulermasto@uol.com.br,
joiosomasto@uol.com.br
Introduction: After treatment of breast cancer, especially in the first
5 years, approximately 10% of breast cancers have some kind of relapse.
The most common sites of metastases are: bones, lungs, liver, brain, ovaries
and skin. Renal metastasis is very infrequent, and the few data reported in
the literature reveal infiltrative lobular as the most common histological
subtype sending cells to this organ. If a single lump the treatment is surgical,
with adjuvant chemotherapy and radiotherapy as a complement to surgery
for residual lesions or infiltration of unresectable adjacent structures.
Objectives: The goal is to demonstrate that renal metastasis from
breast cancer is rare, but exists, and also the importance of differential diagnosis with kidney cancer.
Methods: We decided to expound an interesting case report.
Results: We present the case of a woman 63 years of age with a history
of left breast cancer of invasive lobular type (pT2N1M0, pIIb) treated
S95
7 years ago (radical mastectomy with left axillary lymphadenectomy
and adjuvant chemotherapy, radiation and hormone therapy). The patient
was well, with no evidence of active disease when, during follow-up, an
abdominal CT showed a small cortical solid nodular exophytic mass in the
upper pole of the left kidney. She was referred to the Urology Department
at Amaral Carvalho Oncologic Hospital for better evaluation. After a new
cancer screening did not show any other change, excision of the left renal
lesion was performed with pathology which showed infiltration by metastatic carcinoma, probably from lobular breast, which was confirmed by
immunohistochemical examination.
Conclusions: We conclude that renal metastasis of breast cancer
is rare, but should always be considered in patients with renal masses in
imaging and a previous history of breast cancer, especially when of the
histological invasive lobular type.
028850
Metastatic breast cancer of stomach: a case report
Carvalho, A.M.1, Morais, R.A.1, Campos, R.A.1, Caldeira, J.R.F.1,
1
andremcar@gmail.com, rafaelamoraisgo@hotmail.com,
ricardorac2@gmail.com, jrfcaldeira@gmail.com, jaulermasto@uol.com.br,
Introduction: The most common sites of breast cancer metastases are
bone, lung, liver, brain, ovary and skin. Gastric metastases are rare and little
reported in the literature, with breast cancer the second main cause behind
melanoma. Dyspepsia and melena are the most common complaints. Upper
digestive tract endoscopy (UDE) often shows predominant diffuse intramural infiltration in tumors of the lobular type. The prognosis is poor, since
metastatic disease is rarely limited to the stomach. Treatment is palliative
and includes chemotherapy, hormonal therapy and radiotherapy.
Objectives: To describe a rare case of gastric metastasis of breast cancer
and the differential diagnosis with dyspeptic disorders and dysphagia.
Methods: We decided to expound an interesting case report.
Results: The case was a 74-year-old woman with dysphagia, vomiting
and weight loss. She had never undergone mammography or mammary
USG and denied having breast symptoms. She was submitted to the UDE,
which showed diffuse intramural infiltration in the stomach, with biopsyconfirmed gastric adenocarcinoma that was poorly differentiated, diffuse
and infiltrative, consistent with metastasis probably of breast cancer origin.
The clinical examination showed up an ulcerated, mobile tumor in the left
superior-lateral quadrant, measuring 6.5 x 4.5 cm, with dermal infiltration by 50% breast, and hard ipsilateral enlarged axillary lymph nodes. A
biopsy of the lesion confirmed the hypothesis of an infiltrating ductal carcinoma, and immunohistochemistry showed positive for hormone receptors
(estrogen and progesterone) and negative for HER-2. Systemic screening
revealed the coexistence of diffuse bone metastases without other secondary
outbreaks. The final stage was T4bN1M1, stage IV. She was referred to the
Clinical Oncology Department at Amaral Carvalho Oncologic Hospital and
started on palliative chemotherapy.
Conclusions: Gastric metastasis of breast cancer is rare and increases
morbidity in patients with breast cancer. It should be considered in the
differential diagnosis of cancer patients with dyspeptic complaints, especially if persistent and when the most common causes have been excluded.
S96
028384
Palliative limb amputation for advanced breast cancer
Furtado, J.P.R.1, Laporte, G.A.1, Barros, E.D.1, Schnor, O.H.1,
Correa, L.H.L.2, Leonardi, L.A.2, Conterno, J.2, Polo, R.2, Zoletti, F.2
1
Servio de Cirurgia Oncolgica do Hospital Santa Rita da Irmandade
da Santa Casa de Misericrdia de Porto Alegre, Brazil, 2Servio de
Cirurgia Oncolgica do Hospital Santa Rita da Irmandade da Santa Casa
de Misericrdia de Porto Alegre e Universidade Federal de Cincias da
Sade de Porto Alegre, Brazil
Introduction: Breast cancer is the most frequent malignant pathology
in women. There are several treatment modalities. Amputation is indicated
in advanced breast cancer when the lesion involves the axillar neurovascular bundle. Since diagnosis is generally made in the initial stages, amputation has become an exception.
Objectives: To report a case of advanced breast cancer treated with
limb amputation, and to perform a review of literature.
Methods: This is a case report of an advanced breast cancer treated
with limb amputation due to a large lesion involving axillar neurovascular
bundle; the intervention was carried out by the Surgical Oncology Service
of Hospital Santa Rita of Irmandade da Santa Casa de Misericrdia de
Porto Alegre.
Results: We describe a 47-year-old woman with a nodule in her left
breast and axillary region with 2 years of evolution. After this period, she
arrived at this service and a thoracic CT scan was performed. It showed
a giant vegetative and ulcerated lesion measuring 10 cm in diameter,
compromising the axillary region. She was then submitted to neoadjuvant
chemotherapy with no result; instead, her lesion evolved with myiasis. At
this point, for palliative and hygienic treatment, surgical resection was
performed: radical mastectomy with left limb amputation. The postoperative period was good, despite infection of the wound incision and necrosis
of the skin flap used for the reconstruction. The pathological exam demonstrated a poorly differentiated carcinoma.
Conclusions: Amputation as a palliative treatment for advanced breast
cancer is an exception. It is a radical and hygienic treatment, rarely curative, and it will not modify survival expectancy.
029109
Primary carcinoma of accessory breast in a young patient: a case
report
Camacho, A.T.C.U.1, Falco, C.A.F.2, Henrique, M.D.2, Vilar, C.F.2
1
Medical breast cancer specialist and professor at the Faculdade de
Medicina Nova Esperana and UFPB, Joo Pessoa, Paraba, Brazil,
2
Student of the Faculdade de Medicina Nova Esperana, Joo Pessoa,
Paraba, Brazil
camillafranca@hotmail.com, marina_dantas_@hotmail.com,
cris7vilar@hotmail.com
Introduction: The accessory breast is characterized by the presence of
ectopic breast glandular tissue, a result of an embryologic failure where the
tissue undergoes hormonal action.
Objectives: To describe a rare case of primary carcinoma of accessory
mammary gland in a young patient.
Methods: For this study data collection was conducted on patient
information, laboratory tests and literature review; the databases were
PubMed and Scielo.
Results: MLOA, 35 years old, female, first-degree family history of
breast cancer, presented in October 2013 with a large mass of about 15 cm
in the right axillary region. A thick-needle biopsy was requested, and this
showed a diagnosis of infiltrating ductal carcinoma. The investigation was
completed with mammography, ultrasonography and MRI of the breast,
which did not show neoplastic lesions. In the immunohistochemistry of the
ABSTRACTS
accessory mammary gland, the receptor status was triple-negative (ER,
RMP, HER2). She began treatment with neoadjuvant chemotherapy,
resulting in complete regression of the tumor. There followed nipplesparing mastectomy and complete axillary lymphadenectomy associated
with breast reconstruction with the immediate latissimus dorsi muscle and
breast implant. Of the 13 lymph nodes resected, two had metastases on
pathology. With satisfactory recovery after surgery, she was referred for
radiotherapy. In the course of radiotherapy, the patient noticed a small
lesion in the right breast and a lump in the armpit on the same side. On
completion of radiotherapy in January 2015, she returned after 3 months
for routine examination when a lesion in the armpit suggested locoregional
recurrence. There was new needle biopsy, which confirmed relapse, and
again the patient was subjected to surgery with confirmatory pathology of
infiltrating ductal carcinoma.
Conclusions: This case is relevant to the scientific community because
she is young, with triple-negative infiltrating ductal carcinoma in accessory
breast tissue, and the tumor recurred during radiotherapy treatment.
029274
Primary granulocytic sarcoma of the breast in teenager: diagnostic
and surgical approach
Dias, I.S.1, Oliveira Jr, E.P.2, Diz, F.L.2, Colturato, M.2, Carvalho, G.T.2,
Teshirogi, E.Y.2
1
Intituto Arnaldo Vieira de Carvalho, So Paulo, Brazil, 2GPACI-Grupo de
Pesquisa e Assistencia ao Cancer Infantil, Sorocaba, Brazil
dias.ivana@gmail.com,
elverciojr@gmail.com, falediz@hotmail.com, mateuscolturato@gmail.com,
guitorso@hotmail.com, oncoelson@gmail.com
Introduction: Granulocytic sarcoma (GS) is an uncommon solid tumor
composed of aggregates of immature granulocytic precursors in extramedullary sites. The lesion generally occurs during the natural course of acute
myelogenous leukemia or after remission has been achieved. Primary GS
occurs commonly in skin and lymph nodes. The breast has been reported to
be an uncommon site for GS. Misdiagnosis is therefore common.
Objectives: We report a rare case of breast granulocytic sarcoma.
Methods: Case report.
Results: We report on a rare case of granulocytic sarcoma presenting
as a mass without concomitante acute myeloid leukemia in an 18-year-old
teenager. The patient was admitted to the hospital due to a mass in the
breast, confirmed by immunohistochemistry to be primary granulocytic
sarcoma which was CD45RB+,PD7/26/16-2B11+. Myelography of the
central nervous system showed no anomalies. Ultrasound studies showed
homogeneously hypoechoic areas with well- or ill-defined margins.
Mammographic images showed irregular edges, with increased stromal
density and not associated with microcalcifications compared to the soft
tissues surrounding it. The protocols had been started with daunorubicin,
arabinosideC and etoposide. Months later, the patient submitted to lumpectomy of the changed site shown in the ultrasound after chemotherapy. The
histopathology suggested a complete remission.
Conclusion: Despite the mass being localized, it is a hematological
systemic disease and thus should be treated accordingly. This case also
illustrates that careful histopathological review along with an expanded
panel of immunohistochemistry is extremely important for recognizing
such cases, as misdiagnosis can lead to unnecessary surgery and inappropriate therapy, as described in some reports.
ABSTRACTS
028906
Radical surgical treatment for infraclavicular recurrent breast cancer
with vascular involvement
Andrade, W.P.1, Doi, M., Iyeyasu, H., Bomfim, G.A.Z., Pignataro, B.S.,
Yazbek, G., Nishinari, K., Costa, F.DA., Baiocchi, G.
1
Instituto de OncoMastologia, So Paulo, Brazil
Introducion: Vascular involvement is a rare event in breast cancer and
is usually related to regional recurrence involving infraclavicular lymph
nodes. In the absence of distant metastatic disease, selected patients may
undergo local control and may potentially be cured after a complex surgical
oncology procedure that includes complete en-bloc resection with negative
margins.
Objectives: To describe a case series of patients with locoregional
recurrent breast cancer who were submitted to radical surgical resection.
Methods: We retrospectively reviewed a series of four patients treated
in A.C. Camargo Cancer Center; these patients developed locoregional
recurrence and were submitted to radical surgical resection that included the
axillary and/or subclavian veins. The hospital records were reviewed and
a descriptive analysis of the clinical/pathological variables was performed.
Results: All patients received en-bloc resections that included the
axillary and subclavian veins, and underwent venous reconstruction
with saphenous graft. All patients had vascular graft thrombosis or acute
lymphedema. Late lymphedema occurred only in the patient who developed a second axillary recurrence. The median follow-up after the salvage
surgery was 15.1 months. Disease recurred in two out of the four patients.
One had another local recurrence and pulmonary metastatic disease. The
other patient had only systemic recurrence (skin, bone and peritoneum).
Regarding locoregional disease, three of the four patients had no locoregional recurrence and two (50%) were still alive without evidence of
disease.
Conclusion: En-bloc resection of breast cancer recurrence with
vascular involvement is feasible for selected cases and may improve locoregional control.
029221
Retrospective evaluation of patients with neoplasia submitted to
mastectomy in Salvador, Bahia, from 2008 to 2014
Freitas, V.F.1, Strappa, G.B.S.2, Jesus, M.S.3, Matos, R.M.1, Amaral, J.B.4
1
Medical student, Federal University of Bahia, Salvador, Brazil, 2Nursing
student, Federal University of Bahia, Salvador, Brazil, 3Speech student,
Federal University of Bahia, Salvador, Brazil, 4Department of Community
Nursing, Federal University of Bahia, Salvador, Brazil
vdefritas@gmail.com, giorgiabruna-2006@hotmail.com,
mariazuos@live.com, rayza_matos@hotmail.com,
julianabamaral@yahoo.com.br
Introduction: Breast cancer (CA) is the most common neoplasia in
the female population worldwide, being one of the most frequent cancers
in women in the Northeast region (36.74/100 mil). Aging, factors related
to womens reproductive life, and familial history of breast cancer are risk
factors for its development.
Objective: To describe the clinic profile of patients with neoplasia
submitted to mastectomy in Salvador in the period 20082014.
Methods: We used data from Sistema de Informao sobre
Hospitalizao (SIH/SUS) about patients with neoplasia submitted to
mastectomy between 2008 and 2014 available in data bank: DATASUS.
Data were standardized by age, sex, perioperative death, cross infection,
lymphadenectomy associated with mastectomy, and days of internment
from 2008 to 2014 in Salvador/BA.
S97
Results: We found a decrease in performance of radical mastectomy
in patients with neoplasia from 2008 (n = 133; 27.8%) to 2014 (n = 41;
8.6%). The procedure was carried out much more often in women than in
men (31:1). The age range was most commonly 40 (n = 414; 86.6%), in
particular between 45 and 49 years old (n = 77; 18.6%). Nine more radical
mastectomies with lymphadenectomy were carried out than simple mastectomies without lymphadenectomy. Only one patient died following the
surgery. Days stay in internment were generally 2 (n = 276; 57.7%) and 3
(n = 105; 22%). Cross infection did not occur in any case.
Conclusion: The prevalence of mastectomy in women older than
40 years may indicate age as a risk factor. The reduction in mastectomy
rate could be associated with screening strategies which result in earlier
diagnosis and prevention of breast cancer.
028083
The glycogen-rich clear-cell carcinoma of the breast: a case report
Fermino, A.L.1, Crozzera, A.C.P.1, Silveira, A.L.1, Gabriel, T.C.2,
Perdomo, R.A.1
1
Department of Mastology, Cancer Hospital of Barretos, Barretos, Brazil,
2
Department of Pathology, Cancer Hospital of Barretos, Barretos, Brazil
andrefermino@yahoo.com.br, carolinacrozera@msn.com,
jathaygoyas@globo.com, rperdomo@bol.com.br
Introduction: Clear-cell carcinoma rich in glycogen (GRCC) is an
extremely rare tumor, its incidence being about 13% of all breast cancers.
The tumor has distinct morphology, different from that of other breast
cancers. The tumor cells are moderately to highly pleomorphic, with cytoplasm that is clear in over 90% of cells and finely granulated in some. The
nuclei tend to be hyperchromatic with aggregated chromatin and prominent nucleoli. In general, the light breast carcinoma cells tend to follow an
aggressive clinical course with poor prognosis related mainly to the positive lymph nodes (>10).
Objective: To report a case of glycogen-rich clear-cell carcinoma
in breast presenting initially with right axillary lymphadenopathy, and to
show their characteristic clinical, pathological and immunohistochemical
properties.
Methods: We present the case of a 38-year-old woman with a right
axillary node that, after excision, was found to be a metastatic carcinoma of
unknown origin, with standard clear cells. The immunohistochemical profile
suggested metastatic carcinoma, the probable primary site being breast or
kidney (estrogen-receptor-positive, positive renal-cell carcinoma marker). A
CT scan showed no significant findings in either kidneys or other places. On
breast ultrasound, two nodes in the upper quadrants were found, 1.1 cm and
1.2 cm, with others; both suspected BIRADS 5. Radical mastectomy (with
axillary dissection) and immediate breast reconstruction were performed.
The final pathological report described a glycogen-rich clear-cell carcinoma
2.2 cm, free margins and 23 negative lymph nodes (pT2 pN1a: IIB). In this
case, cells were cuboidal, arranged with defined contours into nests and
trabeculae in a solid pattern; the cytoplasm was clear in more than 90% of
the tumor and some cells had fine granular cytoplasm. The immunohistochemical staining was similar to ductal NOS and was positive for estrogen
markers, mammaglobin (rare cells), EST/GCDFP-15, Pan cytokeratin
AE1-AE3, epithelial membrane (EMA) and RCC (renal-cell carcinoma). The
patient had a good recovery and is undergoing adjuvant therapy.
Conclusion: To distinguish GRCC from other clear-cell tumors
lipid-rich carcinoma, carcinoma histiocytoid, adenomyoepithelioma,
hidradenoma clear-cell carcinoma and metastatic cell (renal origin) associated with histological features on specific staining (PAS, also in combination with diastase and Alcian Blue) and immunohistochemistry. Because
this is a rare tumor, more studies with long follow-up will lead to better
specific management.
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028857
Triple-negative breast cancer: clinical and epidemiological profile
Esteves, F.V.C.S.1, Furtado, L.B.1, Guimares, R.B.1, Moura, L.N.M.1,
Albuquerque, D.M.G.1, Vieira, S.C.2
1
flaviavanessaesteves@hotmail.com,
luanbf93@gmail.com, ruggeriguimaraes@gmail.com,
du-loren@hotmail.com,dennyse_13@hotmail.com,sabas.vieira@uol.com.br
Introduction: The clinical behavior of triple-negative breast cancer
is typically more aggressive than other tumors in the breast, and has lower
survival similar to HER-2+ patients.
Objectives: To assess the epidemiology and clinical aspects in patients
with triple-negative breast tumor.
were used, involving breast cancer patients with triple-negative breast
cancer treated in clinic at Teresina-PI between the years 2001 and 2010.
The aspects evaluated were: age, family history, histopathology, treatment,
subsequent events and social factors.
ABSTRACTS
Results: 18 patients were analyzed. These were aged 40 years
(16.67%), 4060 years (33.33%) and >60 years (50.00%). Family history
of breast cancer included a first-degree relative (one patient) and a seconddegree relative (three patients). Histologically, tumor size averaged 2.69
cm; there was one isolated case of metaplastic tumor and another of Pagets
disease of the breast, and 83.33% were infiltrating ductal carcinomas. Of
the latter, 66.67% were grade III, 63.63% had negative and 36.36% positive lymph-node status, and 38.89% were stage IV; 11.11% were treated
with hormone therapy (100% tamoxifen), 61.11% used chemotherapy, and
55.56% radiotherapy. None of the patients in stage IV reported relapse or
death, but overall 22.22% did so. None reported alcoholism or smoking, but
11.11% had diabetes mellitus and 33.33% had arterial hypertension.
Conclusion: There was predominance of women over 60 years of age,
with infiltrating ductal carcinoma grade III and with a bad prognosis as in
death, relapse or stage IV, with negative lymph-node status, and treated
with radiotherapy and chemotherapy only; none of the social factors was
evaluated.
ABSTRACTS
Cancer of the esophagus and stomach

027305
Abrikossoff esophageal tumor: report of two cases resected by
endoscopy
Fermino, A.L.1, Roriz-Silva, R.2, Marinho-Fermino, N.C.3
1
Surgical Oncology resident of Barretos Cancer Hospital, Barretos, Brazil,
2
Surgeon Digestive the Ary Pinheiro Base Hospital, Porto Velho, Brazil,
3
Medical Hospital Santa Casa de Musericrdia de Barretos, Barretos, So
Paulo, Brazil
andrefermino@yahoo.com.br
Introduction: The Abrikossoff tumor has as its origin cells of the
granular layer of the coating epithelium. It is a rare benign tumor but may
have malignant behavior in 3% of cases. Various body sites including the
skin can be primary sites of this type of tumor. The tumor is identified
casually at endoscopy as a polypoid lesion, sessile, with smooth mucosa
and yellow color, and of varying size. Some studies have shown a strongly
positive immunohistochemical reaction to S-100 protein and neurospecific
enolase found in the cytoplasm; these are specific markers for Schwann
cells, supporting the generally accepted hypothesis of a neural origin. If
the polyp is >4 cm in diameter, it may be suspected of being a malignant
lesion, with rapid growth, invasion of surrounding tissues, and metastasis to
regional or distant lymph nodes. Furthermore, the increased presence of the
markers p53.3 and Ki-67 (nuclear proliferation marker) is associated with
an aggressive clinical course and malignant behavior.
Objective: To report two cases of Abrikossoff tumor resected endoscopically and uneventfully, establishing a parallel with previous reports
of this specific tumor.
Methods: We present the first case of a 59-year-old woman who had
complaints of heartburn and mild recurrent epigastric pain, diagnosed as
hiatal hernia by a gastroenterologist. Endoscopy showed an elevated sessile
lesion (raised approximately 8.0 mm) in the distal esophagus; material from
this was collected for histopathology. Histopathology revealed the lesion as
an esophageal gland cell tumor. A new endoscopy with polypectomy was
carried out and the sample sent to pathology. The second case was a woman
of 44 years with symptoms of dyspepsia and heartburn progressing to mild
dysphagia to solids. Endoscopy showed yellowish elevated lesion with a
central depression of approximately 12 mm not adherent to deep planes
in the transition gastric esophagus. Polypectomy revealed a pathological
tumor of glandular cells of the esophagus. Both cases were confirmed with
a strongly positive immunohistochemical reaction to S-100 protein.
Conclusions: The glandular cell tumors are lesions that can affect
various parts of the body, and in the case of the esophagus differential diagnosis with other submucosal lesions should be made. Endoscopic resection
is the first line of treatment for tumors <2 cm; tumors <1 cm should be
monitored with endoscopy, making use of endoscopic US.
029164
A case of prone esophagectomy
Firmino, N.L.J.1, Miranda, P.H.D.2, Miranda, E.2, Teixeira, W.G.1,
Costa, F.C.R.3, Soares, M.C.1, Almeida, M.M.1, Ramalho, W.C.1,
Gomes, A.S.A.2
1
Oswaldo Cruz Hospital, Pernambuco University, Recife, Brazil,
2
UNIONCO, Surgical and Clinical Oncology Institute, Recife, Brazil,
3
League of Oncology of Pernambuco, Brazil
nflj_@hotmail.com, mirandaphd@hotmail.com, emiranda.onco@
gmail.com, letowgtmed@gmail.com, fernandacecile@hotmail.com,
marianacs_5@hotmail.com, marcella.markman13@gmail.com,
drwcramalho@gmail.com, alexandre.unionco@gmail.com
S99
Introduction: Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo surgery in cases requiring resection of the
esophagus and the surrounding lymph nodes; this is because of the associated advantages of good exposure of the surgical field and ergonomic
considerations for the surgeon. However, no one approach is suitable for all
patients requiring extensive lymphadenectomy.
Objectives: To describe a case of esophagectomy in prone position.
Methods: The patient had been followed since 2006 because of
Barretts esophagus and needed four mucosectomies. In January 2015 a
new endoscopy showed moderately differentiated adenocarcinoma in
Barretts esophagus with the presence of various neoplastic emboli and
high-grade dysplasia.
Results: The patient was submitted to prone position esophagectomy,
which led to a shorter surgical time and better recovery. The surgery was
very successful.
Conclusion: The prone position improved arterial oxygenation
without any deleterious effects. The beneficial effect of the prone position
is possibly attributable to opening of the bronchi obstructed by secretions.
The patient spent 7 days at the hospital and recovered very well.
029085
A phase II clinical trial exploring extensive intraoperative peritoneal
lavage (EIPL) as a prophylactic strategy for peritoneal recurrence in
locally advanced gastric cancer: an update reporting postoperative
morbidity and mortality after early closure
Andrade-Neto, M.R.1, Batista, T.P.1, Lima, C.A.C.2, Martins-Filho, E.D.2,
Martins, M.R.3, Santos, R.L.3
1
Department of surgery/ oncology, FPS/IMIP, Recife-PE, Brazil,
2
Department of general Surgery, FPS/IMIP, Recife-PE, Brazil;
3
Department of abdominal Surgery, HCP, Recife-PE, Brazil
manoel_med@yahoo.com.br, t.paulo@bol.com.br, cecilia_acl@gmail.com,
euclides_martins@yahoo.com.br, mario_rino@hotmail.com,
rogeriosantos1@icloud.com
Introduction: Extensive intraoperative peritoneal lavage (EIPL) has
been proposed as a practical prophylactic strategy to decrease the risk of
peritoneal recurrence in gastric cancer.
Objective: To present a longer follow-up of the patients enrolled in
our trial and to we explore the safety and efficacy of the EIPL in our locally
advanced gastric cancer patients. Previously, we had stressed only shortterm results of our prematurely closed trial.
Methods: This study is an open-label, double-center, single-arm
clinical trial on the safety and efficacy of EIPL in patient with locally
advanced gastric cancer. The protocol was reviewed by our Ethics Research
Committees (CAAE: 04016212.5.0000.5201).
Results: The study protocol was prematurely closed because of slow
accrual after only 16 participants had been recruited. Eight of these were
excluded from the protocol study during the laparotomy, whereas four
cases were also excluded from the per-protocol analysis. Two patients died
in hospital before 30 days and six were alive with no evidence of cancer
relapses after a follow-up ranging from 6.8 to 26 months (median = 16.2) at
the time of this updated analysis. In the intention-to-treat analysis, three of
eight patients suffered gastrointestinal leakages and two of them died. On a
per-protocol basis, two of four patients presented this type of postoperative
complication and one of them died. All deaths occurred to some extent as a
consequence of gastrointestinal leakages.
Conclusion: We could not draw any conclusion about the safety and
efficacy of EIPL, but the possibility that this approach might increase the
rate of gastrointestinal leakage is highlighted. We have found no relapses
at this time of analysis.
S100
028483
A technique to perform gastrectomy with circular staplers
Teixeira, J.C.A.1, Moreira, R.C.L.1, Myata, S.1, Cintra, C.A.1,
Carvalho, M.G.1, Paula, P.H.M.1
1
Mario Penna Institute, Belo Horizonte, Brazil
jairo_cat@terra.com.br,
renicecilia@me.com, seijisilvana@terra.com.br, cassioacintra@ig.com.br,
f.romeu.med@gmail.com, pedrohansendepaula@hotmail.com
Introduction: Gastric cancer presents itself predominantly in three
histopathological types: adenocarcinoma (95% of all gastric tumors),
lymphoma (3% of the cases) and leiomyosarcoma (derived from tissues
that originate in muscles and bones). It peaks in the 70th decade of life, and
affects men more often than women. Approximately 65% of patients diagnosed with stomach cancer are over 50 years old. In Brazil, these tumors
are the third most common kind of cancer among males and fifth among
females. The Brazilian National Cancer Institute (INCA) estimates that
20,390 new cases were diagnosed in 2014: 12,870 in males and 7520 in
females.
Objectives: To present a technique to perform an oncologically
successful gastrectomy using circular staplers.
Methods: A series of patients was submitted to partial gastrectomy
with B1 reconstruction using 25 or 29 mm intraluminal circular staplers.
Results: We present the results in ten cases, five males and five
females. Two patients were diagnosed with diffuse adenocarcinoma; the
inclusion criteria for these patients were the presence of pulmonary metastatic disease in one and poor clinical condition not responsive to previous
nutritional support in the other. The remaining patients were diagnosed with
intestinal type stomach cancer by Laurens classification. All patients were
submitted to D2 lymphadenectomy, with adequate harvest. The gastroduodenal anastomosis (GDA) were performed using 25 or 29 mm intraluminal
circular staplers, depending on duodenal caliber. In the first two cases the
duodenum was sectioned using linear staplers, and the nail retainer of the
circular stapler was positioned through the staple line. Nowadays, we close
the duodenum with a 2.0 prolene or 3.0 mononylon tobacco pouch, for
cost effectiveness. The GDA is carried out through an anterior gastrotomy
where we introduce the cartridge and create the GDA with the posterior
gastric wall. Then we proceed to section the distal part of the stomach with
a linear stapler. We routinely reinforce the staple line with an absorbable
suture. One patient presented with a late-onset fistula (postop day 14) that
was managed clinically, with good outcome. As of now, all patients are
alive and disease-free. Five patients were submitted to EGD, showing wide
and pervious anastomosis.
Conclusion: The use of circular staplers in gastroduodenal reconstruction is feasible, reduces surgical time and does not interfere with lymph
node harvesting. We present early results and intend to expand and update
this study in regards to patient evolution in later stages and greater patient
enrollment.
029295
Adenocarcinoma post-operation and peptic ulcer: a case report
de Melo, M.S.B.1, de Souza, S.R.V.2, de Oliveira, T.B.C.1
1
Centro Universitrio Christus, Fortaleza, Ceara, Brazil, 2Instituto Dr Jos
Frota, Fortaleza, Ceara, Brazil
manuelasbmelo@gmail.com, sandrorvs1210@gmail.com,
thaisbrandaoo@hotmail.com
Introduction: Gastric cancer is still a major cause of mortality, and is
the third most common malignancy in the world. The relationship between
peptic ulcer and gastric carcinoma has been a matter of dispute, as has
infection with H. pylori in the etiology of the disease.
ABSTRACTS
Objectives: To report the case of a 39-year-old male patient in 2009
after operation for a gastric adenocarcinoma and suture of an ulcer treated
in LNRCC, Natal, RN.
Methods: Data were collected in the patients records during his monitoring in the North-Riograndense League Against Cancer from November
2009 to August 2010; these data covered the pre- and postoperative periods.
The specific literature review used the Medline database, Lilacs, Scielo and
Pubmed.
Results: The patient, JGN, born and living in Macaba-RN, presented
himself at the LNRCC in November 2009, referred with biopsy of gastric
malignancy after EDA post-suture surgery to control a peptic ulcer that
perforated 2 years previously; the anatomical/pathological examination
showed positive for H. pylori. The patient was then subjected to exploratory laparotomy with partial gastrectomy and lymphadenectomy; biopsy
revealed signet-ring adenocarcinoma cells, of Lauren diffuse type, and
vascular invasion and infiltration of all layers and vascular and perineural
tissue; lymph nodes were also affected, hence the pathological stage was
pT3N1MX. A chest X-ray was performed to evaluate distant metastasis,
and no change was observed.
Conclusion: Faced with this situation, the patient was referred for
adjuvant treatment with five cycles of chemotherapy (5-FU and leucovorin)
and radiotherapy. The patient is currently asymptomatic and in treatment.
029072
Analysis of predictors of survival in patients with gastric
adenocarcinoma treated with curative intent in a single Brazilian
cancer center
Marques, M.C.1, Costa Jr, W.L.1, Coimbra, F.J.F.1, Diniz, A.L.1,
Ribeiro, H.S.C.1, Godoy, A.L.1, Farias, I.C.1, Cury Filho, A.M.1
1
Department of Abdominal Surgery, A.C. Camargo Cancer Center,
So Paulo, Brazil
dr.marciocarmona@gmail.com
Introduction: Gastric adenocarcinoma is a frequent neoplasm with a
worldwide distribution; identifying predictors of survival is an important
way to improve oncological outcomes.
Objectives: The aim of this study is to identify predictors of survival
in patients with gastric adenocarcinoma undergoing treatment with curative intent.
Methods: A retrospective analysis was performed in the medical
charts of patients who underwent curative resection of gastric adenocarcinoma between 1985 and 2013. Patients with M1 disease or incomplete
resections (R1 or R2) were excluded.
Results: In the study period, 809 patients met the inclusion criteria.
Mean age was 61 years ( 13.6). Most patients were males (58.6%).
Patients classified as ASA I and II comprised 75.3% of the population.
Most patients were symptomatic at diagnosis (93.1%). A subtotal gastrectomy was performed in 57.8% of patients and a total gastrectomy in
42.2%. Most subjects received a D2 lymph-node dissection (71.6%).
Multivisceral resection was necessary in 16.7% of patients, most of them
being splenectomies. Two hundred and forty-four patients received blood
transfusion (30.2%). Mean operative time was 353 minutes ( 101.1) and
mean length of hospital stay was 11 days ( 7.2). Postoperative complications occurred in 30.4% of the surgeries, but most of them were minor
complications (16.1%), and the mortality rate was 4.6%. Two hundred and
sixteen patients received multimodal treatment (26.7%). Estimated median
overall survival was 96 months. Median disease-free survival was not
reached. Independent predictors of overall survival were tumor site, lymphnode disease, perineural invasion, blood transfusion, lymphadenectomy
and blood vessel invasion. Independent predictors of disease-free survival
were tumor site, lymph-node disease, perineural invasion, size of the tumor,
lymph/vascular invasion, and blood transfusion. Independent predictors of
ABSTRACTS
blood transfusion were multivisceral resection, D1 lymph-node dissection,
longer operative time and greater age.
Conclusion: Blood transfusion is a predictor of survival in patients
with gastric adenocarcinoma treated with curative intent.
029231
Anatomopathological profile and results of surgical treatment for
gastric adenocarcinoma
Fava, B.E.C.1, Menezes, J.N.2, Caxeiro, G.L.2, Takahara, I.A.2,
Torres, M.C.1, Apodaca, F.R.3
1
Luzia de Pinho Melo Hospital, Mogi das Cruzes, Brazil, 2University of
Mogi das Cruzes, Mogi das Cruzes, Brazil, 3Luzia de Pinho Melo Hospital
& University of Mogi das Cruzes, Mogi das Cruzes, Brazil
bianca_fava@yahoo.com.br, jacque_menezes@hotmail.com
Introduction: Gastric cancer is one of the most common cancers
worldwide, adenocarcinoma being its most common type. Curative resection is the treatment of choice, and its unclear whether this operation
should include an extended (D2) or a limited (D1) lymph-node dissection.
Objective: To describe patients diagnosed with gastric cancer with
confirmed pathology of adenocarcinoma who received surgical treatment.
Methods: Patients submitted to gastrectomies for adenocarcinoma
from January 2013 to December 2014 were included. Data analysis from
medical records was performed, and cases where all the information could
not be provided were excluded.
Results: Fifty-six patients with stomach adenocarcinoma were
submitted to gastrectomy during the period. Twenty-eight of these had
complete medical data; 21 were submitted to a subtotal (75%) and seven
to a total gastrectomy (25%). Length of hospital stay was 14.66 8.68
days and 25.71 10.78 respectively. Complications occurred in 24.9%
as follows: fistula (14.3%), intracavitary abscess (7.1%) and anastomosis
stenosis (3.5%). Histopathological findings revealed tumors predominantly
of the intestinal type in 46.4% of patients, followed by diffuse pattern with
signet-ring cells in 32.1% according to Laurens criteria, and 7.1% had
undifferentiated-type adenocarcinomas. In 14.3% no carcinoma could be
detected in surgical specimens. Most resected tumors were less (35.7%) and
moderately (28.6%) differentiated, with tumor invasion of serosal surface
in 17.9% of cases. Resected lymph nodes mean was 20.9 22.2 with a
median of 15 and a mean of 6.9 7 positive lymph nodes per surgery.
The majority of the patients were described as being in early and locally
advanced clinical stages (64.3%).
Conclusion: Results found regarding histological type, length of
hospital stay, surgery complications and chemotherapy regimens were
similar to those in the medical literature. Median and mean analysis of
dissected lymph nodes showed that most of the patients were submitted to
D2 lymphadenectomy in our service.
028512
Association between smoking and gastric cancer in patients from an
oncology referral center in Salvador, Brazil, between 2004 and 2014
Danieluk, M.F.C.1, Dias, J.P.1, Andrade, L.M.Q.S.2
1
Escola Bahiana de Medicina e Sade Pblica, Salvador, Brazil,
2
Institute of Oncology, Santa Izabel Hospital, Salvador, Brazil
mfdanieluk@yahoo.com.br, juarezdias@bahiana.edu.br,
lmsandrade@yahoo.com.br
Introduction: Smokers are continuously exposed to more than 4000
toxic substances, many of them carcinogenic. In 2002, a causal relationship
was established between smoking and gastric cancer, which, despite the
decline in its incidence in recent decades, still remains the second leading
cause of cancer mortality in the world.
S101
Objective: To test the association between smoking and stomach
cancer.
Methods: This was a cross-sectional analytical study which used
primary and secondary data from medical records and interviews with
patients with malignant stomach cancer treated at a referral hospital in the
city of Salvador, Brazil. We obtained data related to sex, age, histological
type of the tumor and staging, smoking history and way of service. The
mean, standard deviation, variation interval and percentage distributions
were calculated. To check statistically significant differences we used the
chi-square test of Pearson or Fishers exact and Students t test.
Results: The sample comprised mostly women (50.7%), the most
affected age range was 6170 years (28.2%) and the overall mortality was
19.9%. Adenocarcinoma accounted for most types of tumors (84.1%),
being the most common intestinal type (57.5%). The late stages, III and IV,
were predominant (50.9%), being more pronounced in those SUS patients,
with 32.5% of patients in stage IV. Evolution to death occurred in 25.6% of
SUS patients and in 35.3% of smoking patients.
Conclusion: Smoking was an aggravating factor in the staging and
strongly influenced the mortality of patients with stomach cancer. Late diagnosis occurred in most patients, a reality that becomes more pronounced in
SUS patients. There was a difference in mortality between the two groups,
SUS and private patients, with double the deaths in the first group. There
were more cases of malignant neoplasm of the stomach among women,
which differs from reports in the national and international literature.
028922
Cancer of the cardia: experience at the National Cancer Institute of
Brazil
Peixoto, R.M.1, Kesley, R.2, Foster, M.1, Correa, J.H.S.2, Albagli, R.2,
Castro, L.S.2
1
Estacio de S university, Rio de Janeiro, Brazil, 2INCA, Rio de Janeiro,
Brazil
raira_mp@hotmail.com, rubenskesley@gmail.com,
mw.foster@uol.com.br, sicorrea@uol.com.br, rafaelalbagli@uol.com.br,
leonaldson@gmail.com
Introduction: Incidence of cancer of the cardia is increasing worldwide.
Objective: To evaluate experiences in the treatment of tumors of the
cardia over a 13-year period at a center of excellence for the treatment of
gastrointestinal cancers.
Method: We retrospectively studied 152 cases of gastric adenocarcinoma with invasion of the distal esophagus, cardia or proximal stomach,
operated on electively and consecutively at the Cancer Hospital I, INCA.
Results: Overall average age of the study group was 61 13 years with
male predominance (106 cases: 69.7%). Tumors of Siewert type I accounted
for 22 patients (14.5%), mean age 60 11 years; Siewert type II occurred in
35 patients (23%), mean age 62 15 years; Siewert type III was found in 95
patients (62.5%), mean age 60 13 years. Average total number of nodes
of Siewert type I was 26 13; Siewert II: 38 17; Siewert III, 37 18 (P =
0.01). The mean number of metastatic nodes was 7 9 (P = 0 23). The overall
recurrence rate was 35%, similar in all Siewert types (P = 0.17). Estimated
overall survival at 5 years was 43%: 31% in Siewert type I, 43% in type II
and 46% for type III (P = 0.70). The staging was the main prognostic factor
of the disease (P = 0.000). In patients with stage I the 5-year survival rate was
84%, 78% for II, 34% for III and 12% for type IV.
Conclusion: Proximal tumors of the stomach affect younger patients
and continue to be prevalent among those that compromise the cardia.
Radical surgery should be the initial goal of the surgeon as it is the principal
factor associated with remission of the disease. The Siewert classification
is the main indicator for surgical treatment despite it having no influence
on the prognosis of patients, the majority of whom are in advanced stages.
S102
028631
Case report of gastric carcinoma with lymphoid stroma associated
with EpsteinBarr virus
Andrade, R.L.1, Moreira, R.C.L.2, Cintra, C.A.2, Bernardino, L.G.3,
Salles, P.G.O.4, Carvalho, C.C.1
1
General Surgery, Mario Penna Institute, Belo Horizonte, MG, Brazil,
2
Oncological Surgery, Mario Penna Institute, Belo Horizonte, MG, Brazil,
3
Clinical Oncology, Mario Penna Institute, Belo Horizonte, MG, Brazil,
4
Department of Pathology, Mario Penna Institute, Belo Horizonte, MG,
Brazil
raffaelandrade@hotmail.com, renicecilia@me.com,
cassioacintra@ig.com.br, bernardinoluciana@yahoo.com.br,
pgosalles@gmail.com, camila_ccavalcante@hotmail.com
Introduction: It is accepted that gastric cancer is a disease of multifactorial origin. In recent years the EpsteinBarr virus (EBV) has been
described as clearly related to the pathogenesis of gastric cancer. Compared
with H. pylori, this virus may play a more active role in carcinogenesis
and generate tumors with lymphoid stromal dominance. The pathological
analysis may be suggestive, but the diagnosis can be confirmed only with
immunohistochemistry.
Objectives: To report a case of gastric carcinoma with lymphoid
stroma (gastric lymphoepithelioma) associated with EBV.
Methods: A male patient, 68 years old, presented with epigastric pain.
Endoscopy showed lesions in the small gastric curvature, and pathological
examination revealed gastric adenocarcinoma of Lauren intestinal type.
Subtotal gastrectomy was performed with Billroth II reconstruction and D2
lymphadenectomy. The pathological analysis showed mixed gastric adenocarcinoma with intestinal and diffuse types and areas of dense lymphoplasmocytic infiltrate. There was metastasis in one of 36 lymph nodes
resected. Immunohistochemical study showed gastric adenocarcinoma of
the lymphoepithelioma type and was positive for EBV expression.
Results: The patient underwent adjuvant treatment recommended
by the SWOG-directed intergroup 0116 phase III study. Radiotherapy
was given to a dose of 45 Gy in 25 fractions of 1.8 Gy. Fluorouracil and
leucovorin were administered before and during radiotherapy. However,
the patient progressed with significant marrow toxicity and chemotherapy
was suspended in the third cycle. The patient has been followed by clinical
and surgical oncology and shows no evidence of disease recurrence to date.
Conclusion: Carcinoma of the lymphoepithelioma type, undifferentiated with lymphoid or medullary stroma, constitutes 3.8% of gastric
carcinomas and is associated with EBV in 80% of cases. It has distinct clinicopathological characteristics, including male predominance, preferential
location in gastric cardia or postsurgical gastric stump, lymphocytic infiltration, a lower frequency of lymph-node metastases, and perhaps a more
favorable prognosis compared to conventional adenocarcinoma.
029224
Descriptive analysis of patients with esophageal adenocarcinoma
treated at a single Brazilian Cancer Center
Brito, R.H.1, Costa Jr, W.L.1, Franco, C.P.1, Simonetti, V.V.1, Coimbra, F.J.H.1
1
rafaelhbrito@yahoo.com.br,
dr.wilsoncosta@gmail.com,carolparucce@gmail.com,vvsimonetti@hotmail.com,
drfelipecoimbra@gmail.com
Introduction: Esophageal adenocarcinoma incidence has been
increasing constantly in Western countries, due mainly to obesity and
gastroesophageal reflux disease. Cancer is the sixth leading cause of death
worldwide, accounting for 286,000 deaths/year. It is more common in males,
and most cases are diagnosed in the fifth decade of life. The most common
histological types are squamous-cell carcinoma and adenocarcinoma.
ABSTRACTS
Objectives: To analyze patients with esophageal adenocarcinoma
treated at a single Brazilian Cancer Center.
Methods: This is a retrospective study that included 104 patients
treated for esophageal adenocarcinoma in a Brazilian cancer center in the
periods between 1997 and 2013. Patients clinical features, their patient
profiles, and peri-, intra- and postoperative and long-term outcomes are
reported in this series.
Results: The median age of all treated patients was 59 years, and
males predominated (82%). The median operating time was 420 minutes,
and most individuals underwent transhiatal esophagectomy (93%) with
an open technique (92%), 40% after neoadjuvant therapy; a total of
57% patients submitted to multimodal treatment. Regarding the surgical
procedure, 73% underwent a D2 lymphadenectomy, and in 12% palliative surgery was non-curative. Postoperative surgical complications were
observed in 63% patients, most of them Clavien 1 or 2. Evaluating tumor
characteristics: 85% were intestinal type adenocarcinoma, located in the
distal esophagus (86%), and 75% were moderately or poorly differentiated
tumors. Neoadjuvant treatment was administered to 40% of patients, and a
total of 57% of them received some multimodality treatment regimen. The
median survival was 49 months.
Conclusion: Surgery is the primary treatment for esophageal cancer
and its associated lymphadenectomy. The extended surgery depends on the
tumor stage and invasion of adjacent organs. Results in this institution are
consistent with those observed in the medical literature.
028933
Early gastric cancer: INCAs experience
Pena, A.C.B.1, Kesley, R.2, Peixoto, R.M.1, Castro, L.S.2, Correa, J.H.S.2,
Albagli, R.2
1
Brazil
carol.2016@hotmail.com, rubenskesley@gmail.com,
raira_mp@hotmail.com, leonaldson@gmail.com, sicorrea@uol.com.br,
rafaelalbagli@uol.com.br
Introduction: Early gastric cancer has an incidence of 1015% in
Brazil; however, in Japan it represents over 50% of the diagnosed cases.
The survival rate in 5 years is 90% indicating a good prognosis.
Objective: To analyze the clinical behavior, anatomopathology and
survival of the early tumors.
Methods: We analyzed retrospectively 207 cases of early T1a and T1b
electively operated with curative intention, in INCA, between January 1997
and December 2008. These were than analyzed according to demographic,
clinical, endoscopic, surgical and histopathological factors and survival.
Results: The mean global age was 61 13 years, with a prevalence
of females (104 cases). There was a prevalence of type IIc+III (75 cases)
in the Japanese classification for early cancers, followed by IIc (53 cases)
and IIc+IIa (13 cases). We found 95 cases of pT1a and 112 of pT1b. The
mean number of lymph nodes found per surgical specimen was 27 14.
The overall rate of patients with metastatic lymph nodes was 15.9%: 8.5%
in pT1a and 22% in pT1b (P = 0.03). The mean overall metastatic lymph
nodes was 0.6 1.6, being 0.3 1.2 in pT1a and 0.8 1.9 in pT1b (P =
0.003). The survival rate at 5 years was 80%. For pT1a the survival rate
was 86% and for pT1b 76% (P = 0.16). The survival at 5 years for pN0 was
83%, 77% for pN1 and 53% for pN2 and pN3a (P = 0.36). In patients Ia the
survival rate was 83%, in Ib 77% and in IIa and IIb 53%.
Conclusion: Early gastric cancer presents a favorable prognosis. The
higher the infiltration level of the tumor, the higher the number of patients
with metastatic lymph nodes and the mean of metastatic lymph nodes found
in the surgical specimen. Endoscopic resection remains suitable only for
cases with very low risk of metastatic lymph nodes.
ABSTRACTS
028304
Epidemiological profile of gastric cancer patients treated in the
reference cancer center in Bahia, Brazil, according to Laurens
classification
Ribeiro, T.F.1, Teles, M.O.2, Carvalho, D.R.3, Albuquerque, A.F.1,
Meneses, J.I.1, Moura, R.F.1, Costa, V.S.M.1
1
Department of Surgical Oncology, Hospital Aristidez Maltez, Salvador,
Brazil, 2Bahiana School of Medicine and Public Health, Salvador, Brazil,
3
Medical College of Federal University of Bahia, Salvador, Brazil
thiago.francischetto@gmail.com,mariolitel@hotmail.com,odigorc@hotmail.com,
a.f.albuquerque@bol.com.br, juvandymeneses@hotmail.com,
robsomfmoura@uol.com.br, vitor_savio@yahoo.com.br
Introduction: Adenocarcinoma is the most common histological
gastric cancer (95% of cases) and has been subdivided according to
Laurens classification into intestinal and diffuse types. The intestinal type
affects the most distal portion of the organ, occurs in patients between the
6th and 7th decades of life, and is related to eating habits; in contrast, the
diffuse type occurs in younger patients, affects the proximal portion of the
organ, and is more closely related to inheritance.
Objective: To analyze Laurens classification of patients submitted to
surgical treatment in a renowned hospital in Bahia, correlating this groups
characteristics with data from the literature.
Methods: This was a retrospective cohort study with 720 patients with
a histological diagnosis of gastric adenocarcinoma and submitted to gastrectomy between January 2003 and December 2012. Data were analyzed
though the SPSS v17.0 program.
Results: Among the 720 patients, 403 (56%) were of the intestinal
type, 187 (26%) of the diffuse type, and 130 (18.1%) indefinite. The most
common site of occurrence was the antrum (in 365, 49.2% of the cases),
of which 58.6% (202) were of the intestinal type and 27.5% (95) of the
diffuse type. Among lesions of the body, the second most affected part (in
14.2%, 105 cases), 50.5% (47) were of the intestinal type and 31.2% (29)
of the diffuse type. The median age was 63 years in the intestinal type
and 53 years in the diffuse type. Overall survival and disease-free survival
between the intestinal group and the diffuse group did not present a statistically significant difference (P = 0.504; P =0.405).
Conclusions: The results show high prevalence of intestinal-type
lesions, predominantly in the antrum, among patients between the 6th
and 7th decades of life; this is comparable to literature data. Patients with
diffuse-type lesions occurred in a younger age group, with no preference
in stomach location.
028302
Epidemiological profile of stomach cancer in Bahia, Brazil
Ribeiro, T.F.1, Pedrosa, M.O.2, Moura, R.F.1, Meneses, J.I.1, Lopes, H.N.2,
Rodrigues, T.H.T.2
1
Brazil, 2Bahiana School of Medicine and Public Health, Salvador, Brazil
thiago.francischetto@gmail.com, mayaragoes@hotmail.com,
robsomfmoura@uol.com.br, juvandymeneses@hotmail.com,
hamandanl@hotmail.com
Introduction: Gastric cancer is the third most common cancer worldwide, especially in developing countries, although its incidence is declining.
It is speculated that this is due to the reduced intake of smoked foods, better
food preservation, increased intake of vegetables and fruits, and poverty
reduction with improved sanitation. An ecological study in 2011 showed
increasing incidence rates of stomach cancer in Bahia over time, in contrast
to the global trend. In the literature, there are no studies about the epidemiological profile of patients affected by this disease in Bahia, hindering
actions of planning and prevention.
S103
Objectives: To analyze the epidemiological profile of patients with
stomach cancer treated at the reference cancer center in Bahia.
Methods: This was a retrospective cohort study of patients undergoing
surgical treatment for gastric cancer between January 2003 and December
2012. We analyzed proportion for categorical variables and central tendency
for continuous variables.
Results: Included in this study were 796 patients from Bahia, most of
them from Salvador (37.9%); 95.5% declared themselves black or brown,
the median age was 60 years, 85.9% studied only up to elementary school,
35% had a family history of gastric cancer, the most frequent comorbidity
was arterial hypertension, and only 8% of patients were asymptomatic.
The most performed surgery was subtotal gastrectomy (60.8%); 83.7% of
the lesions were adenocarcinomas, 56% were of the intestinal type, and
the predominant area affected was the antrum (49.2%). Lesions at stages
T3 and T4 comprised 54.1% of the cases, and 56.3% had positive lymph
nodes. In the Bormann classification 47% were at grade II and 43.1% grade
III, and 13.9% presented peritoneal carcinomatosis on surgery.
Conclusions: In the present study we observed major involvement of
the low-income population; prevailing lesions were in the antrum, of the
intestinal type, and in an advanced stage at diagnosis, suggesting that the
increase in gastric cancer in Bahia is related to environmental factors.
028442
Esophageal neuroendocrine carcinoma: a case report
Dias, E.N.1, Vaz, L.A.1, Borges, L.C.1, Silva, L.M.C.1, Azevedo, M.M.2,
Lopes, E.P.D.2
1
Instituto Tocantinense Presidente Antonio Carlos, ITPAC, Faculdade de
Medicina, Brazil, 2Hospital Regional de Araguana, Tocantins, Brazil
emille.nascimento@hotmail.com, laizzavaz@hotmail.com,
liviacborges@yahoo.com.br, luiza_marianacs@hotmail.com,
macarioazevedo@hotmail.com, epdlopes@hotmail.com
Introduction: Neuroendocrine tumors are rare neoplasms and represent only 0.66% of all malignancies; when affecting the esophagus they are
even more rare and aggressive. The peak incidence is between the sixth and
eighth decades, and its main symptoms are rapidly progressive dysphagia
and weight loss. Resection is the primary therapeutic approach for most
localized carcinoid tumors. There is still no consensus in the literature for
the treatment of unresectable lesions and/or inoperable patients; there is a
tendency therefore to use chemotherapy and radiotherapy.
Objectives: To report a patient with neuroendocrine esophageal carcinoma (CNE) with small cells, locally advanced and inoperable, and to
conduct a brief review of the literature.
Methods: Data were obtained through reviews of medical records,
interview with the patient, photographic records of diagnostic methods to
which the patient was submitted, and review of the literature.
Results: ZES, an 83-year-old female, had rapidly progressive dysphagia
that initiated 6 months previously with a weight loss of 10 kg in the previous
2 months. Endoscopy showed a stenotic lesion in the lower esophagus which
prevented access to the device, and biopsies were performed. Histopathology
showed a poorly differentiated infiltrative neoplasm; immunohistochemistry
confirmed neuroendocrine carcinoma of small cells through the expression
of markers chromogranin A and synaptophysin, with Ki67 >90%. Computed
tomography showed a large tumor in close contact with the aorta, bronchus
and pericardium. The patient underwent a gastrostomy to improve nutritional
intake, and she was subsequently forwarded to chemotherapy and radiotherapy.
Conclusions: The case reported shows the conduct of the surgical
oncology team in a case of unresectable CNE in an inoperable patient, and
leads to a discussion of the best way to carry out treatment in this patient. It
is important to discuss this case because of its rarity and the lack of studies
and appropriate protocols for treatment.
S104
028299
Evaluation of surgical treatment for gastric cancer at an ontological
center in Bahia, Brazil
Carvalho, D.R.1, Ribeiro, T.F.2, Albuquerque, A.F.2, Rodrigues, D.A.T.3,
Teles, M.O.3, Frana, R.R.3
1
Medical College of Federal University of Bahia, Salvador, Brazil,
2
Brazil, 3Bahiana School of Medicine and Public Health, Salvador, Brazil
odigorc@gmail.com, thiago.francischetto@gmail.com,
a.f.albuquerque@bol.com.br, hamandanl@hotmail.com,
mariolitel@hotmail.com, riamfranca@hotmail.com
Introduction: Gastric cancer is the fourth leading cancer worldwide; the prognosis remains poor despite the decline in mortality in recent
decades. Optimal surgical techniques aim to achieve fewer postoperative
complications and better overall survival and quality of life.
Objectives: To evaluate the results of surgical treatment for stomach
cancer at a reference cancer treatment center in Bahia, Brazil.
Methods: We analyzed retrospectively the records of all gastric cancer
patients submitted to gastrectomy between January 2003 and December
2012 at a reference center in Bahia, Brazil.
Results: We collected data from 796 patients, 60.3% of whom were
men. Mean age was 59 years. Of the cancers, 86.3% were adenocarcinomas, and according to Laurens criteria 25.7% were diffuse and 55.1%
intestinal. The tumor had invaded mucosa, submucosa, muscularis mucosa,
subserosal, serosal and adjacent organs in 8%, 14.1%, 23.5%, 8%, 21.8%
and 16.5%; lymph-nodal statuses were N0, N1, N2 and N3 respectively in
34.9%, 20.6%, 17.9% and 17.2%. M1 status was clear in 9.4% of patients
and hepatic metastases were found in 4%. Total gastrectomy was performed
in 30.8% and subtotal gastrectomy in 60.7% of patients; D0 lymphadenectomy was performed in 5.7%, while D1 and D2 lymphadenectomies took
place in 47.3% and 37.2% respectively. Intercurrence occurred in 1.4% of
procedures and intraoperative transfusion was necessary in almost 9% of
all surgeries. Post-surgical complications were not common; anastomotic
leakage occurred in 1.4%. General postoperative forwarding to ICU and
death were, respectively, 18.2% and 4.7%. The overall 5-year survival
rate was 64.7% related directly to TNM scores and statistical significance
between tumor invasion levels, lymph nodal compromise stage and presence or not of metastases.
Conclusions: In general, our results were equivalent to or better than
those described in the literature, with appropriate surgical choices and
procedures being used on the specific population of patients diagnosed in
Bahia.
028303
Evaluation of T4 gastric cancer patients who underwent extended
surgical resection: a retrospective analysis
Ribeiro, T.F.1, Almeida, D.A.C.2, Moura, R.F.1, Meneses, J.I.1,
Lopes, H.N.3, Rodrigues, T.H.T.3
1
Brazil, 2Medical College of Federal University of Bahia, Salvador, Brazil,
3
Bahiana School of Medicine and Public Health, Salvador, Brazil
thiago.francischetto@gmail.com, anjos.daniela000@gmail.com,
robsomfmoura@uol.com.br, juvandymeneses@hotmail.com,
hamandanl@hotmail.com
Introduction: The extended surgical resection of T4 gastric cancer can
result in high morbidity and mortality; however, it is still recommended
with curative intent. The survival and prognosis of a patient with advanced
gastric cancer is usually poor. The aspects that influence prognosis are the
resection with involved margins and the presence of extensive lymph-node
metastasis.
ABSTRACTS
Objectives: The aim of this study was to evaluate the prognosis of
patients with T4 gastric cancer who underwent extended gastrectomy in a
cancer center in the state of Bahia.
Methods: This was a retrospective cohort study of 795 patients with
histological diagnosis of gastric cancer treated with gastrectomy between
January 2003 and December 2012. The data was analyzed using the SPSS
v17.0 program.
Results: Two hundred and sixty-nine patients (33.8%) were classified as T4, with the disease affecting the serosa layer (SL) in 153 cases
(19.2%) or adjacent organs (AO) in 119 cases (14.6%). Overall survival
and disease-free survival was significantly worse in T4 tumors compared
to other lesions (P < 0.001); 71.7% of patients with SL (27.8% of the total)
and 81% of patients with AO (24% of the total) had lymph-node involvement. The death and recurrence rate increased according to the extent of
lymph-node involvement. The mortality rate was 10.8% in the SL group
and 41.2% in the AO group without lymph-node metastasis (N0), reaching
37.5% in the SL group and 58.7% in the AO group with seven or more
lymph nodes (N3). The recurrence rate for SL ranged from 21.6% to 76.9%
for N0 to N3, and the AO group ranged from 52.9% to 80.4% for N0 to N3
(P < 0.003).
Conclusions: Patients with T4 gastric cancer can benefit from surgical
resection, especially those without invasion of adjacent organs and without
lymph-node involvement.
028944
Evaluation of the Japanese Gastric Cancer Association (JGCA
2010) classification versus the American Joint Committee on Cancer
(AJCC) classification of gastric adenocarcinoma
Abreu, L.V.S.S.S.1, Kesley, R.2, Hygino, M.C.1, Albagli, R.2,
Correa, J.H.S.2, Castro, L.S.2
1
Brazil
luisa.vsa@gmail.com, rubenskesley@gmail.com,
michellehygino@hotmail.com, rafaelalbagli@uol.com.br,
sicorrea@uol.com.br, leonaldson@gmail.com
Intoduction: Perigastric lymph nodes, N1, according to the Japanese
Gastric Cancer Association (JGCA 2010), are defined as located in: right
pericardia (1), left pericardia (2), lesser curvature (3), greater curvature (4),
suprapyloric (5), infrapyloric (6) and left gastric (7). Lymph nodes outside
these regions were classified as N2 or M1 (JGCA, 2010). The goal was to
analyze the influence that the location of the N2 lymph nodes has over the
treatment and prognosis of the patients, according to the TNM classification of 2010.
Methods: We analyzed 141 cases of gastric adenocarcinoma undergoing elective surgery with curative intentions in INCA between January
1997 and December 2008. All cases were classified as N2 (JGCA), with
lymph nodes from extra-gastric regions or distant metastasis. These
subgroups were compared with the AJCC TNM classification from 2010.
Results: In the 141 cases staged N2 and M1 (JGCA), the median age
was 62, with a prevalence of males (51.7%). We found 14 cases of distant
metastatic lymph nodes, especially in the para-aortic region, staged M1
(JGCA 2010). All the others were staged N2 (JGCA 2010). According to
TNM 2010 we found three cases of pT1a, three of pT1b, 15 of pT2, three
of pT3, 114 of pT4a, and three of pT4b; we also found 18 cases of pN1, 35
of pN2, 54 of pN3a, and 34 of pN3b. The 5-year survival for patients in N2
was 22% and M1 16%, 53% pN1, 32% pN2, 13% pN3a, 6% pN3b. TNM
stage I didnt present mortality in 5 years, stage II had a survival of 35%,
stage III 20% and stage IV 0%.
Conclusion: JGCA is the best method to determine which surgery
should be performed, because it provides a better chance of removing the
more frequent sites of metastatic lymph nodes. The TNM classification
ABSTRACTS
of the AJCC (2010) is the preferred form for defining the prognosis after
radical surgery is performed, because it gives an accurate staging of the
disease.
028937
Extended surgery in locally advanced gastric tumors (T4b):
experience at the National Cancer Center of Brazil
Foster, M.1, Kesley, R.3, Souza, H.K.V.2, Correa, J.H.S.3, Albagli, R.3,
Castro, L.S.3
1
Estacio de S university, Rio de Janeiro, Brazil, 2Souza Marques Medical
School, Rio de Janeiro, Brazil, 3INCA, Rio de Janeiro, Brazil
mw.foster@uol.com.br, rubenskesley@gmail.com, helenakvs@gmail.com,
sicorrea@uol.com.br, rafaelalbagli@uol.com.br, leonaldson@gmail.com
Introduction: Surgical resection is the only form of treatment in
advanced gastric adenocarcinoma that can provide a cure. Nevertheless, in
cases of invasion of adjacent organs, T4b (AJCC, 2010), conducting extensive surgery has a high mortality and low 5-year survival rate. The aim of
the study was to evaluate the results of radical surgery in patients staged as
T4b at a center of excellence for the treatment of gastrointestinal cancers.
Methods: Retrospective analysis of 35 gastric adenocarcinoma
patients with T4b organ invasion (AJCC, 2010), who underwent radical
surgery electively at Cancer Hospital I, INCA, Ministry of Health, between
January 1997 and December 2008. Evaluation considered the following
factors: epidemiological, clinical, surgical, histopathological and survival.
Results: The mean age of the 35 cases studied was 61 12, with a
predominance of males (23 cases, 65.7%). Pancreatic invasion was most
frequent (17 cases, 48.6%), followed by liver (11 cases, 31.8%), colon
(four cases, 11.4%), diaphragm (three cases, 8.6%), and adrenal (one case,
2.9%). Postoperative mortality occurred in three cases (8%). The average
number of lymph nodes found in the surgical specimens was 34 16, and
that of metastatic nodes was 11 9. The predominant (TNM 2010) stage
was IIIc (57.1%), followed by IIIb (31.4%) and IV (11.4%). Recurrence
occurred early (less than 6 months) in two cases and after 6 months in 11
cases; the main site was peritoneal (six cases). The overall survival rate at
5 years was 40%. In stage IIIb cases it was 45%, at stage IIIc 38%, and no
patients in stage IV survived more than 15 months.
Conclusion: The invasion of adjacent organs is not a contraindication
for performing radical surgery, and in cases with locally advanced tumors
surgery promotes disease control in 40% of cases despite having high operative mortality (8%).
029171
Gastrectomy for malignant tumors of the stomach: an epidemiological
and surgical indications profile of 720 patients
Toneto, M.G.1, Furlan, F.Z.2, Debon, L.M.2, Silva, B.T.2
1
Department of Surgery, Pontifical Catholic University of Rio Grande
do Sul, So Lucas Hospital, Porto Alegre, Brazil, 2Faculty of Medicine,
Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
mtonetto@terra.com.br, fernandozfurlan@gmail.com,
leti.debon@gmail.ocm, tertulianobruna@gmail.com
Introduction: Malignant neoplasms of the stomach are amongst the
deadliest tumors in Brazil. Surgical resection remains a therapeutic alternative that allows a greater chance of healing.
Objectives: To analyze a series of gastrectomies and the changes in
histopathological characteristics of tumors operated in a referral hospital
for the care of this neoplasia.
Methods: This was a retrospective study. We included patients with
tumors resected between January 1991 and May 2011. The patients were
divided into two groups on the basis of the time the surgery was performed.
S105
Results: We studied 720 patients. The most common histological types
were: 626 (86.9%) adenocarcinomas, 45 (6.25%) GISTs and 19 (2.64%)
lymphomas. The ages of the patients varied between 19 and 97 years, with
an average of 62.2 years. Amongst the adenocarcinomas, the prevalent
gender was male, with 420 (67.09%) cases. Despite the most common
localization in both groups being in the lower third of the stomach, there
was an increased diagnosis of proximal tumors. Only 59 (10.4%) were
early gastric tumors, with no significant difference amongst the two groups.
Conclusions: The results found in this study show an increase in
the diagnosis of stromal tumors in the past decade. The lower third of the
stomach is the prevalent location. Diagnosis is late in most cases, with no
improvement in recent years. This study demonstrates the persistence of late
diagnosis in our field, and is one of the explanations for its poor prognosis.
028949
Gastric adenocarcinoma with signet ring cells: experience at the
National Cancer Center of Brazil.
Cunha, L.F.T.1, Kesley, R.2, Pena, A.C.B.1, Correa, J.H.S.2, Albagli, R.2,
Castro, L.S.2
1
Brazil;
correiodafelix@gmail.cm, rubenskesley@gmail.com,
carol.2016@hotmail.com, sicorrea@uol.com.br, rafaelalbagli@uol.com.br,
Introduction: WHO suggests that gastric tumors be evaluated
according to the pattern of cellularity, highlighting that those with signetring cells (SRCs) are usually associated with poor prognoses due to early
blood and peritoneal dissemination. The aim of this study was to evaluate
experience in the treatment of gastric adenocarcinoma with SRCs.
Methods: A retrospective evaluation was carried out of surgery on 491
cases of gastric adenocarcinoma with SRCs, as defined by the WHO; the cases
were operated on electively and consecutively at the INCA between 1997 and
2008. Factors considered were demographic, clinical and pathological.
Results: These patients with adenocarcinomas with SRCs had an
average age of 58 13 and were predominantly male (257 cases). Tumors
located at the middle and distal thirds of the stomach were the most
common, accounting for 53.3% of the cases, and 74.4% of the tumors were
Borrmann type III and IV. R0 surgery was performed in 56.4% of the cases,
and 33.8% of the patients were considered inoperable. The average number
of lymph nodes in surgical specimens was 20 18 with an average of 4.4
7 metastatic lymph nodes. As for cancer staging: 55 cases (11.2%) were
stage IA, 24 (4.9%) IB, 13 (2.7%) IIA, 37 (7.6%) IIB, 30 (6.1%) IIIA, 41
(8.4%) IIIB, 98 (20%) IIIC, and 191 (39%) IV. The overall estimate of
5-year survival was 35%. Estimated survival was 94% in stage I tumors,
59% in stage II, 34% in stage III and 1% in stage IV. As for residual tumor,
patients who underwent R0 surgery had estimated 5-year survival rates of
57%, 18% in R1 and R2 and 0% in R3.
Conclusion: Gastric adenocarcinomas with signet ring cells are
aggressive tumors, and only 56% of patients are submitted for radical
surgery. The majority present advanced stages of the disease, and the prognosis is defined according to the TNM classification of the disease.
029279
Gastric cancer survival rates in Brazilian patients undergoing
multimodal treatment
Wohnrath, D.R.1, Fava, G.1, Bertolucci, P.1, Lacerda, C.F.1, Oliveira, A.T.T.1
1
Barretos Cancer Hospital, Barretos, So Paulo, Brazil
durvalrw@gmail.com, famigliafavabarretos@gmail.com,
paulobertolucci@hotmail.com, croider@hotmail.com, netto123@uol.com.br
S106
Introduction: Stomach cancer is the third leading cause of cancer
death in both sexes worldwide. In the Barretos Cancer Hospital, Brazil, the
prevalence of new cases of gastric cancer in 2012 was 399 cases.
Objective: To calculate the overall survival rate of Brazilian patients
with gastric cancer.
Methods: This was a retrospective study of 613 sequential patients,
patients with gastric adenocarcinoma who underwent gastrectomy in the
period August 1994 to December 2013. Radiotherapy and chemotherapy
were indicated as adjuvant therapy in cases of invasion of the muscularis
propria and/or in the presence of positive lymph nodes The tumors were
staged or re-staged according to the 7th edition of the TNM. Variables
analyzed were age, gender, type of surgery, type of lymphadenectomy,
tumor size, number of lymph nodes affected by tumor/number of lymph
nodes removed, histological grade, staging, and overall survival. For overall
survival calculation purposes, we included deaths from tumor progression,
postoperative and post-chemotherapy deaths, and deaths from any other
causes. The stages IA and IB, IIA and IIB, and IIIA and IIIB were grouped
in order to make more homogeneous groups. The significance level was
0.05 (5%).
Results: The following variables had statistical significance in the
univariate and multivariate analysis: age (P = 0.014), histological grade
(P = 0.037), type of lymphadenectomy (P = 0.028) and positive lymph
nodes index/removed (P < 0.001). Overall survival rate at 5 and 10 years
were 39.2% and 24.5%, respectively. In accordance with the stages IA
+ IB, IIA + IIB, IIIA + IIIB, IIIC and IV, survival rates were 80.7% and
51.1%; 55.3% and 39.3%; 37.2% and 21.0%; 17.0% and 8.7%; 0% and
1.1% respectively at 5 and 10 years (P < 0.001).
Conclusion: We believe that these survival rates can contribute as a
parameter for other institutions in our country.
028379
Gastric tubulovillous adenoma: an atypical neoplasm
Laporte, G.A.1, Kalil, A.N.1, Furtado, J.R.P.2, Polo, R.2, Conterno, J.2,
Zoletti, F.2, Leonardi, L.A.2, Souza, D.L.S.3, de Morais, C.O.3
1
Irmandade da Santa Casa de Misericrdia de Porto Alegre, Servio de
Cirurgia Oncolgica do Hospital Santa Rita e Universidade Federal de
Cincias da Sade de Porto Alegre, Brazil, 2Irmandade da Santa Casa de
Misericrdia de Porto Alegre, Servio de Cirurgia Oncolgica do Hospital
Santa Rita, Brazil, 3Universidade Federal de Cincias da Sade de Porto
Alegre, Brazil
laportegustavo@gmail.com, ankalil@terra.com.br,
piofurtado@terra.com.br
Introduction: Adenomatous polyps of the stomach are usually located
in the antrum or, less frequently, in the fundus of the stomach. They are
characterized by solitary pedunculated masses, often associated with
genetic syndromes.
Objectives: To report a case of gastric tubulovillous adenoma and
review the literature.
Methods: We present a rare case of gastric tubulovillous adenoma
treated by the Surgical Oncology Service of Hospital Santa Rita of
Irmandade da Santa Casa de Misericrdia de Porto Alegre.
Results: This report describes a 47-year-old man who underwent a
routine endoscopic examination, revealing a giant vegetative polyp measuring 8.5 x 4.0 cm, eroded and friable, occupying approximately 70% of
the stomachs circumference. The abdominal CT scan showed an expansive
mass on the posterior wall of the gastric body and antrum with dimensions
of 9.8 x 3.7 cm. Laboratory findings of tumoral markers were normal. This
patient was submitted to a partial gastrectomy with Roux-en-Y reconstruction. A frozen sample of the lesion was assessed during surgery and was
suggestive of a tubulovillous adenoma, this being confirmed by a definitive
pathological exam.
ABSTRACTS
Conclusions: Gastric tubulovillous adenoma is a rare neoplasm. We
found only one case report regarding this tumor in the literature (by G.B.
Motta in 1986). The prognosis of this pathology is good. It is important to
investigate the genetic panel in these patients because gastric polyps are
often associated with genetic syndromes.
028942
Helicobacter pylori in gastric adenocarcinoma surgical specimens:
INCAs experience
Souza, H.K.V.1, Kesley, R.2, Luz, A.P.S.3, Castro, L.S.2, Albagli, R.2,
Correa, J.H.S.2
1
Souza Marques Medical School, Rio de Janeiro, Brazil, 2INCA, Rio de
Janeiro, Brazil, 3Estacio de S university, Rio de Janeiro, Brazil
helenakvs@gmail.com,rubenskesley@gmail.com,annapaulasluz@gmail.com,
leonaldson@gmail.com, rafaelalbagli@uol.com.br, sicorrea@uol.com.br
Introduction: The WHO considers Helicobacter pylori (HP) as
a gastric carcinogen type I. It is well known that the perpetuation of a
gastric ulcer is a consequence of HP infection. However, the association
of HP in surgical specimens is less well known. Our objective was to
evaluate the clinical and anatomopathological effects related to the presence of HP.
Methods: The presence of HP was researched in 445 surgical specimens operated in INCA between January 1997 and December 2008; the
specimens were divided into two groups: with (+) and without () HP. We
compared the clinical, demographic and anatomopathological profiles.
Results: HP was identified in 61% of cases. The median age was
64 years, range 2390, with a predominance of males (263 cases). HP+
patients were younger, 63 versus 66 in HP (P = 0.08), and there was no
significant gender difference (P = 0.29). The median tumor area was 38
cm, being smaller in HP+: 24 cm versus 32 cm in HP (P = 0.01). The
median thickness of the tumor was 1.3 cm in HP+ versus 1.6 cm in HP
(P = 0.04). There was no difference in the tumor infiltration level. The
median of lymph nodes was higher in the HP+ group (30.5) versus 28 in
HP (P = 0.19). The median of metastatic lymph nodes was similar in both
groups (two MLN) (P = 0.43). In accordance with TNM 2010, we found 77
cases in stage Ia, 39 in Ib, 9 in IIa, 72 in IIb, 51 in IIIa, 66 in IIIb, 101 in IIIc
and 28 in IV. There were no differences in staging and survival.
Conclusion: The majority of adenocarcinomas presented HP. When
HP was present in the stomach, patients were younger; there was no gender
predominance; smaller and shallower tumors were found, with the same
level of tumor infiltration; and there was a tendency towards finding higher
numbers of lymph nodes but similar numbers of metastatic lymph nodes.
Differences in TNM staging and survival were not observed.
028309
Hospital permanency analysis, mortality and ICU daily for patients
submitted to total gastrectomy due to adenocarcinoma in Brazil
Santos, A.C.S.1, Loula, M.D.S.1, Souza, M.O.1, Barbosa, F.R.A.O.1,
Felicio, S.J.O.1, Peixoto, E.2
1
Student from Escola Bahiana de Medicina e Sade Pblica, Salvador,
Brazil, 2Teacher holder of Operatory Technique and experimental surgery
II from Escola Bahiana de Medicina e Sade Pblica, Salvador, Brazil
anacarlasantana@outlook.com, marilialoula@gmail.com,
mari19.oliveira@gmail.com, fernandaranielle@hotmail.com,
Introduction: Gastric adenocarcinomas account for 95% of stomach
cancers. Total gastrectomy may be curative on tumors located in the body
and gastric fundus. Late diagnosis is common, and this compromises the
therapeutic efficacy and prognosis for the patient.
ABSTRACTS
Objectives: To analyze category, hospital stay time, mortality, and use
of the ICU in patients submitted to total gastrectomy.
Methods: This was an analytical study using secondary data from the
Information Technology Department of SUS, 2014; the data were therefore
exempt from submission to the CEP. These data were tabulated in rows of
the variables gender and days of hospital stay. Columns were the variables
age group, deaths; increment: frequency; active selections: total gastrectomy in oncology and utilization of the ICU. Tables were built for all variables. The study included patients with a diagnosis of adenocarcinoma who
were submitted to total gastrectomy. Patients 20 years old were excluded.
Results: In total 727 gastrectomies were carried out. Males predominated, accounting for 65.5% of the cases. There was a prolonged hospital
stay of 814 days, mainly in people over 65 years old; 78.1% of deaths
occurred in patients who used the ICU, and 19.3% of patients over 65
years of age hospitalized over 8 days and who used the ICU died. In total,
10% of all patients died; 16.4% of patients over the age of 65 years died, a
percentage higher than that in other age groups. Women in this age group
accounted for 22.7% of deaths and men 13.4%. The highest frequency of
the deaths occurred in 814 days, but mortality was higher in 1521 days.
Conclusion: The duration of hospital stay is associated with high
mortality rate in females and the elderly (age 65 years) submitted to total
gastrectomy for neoplasm. Thus, age group is closely related to number of
days in hospital, chiefly in the ICU.
028300
Impact of lymphadenectomy extension on survival of patients with
gastric cancer treated in a cancer reference center in Bahia, Brazil
Ribeiro, T.F.1, Frana, R.R.2, Albuquerque, A.F.1, Rodrigues, D.A.T.3,
Almeida, D.A.C.2, Pedrosa, M.O.3, Costa, V.S.M.1
1
Brazil, 2Medical College of Federal University of Bahia, Salvador, Brazil,
3
Bahiana School of Medicine and Public Health, Salvador, Brazil
thiago.francischetto@gmail.com, riamfranca@hotmail.com,
a.f.albuquerque@bol.com.br, hamandanl@hotmail.com,
anjos.daniela000@gmail.com, mayaragoes@hotmail.com,
vitor_savio@yahoo.com.br
Introduction: Gastric cancer is the second most frequent cancer in the
world. In Brazil, it ranks third in the incidence of tumors among men and
fifth among women, with an estimated 20,390 new cases in 2014, according
INCA (National Cancer Institute). The main treatment is gastrectomy in the
case of gastric neoplasms; however, the extent of lymph-node dissection
associated with it is still subject to many questions.
Objectives: To compare the results and survival of patients with
gastric cancer who underwent gastrectomy with D1 or D2 lymphadenectomy in a reference center in Bahia.
Methods: This was a retrospective cohort study with patients undergoing surgical treatment for gastric cancer between January 2003 and
December 2012 in a cancer reference center in Bahia. We carried out
proportional analysis for categorical variables, central tendency for continuous variables and univariate survival analysis with KaplanMeier curve,
considering P < 0.05 significant.
Results: Of the 796 operated patients, 30.7% underwent total gastrectomy, while 60.8% underwent partial gastrectomy. In 5.5% D0
lymphadenectomy was performed, in 46.2% D1 and in 36.2% D2; 15.8%
of D1patients and 19.6% of D2 patients had positive lymph nodes, and 9%
of D1patients and 9.8% of D2 patients required blood transfusion during
surgery. Postoperative complications occurred in 18.2% of D0 patients,
26.7% of D1 patients, and 24.7% of D2. The fistula rate was 3.8% in D1
patients and 4.5% in D2 group. Postoperative mortality was 4.5% of the D0
group, 6.5% of D1 and 3.5% of D2. The overall survival (OS) and disease-
S107
free survival (DFS) was significantly better in patients who underwent D2
lymphadenectomy (P = 0.004 and P = 0.003).
Conclusions: Patients undergoing D2 lymphadenectomy showed
OS and DFS that were significantly better than those undergoing D1
lymphadenectomy, with comparable complication rates.
029028
Intra-corporeal esophagojejunal anastomosis: a challenge in
laparoscopic total gastrectomy for gastric cancer treatment
Lacerda, C.F.1, Bertulucci, P.A.1, DallInha, V.N.2, Burgardt, D.2, Meira
Neto, C.C.2, Oliveira, A.T.T.1
1
Department of Surgery Oncology Upper Digestive Tract, Barretos
Cancer Hospital, So Paulo, Brazil, 2Department of Surgery Oncology,
Barretos Cancer Hospital, So Paulo, Brazil
croider@hotmail.com, paulobertulucci@uol.com.br, oncovnd@gmail.com,
diego_burgardt@yahoo.com.br, claudemironeto@yahoo.com.br,
netto123@uol.com.br
Introduction: The laparoscopic gastrectomy is a relatively new
procedure mainly because of the difficulties related to lymphadenectomy
and reconstruction. Even now, techniques or devices for performing the
esophagojejunal anastomosis by laparoscopy is still a challenge. The development of a safe, cheap and quick technique is therefore desirable.
Objective: To present a technique proposed by the authors with technical details on reconstruction with a reverse anvil.
Methods: After total gastrectomy completed intra-corporeally, the
reconstruction starts with the preparation of the intra-abdominal esophagus
cross-section next to the esophagogastric transition of 50%. A graduated
device is prepared using Levine gastric tubes (numbers 14 and 10), 3 cm
in length, connected to the anvil of the circular stapler (n. 25) with a wire
thread (2-0 or 3-0) of 10 cm, which is connected to the end of this device.
The whole device is introduced in reverse esophagus. The esophagus is
amputated, the wire is pulled after previous transfixation into the distal
esophagus, and the anvil is positioned. The jejunal loop is sectioned 2030
cm from the duodenojejunal angle, and the anvil put in the jejunal loop and
connected previously in the esophagus. A linear stapler (blue 60 mm) is
used to close the opening of the jejunal loop.
Results: Since 2009 this procedure has been performed in 164 patients
at the Barretos Cancer Hospital, Barretos, SP, Brazil.
Conclusion: The technique used by the authors facilitated the transit
reestablishment after total gastrectomy, contributing to obviating reconstruction problems after total gastrectomy.
029131
Laparoscopic gastrectomy in gastric cancer: initial experience
Jonhson, L.F.P.1, Rohrs, D.F.1, Barreto, P.H.F.1, Moraes, M.D.1,
Freire, A.N.M.1, Ferreira, P.A.1
1
Santa Casa de Misericordia da Bahia, Brazil
fernando.johnson@uol.com.br, danielrohrs@hotmail.com,
phfbarreto@hotmail.com, marcosdmfreire@yahoo.com.br,
andreney.freire@gmail.com, pryscillaferreira@yahoo.com.br
Introduction: Surgical treatment of gastric adenocarcinoma through
laparoscopy has been gaining attention and popularity in recent years,
combining the benefits of laparoscopy with similar results of conventional
surgery.
Objective: To compare conventional laparotomy to laparoscopy in the
surgical treatment of gastric cancer in an oncological surgery service.
Methods: This was a retrospective review of gastrectomy for adenocarcinoma conducted between May 2013 and June 2015 by laparoscopic
surgery and conventional laparotomy performed by a single surgeon.
S108
ABSTRACTS
Results: Twenty-four gastrectomies were performed (12 for laparoscopy and 12 for laparotomy). Of the 12 laparoscopies, seven were
for adenocarcinoma and six of these were total gastrectomies with D2
lymphadenectomy. The average age was 53.2 years, five of the patients
were females. The mean operative time of laparoscopic gastrectomy was
310 min, with an average time of 253 minutes in the last three laparoscopic total gastrectomies. Conversion to conventional surgery occurred
in two cases to construct the esophagojejunal anastomosis. The average of
dissected lymph nodes was 33 (1947), with an average hospital stay of
6.7 days. Of the 12 gastrectomies by conventional laparotomy, five were
total gastrectomies with D2 lymphadenectomy. The average age was 60.5
years, and there were five women and seven men. The mean operative time
was 170 min. The average of dissected lymph nodes was 32 (1655) with
length of hospital stay of 7.3 days on average. There was one death in the
laparoscopic group and two in the conventional laparotomy group.
Conclusions: Gastrectomy with D2 lymphadenectomy is the gold
standard curative procedure for gastric cancer. The laparoscopic procedure is gaining preference over open surgery because of the advantages
of minimally invasive surgery. Our review shows that the initial results
of laparoscopic gastrectomy are similar to those of open gastrectomy, but
with longer surgical time, probably because of the learning curve required
for the procedure.
Background: In Belgium, in June 1993, Azagra et al. performed the

first total gastrectomy for the treatment of gastric cancer. In 1999 they
published their experience with 13 patients, concluding that laparoscopy
for the treatment of gastric cancer is feasible and oncologically safe.
Methods: We present a laparoscopic total gastrectomy with D2
lymphadenectomy for adenocarcinoma of the lesser curvature of the
stomach. An original technique of circular esophagojejunal anastomosis is
described.
Results: Among the studied variables, laparoscopy has a shorter
surgical time and an earlier time for the introduction of oral and enteral
nourishment than open surgery. As to the amount of dissected lymph nodes,
this has exceed 25 nodes as recommended by the JAGC. No significant
difference was found between the studied groups with regard to age, ASA,
type of surgery, need for blood transfusion, stage of the disease, Bormann
classification, degree of differentiation, damage to the margins, further
complications, and death.
Conclusion: Total gastrectomy with D2 lymphadenectomy performed
by laparoscopy presented the same benefits as laparotomy with all the
advantages of minimally invasive surgery. It was achieved with a shorter
surgical time, less time before reintroduction of oral and enteral diets, and
shorter hospitalization time compared to laparotomy, without increasing
postoperative complications.
028387
Laparoscopic subtotal gastrectomy with D1+ lymphadenectomy for
an early-stage gastric adenocarcinoma
Ribeiro, L.C.B.1, Sabino, F.D.1, Albagli, R.O.1, Oliveira, J.L.1, Oliveira, J.L.1
1
National Cancer Institute, Rio de Janeiro, Brazil
029303
Locally advanced gastric cancer: a series of cases treated at FCECON
with extended multiorgan resection
Di Tommaso, R.A.S.1, Santos, M.H.1, Haji Junior, A.C.1, Stefani, M.N.1,
Santos Junior, P.R.M.1, Correa Junior, M.A.R.1
1
Fundao Centro de Controle de Oncologia do Estado do Amazonas
(FCECON), Manaus, Brazil
lurribeiro@yahoo.com.br, fdsabino@gmail.com, rafaelalbagli@uol.com.br,

jadivanleite@hotmail.com, jadivanleite@hotmail.com
Introduction: Since its introduction, laparoscopic gastrectomy has
shown classical advantages of minimally invasive surgery over its open
counterpart. Recently, it has been regarded as the standard treatment for
early gastric cancer.
Objectives: To demonstrate a radical laparoscopic subtotal gastrectomy with D1+ lymph-node dissection for an early gastric adenocarcinoma.
Methods: A 45-year-old female patient underwent endoscopy which
revealed a depressed flat tumor, located at the distal antrum and measuring
2.5 cm, classified as type 0 IIa+IIc. The biopsy showed a poorly differentiated adenocarcinoma with signet-ring cells. She was submitted to a totally
laparoscopic subtotal gastrectomy with D1+ lymphadenectomy.
Results: The procedure took 210 minutes and the blood loss was
minimal. Oral intake was started at the second postoperative day (POD)
and the patient was discharged on the fifth POD. Histopathological analysis
revealed an intramucosal moderately differentiated adenocarcinoma of the
intestinal type, measuring 2.0 x 2.0 cm, pT1a pN0.
Conclusions: Radical laparoscopic subtotal gastrectomy was shown to
be safe and feasible and presented a good short-term outcome.
029123
Laparoscopic total gastrectomy with D2 lymphadenectomy for gastric
adenocarcinoma
Lacerda, C.F.1, Bertulucci, P.A.1, DallInha, V.N.2, Meira Neto, C.C.2,
Moraes, F.P.2, Oliveira, A.T.T.1
1
Department of Surgery Oncology Upper Digestive Tract, Barretos
claudemironeto@yahoo.com.br, flaviosaopaulino@hotmail.com,
netto123@uol.com.br
bekinha_santos@hotmail.com, oncomhs@gmail.com,
caoru.jr@gmail.com, marcioprofic@yahoo.com.br
Introduction: Curative resection is the most important factor for
long-term survival in patients with T4 gastric cancer. It is unclear whether
combined resection can improve the results of surgery in these patients.
Objectives: To report the surgical experience at FCECON in patients
with T4 gastric cancer in 2014.
Methods: Six patients underwent surgical resection for T4 gastric
cancer in FCECON. (1) A male, 43 years old, underwent subtotal gastrectomy, D2 lymphadenectomy, transversectomy, and Roux-Y reconstruction.
(2) A male, 76 years old, underwent subtotal gastrectomy, D1 lymphadenectomy, transversectomy, and Roux-Y reconstruction. (3) A female, 68 years
old, underwent total gastrectomy, D2 lymphadenectomy, subtotal colectomy,
distal pancreatectomy, splenectomy, and jejunostomy. (4) A male, 67 years
old, underwent distal esophagectomy, total gastrectomy, D2 lymphadenectomy, resection of the diaphragm (crus), distal pancreatectomy, splenectomy, and Roux-Y reconstruction. (5) A male, 78 years old, underwent distal
esophagectomy, total gastrectomy, D1 plus lymphadenectomy, hepatectomy
(segments 2 and 3), jejunostomy, and Roux-Y reconstruction. (6) A female,
28 years old, underwent total gastrectomy, D2 lymphadenectomy, pancreaticoduodenectomy, and Roux-Y reconstruction.
Discussion: Extended multiorgan resection (EMR) is performed for
treating patients with T4 gastric cancer as the only choice for achieving
curative resection. Significant factors for a poor prognosis for T4 gastric
cancer have been suggested to include tumor diameter (>100 mm), number
of lymph-node metastases (>6), advanced age (>70 years) and resection
of >1 additional organ. The tumor frequently invades the pancreas and
the transverse colon/mesocolon; consequently, pancreaticosplenectomy
or colon resection are carried out. But combined resection induces more
serious postoperative morbidity (25%) and mortality (3.6%), which could
offset any potentially beneficial effects on survival.
ABSTRACTS
Conclusion: Surgery is the only proven effective therapy and each
patient should be given the chance of R0 resection, although multi-organ
resection has a limited survival advantage because of the advanced stage
of the disease.
028926
Minimally invasive IvorLewis surgery for esophagogastric junction
cancer treatment
Cury Filho, A.M.1, Diniz, A.L.1, Ribeiro, H.S.1, Da Costa, W.L.1, De
Brito, R.H.1, Coimbra, F.J.F.1
1
A. C. Camargo Cancer Center, So Paulo, Brazil
curyantonio@gmail.com,
dr.aldiniz@gmail.com, hsalvadorcr@gmail.com, dr.wilsoncosta@gmail.com,
rafaelhbrito@yahoo.com.br, drfelipecoimbra@gmail.com
Introduction: Esophagectomy is a high-morbidity surgery due mainly
to pulmonary complications. Minimally invasive surgery is an alternative
associated with better postoperative outcomes.
Objectives: To demonstrate that minimally invasive Ivor-Lewis
surgery for a Siewert I cancer is a feasible approach.
Methods: The dissection starts by laparoscopy with lymph-node
dissection and placement of a gastric tube. Putting the patient in prone
position for the thoracoscopic approach, we show the dissection of the
esophagus, thoracic lymphadenectomy and the reconstruction.
Results: We demonstrated that IvorLewis surgery for a case of
Siewert I cancer is a feasible approach.
Conclusion: IvorLewis surgery for Siewert I cancer is a feasible
approach.
029179
Morbidity and mortality in resected elderly gastric cancer patients
Franco, C.P.1, Costa Jr., W.L.1, Begnami, M.D.F.S.1, Brito, R.H.1,
Marques, N.1, Coimbra, F.J.F.1
1
carolparucce@gmail.com, dr.wilsoncosta@gmail.com,
mariadirlei@gmail.com,rafaelhbrito@yahoo.com.br,narimarques@gmail.com,
Introduction: Elderly patients with gastric cancer have a higher risk of
postoperative complications after resection. Despite technical advances and
referral to specialized centers, morbidity and mortality are still significant.
The identification of factors associated with them is a main component in
improving outcomes.
Objectives: To identify prognostic factors of postoperative morbidity
and mortality for elderly patients with gastric cancer.
Methods: This was a retrospective study that included only patients
over 70 years of age with gastric adenocarcinoma operated with curative
intent in a period of 5 years in a Brazilian cancer center. The relationship
between patient and surgical prognostic factors and postoperative morbidity
and mortality was investigated.
Results: Among the 199 patients operated, only 65 were over 70 years
old. Of these, 24 underwent total gastrectomy, 34 a distal resection and
seven a resection of gastric stump tumors. Most were male (63.1%) and
their median age was 76 years (7091 years). Complications were found
in 36 cases (55.4%), with pneumonia (15.4%), digestive fistula (10.8%)
and wound infection (15.4%) being the most common. Overall 30-day
mortality was 10.8%. Only multivisceral resections were associated with
higher mortality (P: 0.008).
Conclusion: In this sample, morbidity and mortality findings were
similar to those reported in other studies, especially regarding prognostic
factors such as nutritional status, BMI, ASA and extended resections.
S109
Strategies to improve outcomes should focus on better preoperative care
and tailored surgery for elderly patients.
029140
Multivisceral resection in gastric cancer
Simonetti, V.V.1, Marques, M.C.1, Costa Jr, W.L.1, Coimbra, F.J.F.1,
Diniz, A.L.1, Ribeiro, H.S.C.1, Godoy, A.L.1, Farias, I.C.1, Cury
Filho, A.M.1
1
Department of Abdominal Surgery, A.C. Camargo Cancer Center,
So Paulo, Brazil
dr.vinicius.simonetti@gmail.com, dr.marciocarmona@gmail.com
Introduction: In Brazil, gastric cancer is still diagnosed in advanced
stages in more than half of the cases, which is due mainly to late presentation. Surgical treatment for locally advanced tumors involving multivisceral resection has been extensively debated and reviewed.
Objective: To analyze data from multivisceral resections in our center
during the last two decades.
Methods: This is a retrospective study which included 206 consecutive patients treated with multivisceral resection for gastric cancer between
1988 and 2013. Our endpoints were overall survival (OS), morbidity and
mortality.
Results: We analyzed 206 subjects. Their mean age was 59 years,
129 were male, and median operative time was 413 minutes (105960).
Regarding clinical presentation before surgery, 82 subjects had >10%
weight loss, 58 had <10%, 36 presented with gastrointestinal bleeding, and
19 had gastric/bowel obstruction symptoms. Surgically, 83.5% underwent
total gastrectomies and the other 16.5% underwent subtotal gastrectomies;
D2 lymphadenectomy was performed in 140 individuals, and the different
multivisceral resections included 57 (27.7%) pancreatectomies, 168
(81.6%) splenectomies, 27 (13.1%) colectomies, and 13 (6.8%) hepatectomies. Blood transfusion was needed in 93 subjects. Overall 60-day postoperative morbidity was 45.1%. Identified risk factors for complications were
total gastrectomy, blood transfusion and neoadjuvant treatment. Mortality
risk factors were male gender, blood transfusion and ASA categories 3 and
4. Median overall survival was 25 months, with a 5-year overall survival of
36.4%. Prognostic factors associated with worse survival were weight loss
>10%, obstructive tumors, D1 lymphadenectomy, pancreatectomy, blood
transfusion, T3-4 stage, N2-3 stage, lymphatic vessel invasion, perineural
invasion and tumor site.
Conclusion: Multivisceral resections for gastric cancer are associated with higher morbidity and mortality and worse survival outcomes.
They should be performed only in patients in whom an R0 resection is
possible.
029074
One hundred twenty-nine patients threatened with perioperative
chemotherapy for esophagogastric adenocarcinoma in a single
Brazilian cancer center
Marques, M.C.1, Costa Jr, W.L.1, Coimbra, F.J.F.1, Diniz, A.L.1,
1
Department of Abdominal Surgery, A.C. Camargo Cancer Center, So
Paulo, Brazil
Introduction: Multimodal treatment for locally advanced esophagogastric adenocarcinoma has already been established as the standard
care. The use of perioperative chemotherapy has increased in recent years,
replacing the use of adjuvant chemoradiotherapy.
Objectives: To show the experience of a Brazilian tertiary cancer center
with perioperative chemotherapy for esophagogastric adenocarcinoma.
S110
Methods: A retrospective analysis was performed of the medical
charts of patients who underwent resection of esophagogastric adenocarcinoma after neoadjuvant chemotherapy between 2005 and 2015.
Results: In the study period, 129 patients underwent resection of
esophagogastric adenocarcinoma with curative intent after preoperative
chemotherapy. Mean age was 61 years ( 12.7 years). There was a higher
number of males (65.1%). Fifty-one patients presented esophagogastric
junctions (EGJ) tumors. An esophagectomy was performed in 31 patients
and a total or subtotal gastrectomy was done in 98 patients. Most patients
received a D2 lymph-node dissection (94.5%). Mean operative time was
452 minutes ( 131 minutes) and length of hospital stay was 15 days ( 10
days). Forty patients received blood transfusion. Postoperative morbidity
occurred in 48% of the surgeries, most of them minor complications (58%).
Five patients died after surgery. The most common type of tumor was intestinal (61.5%). Most patients completed the preoperative chemotherapy
regimen (92.4%); however, only 37.9% completed postoperative treatment.
Estimated median overall survival (OS) was 63 months. Estimated median
disease-free survival (DFS) was not reached. Independent predictors of OS
were lymph-node disease (HR 5.2, P = 0.003, CI 1.715.6) and inability to
complete postoperative chemotherapy (HR 2.3, P = 0.049, CI 1.05.4). The
only independent predictor of DFS was lymph-node metastasis (HR 2.7, P =
0.040, CI 1.0 7.3). Age was the only independent predictor of completing
postoperative chemotherapy (OR 4.0, P = 0.001, 95%CI 1.78.9).
Conclusion: Completion of perioperative chemotherapy treatment
seems to be a predictor of overall survival in patients with esophagogastric
adenocarcinoma.
028871
Palliative treatment of esophageal cancer: Postlethwait technique:
proposal for a laparoscopic approach
Lacerda, C.F.1, DallInha, V.N.1, Bertulucci, P.A.1, Burgardt, D.1,
Meira Neto, C.C.1, Oliveira, A.T.T.1
1
Hospital de Cncer de Barretos, So Paulo, Brazil
croider@hotmail.com, oncovnd@gmail.com, paulobertulucci@uol.com.br,
diego_burgardt@yahoo.com.br, claudemironeto@yahoo.com.br,
netto123@uol.com.br
Introduction: The first reference to the isoperistaltic gastric tube
perfused by the right gastroepiploic artery was by Dengel in 1930, who
attributed the concept to Rutkowiski. Only in 1979 did Postlethwait report
the use of the isoperistaltic gastric tube to bypass an esophagus with
advanced neoplasia. Now, with advances in the use of videosurgery in the
treatment of cancer patients, we propose a laparoscopic approach for the
surgery recommended by Postlethwait.
Objective: To demonstrate a bypass procedure in a patient with
advanced esophageal cancer, in which an isoperistaltic gastric tube of the
greater curvature is positioned retrosternally with a cervical anastomosis,
as proposed by Postlethwait in 1979. The authors propose a laparoscopic
approach for this technique.
Methods: The technique involves creating a bypass with a 3-cmwide gastric tube, with an average length of 30 cm and preservation of the
right gastroepiploic vessels. The stomach is sectioned into V, in a line
parallel to the greater curvature, with the aid of linear mechanical stapler
and a circular stapler in the antrum. The gastric tube made with the greater
curvature is positioned retrosternally through the creation of an area below
the xiphoid process to the sternal notch. The anastomosis of the proximal
stump of the cervical esophagus with the proximal end of the gastric tube is
performed a with a 25-mm intraluminal stapler.
Conclusion: An isoperistaltic gastric tube inserted by laparoscopy is feasible
and reproducible; it is a good surgical method for the palliative treatment of
advanced esophageal cancer and to improve the quality of life for these patients.
ABSTRACTS
028323
Perioperative chemotherapy and D2 laparoscopic gastrectomy for
advanced gastric cancer: results from a single institution
Araujo, R.O.C.1, Sabino, F.D.1, Valadao, M.1, Bugarin, A.1, Soldati, D.1,
Maltoni, L.A.1
1
Pasteur Oncology Center, Hospital Pasteur, Rio de Janeiro, RJ, Brazil
rotaraujo@yahoo.com.br,fdsabino@gmail.com,drmarcusvaladao@gmail.com,
lecomed03@hotmail.com, dschaves@amil.com.br, lamaltoni@amil.com.br
Introduction: Radical surgical resection is the mainstay of treatment
for advanced gastric cancer (AGC), but overall survival is reduced due to
regional and systemic progression. Perioperative chemotherapy (CT) offers
improvement in 5-year overall survival and disease-free progression, but
it hasnt gained widespread adoption for resectable cases. Laparoscopic
radical gastrectomy is accepted for early gastric cancer but long-term
results are awaited for advanced cases.
Objectives: To report the early results of perioperative CT combined
with laparoscopic D2 gastrectomy for AGC in a single institution.
Methods: Perioperative epirubicine, cisplatin and 5-fluorouracil
(ECF) is routine for AGC in our institution. Patients diagnosed with resectable AGC received three cycles of ECF followed by D2 laparoscopic gastrectomy and additional three cycles of postoperative ECF. All patients had
implanted catheters for CT infusion. D2 dissection varied accordingly to
tumor location, as also did the decision to perform partial or total gastrectomy or esophagogastrectomy.
Results: Eight patients (seven females) were submitted to preoperative CT followed by R0 laparoscopic D2 resection. The mean age of the
patients was 47.4 years (range 3559 years). One patient was treated for
tuberculosis before resection. Four patients had total gastrectomy, three had
subtotal gastrectomy and one had esophagogastrectomy. The median length
of postoperative hospital stay was 19 days (570 days). Surgical complications occurred in four patients, and two reoperations were necessary. There
were no deaths, and all patients received postoperative CT. Mean nodal
retrieval was 19 (range 1435), and all surgical margins were negative
(R0). Pathological stage was stage I in one patient, stage II in four patients
and stage III in three patients. No recurrences were detected in a mean
follow-up of 8.6 months.
Conclusion: Perioperative chemotherapy and D2 laparoscopic gastrectomy for AGC is feasible and is associated with 100% resectability with
no treatment-related deaths. Short follow-up results are encouraging.
028248
Port-site metastases following laparoscopic gastrectomy
Accordi, C.C.1, Uliano, E.J.M.1, Reis, M.P.1, Carvalho, A.C.1, Feil, D.C.1
1
HNSC, Tubaro-SC, Brazil
ccaccordi@icloud.com, estevao.uliano@hotmail.com,
matheusbig@hotmail.com, anaccarvalho7@gmail.com,
anaccarvalho7@gmail.com
Introduction: The laparoscopic approach has been used increasingly
because of its various benefits. However, metastases in laparoscopic ports
have been observed after some oncological procedures. The exact reason
for this has yet to be revealed, but several explanations such as contamination of surgical instruments with neoplastic cells, and the turbulence of
the CO2 leading malignant cells to the interior of laparoscopic ports are
being considered.
Objectives: To report a case of a port-site metastasis in a patient after
a laparoscopic gastrectomy follow-up.
Methods: The information was obtained by review of medical records,
patient interview and literature review.
Results: A male Caucasian patient, 52 years old, was diagnosed
with gastric adenocarcinoma. The patient underwent a successful total
ABSTRACTS
laparoscopic gastrectomy. After 23 months in a follow-up visit an abdominal mass was identified. At the time an MRI of the abdomen was requested
and this showed an expansive and infiltrative lesion in the abdominal wall.
Surgical resection was scheduled, and then a port-site metastasis was
diagnosed.
Conclusions: It was shown that the survival and cancer recurrence
rates are similar to those in traditional open surgery. Port-site metastasis
is not a risk exclusive to laparoscopic surgeries but is a consequence of a
learning curve and advanced disease. The rates usually decrease when there
is adequate training and technical skill.
028951
Analysis of quality of life in patients with gastrectomy due to gastric
adenocarcinoma
Menezes, J.N.1, Caxeiro, G.L.1, Takahara, I.A.1,
Fava, B.E.C2., Torres, M.C.2, Apodaca, F.R.3
1
University of Mogi das Cruzes, Mogi das Cruzes, Brazil, 2Luzia de Pinho
Melo Hospital, Mogi das Cruzes, Brazil, 3University of Mogi das Cruzes
& Luzia de Pinho Melo Hospital, Mogi das Cruzes, Brazil
jacque_menezes@hotmail.com,
gcaxeiro1@gmail.com, isabella_asari@hotmail.com,
bianca_fava@yahoo.com.br, maacerdan@gmail.com, apodaca@uol.com.br
Introduction: Gastric cancer is one of the main causes of death worldwide. In Brazil, it is the third most frequent malignant neoplasia among
men and the fifth among women. Surgery is the main treatment and can be
associated with jeopardy to quality of life (QL).
Objectives: To analyze the QL of patients with total or subtotal gastrectomy for gastric adenocarcinoma.
Methods: We included 28 patients diagnosed with histopathology
of gastric adenocarcinoma treated with total or subtotal gastrectomy. The
patients had at least a 6-month post-surgery period from January 2013
to December 2014. They were requested to answer the EORTC QLQ
(European Organization for Research in the Treatment of Cancer Quality
of Life Questionnaire) in Portuguese, divided into: EORTC QLQ C30 and
EORTC QLQ STO22 (gastric module).
Results: There was an abstention rate of 7.2%. The overall performance of the patients (n = 26) revealed an average of 80.4 22.6 in the
applied scale. Role, emotional, cognitive, physical and social functioning
showed averages of 78.2 32.2; 83.3 24; 78.2 27.4; 75.4 26.2 and
87.8 18, respectively. The analysis among patients with total or subtotal
gastrectomy revealed a significant difference in physical (P = 0,021) and
role functioning (P = 0.009). Higher symptomology rates have been associated with patients with a total gastrectomy. Body image perception (P =
0.048) was worse in those who had undergone any post-surgery complication. When the length of hospital stay exceeded 15 days, there were worse
scores of the overall (P = 0.01) patients physical (P =0. 033) and role
functioning (P = 0.03). Patients with advanced clinical stage (IIIB and IV)
presented significant jeopardized overall functional scale (P = 0.017) and
social functioning (P =0.031).
Conclusions: Total gastrectomy, advanced clinical stage and long
hospital stay are factors associated with worse QL in patients with gastrectomy. More studies aiming to improve the understanding of the impact of
gastrectomy on QL are necessary.
028623
Ratio of metastatic lymph nodes examined in gastric cancer
Laporte, G.A.1, Weston, A.C.2, Zoletti, F.2, Leonardi, L.A.1, Giordani, D.3,
Cereser, C.H.3, Assumpo, J.I.4, Souza, D.L.S.5, de Morais, C.O.5
1
da Santa Casa de Misericrdia de Porto Alegre e Universidade Federal
S111
de Cincias da Sade de Porto Alegre, Brazil, 2Servio de Cirurgia
Oncolgica do Hospital Santa Rita da Irmandade da Santa Casa de
Misericrdia de Porto Alegre, Brazil, 3Servio de Cirurgia Geral da
Irmandade da Santa Casa de Misericrdia de Porto Alegre, Brazil,
4
Universidade Luterana do Brazil, 5Universidade Federal de Cincias da
laportegustavo@gmail.com
Introduction: Gastric cancer is one of the most common malignancies in the world. Metastasis to lymph nodes is an important predictor
of mortality in this pathology. However, many lymph nodes are poorly
resected or resected in insufficient numbers for evaluation by the TNM
system.
Objectives: To describe a statistical analysis of a ratio of 0.2 between
clinical and pathological characteristics and survival of surgical patients
with gastric cancer.
Methods: This is a historic cohort study from May 2000 to December
2011 including patients surgically managed for gastric cancer in stages I,
II and III.
Results: A total of 175 patients in stages I, II and III were included.
From these, 104 patients were in the group <0.2 and 71 patients were in the
group >0.2. The group <0.2 had an average of 16.09 nodes resected with an
average of 0.7 positive nodes. This group had minor tumors with 66.3% of
patients with N0, 22.8% N1, 9.6% N2 and 0.9% N3a. The group >0.2 has
an average of 17.92 nodes resected with an average of 9.45 positive nodes.
This group had major tumors with 9.8% of patients with N1, 31.0% N2,
39.2% N3a and 17.5% N3b. The survival rate was 60% for the group <0.2
and 18% for the group >0.2.
Conclusions: The use of a 0.2 ratio is a good tool for predicting
mortality and can be use as a prognostic factor in patients without a sufficient number of lymph nodes resected. It can also have great value as an
addition to the TNM system.
029314
Recurrence and death following curative resection for gastric cancer
Wohnrath, D.R.1, Moraes, F.P.1, Neto, C.C.M.1
1
durvalrw@gmail.com, flaviocirurgiageral@gmail.com,
claudemironeto@yahoo.com.br
Introduction: Recurrence of gastric cancer treated with curative
intent is described in the literature as frequent and is of great concern to
oncologists.
Objective: To analyze the frequency of relapse, the time it occurs, and
the modes of recurrence.
Methods: This was a retrospective study of 504 sequential patients
with gastric adenocarcinoma who underwent curative (R0) gastrectomy
in the period August 1994 to September 2013, at the Barretos Cancer
Hospital, SP, Brazil. The tumors were staged or re-staged according to the
seventh edition of the TNM.
Results: From 504 patients eligible for the study, 185 (36.7%)
relapsed. In accordance with the stages, we had the following recurrence
distributions. IA: 64 patients/3 relapses (4.7%); IB: 51/5 (9.8%); IIA: 15/3
(20%); IIB: 90/30 (3.3%); IIIA: 59/32 (54.2%); IIIB: 77/36 (46.7%); and
IIIC: 148/76 (51.3%). Average time from surgery to recurrence was 21.4
months (range 0.4132.9 months). Median time from recurrence to death
was 7.7 months (range 0.0334.4 months). Most frequent sites of relapse
were carcinomatosis (39 cases), liver (17 cases), retroperitoneum (ten
cases), lung (eight cases), and bones (seven cases). Distribution of relapse
over time was up to 36 months (141 recurrences, 76.2%); >3660 months
(24 recurrences, 13.0%); >60120 months (18 relapses, 9.7%); and >120
months (two recurrences, 1.1%).
S112
Conclusion: The recurrence of gastric cancer is highly lethal; every
one of our patients who suffered relapse progressed to death. Despite the
patients follow-up trend for 5 years after curative surgery, we believe that
this period should be extended for at least 10 years.
028421
Robotic assisted Ivor Lewis esophagectomy. Single center experience
Padovese, C.C.1, Epstein, M.G.1, Schraibman, V.1, Marcondes, W.1,
Bertocco, L.A.S.1, Macedo, A.L.V.1
1
Albert Einstein Hospital, Brazil
camila_padovese@yahoo.com.br, ma_epstein@hotmail.com,
vschraibman@hotmail.com, wagnermarcondes@hotmail.com,
luisbertocco@zipmail.com.br, tala@uol.com.br
Introduction: Ivor-Lewis esophagectomy (ILE) is one of the most
commonly employed open techniques of esophagectomy. Minimally invasive approaches have been explored in ILE in an effort to reduce operative morbidity. Robotic systems have been designed to overcome some of
the disadvantages of standard minimally invasive surgery. These technical
improvements facilitate precise dissection in a confined operating field,
and may benefit mediastinal dissection of the esophagus and surrounding
lymph nodes.
Methods: From July 2013 to May 2015 at Albert Einstein Hospital,
Sao Paulo, Brazil, six patients underwent robotic esophagectomy with
manual esophagogastric anastomosis. In five patients, robot-assisted thoracoscopic dissection was accomplished, followed by laparoscopy for the
preparation of the gastric tube. In the last patient we adopted a modified
Ivor-Lewis technique, with a totally robotic procedure. The surgery was
performed by the senior surgeon A.L.V. Macedo.
Results: A total of six patients in this report underwent robotic IvorLewis esophagectomy. They were three male and three female patients,
and had a mean age of 51 years (range 3979 years). The thoracic and
abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy. The mean
overall operative time was 520 minutes (range 480780 minutes), and the
mean estimated blood loss was 216 mL (range 80750 mL). A median of
21 (1334) lymph nodes were retrieved by thoracic lymphadenectomy. The
mean length of hospital stay was 19 days (range 827 days). One female
patient developed an anastomotic leak (postoperative day 7) and was
successfully managed non-operatively. There were no recurrent laryngeal
nerve injuries.
Conclusions: In this report we have shown that a minimally invasive
Ivor-Lewis esophagectomy is feasible and that the technique is reproducible. However, this is a relatively small series, and the follow-up was insufficient to determine patterns of recurrence and overall survival.
028295
Robotic assisted mobilization and esophagogastric anastomosis for
minimally invasive esophagectomies: initial experience of a single
center
Epstein, M.G.1, Schraibman, V.1, Padovese, C.C.1, Maccapani, G.1,
DOrto, U.C.1, Macedo, A.L.V.1
1
Hospital Albert Einstein, Brazil
ma_epstein@hotmail.com, vschraibman@hotmail.com,
camila_padovese@yahoo.com.br, gaba65@hotmail.com,
dr.ulisses@uol.com.br, tala@uol.com.br
Introduction: Open esophagectomy is a complex procedure requiring
laparotomy and usually a thoracotomy. Because of concerns related to the
mortality and morbidity of open esophagectomy, minimally invasive techniques have been developed and are increasingly being reported.
ABSTRACTS
Objective: To report our experience in performing minimally invasive
esophagectomy (MIE) using the DaVinci Robotic system for the treatment
of esophageal and gastric junction neoplasia.
Methods: From July 2010 to May 2015, 18 patients underwent robotassisted esophagectomy in a single institution located in Brazil. All procedures were performed by the same surgical team. In our early experience,
robot-assisted thoracoscopic dissection was accomplished, followed by
laparoscopy for the preparation of the gastric tube. A cervical anastomosis
was performed. More recently we have adopted a modified Ivor-Lewis
technique, with robot-assisted thoracic anastomosis
Results: The patients were 14 men and 5 women. Mean age was 58
years (3881 years). Clinical stages were I (n = 6), II (n = 10) and III (n =
3). Neoadjuvant therapy was performed in seven patients. Cervical anastomosis was performed in 14 and thoracic anastomosis in five patients.
There were no conversions to an open procedure or from a robot-assisted
to a video-assisted thoracic surgery (VATS). Mean operative time was 380
(90720) minutes. Median ICU stay was 4 (114) days. Mean length of
stay (LOS) was 8 days. Thoracic lymphadenectomy included a median of
18 (934) lymph nodes retrieved. There was a 5.5% mortality (one patient)
due to aorto-esophageal fistula in the postoperative period, and complications occurred in 33.3% (cervical anastomotic leakage, temporary laryngeal
recurrent nerve palsy, pneumonia).
Conclusion: Robot-assisted esophagectomy is an effective procedure,
and is a good alternative to open esophagectomy. However, robotic experience is necessary before the undertaking of these advanced operations.
028417
Robotic duodenopancreatectomy: experience in a single center
Schraibman, V.1, Epstein, M.G.1, Padovese, C.C.1, Okazaki, S.1,
Lucena, L.1, Macedo, A.L.V.1
1
vschraibman@hotmail.com, ma_epstein@hotmail.com,
camila_padovese@yahoo.com.br, doutor.samuel@yahoo.com,
lucasslucena@hotmail.com, tala@uol.com.br
Introduction: Duodenopancreatectomy was first described in 1935 by
Whipple, and it may be indicated for malignant and premalignant lesions
in the head of the pancreas and periampular region. Robotic surgery is
gaining momentum with advantages for minimally invasive management
of pancreatic diseases. The major problems for the spreading of laparoscopic pancreatoduodenectomy are the dissection of the retroperitoneal
margin, the thorough reconstruction phase, the length of operating time,
and the few published papers regarding the advantages of this technique
over the conventional open technique.
Objective: To describe our experience with robot-assisted
duodenopancreatectomy.
Methods: From August 2010 to June 2015, 23 patients underwent
robotic duodenopancreatectomy at the Albert Einstein Hospital, Sao Paulo,
Brazil. Preoperative measured variables included age, gender and indication for surgery. Intraoperative variables included operative time and blood
transfusion. Twenty two surgeries were performed by the senior surgeon
(ALVM) and one surgery by the surgeon VS.
Results: Mean operative time was 635 min (300900 min). Except for
two patients who evolved with pancreatic leakage (8.6% of the cases with
no surgical treatment) and had a longer hospital stay (31 and 47 days), the
mean postoperative hospitalization was 17 days. Six patients needed blood
transfusion during surgery, which represents 26% of the cases. There was
just one conversion and one death due to intra-abdominal bleeding. Four
patients had abdominal bleeding (17.3% of the cases) and three needed
reoperation. Pathology revealed benign, premalignant, malignant and
precursor lesions. There were six intraductal papillary mucinous neoplasms
(26%), four ductal adenocarcinomas (17.3%), four neuroendocrine
ABSTRACTS
neoplasms (17.3%), four duodenal adenocarcinomas (17.3%), one mucinous cystic neoplasm (4%), one intraepithelial neoplasia (4%), one tubular
adenoma (4%), one pseudocyst (4%) and one GIST (4%).
Conclusions: Robotic duodenopancreatectomy is feasible and safe in
selected patients. The main advantages are short hospital stay, decreased
blood loss and lower morbidity for the patients; these are the advantages of
a minimally invasive technique.
029307
Robotic subtotal gastrectomy after neoadjuvant treatment for gastric
cancer
Coimbra, F.J.F.1, Ribeiro, H.S.C.1, Godoy, A.L.1, da Costa Junior,W.1, de
Farias, I.C.1, Cury, A.M.1
1
AC Camargo Cancer Center, Brazil
Introduction: Gastric cancer is an aggressive but curable cancer that
occurs worldwide. Treatment has evolved these last two decades, going
from exclusive surgery to multimodal treatment. Gastrectomy with R0 and
D2 lymph-node dissection is the standard of care and the only option for
long-term survival. A minimally invasive approach has become a valid
alternative to open access, with important advantages such as lower blood
loss, shorter hospital stay, less postoperative pain, and even fewer complications according to some recent studies. Robot-assisted gastrectomy may
have a role in this surgical approach, allowing the possibilities of 3D visualization and multi-directional instrument movements.
Objectives: To show a robotic gastrectomy after neoadjuvant treatment for advanced gastric cancer and to discuss the effects of the preoperative treatment on the disease and the procedure.
Methods: The subject was a 73-year-old male. He had a previous
history of epigastric burning pain and weight loss. PA: controlled arterial
hypertension, no additional comorbidities, ASA 2. Endoscopy showed a
4-cm ulcerated and infiltrated lesion at angular incisure, CEA 1,2/CA 19-9
41.8. Thoracic CT showed no lesions. Staging laparoscopy showed no
macroscopic serosal invasion and negative peritoneal washing. Clinical
staging was cT3N+. Planned treatment: perioperative chemotherapy +
surgery. The patient received three cycles of EOX and showed a complete
clinical response after evaluation with endoscopy and CT. A standard D2
gastrectomy was performed by the SI Da Vinci Robot platform.
Results: Recovery was uneventful. The pathology study showed a
complete pathological response, and there were signs of treatment response
in two lymph nodes: LND 0/44. After the procedure the patient received
three more cycles of the same chemotherapy. The patient is alive with no
signs of recurrence 6 months after this surgical approach.
Conclusions: Gastrectomy with R0 resection and D2 dissection is the
standard of care and the only option for cure of gastric cancer. Neoadjuvant
treatment has an increasing role on the multidisciplinary treatment of gastric
tumors. Minimal invasive surgery including robot-assisted gastrectomy is
safe and has no limitations regarding the use of neoadjuvant treatment.
029245
Screening in patients with family history of gastric cancer: a case
report
Lira, G.A.1, Costa, T.R.P3., Silva, R.P.3, Magno, A.W.G.3, Holanda, A.M.2
1
Department of surgical Oncology, Hospital M.D. Luiz Antonio, Natal,
Brazil, 2Academic medicine, Federal University of Rio Grande do Norte,
Natal, Brazil, 3Academic medicine, Potiguar University, Natal, Brazil
georgelira@hotmail.com, quel.pc@hotmail.com,
rafaelpacheco_s@hotmail.com, alexandre_wgm@hotmail.com,
ayrtonmh@hotmail.com
S113
Introduction: In Brazil, gastric cancer is the fourth most common
malignancy among men and sixth among women. It has shown a decreased
incidence, but mortality remains high. This cancer is considered a disease
of the elderly with higher occurrence in individuals over 50 years of age,
and less than 5% of the cases occur in patients under the age of 40. Because
of this, diagnoses of gastric cancer in young patients occur later in the
course of disease.
Objectives: To report the case of a patient from Liga Norterriograndense
Contra o Cncer with early gastric adenocarcinoma, with a positive family
history of the disease (mother died of gastric cancer at the age of 36), highlighting the importance of tracing family members who have a genetic
influence.
Methods: This is a case report from information collected from
the medical records of a GLM patient, 39 years old, who complained of
dyspepsia since the age of 18. In May 2014, he began to experience epigastric pain and weight loss of approximately 2 kg/month. He sought medical
advice and underwent endoscopy on 09/12/2014 that showed an ulcerated
lesion on the lesser curvature measuring 0.5 cm; biopsy revealed a mucinous adenocarcinoma. A total gastrectomy was performed with retroperitoneal lymphadenectomy and Roux-en-Y reconstruction on 12/12/2014.
On 12/15/2014, pathology showed slightly cohesive carcinoma with
signet-ring cells (Lauren diffuse type), size 1.7 cm, infiltrating to the subserosa but without involvement of serous and free resection margins. The
greater curvature presented lymph-nodes metastasis in 1 of 17 lymph nodes
surveyed; lymph nodes of the lesser curvature and the round ligament of the
liver showed no evidence of metastasis. Pathological staging was pT3N1.
Results: Therapeutic patient radiation and chemotherapy are ongoing,
and imaging shows no evidence of disease recurrence.
Conclusion: This case demonstrates the importance of screening in
patients with a family history of gastric cancer, because of its insidious
evolution and its high mortality rate; the course of the patients life can be
changed by emphasizing their family history.
029304
Should the residual tumor (R) be incorporated into the TNM staging
system for gastric cancer?
Wohnrath, D.1, Neto, C.C.M.1, Moraes, F.P.1
1
Barrretos Cancer Hospital, Barretos, So Paulo, Brazil
durvalrw@gmail.com, claudemironeto@yahoo.com.br,
flaviocirurgiageral@gmail.com
Introduction: The presence of residual tumor after a gastrectomy is
an event of great concern to surgeons. While recognizing the importance
of residual tumor in the surgical field, until now the presence of residual
tumor has not been incorporated into the TNM staging system. The authors
assessed the implications of residual tumor on survival of patients with
gastric cancer who underwent gastrectomy and suggest its inclusion in
future modifications of the TNM staging system.
Objective: To analyze the impact of residual tumor (R) on survival of
patients with gastric cancer undergoing gastrectomy.
Methods: A retrospective analysis was performed of 636 patients with
gastric adenocarcinoma who underwent surgical treatment at the Cancer
Hospital, Barretos, SP, Brazil, according to The General Rules for the
Gastric Cancer Study in Surgery and Pathology (JRSGC, 1981), between
August 1994 and December 2013. Residual tumor was defined in accordance with the Residual Tumor (R) Classification and Prognosis. Survival
analysis was performed by the estimator of the method of KaplanMeier
product-limit and for the comparison between the curves we used the log
rank test. The significance level was 0.05 (5%).
Results: Residual tumor was found in: R0 494 patients (77.7%); R1
46 patients (7.2%); R2 96 patients (15.1%). Specific survival rates at 5
and 10 years were: R0 50.1% and 40.1%; R1 12.4% and 0%; R2 7.1%
S114
and 0%, respectively (P < 0.001). R0 median survival times were: R0 62.9
months (95%CI: 39.586.5); R1 12.7 months (95%CI: 8.416.9) and R2
9.7 months (95%CI: 7.412.1) (P < 0.001).
Conclusions: In our experience, the presence of residual tumor R1
or R2 has a strong impact on the survival of patients with gastric cancer,
suggesting that it is an indicator for prognosis. This is why we believe it
should be incorporated into future editions of the TNM staging system,
improving guidance of treatment decisions and predicting outcomes.
028953
Study stage migration phenomenon: the number of lymph nodes in
surgical specimens influences prognosis for gastric adenocarcinoma
stage
Luz, A.P.S.1, Kesley, R.2, Dantas, D.1, Correa, J.H.S.2, Albagli, R.2,
Castro, L.S.2
1
Brazil
annapaulasluz@gmail.com, rubenskesley@gmail.com,
dantascdani@gmail.com, sicorrea@uol.com.br, rafaelalbagli@uol.com.br,
Introduction: The SJGC Association have on average more than 60
lymph nodes in resected surgical specimens.
Objective: To evaluate the increasing number of lymph nodes identified in the prognosis of patients.
Method: We retrospectively evaluated 1079 resected SS presenting
gastric adenocarcinoma at the INCA from 1997 to 2008. They were grouped
as follows: group I: <15 lymph nodes; group II: 1530 lymph nodes; group
III: 3145 lymph nodes; and group IV: >45 lymph nodes.
Results: The 1079 cases comprised group I: 141 (13.1%); group II:
417 (38.6%); group III: 329 (30.5%); group IV: 192 (17.8%). The median
number of MLNs in group I was one; group II: two MLNs; group III: three
MLNs; and group IV: five MLNs (P < 0.000). The pT4a was the most
common level of infiltration with 726 cases, and there was no difference in
frequency between the groups (P = 0.48). pN0 was found in 383 (35.5%),
pN1 in 166 (15.4%), pN2 in 214 (19.8%), pN3a in 200 (18.5%) and pN3b
in 116 (10.8%). To find 15 or more MLNs in a surgical specimen it was
necessary to study more than 30 lymph nodes in a specimen in 84.5% of the
samples. To find 714 MLNs required the examination of between 15 and
45 lymph nodes in the surgical specimen in 74.5%. The estimated 5-year
survival in group I was 44%, in group II it was 49%, in group III 51% and in
group IV 58% (P = 0.12). Approximately 50% of pM1 patients died within
7 months. In stage I patients 5-year survival was 82%, 66% in stage II, 36%
in stage III and 3% in stage IV.
Conclusion: For every 15 lymph nodes studied one or more MLNs
were found. For staging in pN3a and pN3b we recommend the study of
more than 30 lymph nodes.
029273
Subtotal esophagectomy: approach by thoracoscopy with posterior
access and laparoscopy
Johnson, L.F.P.1, Rohrs, D.1, Barreto, P.1, Freire, M.D.M.1, Galvo, M.P.1,
Freire, A.N.M.1
1
Department of Surgical Oncology, Santa Izabel Hospital, Salvador, Brazil
fernando.johnson@uol.com.br
Background: Many studies have demonstrated the surgical accuracy
of the oncological resections for esophageal cancer through laparoscopy.
The advance of minimally invasive surgery and its advantages when
compared to traditional methods makes this the most frequently chosen
technique.
ABSTRACTS
Objective: To present the minimally invasive surgical approach to
esophageal cancer at an oncological surgery service.
Methods: We performed a minimally invasive esophagectomy with
thoracoscopy, with a posterior access in a prone position, using laparoscopic approaches and reconstruction with gastric tube.
Results: The subject was female, 73 years old, and obese; she related
diagnosis of reflux disease and had intermittent treatment for 10 years
using PPI irregularly. The patient reported the presence of progressive
dysphagia and weight loss over the last 10 months. She was subjected to
an upper gastrointestinal endoscopy that showed epithelium suggestive
of Barretts esophagus in the lower third, with an ulcerated lesion 1 cm
above the gastric esophageal transition. The biopsy revealed the presence
of carcinoma cells associated with Barretts metaplasia. Tomography of the
abdomen and chest showed no evidence of advanced disease. The patient
was subjected to laparoscopic subtotal esophagectomy in two stages, with
thoracoscopy and laparoscopy approaches. Thoracoscopy took 120 minutes
and laparoscopy 130 minutes without complications and without the use of
blood products. The bleed was approximately 200 mL. Pathological analysis yielded a diagnosis of epidermoid carcinoma, stage IIA.
Conclusions: Subtotal esophagectomy is the gold standard curative
procedure for esophageal cancer when diagnosed early. The laparoscopic
procedure is gaining preference over open surgery because of the advantages of minimally invasive surgery. We demonstrate the minimally invasive surgical technique with thoracoscopy and laparoscopy in the prone
position, with gastric and cervical anastomosis of the gastric esophageal
tube.
028593
Synchronous tumor of the stomach and breast: a case report of a rare
find
Ferreira, F.C.S.1, Maroun, J.J.1, Eccard, G.O.1, Guimares, R.S.1,
Sobrinho, J.F.P.1
1
Department of General Surgery, Hospital Naval Marclio Dias, Rio de
Janeiro, Brazil
flaviaf21@gmail.com, jamiljorge@hotmail.com, goeccard@gmail.com
Introduction: The incidence of synchronous cancer has been reported
to vary from 0.7% to 3.5%. A second primary cancer influences the prognosis of gastric cancer patients, and because primary or secondary prevention is the best way to cure cancer, some investigators have focused on
the characteristics of second primary cancers in gastric cancer patients.
However, few studies have been performed in this regard, and most of these
studies are limited to metachronous cancers or the treatment-related second
primary malignancies of gastric cancer patients. The detection of synchronous cancers gives us the opportunity to treat both cancers simultaneously
using less invasive techniques and thus to beneficially influence the prognosis and quality of life of these patients.
Objectives: Both colorectal and lung cancer have been frequently
detected, followed by cancer in the liver, esophagus and breast, the latter
being the rarest in the literature. We present a rare case of synchronous
gastric tumor and breast cancer in a tertiary general hospital.
Methods: The subject was a 56-year-old female with no comorbidities, referred from the gastroenterology service with gastric adenocarcinoma as a candidate for surgical treatment. Physical examination revealed
a palpable mass in the left breast, suspicious for malignancy. As in our
hospital the department of general surgery isnt allowed to perform mastectomy, we chose to perform subtotal gastrectomy D2; after recovery the case
was discussed in an oncology committee, and adjuvant treatment for gastric
cancer and surgical treatment for breast cancer was indicated. Together, we
decided to proceed with the left mastectomy by the gynecology service, and
the adjuvant was delayed until after the second surgery, when it could be
effective for both tumors.
ABSTRACTS
Conclusions: Since gastric cancer patients may develop synchronous
and metachronous second cancers in other organs, effective preoperative
and postoperative diagnostic modalities both for second primary cancers
as well as for the recurrence of gastric cancer need to be developed. In
some studies, second malignancies were the first cause of death, except for
recurrence or metastasis of the initial gastric cancer, and the importance of
a follow-up system for cancer patients is indicated.
028940
Thickness as an important prognostic factor in advanced gastric
adenocarcinomas (pT4a)
Dantas, D.C.1, Kesley, R.2, Cunha, L.F.T.1, Correa, J.H.S.2, Albagli, R.2,
Castro, L.S.2
1
Brazil
dantascdani@gmail.com, rubenskesley@gmail.com,
correiodafelix@gmail.com, sicorrea@uol.com.br, rafaelalbagli@uol.com.br,
Introduction: Just as in melanoma staging, the thickness of the
gastric adenocarcinoma has an influence on the prognosis of the disease,
a fact already identified in early stomach tumors. There are, however, no
accounts in the medical literature about the prognostic value of thickness
in advanced cancers.
Objective: To correlate tumor thickness with infiltration in cases with
serosa invasion T4a according to TNM 2010.
Methods: We analyzed, retrospectively, 686 cases, staged pT4a (TNM
2010), where the transparietal gastric tumor thickness was measured, in
micrometers, at the shallowest and deepest points of the tumor. They were
all electively and consecutively operated on in the INCA between January
1997 and December 2008. Tumors fell into two groups: thin tumors, when
the tumor thickness was 1.5 cm; and thick tumors, when their thickness
was 1.6 cm. Both groups were compared according to clinical factors,
anatomopathology and survival rate.
Results: The mean age of the 686 cases was 62 13 years and there
was a predominance of males (432, 63% of cases). The mean thickness in
pT4a was 1.6 cm. The mean number of lymph nodes found and metastatic
lymph nodes in the surgical specimens was the same for both groups (not
significant, NS). There were 148 (21.6%) cases in stage IIb, 103 (15%) in
stage IIa, 152 (22%) in stage IIIb, 233 (34%) in stage IIIc and 50 (7.4%)
cases in stage IV. When divided into groups, no significant differences,
according to staging, were found (NS). In patients staged at pT4a the global
survival in 5 years was 42%, being 44% in pT4a thin and 34% in pT4a
thick (P = 0.005).
Conclusion: The measurement of tumors thickness is a simple and
very low-cost method that can be universally used; it allows us to say
that, in cases where the serous is compromised, pT4a (AJCC, 2010) thick
tumors, those with depth >1.6 cm, present a worse prognosis.
028342
Thoraco-laparoscopic esophagectomy
Ferreira A.G.L.1, Sabino F.D.1, Arajo R.O.C.1, Da Silva M.V.M.V.1
1
Instituto Nacional de Cncer, Rio de Janeiro, Brazil
andregustavolopesferreira@gmail.com, fdsabino@gmail.com,
raraujooncologia@gmail.com, drmarcusvaladao@gmail.com
Introduction: Traditionally, esophagectomy has been performed via
open transthoracic or transhiatal approaches, but minimally invasive techniques can reduce procedure-related morbidity without compromising the
oncological outcomes.
S115
Objectives: To demonstrate a totally thoraco-laparoscopic esophagectomy for a Siewert I adenocarcinoma.
Methods: The subject was a 36-year-old female patient with history
of obesity and gastro-esophageal reflux disease whose endoscopy revealed
a polypoid tumor in the distal esophagus (Siewert I). The biopsy showed
adenocarcinoma and the endoscopic ultrasound staged it as uT2N0. The
patient underwent neoadjuvant chemotherapy with three cycles of ECF
according to the MAGIC protocol and, 8 weeks later, was submitted to a
thoraco-laparoscopic esophagectomy.
Results: The procedure took 5 hours and the blood loss was minimal.
Oral intake was started at the seventh postoperative day (POD). The
patient recovered uneventfully and was discharged on the tenth POD.
Histopathological analysis revealed an adenocarcinoma staged as
ypT1bypN0. The patient completed three cycles of adjuvant chemotherapy
with ECF.
Conclusions: The thoraco-laparoscopic esophagectomy was shown to
be safe, feasible and presented good short-term outcomes.
029112
Thoracoscopic esophagectomy in the prone position for esophageal
cancer
Lacerda, C.F.1, Bertulucci, P.A.1, DallInha, V.N., Burgardt, D.2,
Moraes, F.P.2, Oliveira, A.T.T.1
1
Department of Surgery Oncology Upper Digestive Tract, Barretos Cancer
Hospital, So Paulo, Brazil, 2Department of Surgery Oncology, Barretos
Cancer Hospital, So Paulo, Brazil
diego_burgardt@yahoo.com.br, flaviosaopaulino@hotmail.com,
netto123@uol.com.br
Background: For a patient with esophageal cancer we performed
esophagectomy in the prone position. We used thoracoscopy for thoracic
access. We used laparoscopy during the insertion of a gastric tube into
the stomach; during intra-abdominal construction of the gastric tube we
carried out lymphadenectomy of the celiac trunk. We dissected the abdominal esophagus with a posterior neck incision (necklace) and carried out
cervical lymphadenectomy. Mechanical staplers were used for anastomosis, forming an esophagealgastric tube.
Objective: To present a case of treatment of cancer of the esophagus.
Methods: The patient is in the prone position, leaving the surgeon and
assistant on the patients right. The procedure starts with lysis of pleural
adhesions, moving the lung away from the surgical site with an appropiate
retractor, using one-lung ventilation. The dissection of the pleura near the
upper esophagus continues with dissection and ligation of the azygos vein
with clips of metal, plastic, sutures or staples. The esophagus is completely
dissected with mediastinal and infra-carinal lymphadenectomy, with good
visualization of the pulmonary vessels; the thoracic duct is included in the
surgical excision along with para-esophageal lymph nodes. The chest drain
tube is placed under direct vision through the hole of the inferior trocar.
The patient is repositioned, and surgery follows with conventional laparoscopy and neck incision, construction of the gastric tube, and cervical esophagogastric anastomosis after the cervical lymphadenectomy.
Conclusion: The observed results are satisfactory for patients with
indication for a thoracotomy approach. This avoids an approach that is
painful and limiting for the patient; the postoperative outcome is good.
Lymphadenectomy was satisfactory, with an adequate number of lymph
nodes allowing staging of the patient.
S116
028929
Tips and tricks in laparoscopic gastrectomy for cancer
Cury Filho, A.M.1, Da Costa, W.L.1, Marques, M.C.1, De Brito, R.H.1,
Simonetti, V.V.1, Coimbra, F.J.F.1
1
curyantonio@gmail.com, dr.wilsoncosta@gmail.com,
dr.marciocarmona@gmail.com, rafaelhbrito@yahoo.com.br,
vvsimonetti@hotmail.com, drfelipecoimbra@gmail.com
Introduction: We started our experience in laparoscopic gastrectomy
for cancer treatment 11 years ago. After a learning curve, we do this procedure easily in daily routine.
Objectives: To focus on D2 lymphadenectomy, dissection and section
followed by reconstruction for total and partial gastrectomy, pointing out
tips and tricks.
Methods: The procedure follows the oncological precepts on dissection and reconstruction.
Results: We show the most important points in using this methodology
to make this procedure feasible and safe.
Conclusion: This is a safe and feasible procedure but requires some
laparoscopic skill.
029292
Total gastrectomy with D2 lymphadenectomy: a laparoscopic
approach
Johnson, L.F.P.1, Rohrs, D.1, Barreto, P.1, Freire, M.D.M.1, Galvo, M.P.1,
Freire, A.N.M.1
1
Department of Surgical Oncology, Santa Izabel Hospital, Salvador, Brazil
Background: Numerous studies are demonstrating the effectiveness
of surgical oncological resections for gastric cancer performed laparoscopically. Advances in minimally invasive surgery and its advantages over
conventional surgery make this technique increasingly used.
Objective: To demonstrate the laparoscopic surgical approach to
gastric cancer in an oncological surgery service.
Methods: Edited video of laparoscopic gastrectomy with a five portals
and reconstruction with Y-Roux.
Results: The subject was a 53-year-old female patient with epigastric pain, dyspeptic symptoms, appetite loss and weight loss not quantified
in around 6 months. She was a carrier of Chagas cardiomyopathy and a
Jehovahs Witness. She had a history of smoking. The endoscopy identified an ulcerated and depressed lesion in the posterior wall of the body of
the stomach, compatible with Borrman 3. Biopsy of the lesion resulted in
pathological diagnosis of adenocarcinoma. A CT scan of the abdomen and
chest showed no evidence of advanced disease. The patient was submitted
to a total laparoscopic gastrectomy with D2 lymphadenectomy, and the
esophagusjejunum end anastomosis was achieved with use of a stapler.
The surgery took 240 minutes; it was uneventful and did not need the use
of blood products. The pathological diagnosis was: poorly differentiated
adenocarcinoma of the Lauren diffuse type, tumor infiltrating to subserosa;
39 lymph nodes were dissected with 27 affected with free margins. End
stage IIIB (T3N3M0).
Conclusions: Total gastrectomy with D2 lymphadenectomy is the gold
standard curative procedure for gastric cancer. The laparoscopic procedure
is gaining preference over open surgery because of the advantages of minimally invasive surgery. The video demonstrates the surgery performed by
laparoscopy, with Y-Roux reconstruction, and with jejunal esophageal end
anastomosis using a circle stapler and the jejunumjejunum lateral-side
anastomosis using a linear stapler.
ABSTRACTS
028385
Totally thoraco-laparoscopic esophagectomy with preservation of an
aberrant left hepatic artery
Ribeiro, L.C.B.1, Sabino, F.D.1, Araujo, R.O.C.1, Silva, F.F.C.1,
Pinto, C.E.1, Albagli, R.O.1
1
lurribeiro@yahoo.com.br,
fdsabino@gmail.com, rotaraujo@yahoo.com.br, flaviaf21@gmail.com,
ceduardopinto@gmail.com, rafaelalbagli@uol.com.br
Introduction: The aberrant left hepatic artery (ALHA) originates from
the left gastric artery (LGA), supplies a part of or the entire left hepatic
lobe, and may be present in up to 30% of patients. Radical esophagectomy
for cancer requires an extended lymph-node dissection, which includes the
division of the LGA in its origin and the resection of the lesser omentum.
Therefore, the accidental finding of an ALHA during laparoscopy may
represent an additional challenge for the procedure.
Objectives: To show that is possible to preserve the ALHA during the
lymphadenectomy, maintaining oncological principles.
Methods: The subject was a 70-year-old female patient whose endoscopy showed a 2-cm pedicle tumor with intramural invasion located 33
cm away from the incisors.The biopsy revealed a moderately differentiated
adenocarcinoma.The patient underwent neoadjuvant chemoradiotherapy
according to the CROSS protocol, and 8 weeks latter was submitted to a
fully thoraco-laparoscopic esophagectomy with cervical anastomosis.
Results: The lymphadenectomy in the superior border of the pancreas
and lesser omentum revealed the presence of an ALHA. The LGA was
completely dissected and divided above the emergence of the ALHA.
Conclusions: When accidentally found, the ALHA can be safely
preserved without compromising the lymph-node dissection and hepatic
perfusion.
028938
Validation of the new TNM (AJCC, 2010) in gastric cancer
Hygino, M.C.1, Kesley, R.2, Abreu, L.V.S.S.S.1, Correa, J.H.S.2,
Albagli, R.2, Castro, L.S.2
1
Estacio de S University, Rio de Janeiro, Brazil; 2INCA, Rio de Janeiro,
Brazil
michellehygino@hotmail.com, rubenskesley@gmail.com,
luisa.vsa@gmail.com, sicorrea@uol.com.br, rafaelalbagli@uol.com.br,
Introduction: The universal form of staging of gastric cancer is the
TNM system. In 2010, the AJCC launched the 7th edition, which made
changes in this system.
Objective: To compare the potential benefits of the new edition of the
TNM 2010 with the TNM 2002 to determine whether the new system is
more accurate.
Method: Retrospective evaluation was carried out of 1479 cases of
gastric adenocarcinoma presenting consecutively for elective surgery at
INCA between January 1997 and December 2008. The staging according
to the 6th edition (2002) was compared to that of the 7th. Survival curves
were generated in each of the 2002 TNM stages and tested against TNM
2010 to identify whether there was a significant difference between them.
Results: In 1479 cases of gastric adenocarcinoma the average global
age was 60 19 years, and females predominated (897 cases). According
to the TNM classification 2002, Ia group patients remained the same group
in TNM 2010. Ib stage patients (TNM 2002) showed 82% survival at 5
years and Ib cases remaining in the TNM System 2010 (89% survival), or
migrated to IIa (52% survival), or to IIb (40% survival), P = 0.04. Stage II
patients (68% survival) were divided into IIa (44% survival) and IIb (72%
survival), or migrated to IIIa (62% survival), or to IIIb (33% survival), P =
ABSTRACTS
0.14. Stage IIIa patients (53%) remained IIIa (61%) or migrated to IIIb
(47%), P = 0.03. Stage IIIb patients (41%) remained in stage IIIb (33%) or
migrated to IIIc (42%), P = 0.53. Stage IV patients (31%) downstate to IIIc
(30%) or remained in stage IV (31%), P = 0.13.
Conclusion: The 7th TNM Edition, in comparison with the 6th, did not
change the Ia stage, became more accurate for Ib and IIIa (TNM 2002), and
did not significantly change stages II, IIIb and IV (TNM 2002).
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S118
Cancer of the liver, pancreas and biliary ducts

029326
ALLPS on reversal strategy of colorectal liver metastasis: case report
Santos, L.C.1, Silva, R.T.F.1, Miranda, T.N.A.E.2
1
Departmento de Cirurgia Abdomino-plvica, Instituto Nacional
do Cncer, Rio de Janeiro, Brazil, 2Departmento de Radiologia
Intervencionista, Instituto Nacional do Cncer, Rio de Janeiro, Brazil
leonaldson@gmail.com, rodolfohermes@hotmail.com,
tiago_naem@yahoo.com.br
Introduction: Colorectal liver metastases (CRLM) occur in 25% of
patients and only 20% complete the treatment. The concern is to avoid
post-hepatectomy liver failure (PHLF) since the value determined after
chemotherapy (CHT) is at least 30% from future remnant liver (FRL). In
synchronous presentation, studies demonstrated benefits associating CHT
and techniques that induce hypertrophy. However, common failures are
disease progression (10%) and inadequate hypertrophy (2%).
Objectives: The objective of this article is to report reversal strategy
with ALLPS.
Case report: The patient was a male, 69 years old, diagnosed with
rectal adenocarcinoma with synchronous liver metastases (SIVVIII), the
greatest of these measuring 4.9 cm. CEA was 25 ng/mL. It was decided to
use ALLPS in the reversal approach after CHT (Xelox + mFlox). Volumetry
from FRL was 31.2%. In the first ALPPS stage, the left hepatic duct was
cut, sutured and a Kerh drain inserted. The patient suffered transitory PHLF
(serum bilirubin: 5.38 mg/dl and INR: 2.1) which reverted before the 2nd
stage. On the 7th day, the FRL increased 101%, representing 48%. On the
14th day, the 2nd stage occured without complication and the patient left
the hospital after 13 days. Six months after the anterior rectal resection
(ARR) was carried out with preoperative radiochemotherapy (50.4 cGy +
FOLFIRI). However, on the 31st day after ARR, secondary sepsis from the
biliary tract set in and the patient died.
Discussion: The treatment of CRLM with ALLPS has 98% feasibility.
Post-ALLPS hypertrophy is described after the first stage ranging from 61
to 93%, and volumetric analysis showed satisfactory hypertrophy, operated with 101%. Despite the ALLPS being realized with FRL over 30%,
transitory PHLF was noticed after the first stage. The mortality of ALLPS
over <90 days ranges from 9 to 12%. Despite death after ARR, the patient
completed ALLPS without excessive morbidity.
Conclusion: The feasibility of ALLPS in reversal approach is clear
and it is necessary to define which patients may benefit from this tactic.
029211
Assessment of postoperative pancreatic fistula development after
gastrectomy for cancer
Lima,L.R.C.1, Costa, J.A.S.1, Mrue F.2, Cabero, F.V.2, Viana, T.2,
Miranda, T.T.2, Vieira, T.R.2
1
Pontifical Catholic University of Goias,Goias,Brazil, 2Clinical Hospital,
Federal University of Gois,Goias, Brazil
lurian06@hotmail.com, jessikaalvessousa@gmail.com
Introduction: Gastric cancer is currently the fifth cause of cancer in
the world and the third leading cause of death. Total or partial gastrectomy
with lymphatic dissection are indicated some cases. Performing this procedure laparoscopically with manipulation of the pancreas can cause about
20% complications.
Objectives: To evaluate the development of postoperative pancreatic
fistula (PF) in gastrectomy for cancer.
Methods: We analyzed retrospectively the medical records of 20
patients with gastric cancer who underwent total or subtotal gastrectomy.
PF was considered when the peritoneal amylase dosage was 3 times the
ABSTRACTS
amount of serum amylase, and its severity was classified as A, B or C,
according to the International Study Group on pancreatic fistula.
Results: The group consisted of 15 men and five women. Seven
patients underwent a total gastrectomy, two of them with flow pancreatectomy, and 13 underwent a subtotal distal gastrectomy. All underwent
D2 lymphadenectomy, according to the Japanese standardization for the
surgical treatment of gastric cancer. In all cases drainage of the peritoneal
cavity with a tubular drain by gentle suction was performed. The levels of
serum and peritoneal amylase were determined from the first postoperative
day. There were six cases of pancreatic fistula, four of them in the total
gastrectomy group and two in the subtotal gastrectomy group. Most cases
were clinical classification category A, and in one case there was no need
for percutaneous drainage.
Conclusions: Acute pancreatitis and postoperative PF are relatively
common complications in gastrectomy with lymphadenectomy, rates
of around 20% being described. Pancreatic handling and removal of the
pancreatic capsule in some cases are acceptable for the causes of these
complications. The rate of fistulae in this series is higher than those reported
in the literature, which can be explained in part by the small sample. On the
other hand, taking into account the rates according to the type of surgery,
the present results are consistent with the literature, the most frequent cases
of PF occurring in the total gastrectomy group compared with the subtotal
gastrectomy group.
029121
Associating liver partition and portal vein ligation for staged
hepatectomy: description of two cases
Jesus, M.1, Cardona, L.1, Mazzini, L.1, Castro, L.1, Orletti, L.1
1
Santa Rita de Cassia Hospital, Brazil
drmauriciodantas@gmail.com, analuiza_cardona@gmail.com
Introduction: Colorectal cancer is the third most common cancer in
the Western world. Almost 50% of cases will develop liver metastases.
Two-staged hepatectomy is a well established procedure for the treatment
of patients who have colorectal cancer liver metastases with a small liver
remnant. The technique of associating liver partitioning and portal vein
occlusion for staged hepatectomy has been chosen as a tool to increase
resectability. Liver resection remains the gold standard of treatment with
long-term overall survival.
Objectives: To describe with details two successful cases of associated
liver partition and portal vein ligation for staged hepatectomy done in a
cancer hospital from a Brazilian city.
Methods: The procedure consists in ligation of the right portal vein
branch as the first step, after which almost total parenchyma is dissected
along the falciforme ligament including the middle hepatic vein. Finally,
we put a bag over both lobes and the abdomen is drained and closed. We
wait 79 days and open the abdomen again to complete the resection,
removing the right lobe and, after draining, close it.
Results: Both cases needed a long stay in the intensive care unit.
Because of old age, the male had more complications and took 2 months to
walk and function normally again. Apart from this wonderful results were
achieved and give a hope to severe colon cancer cases.
Conclusions: The ALPPS procedure may be a valid option to enable
resection in selected patients with colorectal liver metastases considered
unresectable when in a reference hospital and there is no portal vein branch
embolization. High morbidity and low mortality were achieved in our
patients. We use this procedure as a tool for hepatic disease resection.
ABSTRACTS
029081
Benign lesion of the biliary ducts mimicking Klatskin tumor
Giordani, L.1, do Espirito Santo, G.F.1, Sanches, M.C.O.1,
Tenrio, L.E.M.1, de Morais, L.L.G.1, Gomes, F.G.1
1
UNIC, Universidade de Cuiab, Brazil
lucianogiordani@gmail.com,
santogfe@gmail.com,marac_sanches@hotmail.com,luizzedu@hotmail.com,
lari_lah@hotmail.com, fggomes@live.com
Introduction: Biliary perihilar strictures are often a diagnostic
dilemma; patients with cholangiocarcinoma or benign lesions can have
similar symptoms and diagnoses. Techniques are usually non-specific.
Objectives: To report a case of a benign lesion mimicking Klatskin
tumor.
Methods: Review of medical records and literature.
Case report: The subject was a man, age 39, who had had obstructive
jaundice for 5 months, associated with diarrhea and loss of weight of 0.8 kg
over that period. Magnetic resonance cholangiopancreatography (MRCP)
was performed which identified biliary tract (BT) obstruction at the junction of the main hepatic ducts. Due to the high level of bilirubin (TB = 17.6;
DB = 15.5), it was decided initially to perform an endoscopic retrograde
cholangiopancreatography (ERCP) with stent, resulting in a significant
improvement in the jaundice (TB = 1.3; BD = 0.9). After staging negative
for metastasis, the patient underwent a lymphadenectomy of the hepatic
hilum, liver resection en bloc with the confluence of the hepatic ducts and
biliodigestive derivation. Postoperative evolution was good. Macroscopic
anatomopathology demonstrated stenosis due to thickening of the walls of
the BT, but no tumor was observed. Microscopy revealed a chronic inflammatory process without signs of malignancy, and reactive hyperplasia of
resected lymph nodes.
Conclusion: Malignant diseases is responsible for 8595% of the cases
of biliary tract stenosis in the absence of a previous history of calculus and
manipulations. Tumors located in the confluence of hepatic ducts (Klatskin)
correspond to 5070% of cholangiocarcinomas. The curative treatment is
surgical resection, which is a major procedure and associated with significant morbidity and mortality. Meanwhile, in 515% of the cases the pathological anatomy reveals only benign lesions. The diagnostic methods for
these lesions are flawed, and the tumors markers CA19-9 and CEA, the
MRCP, the ERCP and the cytobrush are the most used. We conclude that
although some patients may undergo major surgery unnecessarily, the high
incidence of cholangiocarcinoma, the absence of alternative therapies and
the lack of good diagnostic techniques justify the surgical approach.
028877
Complex liver segmentectomies: caudate lobectomy and
mesohepatectomy performed in a single patient within a 10-month
interval at the Aristides Maltez Hospital, Brazil
Prisco, E.1, Quadros, C.A.1, Falco, M.F.1, Prisco Filho, L.G.R.2
1Aristides Maltez Hospital, Salvador BA, Brazil, 2Medical School,
University of Caratinga MG, Brazil
emersonprisco@hotmail.com, caquadros@gmail.com,
mariofalcao@hotmail.com, luizprfilho@hotmail.com
Introduction: Liver metastases are found among 25-50% of patients
with colorectal cancer. Whenever possible, liver resection has been considered as the gold standard treatment for these cases, improving overall
survival. Complex segmentectomies have been performed among oncological surgical strategies; however, they remain a surgical challenge due to
specific technical difficulties.
Objectives: To report a successful case of 2 complex liver segmentectomies performed in a single patient who had metachronic colorectal liver
metastasis within a 10-month interval.
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Results: JGS, 61 years old, male, had a good performance status, with
a diagnosis of metastatic low rectal adenocarcinoma; in October 2013 he
had been treated with bypass colostomy and neoadjuvant radiochemotherapy followed by radical rectum resection with total mesorectal excision, colorectal anastomosis and hepatic single nodulectomy (segment
IVb). His status was ypT3N0M1a. He received adjuvant chemotherapy,
presenting recurrent multiple hepatic disease after 5 months (CT). In April
2014 he was underwent caudate lobectomy plus segments V + VI + VIII
nodulectomies, without any surgical morbity, receiving hospital discharge
after 3 days. In spite of second-line chemotherapy, 7 months later a new
single hepatic nodule was identified (MR) in segment IVa, 2 cm, along with
inferior vena cava, between right and left suprahepatic veins, confirmed
as single metastatic disease by PET-CT with high SUV (16.2). New
surgical treatment was carried out in February 2015, when mesohepatectomy (segments IVa/b+V+VIII) was performed, preserving full hilar structures, requiring 2 units of erythrocyte blood transfusion. Five days later,
he presented a biliary leakage in the left liver lobe; this was successfully
treated with surgery, and the patient left hospital 6 days later. Systemic
chemotherapy was completed. The patient is now alive without detectable
neoplasic disease.
Conclusion: Currently, liver segmentectomies are considered the
main treatment alternative to major hepatic resections in patients with liver
colorectal metastasis, who may have recurrent disease requiring additional
liver resection. The surgeons skills, experience and advanced training are
decisive factors in the performance of these difficult procedures.
029194
Descriptive analysis of patients with intrahepatic cholangiocarcinoma
treated at a Brazilian cancer center
Brito, R.H.1, Costa Jr., W.L.1, Cury Filho, A.M.1, Simonetti, V.V.1,
Franco, C.P.1, Coimbra, F.J.H.1
1
rafaelhbrito@yahoo.com.br, dr.wilsoncosta@gmail.com,
curyantonio@gmail.com,vvsimonetti@hotmail.com,carolparucce@gemail.com,
Introduction: Intrahepatic cholangiocarcinoma is a rare form of
biliary tract tumor and is a less common primary malignant liver tumor.
Some controversies remain regarding its treatment.
Objective: To analyze patients with intrahepatic cholangiocarcinoma
treated at a Brazilian Cancer Center
Methods: This is a retrospective study, including patients with cholangiocarcinoma treated at a Brazilian cancer institute during the period
between June 2000 and December 2014. Postoperative and long-term
outcomes are reported in this series.
Results: The median age of all treated patients was 61 years (37-79),
and there was no gender predominance. In four individuals resection of up
to three segments was performed, in 11 patients a formal right or left hemihepatectomy was the procedure of choice, and in another eight an extended
resection was necessary. Regarding the histological feature of these tumors,
13 were moderately differentiated, and solitary tumors were more frequent,
occurring in 87% of patients. Postoperative morbidity was 40%, and eight
individuals had Clavien 1 or 2 complications. There was one death in 60
days (4%). The oncological outcomes showed recurrence in 14 patiets after
up to 5 years of follow-up, and median overall survival was 24 months.
Conclusion: The curative treatment of cholangiocarcinoma is surgical,
and an R0 resection is the main prognostic factor. Results in this institution
are consistent with those observed in the medical literature.
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028960
Dissection of the uncinate process: description of a laparoscopic
technique
Canedo, L.F.1, Vieura, I.F.1, Teixeira, G.1, Sena Jr, A.S.1
1
Hospital Geral Roberto Santos, Salvador, Brazil
leo.canedo1@gmail.com, ifvieira86@gmail.com,
contato@giselleteixeira.com.br, senajrfar@gmail.com
Introduction: Pancreatoduodenectomy (PD) is the treatment of choice
for periampulary tumors. One of the crucial and difficult points in the technique is the resection of the uncinate process.
Objective: To describe a laparoscopic technique for resection of the
uncinate process.
Methods: After opening the pneumoperitoneum, a 10-mm trocar
is placed on the umbilicus to introduce a 30 optical camera; two other
12-mm trocars are placed bilaterally, in the para-umbilical area, at the
midclavicular line. Next, 5-mm trocars are placed in the subcostal area,
at the midclavicular line, bilaterally, and another 2 cm below the xiphoid
appendix. After the Kocher and Warren maneuvers, dissection of the uncinate process is performed with repair of the pancreas neck. The jejunal
stump, already sectioned with a laparoscopic stapler, serves as a support
traction point for the surgeon. The caudal vision from this area and the traction of the head and neck of pancreas through the repairs by the auxiliary
favors a careful dissection, avoiding unnoticed lesions of the mesenteric
vessels. The camera stays at the umbilicus trocar and an energy device is
placed at the left para-umbilical trocar, thus starting the liberation of the
uncinate process from the mesenteric vessels.
Results: During 2014, a total of eight patients underwent laparoscopic
PD with the technique described in here in a public hospital at Salvador,
Bahia, Brazil. Only one patient died after the surgery due to abdominal
sepsis.
Conclusion: We believe that the dissection of the uncinate process by
laparoscopic surgery is superior to open surgery, because of the exclusive
view from caudal positioning. In the future, minimally invasive surgery
will become standard.
028696
Distal laparoscopic pancreatectomy with splenic preservation for
treating mucinous cystadenoma of pancreas
Debon, L.M.1, Toneto, M.G.2, Furlan, F.Z.1, Silva, B.T.1
1
Medical Student, Pontifical Catholic University of Rio Grande do
Sul, Porto Alegre, Brazil, 2Department of Surgery, Pontifical Catholic
University of Rio Grande do Sul, So Lucas Hospital, Porto Alegre, Brazil
leti.debon@gmail.com, mtoneto@terra.com.br,
fernandozfurlan@gmail.com, tertulianobruna@gmail.com
Introduction: Minimally invasive surgery has been gaining acceptance, and improvement of the technique makes it possible to approach
pancreatic lesions. Around a third of pancreatic cysts are mucinous and
over 95% develop in younger women. The laparoscopic approach brings
both functional and esthetic advantages. Preservation of the spleen in
benign pathologies has immunological importance.
Objectives: To demonstrate the technique used by the authors for the
resection of a mucinous pancreatic cystadenoma with spleen preservation
in a 32-year-old patient.
Methods: After the evaluation of the lesions vascularization through
magnetic angioresonance, the indication was a distal pancreatectomy. The
video shows the standardized steps in performing the procedure, emphasizing the importance of vascular control of the splenic artery and splenic
vein. The section of the pancreas was performed with an endoscopic stapler.
The removal of the piece from the abdominal cavity was made through a
previous Pfannenstiel incision. Total operating time was 96 minutes.
ABSTRACTS
Results: The patient started an oral diet on the first postoperative day
and was discharged on the fourth day. Histopathological exam confirmed
the diagnosis of a mucinous cystadenoma of 4.8 cm.
Conclusions: Distal laparoscopic pancreatectomy with splenic preservation is safe and reproducible. It presents postoperative advantages such
as a lower use of analgesics and an early return to normal activities.
028507
Does chemotherapy for patients with colorectal liver metastases who
underwent curative resection improve overall survival? A systematic
review and meta-analysis
Araujo, R.L.C.1, Gnen, M.2, Herman, P.1
1
Liver Surgery Unit, Department of Gastroenterology, University of
So Paulo Medical School, So Paulo, SP, Brazil, 2Department of
Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center,
New York, NY, USA
raphael_araujo@usp.br, gonenm@mskcc.org.br, pherman@uol.com.br
Introduction: Hepatic resection is considered a potentially curative
treatment for patients with colorectal liver metastases (CRLM). The benefit
of the use systemic chemotherapy in these patients is likely to improve
recurrence-free survival (RFS); however, no differences in overall survival
(OS) have yet been demonstrated.
Objectives: To compare surgery plus systemic chemotherapy, regardless of the timing of administration, with surgery alone, looking at longterm outcomes in patients with CRLM who underwent liver resection with
curative intent.
Methods: Systematic review and meta-analysis of studies published
from January 1991 to December 2013 that compared surgery alone and
surgery plus chemotherapy for patients with CRLM who underwent curative-intent liver resection. Randomized clinical trials (RCTs) were evaluated by Cochrane risk-of-bias tool. Selection of high-quality observational
comparative studies (OCS) was based on a validated tool (Methodological
Index for Non-Randomized Studies, MINORS). RFS and OS were
compared using fixed and random effects model and hazard ratio (HR).
Results: Concerning OS, five studies (three RCTs and two OCSs),
comprising 2475 patients, were analysed; chemotherapy (750 patients)
relatively improved OS rates in 23% when compared to surgery alone (HR
0.77, 95%CI 0.670.88, P < 0.001). Four studies described RFS (three RCT
and one OCS) totalling 1592 patients, and chemotherapy (702 patients)
decreased the risk of recurrence in 29% (HR 0.71, 95%CI 0.610.83, P
< 0.001).
Conclusion: This systematic review and meta-analysis has demonstrated that the use of chemotherapy for patients with CRLM who underwent curative-intent resection is a worthwhile strategy to improve both
RFS and OS.
028454
Laparoscopic duodenopancreatectomy: a successful surgery
Accordi, C.C.1, Uliano, E.J.M.1
1
marinacdutra@hotmail.com, estevao.uliano@hotmail.com
Objective: To report a laparoscopic duodenopancreatectomy experience in a 57-year-old patient diagnosed with pancreatic cancer.
Method: The information was obtained through review of medical
records, patient interviews and literature review.
Result: A 57-year-old male sought the oncology surgery service after
being diagnosed with pancreatic cancer. The patient was advised to undergo
laparoscopic duodenopancreatectomy for tumor resection. During the
ABSTRACTS
surgical procedure an extensive tumor was observed in the pancreatic head.
Laparoscopic surgery was performed successfully.
Conclusion: The first open full pancreatoduodenectomy (DP) was held
in 1935 by Whippet. Years later in 1994 the first DP video was recorded by
Gagner and Pomp. Since then the procedure has gained popularity with
some surgeons. Laparoscopic DP is a highly complex surgery and therefore is not performed by all surgical oncology services. Some studies have
compared the safety and efficiency of different techniques. The conclusion
is that laparoscopic surgery may benefit and most importantly improve
quality of life for the patient.
029004
Extended left pancreatectomy with en-bloc portal vein and celiac axis
resection for a locally advanced pancreatic body cancer: a case report
Anghinoni, M.1, Tefilli, N.1, Fin, F.R.1, Campos, E.C.R.1,
Azevedo, B.R.B.1, Castro, M.1
1
So Vicente Hospital, Curitiba, Brazil
manghinoni@yahoo.com.br,
nertantefilli@yahoo.com.br, fabiofin@hotmail.com, ecrcampos@uol.com.br,
brunobazevedo@hotmail.com, mari_castro1006@yahoo.com.br
Introduction: Despite the advance of diagnostic modalities, carcinoma in the body and tail of the pancreas commonly presents at a late stage.
Portal vein resection in pancreatectomies is a valid technical procedure, but
the clinical benefits of distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer remains controversial.
Objective: To show an atypical case of distal pancreatectomy with
concomitant arterial and venous resection.
Method: We report here our experience with a case of a locally
advanced pancreas body adenocarcinoma with portal vein and celiac
axis invasion that was successfully treated with an en-bloc resection and
vascular reconstruction.
Results: A 71-year-old Caucasian male patient was admitted with
severe abdominal pain and a 4 x 3 cm pancreatic body cancer invading the
portal vein and celiac axis. After neoadjuvant chemotherapy, the patient
underwent exploratory laparotomy and subsequent distal pancreatectomy
with en bloc resection of a segment of the portal vein and concomitant
resection of the celiac axis. Venous reconstruction was perfomed with an
end-to-end mesentericportal anastomosis. Arterial reconstruction was
necessary as hepatic flow was inadequate, as determined by intraoperative
Doppler ultrasonography. It consisted of end-to-end anastomosis between
the hepatic artery and the aorta. The postoperative course was uneventful
and complete tumor resection (R0) was achieved.
Conclusion: With the recent improvement in perioperative management techniques and multimodal treatment strategies for pancreatic cancer,
concomitant major vessel resection and reconstruction have been aggressively attempted in association with comparatively better pathologically
negative surgical margins and postoperative survival.
029213
Extrahepatic cholangiocarcinoma: a case report
Fava, B.E.C.1, Menezes, J.N.2, Apodaca, F.R.3
1
Luzia de Pinho Melo Hospital, Mogi das Cruzes, SP, Brazil, 2University
of Mogi das Cruzes, Mogi das Cruzes, SP, Brazil, 3Luzia de Pinho Melo
Hospital & University of Mogi das Cruzes, Mogi das Cruzes, SP, Brazil
bianca_fava@yahoo.com.br, jacque_menezes@hotmail.com,
apodaca@uol.com.br
Introduction: Extrahepatic bile-duct cancer or cholangiocarcinoma
(EH-CCA) is a rare disease, with an incidence rate of 1-2/100,000. In
6080% of cases the tumor arises in the proximal third of the extrahepatic
S121
bile duct (BD), followed by distal presentation and, less frequently, middlethird tumors. We report a case of middle-third cholangiocarcinoma.
Methods: A 70-year-old female presented to our service with a 5-day
history of cholestatic syndrome characterized by dark urine and jaundice
associated with decreased clinical condition. Bilirubin levels were 35 mg/
dL, mostly from conjugated bilirubin. Magnetic resonance imaging (MRI)
was performed and showed an expansive mass in the extrahepatic bile duct
middle third. After biliary drainage the patient was submitted to extrahepatic bile-duct resection and Roux-en-Y hepaticojejunostomy with frozen
section analysis of the surgical margins.
Results: Anatomical pathology analysis results were a well differentiated, invasive adenocarcinoma, status T2aN1M0. Adjuvant treatment was
performed. Control MRI after 7 months showed secondary lesions in the
liver.
Conclusion: Surgical resection of cholangiocarcinomas remains the
mainstream for curative treatment. Prognosis is related to TNM staging at
the time of presentation. Preconized techniques vary from hepatectomies,
with bile-duct resection for perihilar tumors and duodenopancreatectomy
for distal lesions. The data seem unclear on the best surgical approach for
middle-third cancers; the most performed techniques are HE-CCA resection alone and associated with hepatectomy. Extended resections have
shown better overall survival results. In selected cases, local resection and
lymphadenectomy combined showed better long-term results. In the case
presented, although margins were free of cancer at the time of surgery,
clinical stage IIIB clearly justifies the recurrence.
028925
Fibrolamellar hepatocellular carcinoma: case report
Guth, G.Z.1, Atade, L.O.1, Loureno, L.A.1, Ribeiro, L.R.1, Richwin, N.J.1,
Oliveira, J.X.1
1
Urgecy Surgery Department, Irmandade Santa Casa de Moresicrdia de
Limeira, Limeira, So Paulo, Brazil
gguth@uol.com.br,
lillianataide@hotmail.com,lara.lourenco@yahoo.com,ribeirorlucas@live.com,
nicolasrichwin@hotmail.com, jairo_xavier@hotmail.com
Introduction: The fibrolamellar hepatocellular carcinoma, a variant of
hepatocellular carcinoma, is a rare neoplasm, accounting for 2% of those
with hepatocellular origin. The majority are asymptomatic, so diagnosis
usually occurs at an advanced stage; they are recognized incidentally and/
or when finding a palpable abdominal mass. When symptomatic, the usual
presentation is abdominal pain.
Objective: To present a case of rare liver tumor in a young patient.
Methods: We have studied the case of a male patient from Americana
(SP), 19 years old, with abdominal pain, dyspepsia and weight loss. Normal
endoscopic examinations and normal colonoscopy were carried out. CT
and MRI showed a large tumor in the left lobe of the liver
Results: The patient was submitted to exploratory laparotomy, and
evidence was found of a tumor lesion of about 20 cm in the left liver lobe,
invasion by contiguity of gastric serous cells throughout the body, and a
peritoneal implant in the pelvis. He underwent left hepatectomy, total gastrectomy with retroperitoneal lymphadenectomy, and Y Roux reconstruction in. Pathological examination showed the presence of hepatocellular
carcinoma of a moderately differentiated fibrolamellar variant.
Conclusion: The treatment is surgical for all resectable cases of fibrolamellar hepatocellular carcinoma. As this is a rare neoplasm, additional
studies are needed to assess the benefits of neoadjuvant/adjuvant treatment.
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029230
Fibrolamellar metastatic hepatocellular carcinoma in an adolescent
patient: case report
Pompermaier, C.1, Winkelmann, C.P.1, Kurtz, G.S.T.1, Pr, R.B.1, dos
Santos, F.M.1, Fontana, R.1
1
Universidade de Caxias do Sul, Brazil
carolpompermaier@gmail.com,
clapw@terra.com.br, guilhermestkurtz@gmail.com, rochelepra@gmail.com,
ferdemarco@yahoo.com.br, fmroliveira@hotmail.com
Introduction: Liver neoplasm diagnosis accounts for 7% of all
cancers. Hepatocellular carcinoma in its fibrolamellar variant, however,
corresponds to only about 1% of cases.
Objective: To report a case of metastatic fibrolamellar hepatocellular
carcinoma in an adolescent patient.
Methods: Patient NT, 15, female, previously healthy, was diagnosed
with fibrolamellar hepatocellular carcinoma (FHCC) in February 2013 and
underwent mesohepatectomy (segments VVIII). Pathology showed clear
margins, angiolymphatic invasion and metastasis in one of eight lymph
nodes removed. In March 2015, a chest CT and a breast ultrasound identified nodulation in the topography of the internal mammary lymph-node
chain. The patient was referred to the Department of Thoracic Surgery,
where an excisional biopsy of the parasternal lesion with resection of the
subpleural tumor mass were performed. Histopathology revealed metastasis of fibrolamellar hepatocellular carcinoma. The patient was referred
for chemotherapy.
Results: FHCC is a tumor of unknown etiology and limited clinical
information due to its low incidence. Usually FHCC is diagnosed before
the patient is 40 years old and is more likely to occur in women than the
conventional hepatocellular carcinoma. FHCC is usually diagnosed in
patients without underlying liver disease. The prognosis seems to be better;
however, no difference was found in survival between the two types after
treatment with curative intent. In patients with preserved liver function,
resection is the best option for control, but recurrence usually occurs after
resection.
Conclusion: The aggressiveness of FHCC cannot be taken as known.
This case a 15-year-old patient with lymph-node involvement at diagnosis
of the primary tumor, and recurrence in the chest and internal mammary
lymph nodes (atypical sites according to the literature) suggests aggressiveness in this variant. Being an insidious manifestation of a tumor that
affects previously healthy young patients, FHCC warrants further study to
add knowledge to the literature, which is rather scarce due to the rarity of
this pathology.
028876
Frantz tumor: a case report of a young woman
Oliveira, F.A.P.F.1, Barros, A.V.1, Melo, C.L.A.1, Mota, B.R.1, Ferro
Neto, O.C.1, Silva, R.A.T.A.1
1
Oncological Surgery Department, Santa Casa de Misericrdia, Macei,
Brazil
fapfo.med@uol.com.br,
aldobarros@ig.com.br,ciceroludgero@ig.com.br,drbrunormota@bol.com.br,
oscarferro09@gmail.com, d_andrada@hotmail.com
Introduction: The Frantz tumor or solid-cystic papillary tumor is a
rare pancreatic cancer, first described in 1959 by Frantz; it represents about
12% of pancreatic tumors. These tumors have extensive synonymy and
have a favorable biological behavior, with low malignancy and good prognosis; they occur predominantly in young women. They manifest clinically
mostly by pain, discomfort and abdominal mass, but they may be asymptomatic. They are usually bulky and well defined. The treatment of choice is
complete surgical resection.
ABSTRACTS
Objectives: To report a case of Frantzs tumor in a young woman
who in our surgical oncology service underwent surgery with satisfactory
results.
Methods: An 18-year-old female patient, ECOG 0, presented in our
surgical oncology clinic with a history of pain, discomfort and abdominal
mass, with 6 months of evolution. On magnetic resonance imaging of the
upper abdomen a large tumor (9.7 x 8.0 cm) at the head of the pancreas was
found; the tumor was compressing the inferior vena cava. The patient was
later referred for surgical treatment and subjected to pancreaticoduodenectomy and lymphadenectomy.
Results: The patient had good evolution and was discharged on the
13th day after surgery. Gastroparesis presented, which was successfully
managed medically. Pathological examination revealed a solid pseudopapillary tumor with free surgical margins and without metastases to any
of 15 isolated lymph nodes. Immunohistochemical study confirmed the
diagnosis. On clinical follow-up, there were no signs of recurrence after 7
months. The patient was not subjected to adjuvant treatment.
Conclusion: The Frantz tumor should always be suspected in young
women with an abdominal mass of pancreatic origin. Treatment should
always be possible with surgery, with complete resection of the lesion. The
prognosis is good, these lesions having a low degree of malignancy.
029115
Gallbladder advanced neoplasia: surgical approach.
Freitas, V.F.1, Bastos, J.L.A.2, Carvalho, W.S.F.1, Tavares, L.P.3,
Ferracini, I.C.F4, Matos, R.M.1
1
Medical student, Federal University of Bahia, Salvador, Brazil,
2
Department of Anesthesiology and Surgery, Academic Advisor of
Surgery League, Federal University of Bahia, Salvador, Brazil,3Medical
student, Bahia School of Medicine and Public Health, Salvador, Brazil,
4
Medical Student, College of Technology and Science, Salvador, Brazil
vdefritas@gmail.com, jorgelabastos@gmail.com, wsfc1989@gmail.com,
lportela_7@hotmail.com, belacff@gmail.com, rayza_matos@hotmail.com
Introdution: Cancer of bile ducts and gallbladder is considered rare.
Diagnosis is usually tardy, and the most common tumor is adenocarinoma,
which presents aggressive behavior. Signs and symptoms are often nonspecific. The relationship between the patient and their prognosis has been
evaluated with the objective of identifying those patients who may be
benefit from an aggressive surgical resection.
Objectives: To report cases of advanced malignant neoplasia of the
gallbladder in stage T3 (stage IIA), highlighting its prognosis.
Methods: This was a retrospective evaluation of eight cases of
advanced gallbladder adenocarcinoma with differences and peculiarities
of signs and symptoms, diagnosis, surgical approach and complementary
treatment.
Results: Of eight patients, two were male with surgical risk ASA I
and six were female ASA II, age from 46 to 78 years old. Three patients
presented jaundice as the first symptom, one with chronic abdominal pain in
the right hypochondrium, two with pain in the right hypochondrium associated with nausea, one with pain in right hypochondrium associated with
postprandial bloating, and another with an asymptomatic palpable mass
in the right hypochondrium. Of these eight patients, four had cholelithiasis, one had isolated neoplasia in segment I of the liver, two had tumors
in the hepatic hilo, and another had a complication from a biliary cutaneous fistula from hepatic parenchyma. Two deaths were reported: one for
complications from a stroke and the other for complications from hepatic
hilar tumor recurrence. Hepatic invasion and growth of the hilar lymph
node were the most prevalent surgical findings. All patients were submitted
to a cholecystectomy and other associated tissue resection; other surgical
approaches and therapeutics were indicated in some of the cases.
ABSTRACTS
Conclusions: Treatment should be individualized for each patient. The
gallbladder adenocarcinoma may present different patterns and degrees of
commitment, often limiting, and there are benefits from complementary
treatments such as adjuvant chemotherapy after resection. Among patients
submitted to a surgical resection, survival rate varied according to TNM
tumor staging.
029205
Gallbladder carcinoma in a man: a case report
Teixeira, R.L.1, Lima, L.W.R.1, Ruvio, V.B.1, Jnior, J.S.2, PicanoJunior, O.M.3, Alves, R.M.S4
1
Universidade Federal do Amap, graduanda em Medicina, 2Mdico
Residente em Cirurgia Geral pela UNIFAP, Brazil, 3Mdico especialista
em Cirurgia do aparelho digestivo e Cancerologia Cirurgica; Mestre em
Cincias (UNIFESP); Professor Auxiliar de Cirurgia Geral na UNIFAP,
Brazil, 4Medico especialista em Cancerologia Cirrgica prof Auxiliar de
Cirurgia Geral na Universidade Federal do Amap (UNIFAP), Brazil
railalinhares@hotmail.com,
lana_wrl@hotmail.com, vitor_benevides@hotmail.com,
drjoaosjr@hotmail.com,ompjunior@bol.com.br,robertomacelsa@yahoo.com.br
Introduction: Gallbladder carcinoma is the seventh most common
neoplasia of the digestive tract; the adenocarcinoma comprises 8095%
of the cases, the epidermoid carcinoma 210%, and others that make up
the rest such as sarcomas, lymphomas and melanomas are infrequent.
Incidence of gallbladder carcinoma is higher in women (>65 years). The
risk is increased by cholelithiasis, obesity, multiparity and infection by
H.pylori.
Objective: To describes a case of epidermoid carcinoma of the
gallbladder.
Methods: The data were obtained with the patients consent, through
chart review and interview. Patient JEQD, a 51-year-old male from Macap
(AP), presented with complaints of intense abdominal pain associated with
a sensation of gastric fullness, nausea and postprandial vomiting for 3
months and loss of 10 kg in 2 months. Background: he was diabetic, had a
history of cancer in the family, was a smoker and analcoholic. The abdominal ultrasound showed lithiasic cholecystitis. The endoscopy showed
voluminous extrinsic compression of the greater curvature of the stomach
and pyloric stenosis. On 02/22/2013, cholecystectomy and drainage of a
duodenal subserosal intraperitoneal abscess were made. The histopathological exam showed a moderately differentiated squamous-cell carcinoma,
of 2.0 x 1.5 cm, with subserosal infiltration, stage pT3, pNx, pMx. On
05/16/2015, the patient was reoperated with laparotomy, subtotal gastrectomy, duodenectomy (first portion), liver segmentectomy and resection of
the round ligament that by the histopathological exam showed absence of
residual neoplasia.
Conclusion: It is important to highlight the importance of early detection of this neoplasia, because of its aggressive, infiltrative and metastatic
growth. We aimed to highlight the singularity of an epidermoid carcinoma
of the gallbladder in a man, to evidence the course of action that was taken
to increase his survival, and to expand upon comparative, analytical, retrospective studies, establishing a better theoretical basis for understanding
this condition.
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028804
Fully videolaparoscopic oncological gastroduodenopancreatectomy
Lacerda, C.F.1, DallInha, V.N.1, Bertulucci, P.A.1, Meira Neto, C.C.1,
Burgardt, D.1, Oliveira, A.T.T.
1
Hospital de Cncer de Barretos, So Paulo, Brazil
croider@hotmail.com, oncovnd@gmail.com,
paulobertulucci@uol.com.br, claudemironeto@yahoo.com.br,
diego_burgardt@yahoo.com.br, netto123@uol.com.br
Introduction: Gastroduodenopancreatectomy is the only safe and
accurate modality of treatment for patients with malignant neoplasms of
the head of the pancreas and periampular region. In 1935, Wipple published
three cases of open pancreaticoduodenal resection.
Objective: To demonstrate this same technique, now fully reproduced
by laparoscopy, with reconstruction in single handle with pancreatojejunostomy by telescoping, followed by end-side single-plan hepaticojejunostomy and gastrojejunoanastomosis.
Methods: The surgical steps are the same as for the open procedure.
After the cavity staging, we open the retrocavity towards the duodenum
and right gastroepiploic vessels, which are ligated. The Whipple maneuver
follows with dissection and identification of the superior mesenteric vein,
splenic vein, and the beginning of the portal vein. The Kocher maneuver,
after the dissection of the hepatic hilum, follows with identification of the
hepatic artery, portal vein and common bile duct. We performed cholecystectomy and isolated the common bile duct, but this section occurs only at
the end of the procedure. We prepare the stomach for section, made with a
laparoscopic stapler with two blue cargo 60 mm. The pancreas is transected
at the level of the neck with HARMONIC ACE tweezers, the main
pancreatic duct being identified and catheterized. The next surgical step is
the section of the jejunum 20 cm from Treitz, with ligation of the arcade
right next to the wall of the handle. The procedure ends with the section
of the uncinate process with laparoscopic energy tweezers or laparoscopic
stapler with white load (vascular 60 mm). The gastroduodenal artery and
the common bile duct are well identified, facilitating its ligature and section
respectively. The piece is placed in a collector, suitable for subsequent
withdrawal. Reconstruction involves a single telescoping handle with TT
(pancreasjejunal); choledochojejunostomy TL anastomosis; and finally,
gastroenterostomy LL with blue load 60 and synthesis of a loophole.
Nasalenteral feeding and testing of methylene blue is carried out with
subsequent bilateral drainage of the abdominal cavity. Experience and the
volume of procedures has improved the performance of the teams.
Conclusion: The laparoscopic procedure is feasible, mainly for periampullary tumors. Surgical time on our initial experience was slightly
greater than in conventional surgery. The PO diet is introduced 24 hours
after the procedure. The postoperative evolution is better in relation to
patient comfort with less pain, early ambulation, early onset of eating, and
hospital discharge, without prejudice to cancer resection.
028455
Gastrointestinal stromal tumor metastatic to liver: a successful
laparoscopic right hepatectomy
Accordi, C.C.1, Uliano, E.J.M.1
1
ccaccordi@icloud.com, estevao.uliano@hotmail.com
Introduction: Gastrointestinal stromal tumors are neoplasms of the
gastrointestinal tract. Despite their less aggressive pathological nature,
GISTs can metastasize. When GISTs originate in the small bowel, they
behave in a more aggressive manner. The most common sites for metastases is the liver and the peritoneal cavity, but can also be bone, skin, soft
tissues, and lymph nodes.
S124
Objective: To report a laparoscopic right hepatectomy experience in
a 50-year-old patient diagnosed with gastrointestinal stromal tumor metastatic to liver.
Methods: The information was obtained through review of medical
records, patients interview and literature review.
Results: A 50-year-old patient presented with epigastric fullness and
weight loss, with a history of a bowel resection a few years prior for a
primary GIST of the small bowel. At the time he was diagnosed with four
hepatic metastatic lesions due to a gastrointestinal stromal tumor in the
small intestine.
Conclusion: The laparoscopic right hepatectomy was successful and
the patient is being followed up regularly.
028294
Hepatocellular carcinoma secondary to hepatitis B and BuddChiari
syndrome in a young patient: a case report
Brito, F.P.B.1, Duarte, J.L., Silva, F.T.V.2, Leo, F.G.A.2, Morais
Jnior, M.A.1, Santana, G.A.A.1
1
Uninovafapi, Teresina, PI, Brazil, 2Uespi, Brazil
flaviapimentab@hotmail.com
Introduction: Hepatocellular carcinoma is the sixth most common
cancer worldwide and the third leading cause of cancer death. Poor prognostic factors include hepatitis B and C, and treatment approaches depend
on the stage of disease at diagnosis and access to complex treatment regimens. However, advanced disease is incurable.
Objective: To report a case of hepatocellular carcinoma secondary to
vertical infection with hepatitis B associated with BuddChiari syndrome.
Method: This is a case report conducted by medical record review.
The patient signed a consent form authorizing the disclosure of the case.
Results: SAS, a 32-year-old male, complaining of swelling in the
lower limbs and ascites for 40 days after an episode of alcohol consumption. He was taken to the emergency room where, during hospitalization,
he underwent an abdominal CT scan which showed a solid, heterogeneous
lesion in the liver, with moderate enhancement after contrast, measuring
about 13 x 11 x 11 cm; the tumor involved almost the entire right lobe,
and caused a filling defect in the vena cava that stretched from the infrarenal portion to the right atrium, suggesting a tumor thrombus. Serology
for hepatitis B confirmed the diagnosis of infection and CA 19.9: 5660 IU/
mL. We concluded a diagnosis of hepatocellular carcinoma. Analyzing the
family history of his patient reports, we found that this brother had died at
the age of 12 of hepatocellular carcinoma, and his mother is carrying the
hepatitis virus B, which suggests vertical transmission of this virus and
poor prenatal and neonatal care. The patient was offered only palliative
care and comfort, such as relief paracentesis in case of significant ascites
with dyspnea.
Conclusions: There was poor prenatal care with regard to prevention
of vertical transmission of the hepatitis virus B, beyond the description
of a Budd-Chiari syndrome presenting with thrombus extending from the
infrarenal cava to the right atrium in the patient; there was no therapeutic
perspective.
029125
Hilar cholangiocarcinoma in a teenager: a case report
Viana, E.F.1, Cruz, I.D.M.2, Maia, D.S.3, Maia, G.H.M.R.3, Sanches, N.S.3,
Ribeiro, V.H.O.3
1
Department os Anesthesiology and Surgery, Bahia Medical School,
Federal University of Bahia, Salvador, Brazil, 2Universitary Hospital
ABSTRACTS
Professor Edgar Santos, Federal University of Bahia, Salvador, Brazil,
3
Bahia Medical School, Federal University of Bahia, Salvador, Brazil
edufviana@hotmail.com,
idmcruz@gmail.com,maia.daniel93@gmail.com,gustavo.maia.med@gmail.com,
nathiess@hotmail.com, hugo_ribeiro.cms@hotmail.com
Introduction: Cholangiocarcinoma is a tumor originating from the
bile duct, and is the second leading cause of primary liver cancer. By
presenting in rare and diverse locations, it poses a challenge in terms of
early diagnosis and treatment. It occurs most frequently in men over the
age of 50, and can be subdivided in intrahepatic, hilar (Klatskin tumor) and
extrahepatic.
Objectives: To report a case of cholangiocarcinoma in a 17-year-old
male who was followed by a surgery service in Brazil.
Methods: We carried out a review of medical records and literature in
MEDLINE, LILACS, SciELO and MD Consult.
Results: In this report we describe a 17-year-old boy, admitted to a
hospital with a history of jaundice, choluria and acholic stools for the last
3 months, associated with progressive asthenia and hyporexia, with weight
loss and hepatomegaly. Laboratory tests proved hyperbilirubinemia and
altered canalicular enzymes. Imaging exams were performed, evidencing
intrahepatic bile duct distension and a rounded lesion in the hilum. Surgical
exploration was performed, when a hilar lesion with the macroscopic
aspect of Klatskin tumor type IIIa on the Bismuth scale was found. As
vascular invasion and liver metastasis were not detected, surgical resection
was chosen as the single curative therapy.
Conclusions: The occurrence of cholangiocarcinoma in young people
is rare, but should always be considered as a differential diagnosis in cases
of cholestatic syndromes.
028936
Laparoscopic duodenopancreatectomy: what we have learned after
11 years?
Cury Filho, A.M.1, De Godoy, A.L.1, De Farias, I.C.1, Marques, M.C.1,
1
curyantonio@gmail.com, andreluisgodoy@yahoo.com.br,
dr.igorfarias@gmail.com, dr.marciocarmona@gmail.com,
Introduction: We started our experience in the laparoscopic Whipple
procedure 11 years ago. After a long learning curve, this complex procedure is still one of the most challenging in our everyday routine.
Objectives: To show step by step the tips and tricks we have learned,
also for control of the pitfalls and bleeding.
Methods: We divided the procedure in two big steps: dissection and
reconstruction.
Results: Our video shows the most important measures to take so we
can make this procedure feasible, safe and performable in a good operating
time.
Conclusion: This is a safe and feasible procedure but requires a high
degree of laparoscopic skill.
028249
Laparoscopic duodeonopancreatectomy in a elderly patient diagnosed
with pancreatic cancer
Accordi, C.C.1, Uliano, E.J.M.1, Reis, M.P.1
1
matheusbig@hotmail.com
ABSTRACTS
Introduction: The first open pancreatoduodenectomy (DP) was
performed in 1935 by Whipple et al., and years later in 1994 the first DP
video was made by Gagner and Pomp. Since then DP has gained popularity with some surgeons. Laparoscopic DP is a highly complex technical
surgery and therefore is not performed by all oncological surgeons. Some
studies have compared the safety and efficiency of these two techniques.
Objectives: To report a laparoscopic DP experience in an 81-year-old
patient diagnosed with pancreatic cancer.
Methods: The information was obtained through a review of medical
records, patient interview and literature review.
Results: An 81-year-old male sought the oncological surgery service
after being diagnosed with pancreatic head cancer. The patient was advised
to undergo laparoscopy duodeonopancreatectomy for tumor resection.
During the surgical procedure an extensive tumor in the pancreatic head
was observed; there was no invasion of mesenteric vessels or the portal
vein. Laparoscopic surgery was performed successfully.
Conclusions: Laparoscopic surgery has become widely accepted.
However, when it comes DP very few cases have been published, maintaining its use as controversial. Laparoscopic DP is still one of the most
difficult techniques due to its high morbidity and complexity. Recently,
the technique has been applied more often and is associated with a lower
complication rate and faster recovery. We conclude that laparoscopic
surgery in these patients may be of benefit and, most importantly, improve
quality of life after the procedure.
028932
Laparoscopic left pancreatectomy: tips and tricks
Cury Filho, A.M.1, Diniz, A.L.1, Ribeiro, H.S.1, Da Costa, W.L.1, De
Brito, R.H.1, Coimbra, F.J.F.1
1
curyantonio@gmail.com,
dr.aldiniz@gmail.com, hsalvadorcr@gmail.com, dr.wilsoncosta@gmail.com,
rafaelhbrito@yahoo.com.br, drfelipecoimbra@gmail.com
Introduction: Laparoscopic left pancreatectomy is an efficient method
for the treatment of neck and tail lesions, allowing shorter hospital stay and
less postoperative pain than open surgery. On the other hand, it is more
complex and has different pitfalls compared to open surgery, demanding a
new learning curve from the surgeon.
Objective: To show in a video step by step the tips and tricks we have
learned on laparoscopic distal pancreatectomy.
Methods: Filming of laparoscopic surgery.
Results: We recorded several surgeries to show comprehensively tips
and tricks on left laparoscopic pancreatectomies, from the patients table
position, neck or tail lesions, to spleen preservation, avoiding bleeding and
some pitfalls.
Conclusion: Laparoscopic left pancreatectomy is feasible and safe
when performed by a skilled surgeon and provides the same oncological
results as open surgery but with better postoperative outcomes.
028934
Laparoscopic total pancreatectomy for pancreatic metastasis from
kidney cancer
Cury Filho, A.M.1, De Godoy, A.L.1, De Farias, I.C.1, Marques, M.C.1,
1
curyantonio@gmail.com, andreluisgodoy@yahoo.com.br,
dr.igorfarias@gmail.com, dr.marciocarmona@gmail.com,
S125
Introduction: Total pancreatectomy is a high-morbidity surgery from
the first postoperative days, with a high inflammatory response, high risk of
bleeding, and longterm gastroparesis. Minimally invasive surgery can be an
option to reduce these risks.
Objectives: To show a total pancreatectomy done by a laparoscopic
approach for kidney metastasis.
Methods: A 54-year-old male patient presented with kidney cancer
with metastasis to the pancreas. He had been operated 5 years previously
for left nephrectomy and showed some lesions in the pancreas on follow-up.
Results: We started the procedure by enucleation of the uncinate lesion
and distal pancreatectomy. Laparoscopic ultrasound was performed intraoperatively and showed one more lesion at the head of the pancreas; this
changed our choice to total pancreatectomy
Conclusion: Total pancreatectomy is feasible and safe when done by
laparoscopy
029210
Laparoscopic treatment of pancreatic tumors
Oliveira, I.R.1, Pereira, V.B.M.1, Marquez, G.J.1, Rodrigues, A.R.1,
Tefilo, A.L.O.Q.1, Lima, L.R.C.1, Neto, M.L.S.2, Pereira, A.A.1
1
Pontificia Catholic University of Gois, Goiania, Brazil, 2Santa House of
Mercy Goiania, Goiania, Brazil
izabellajatai@yahoo.com.br, vianipereira@gmail.com,
germanajardim@hotmail.com, andre_rezek@hotmail.com,
analuizateofilo@gmail.com,lurian06@hotmail.com,manoellsm@gmail.com,
anne_gyn@hotmail.com
Introduction: Laparoscopy has been one of the most important
advances in abdominal surgery in recent years. The development of laparoscopic instruments and technical improvements obtained with the accumulation of experience has enabled surgeries considered of high complexity
with minimally invasive techniques. The use of laparoscopy for pancreatic diseases has been initially used for the staging of neoplastic diseases,
palliative treatment of obstructive symptoms, or pseudocyst drainage. But
only recently have laparoscopic pancreatic resections begun to be realized.
Objectives: To report the benefits of laparoscopic treatment for
pancreatic tumors.
Methods: Integrative literature review carried out in June 2015, based
on searches of databases LILACS, SciELO and PubMed.
Results: The history of laparoscopic pancreatic resections is relatively
recent. Experience is still very limited, but even so some studies show
that laparoscopy can be very useful in the resection of pancreatic tumors.
The advancement of this technique offers a less invasive access port, with
low morbidity, faster recovery postoperatively and low complication rates
compared to open surgery.
Conclusion: The laparoscopic approach to pancreatic diseases is
feasible, can bring benefits to patients with cystic neoplasms of the distal
portion of the pancreas, with little postoperative pain, shorter hospital stay,
low complication rates and better cosmetic results. Controlled studies with
more patients are needed to confirm the findings of this study.
S126
028693
Left hepatic trisegmentectomy with resection of all three hepatic
veins: a case report
Zanin, L.A.G.1, Farias, I.C.1, Costa, W.L.J.1, Coimbra, F.J.F.1, Diniz, A.L.1,
Godoy,A.L.1
1
Department of Abdominal Surgery, A.C.Camargo Cancer Center, So
Paulo, Brazil
lgzanini@hotmail.com, dr.igorfarias@gmail.com,
dr.wilsoncosta@gmail.com,drfelipecoimbra@gmail.com,dr.aldiniz@gmail.com,
andreluisgodoy@yahoo.com.br
Introduction: The better oncological outcomes of patients with liver
metastases from colorectal cancer have been attributed mainly to advances
in surgical and chemotherapeutic treatments. Complex surgical approaches
have allowed operations on patients with lesions previously considered
inoperable. However, involvement of the three supra-hepatic veins is still
considered a contraindication to curative surgical resection.
Objectives: To report and analyze an unusual case of left hepatic
trisegmentectomy with resection of three hepatic veins.
Results: A 65-year-old male patient was submitted in 2006
retrosigmoidectomy for adenocarcinoma of the sigmoid (pT3N0cM0).
Regular follow-up was maintained, and the patient presented in 2013 a
hepatic recurrence with a large mass (159 x 121 x 120 mm) occupying
the liver segments II/III/IV/V/VIII; the supra-hepatics veins were invaded,
and the tumor was in close contact with the retro-hepatic vena cava and
left portal vein. As the tumor was considered unresectable by the surgical
team, the patient was started on palliative chemotherapy, with an excellent response. It was decided to do a surgical exploration. The performance of intraoperative US identified infiltration of the right supra-hepatic
vein, no cleavage plan with the right portal branch, and the procedure was
aborted. Treatment was followed for locoregional control, with completion
of two cycles of TACE with Debiri. Because of the good clinical response,
biochemistry and reduction in tumor mass, there was another attempt at
surgery. Trisegmentectomy was carried out with the left hepatic resection of the three veins mentioned above, while maintaining drainage of
the remaining liver by a further accessory hepatic vein (vein Makuchi).
The patient remained in the ICU for 5 days, and the outcome was good.
The patient presented with a biliary fistula on the 7th postoperative day;
papillotomy and plastic prosthesis passage via ERCP was performed.
Histopathological examination showed free margins. The patient was
discharged on the 14th postoperative day.
Conclusions: In selected cases, after a good response to chemotherapy, the surgeon may opt for extensive liver resections, thus treating
more patients once considered unresectable and offering greater chemotherapy-free survival and eventual cure.
028419
Left trisectionectomy in two stages (radio-frequency-assisted liver
partition with portal vein ligation) for the treatment of extensive
colorectal metastases
Epstein, M.G.1, Schraibman, V.1, Padovese, C.C.1, Dario, R.P.D.1,
DOrto, U.C.1, Macedo, A.L.V.1
1
ma_epstein@hotmail.com,
vschraibman@hotmail.com, camila_padovese@yahoo.com.br,
didario@uol.com.br, dr.ulisses@uol.com.br, tala@uol.com.br
Introduction: Associating liver partition and portal vein ligation for
staged hepatectomy (ALPPS) has emerged as a new method for patients
with comprehensive liver metastases and a small future liver remnant.
Objective: To report the surgical technique, patient management, and
results with this ALPPS procedure.
ABSTRACTS
Methods: The RALPP (radio-frequency-assisted liver partition with
portal vein ligation) procedure was performed on a 47-year-old male
patient with multiple hepatic metastases of colorectal origin. He had been
submitted to a total colectomy due to an intestinal obstruction caused by
an invasive adenocarcinoma. He had undergone adjuvant chemotherapy
(FOLFOX) 6 months before hepatectomy. At that time, magnetic resonance
imaging (MRI) showed a reduction in size of the multiple metastases. The
hepatic function was normal, and the patient underwent the surgery for the
first time, without complications.
Results: During the first stage, liver partition and portal vein ligation
of the diseased hemi-liver were performed. We used a novel technique to
achieve a rapid increase in future liver remnant within a short period of time
by using inline radio frequency to create a virtual liver partition with portal
vein ligation (RALPP). After the first procedure, the patient was managed
at an intensive care unit for 1 day. The second procedure was performed
7 days after the first. Previous MRI showed a hepatic volume in the right
lateral segment of the liver sufficient to perform the second stage. A left
trisectionectomy was performed. The patient was discharged on postoperative day 5. The surgery was performed by the senior surgeon ALVM.
Conclusions: The ALPPS procedure induces rapid liver hypertrophy,
avoiding liver failure in most patients. However, morbidity and mortality
are still high. This strategy emerges as a tempting alternative to be considered in the surgical armamentarium of an already experienced HPB surgeon.
028381
Management of cystic neoplasms of the pancreas: a review of 36 cases
Kalil, A.N.1, Laporte, G.A.1, Remonti, T.A.P.1, Kwiatkownski, R.V.2,
Correa, L.H.L.1, Polo, R.1, Conterno, J.1, Souza, D.L.S.3, de Morais, C.O.3
1
Misericrdia de Porto Alegre, Brazil, 3Universidade Federal de Cincias
da Sade de Porto Alegre, Brazil
Introduction: Despite the growing interest in cystic neoplasms of the
pancreas and their high prevalence (about 20% of the general population
is affected), their diagnosis, treatment and prognosis are still controversial
and obscure.
Objectives: To describe clinical characteristics, surgical strategies
and possible complications due management of cystic neoplasms of the
pancreas.
Methods: This is an historic cohort study from September 1989 to
December 2011, including patients who were submitted to surgical treatment for cystic neoplasms of the pancreas.
Results: A total of 36 patients were included. From these, 31 were
female and the overall average age was 49.75 years. The treatment
performed was surgical resection: cephalic gastroduodenopancreatectomy
in eight patients; body and tail pancreatectomy in 19 patients; tail pancreatectomy alone in two patients; and central pancreatectomy in one patient.
The other three cases were submitted to enucleation of a small lesion in
the head of the pancreas, internal drainage through cystogastrostomy, and
cystojejunostomy respectively. Regarding the location: in 26 cases the
tumor occurred in the body and tail region and in the other ten cases the
location was the head of the pancreas. Three patients had postoperative
complications, including respiratory tract infection, surgical wound infection, and abdominal abscess. Five patients developed diabetes mellitus
during the late postoperative period. One patient died 45 days after surgical
procedure.
Conclusions: Patients presenting pancreatic cystic lesions should
be submitted to surgery whenever local and medical conditions allow
it. Additionally, intraoperative frozen biopsy has to exclude pancreatic
ABSTRACTS
pseudocyst as a differential diagnosis. If the nature of the lesion cannot
be determined, we recommend resection, since it is preferable to resect a
pseudocyst than to leave or drain a cystic neoplasm.
028626
Marked CA 19-9 elevation due to portal vein thrombosis after
pancreatic cancer resection
Roman, L.I.1, Rech, E.L.1, Frana, V.T.1, Fuga, G.R.1, Rosa, A.S.K.K.1,
Weber, V.G.1, Magalhes, M.A.2, Dotto, M.S.3, Balzan, S.M.P.3
1
Faculade de Medicina, Universidade de Santa Cruz do Sul, Santa Cruz
do Sul, Brazil, 2Centro de Oncologia Inegrado, Hospital Ana Nery, Santa
Cruz do Sul, Brazil, 3Centro de Oncologia Inegrado, Hospital Ana Nery/
Faculdade de Medicina, Universidade de Santa Cruz do Sul, Santa Cruz
do Sul, Brazil
Introduction: Serum carbohydrate antigen 19-9 (CA19-9) is a reliable tumor marker of biliopancreatic and other malignancies. It is useful
for diagnosis, prognosis and monitoring of postoperative recurrence of
pancreatic cancer. Certain benign conditions such as obstructive jaundice, chronic liver diseases, pancreatitis, interstitial pulmonary disease and
thyroiditis are also known to be related to mild CA19-9 elevation. Rarely,
CA19-9 elevation is related to portal vein thrombosis.
Objectives: To report a case of markedly raised serum levels of
CA19-9 related to portal vein thrombosis after resection of a pancreatic
adenocarcinoma.
Methods: Review of records and case report.
Results: A 68-year-old male, former smoker, with diabetes and hypertension, presented with abdominal pain, and a mass on the pancreatic
tail was identified. Computed tomography revealed a 2.6-cm hypodense
lesion suggestive of pancreatic cancer with no vascular involvement.
Serum CA19-9 was 46 UI/L. A splenopancreatectomy was performed with
uneventful postoperative recovery and hospital discharge on postoperative
day (PO) 7. Pathological examination identified a moderately differentiated
pancreatic adenocarcinoma of 3.8 cm, without nodal or vascular involvement, and with free margins. Adjuvant chemotherapy with gemcitabine and
oxaliplatin was initiated. Fifteen days after hospital discharge the patient
was readmitted with abdominal pain. An extensive portal vein thrombosis
was observed on Doppler ultrasonography, and anticoagulant therapy was
instituted. CA19-9 markedly increased to >20,000 UI/L. Additional evaluation with thoracic and abdominal CT did not find evidence of tumor recurrence, but did find persistent portal vein thrombosis and collateral portal
circulation.
Conclusion: Serum CA 19-9 elevation after pancreatic cancer resection can be related to postoperative portal vein thrombosis.
029203
Mucinous cystadenoma of the appendix: a case report
Freitas, E.C.1, Borges, W.R.2, Costa, C.M.3, Souza, T.S.4, Silva, A.C.M.1,
Leal, C.S.5
1
State University of Southwest Bahia (UESB), Brazil, 2General Surgeon,
Department of General Surgery, State University of Southwest Bahia
(UESB), Brazil, 3Department of Medicine, State University of Southwest
Bahia (UESB), l., Brazil, 4Pediatric Surgery Resident at Childrens
Hospital Joana de Gusmo, Salvador, Bahia, Brazil, 5Department of
Physiology, Federal University of Bahia (UFBA), Brazil
erllannya@hotmail.com, carolmorais_@hotmail.com,
dekkaferraz@hotmail.com
Introduction: Mucinous cystadenoma of the appendix is a rare
and important tumor for surgical practice because of its diagnostic challenges and risk of spread if not surgically treated early and appropriately.
S127
Furthermore, this tumor is associated with others, such as adenocarcinoma
of the colon.
Objectives: To report the case of a 60-year-old patient diagnosed with
mucinous cystadenoma of appendix.
Methods: This study is a retrospective case report approved by the
Ethics Committee of the State University of Southwest Bahia, Vitoria da
Conquista, Bahia, Brazil (number of the opinion of CEP: 516900A). This
is about a 60-year-old woman with lower abdominal pain of mild intensity
for 6 years with no history of weight loss or change in bowel habits. On
physical examination a right adnexal mass on bimanual vaginal examination with painful compression was found.
Results: During diagnostic laparoscopy, an appendicular mass was
observed and selected for removal according to the standardized technique
of open appendectomy; care was taken not to spill the contents of the piece,
proceeding to the accurate inspection of the cavity. Histology confirmed the
diagnosis of mucinous cystadenoma of the appendix. The patient recovered
uneventfully.
Conclusions: Mucinous cystadenoma of the appendix is a rare disease
with non-specific symptoms that has a high potential for complication, but
is usually curable with surgical treatment. Moreover, it is important not to
forget to investigate synchronous tumors.
028422
Neuroendocrine tumor of duodenal papilla: a case report
Sousa, A.R.1, Dias, A.N.1, Borges, L.C.1, Ssilva, L.M.C.1, Azevedo, M.M.2,
Lopes, E.P.D.2
1
Medicina, Brazil, 2Hospital Regional de Araguana, TOCANTINS, Brazil
angelicaribeirodesousa@hotmail.com, emille.nascimento@hotmail.com,
macarioazevedo@hotmail.com, epdlopes@hotmail.com
Introduction: The tumors of Vaters papilla have an unusual appearance, and their incidence represents less than 5% of gastrointestinal tract
tumors. The peak incidence occurs at about 50-70 years, and males predominate. The incidence of neuroendocrine tumors are even lower: 0.66% of
all malignancies. The duodenopancreatectomy, also called Wipple procedure, is the surgical alternative of choice used in the management of this
pathology.
Objectives: To report a case of a patient with a neuroendocrine tumor
at the duodenal papilla and to perform a brief review of the literature.
Methods: Retrospective medical record consultation of the event,
attended by the surgical oncology department in 2015.
Results: The subject was MPL, a 72-year-old female, who was hypertensive and diabetic; she had had a cholecystectomy 20 years previously,
and presented with pain at the upper part of the abdomen, radiating to the
back, associated with abdominal distension and vomiting of coffee grounds
and melena. Jaundice was variable 3+/4+, stools were acholic and urine
was dark. Abdominal ultrasonography showed up discrete hepatosplenomegaly and dilated intrahepatic bile ducts. Cholangiography confirmed a
nodular infiltrative lesion at the duodenal papilla measuring 21.9 x 17.1mm
with ectasia of the bile duct inside, extrahepatic, main pancreatic duct and
accessories. The patient underwent duodenopancreatectomy and regional
retroperitoneal lymphadenectomy. The histopathology found an infiltrative tumor, with small and round cells and clear margins for gastric and
duodenal (0/2), peripancreatic (0/3) and retroperitoneal (0/1) lymph nodes
and round ligament. The diagnosis was a neuroendocrine tumor grade 1
with expression of cytokeratin AE1/AE3, CK7 and CK8, chromogranin A,
synaptophysin and Ki67 <1% by immunohistochemistry.
Conclusion: Papilla of Vater tumors of neuroendocrine type are very
rare; it is therefore important to report cases and essential to discuss the best
management options. On resectable lesions the duodenopancreatectomy is
S128
considered the treatment of choice for operable patients, as was done in
this case report.
029296
Palliative treatment for obstruction of the biliary tract with malignant
drifting bilio-digestive segment III in the liver: a case report
Picanco Junior, O.M.1, Picanco, T.S.C.1, Alves, R.M.S.1, Fonseca, C.C.F.1,
Homobomo, K.F.2, Oliveira-Junior, R.N.R.2
1
Federal University of Amapa, Macapa, Brazil, 2Alberto Lima Hospital,
Macapa, Brazil
ABSTRACTS
Results: The elderly group included 113 resections, while the younger
group was underwent 334 procedures. The elderly group had more malignant lesions and more comorbidities. Regarding transoperative and postoperative data, both groups displayed similar results. According to the
multivariate analysis, cirrhosis and the use of transoperative pedicular
clamping were independent predictors of morbidity. Cirrhosis was also an
independent predictor of mortality.
Conclusions: Our results indicate that age is not a predisposing factor
for worse outcomes of hepatic resection, especially regarding cirrhosis.
Additionally, we recommend avoidance of the usage of transoperative
pedicular clamping.
ompjunior@bol.com.br
Introduction: The malignant diseases of the biliary tract can develop
anywhere on the intra-biliary tree or extrahepatically; they account for only
2% of all cancers and are considered to have a poor prognosis in most cases.
Objective: To report the case of a patient with undifferentiated carcinoma of small cells in an unresectable bile duct treated by bilio-digestive
derivation using the bile duct in segment III of the liver.
Method: The data in the study were obtained through photographic
record, history, physical examination of the patient, additional tests with
patient chart review and consultation of the medical literature.
Case report: Patient SASR, a 31-year-old brown male, presented with
abdominal pain, weight loss, jaundice and severe itching with elevated
bilirubin levels at the expense of direct. A CT scan of the abdomen showed
a tumor in the region of the pancreatic head and ERCP with evidence of
biliary stenosis of the middle portion compatible with cholangiocarcinoma.
The patient underwent exploratory laparotomy; an unresectable bile duct
tumor was found involving the portal triad and occupying the hepatic hilum
with pericolonic lymph node, preventing access for palliation; freezing
biopsy was positive for malignancy. We chose to dissect the hepatic parenchyma to the left of the round ligament with access to the hepatic duct
in segment III; we performed biliodigestive anastomosis in a Y shape
with monofil 5-0. Histopathology revealed a poorly differentiated malignant neoplasm of round cells; the immunohistochemical report revealed
an undifferentiated small-cell carcinoma. There followed an improvement
in the itching and a decrease in bilirubin levels. However, after about 90
days there was a general worsening in the condition of the patient, with a
palpable mass in the upper floor with evolution to death.
Conclusion: Biliary-enteric bypass in liver segment III could be a
form of palliation, and as an option in cases of inaccessibility of the hepatic
hilum and for lesions distant from the primary tumor.
028382
Outcomes of Liver Resection in the elderly: is it safe?
Kalil, A.N.1, Laporte, G.A.1, Remonti, T.A.P.1, Polo, R.1, Conterno, J.1,
Zoletti, F.1, Leonardi, L.A.1, de Morais, C.O.2, Souza, D.L.S.2
1
de Cincias da Sade de Porto Alegre, Brazil, 2Universidade Federal de
Cincias da Sade de Porto Alegre, Brazil
Introduction: The literature shows a recent increase in the incidence of
liver neoplasms. Nevertheless, there is still a hesitancy to perform aggressive surgical procedures especially hepatic surgery in elderly patients.
Objectives: To analyze the influence of age on the morbidity and
mortality of patients undergoing hepatic resection.
Methods: This retrospective study included 414 patients who underwent 447 hepatic resections between November 1993 and December 2010.
The patients were divided into two groups according to whether they were
65 or >65 years of age.
029142
Pancreatic resections in ampullary tumors: analyses of early and
long-term survival
Marques, M.C.1, Coimbra, F.J.F.1, Costa Jr, W.L.1, Diniz, A.L.1,
1
Paulo, Brazil
Introduction: Ampullary neoplasms are uncommon and correspond to
around 6% of all periampullary neoplasms.
Objectives: To analyze the results of early and long-term survival of
patients with resected ampullary tumors in a single Brazilian cancer center.
Methods: A retrospective analysis was performed of the medical
charts of patients who underwent resection of ampullary tumors between
1998 and 2014.
Results: In the study period, 57 resections of ampullary tumors were
performed. A pylorus-preserving duodenopancreatectomy was performed
in 36 individuals; a gastroduodenopancreatectomy in 20, and one patient
underwent a total duodenopancreatectomy due to extensive involvement of
the pancreas. Gender distribution was similar (30 males and 27 females).
Median age was 62 years old (3184). Most subjects were ASA I and II
(63.2%) and only one patient was ASA IV. Jaundice was present in 57.9%
of the individuals with seven developing cholangitis. Vascular resection
was necessary in two patients. Median operative time was 540 minutes
(120840). Blood transfusion was necessary in 42.1% of the surgeries.
Postoperative morbidity was 73.7% and mortality was 14.0%. Pancreatic
leak occurred in 42.1% of the subjects. Most patients had ampullary adenocarcinoma (86.0%). Multimodal treatment was administered in 38.8% of
the individuals and three received neoadjuvant treatment. With a median
follow-up of 30 months, the estimated median overall survival (OS) was
110 months and median disease-free survival (DFS) was 28 months.
Three-year OS and DFS were, respectively, 72.8% and 49.8%. The only
predictor of OS was poorly differentiated tumors (3-y OS: 78.7% x 40.0%,
P = 0.026); however, it was not independent on multivariate analyses.
BMI >24.9 kg/m2 (HR = 4.6, P = 0.003, 95%CI 1.712.5) and lymphnode metastases (HR = 4.0, P = 0.007, 95%CI 1.411.4) were independent
predictors of DFS.
Conclusion: Ampullary tumors are infrequent. In this population,
histological grade, BMI and lymph-node metastases were predictors of
survival.
ABSTRACTS
028329
Pancreatic trauma after laparoscopic transverse colectomy causing
retropancreatic abscess treated laparoscopically
Quadros, C.A.1, Andrade, M.N.2, Claus, C.M.P.3, Cury-Filho, A.M.3,
Canguss, H.C.1, Reis, J.M.S.1
1
Surgical Oncology Team, So Rafael Hospital, Salvador, Brazil, 2Medical
School, Bahia State University, UNEB, Salvador, Brazil, 3Jacques Perissat
Institute, Curitiba, Brazil
caquadros@gmail.com, manaandrade@hotmail.com,
christiano.claus@gmail.com, antoniocury@hotmail.com,
hcangussu@hotmail.com, jadsonreis@yahoo.com.br
Introduction: Minimally invasive surgical access is considered to
be an excellent option in the treatment of colorectal cancer, notably for
reducing surgical morbidity and the length of hospital stay. The 5-year
follow-up period of patients treated by minimally invasive access or
laparotomy has shown similar results in cancer treatment and survival.
Transverse laparoscopic colectomy requires a specific systematic surgical
technique because of its complexity. This video describes an abscess,
resolved laparoscopically, caused by pancreatic trauma after a transverse
colectomy was performed by minimally invasive access.
Objectives: To avoid pancreatic trauma-related complications in transverse laparoscopic colectomy.
Methods: This video describes potential complications that might
occur in a transverse laparoscopic colectomy and suggests ways to avoid
them.
Results: There are peculiarities of laparoscopic minimally invasive
procedures that differ from laparotomy, and specific training is required.
Emphasis has been given in the training programs for surgeons performing
minimally invasive surgery for colorectal cancer. Among the minimally
invasive procedures for the treatment of colorectal cancer, the transverse
colectomy has been considered a more complex procedure than surgeries
for cancer of the ascending, descending and sigmoid colons. After the ligation and transection of the middle colonic artery and vein, surgeons need to
give special attention to dissecting above the anterior limit of the pancreas.
Dissection inferior to the pancreas might cause pancreatitis and abscess.
This video shows pancreatic trauma in a transverse laparoscopic colectomy
for the resection of a pT3N1aM0 adenocarcinoma, causing a retropancreatic abscess that was treated laparosopically. The patient was discharged
from hospital on the 25th day after conclusion of antibiotic therapy.
Conclusions: In transverse laparoscopic colectomy, after the ligation and transection of the middle colonic artery and vein, special attention should be paid to dissection above the anterior limit of the pancreas,
avoiding pancreatic trauma.
029145
Pathological analyses of patients with colorectal liver metastases
resected after preoperative chemotherapy and its correlation with
survival
Marques, M.C.1, Ribeiro, H.S.C.1, Coimbra, F.J.F.1, Costa Jr, W.L.1,
Diniz, A.L.1, Godoy, A.L.1, Farias, I.C.1, Cury Filho, A.M.1
1
Paulo, Brazil
Introduction: The use of preoperative chemotherapy in patients with
colorectal liver metastases has increased in the last decade and pathological
response has been identified as an important predictor of survival.
Objective: Analyze the incidence of pathological components in
patients exposed or not to preoperative treatment and identify predictive
factors of pathological response and their impact on survival in patients
exposed to preoperative chemotherapy.
S129
Methods: A retrospective analyzes in the medical charts of patients
who underwent liver resection from 2009 to 2012 was performed. Patients
who had complete pathological analyses were included. Survival analyses
included only patients who received preoperative chemotherapy.
Results: In the study period, 90 patients met the inclusion criteria.
Seventy patients received preoperative chemotherapy. The group exposed
had higher percentages of 25% tumor fibrosis (p=0.043) and < 50% viable
cells (p=0.018). In the univariate analyses patients with < 50% viable
cells had a better 3 year overall survival however it was not significant
(75.7% x 63,7%, p=0.500). On the other hand, patients with < 25% tumor
fibroses had a significantly worse 3 year overall survival (96.4% x 59.9%,
p=0.019) and it was the only independent predictor on multivariate analyses (HR=5.5, p=0.045, 95% CI 1,0 29.3). No pathological component
was predictor of disease free survival. On univariate analyses, objective
response by RECIST on preoperative tests (p=0.038) and K-ras wild type
status (p=0.022) were the predictors of 25% tumor fibrosis; however
on multivariate analyses, only K-ras status maintained its significance
(OR=4.1, p=0.032, 95% CI 1.1 15.4).
Conclusion: Pathological response is a good predictor of overall
survival in patients with colorectal liver metastases resected after preoperative chemotherapy and tumor fibroses seems to be best one among the
response variables.
029138
Predictors of survival in patients with resected colorectal liver
metastases: experience of a single Brazilian cancer center
Marques, M.C.1, Ribeiro, H.S.C.1, Coimbra, F.J.F.1, Costa Jr, W.L.1,
Diniz, A.L.1, Godoy, A.L.1, Farias, I.C.1, Cury Filho, A.M.1
1
Paulo, Brazil
Introduction: Improvements in perioperative care and multimodal
treatment made the resection of colorectal liver metastases the standard of
care and the only chance of cure for such patients. However, these patients
still present with high rates of recurrence.
Objective: To determine the predictors of survival in patients with
resected colorectal liver metastases in a single Brazilian cancer center.
Methods: Patients who underwent liver resection for colorectal liver
metastases between 1998 and 2012 were retrospectively analyzed.
Results: Three hundred forty-six liver resections were performed in
285 patients. Most patients were male (56.5%). Median age was 58 years
(2384). The primary tumor was in the colon in 69.5% of the patients, and
58.9% had lymph-node metastases. Most subjects had synchronous disease
(58.9%) and 17.2% had extrahepatic disease. Preoperative chemotherapy
was administered in 57.8% of the surgeries. An R0 resection was achieved
in 82.9% of the surgeries. Postoperative complications occurred in 57.8% of
the operations, but most of then were minor (63.5%). Ninety-day mortality
was 3.4%. Estimated median overall survival (OS) was 96 months and
disease-free survival (DFS) 15 months. Independent predictors of OS were
bilobar disease (HR 2.5, P < 0.001, 95%CI 1.54.0), extrahepatic metastases (HR 2.4, P = 0.001, 95%CI 1.44.1), occurrence of major postoperative complications (HR 2.1, P = 0.004, 95%CI 1.23.7), postoperative
liver failure (HR 1.9, P = 0.046, 95%CI 1.03.8) and rectal primary tumor
(HR 1.8, P = 0.008, 95%CI 1.13.0). Independent predictors of DFS were
bilobar disease (HR 2.2, P < 0.001, 95%CI 1.63.1), extrahepatic metastases (HR 2.0, P < 0.001, 95%CI 1.32.9), lymph-node metastases in the
primary (HR 1.7, P = 0.001, 95%CI 1.22.4) and blood transfusion (HR
1.4, P = 0.040, 95%CI 1.01.9).
Conclusion: Major postoperative complications and postoperative
liver failure were independent predictors of overall survival in patients with
resected colorectal liver metastases.
S130
029192
Prognostic evaluation of resectable ductal adenocarcinoma after
pancreaticoduodenectomy based on retroperitoneal margin
Ribeiro, L.C.B.1, Albagli, R.O.1, Carvalho, G.S.S.1, Barbosa, C.A.1,
Oliveira, L.O.1
1
Department of abdominopelvic surgery, National Cancer Institute, Rio de
Janeiro, Brazil
lurribeiro@yahoo.com.br, rafaelalbagli@uol.com.br,
gustavostoduto@yahoo.com.br, cibele.aquino@gmail.com,
jadivanleite@hotmail.com
Introduction: Curative resection has been shown to be one of the key
factors influencing survival of pancreatic ductal adenocarcinoma (PDAC)
patients. After the resection of a solid tumour, microscopic resection margin
involvement (R1) has been reported as an independent predictor of poor
long-term survival following pancreaticoduodenectomy (PD) for PDAC in
several studies, but not in others. There has recently been increased interest
in resection margin involvement in PDAC, as well as in its prognostic and
therapeutic implications.
Objectives: To determine the impact of survival based on posterior margin status after pancreaticoduodenectomy (PD) for ductal
adenocarcinoma.
Methods: We present a single-center experience with 14 consecutive
macroscopic complete pancreatic head resections for PDAC carried out
between 2009 and 2014 by using standardized pathological processing and
reporting. The circumferential soft-tissue margins (medial, anterior surface,
superior, and posterior), were inked and analyzed. Then we classified the
posterior margin as the portal veinsuperior mesenteric vein margin (PV
SMVm) as R0 or R1.
Results: The 14 patients classified for the study were submitted to
histopathological analysis of the specimen, with evaluation of the posterior margin. Nine of them had the R0 resection and the other five had R1
resections. There were no differences on overall survival between the two
margins status.
Conclusions: Underreporting of microscopic posterior margin
involvement may cause some discrepancy between margin status and clinical outcome, and hence the clinical significance of R1 resection remains
unclear.
029276
Radiofrequency ablation on hepatocellular carcinoma treatment: a
case report
Graebin, L.1, Jablonski, R.2, Gomes, L.N.2, Tiago, L.H.B.L.3,
Freitas, A.C.3, Paim, G.G.3, Ferrari, C.3, Miranda, I.H.3, Silva, N.Z.3
1
Federal University of Pelotas, Pelotas, Brazil, 2Cancer Institute of
Pelotas, Pelotas, Brazil, 3Federal University of Pelotas, Pelotas, Brazil
liege.graebinmm@gmail.com,
rauljjr36@hotmail.com, lng@terra.com.br, luuiza_bt@hotmail.com,
andersoncasalifreitas@gmail.com, giovana_paim@hotmail.com,
cristianoferrari90@hotmail.com, isabelhmiranda@gmail.com,
nataliazanini@outlook.com
Introduction: Hepatocellular carcinoma is the most frequent primary
tumor in the liver, accounting for almost 80% of the cancer cases. The
fibrolamellar variant has the better prognosis because of the better surgical
access and it involves mostly young people (535 years). The rate of incidence is three times greater in men, with a peak between the 80s and 90s.
Objective: To demonstrate diagnostic methods and treatments of a
patient with hepatocellular carcinoma.
Methods: We used information collected in interviews with the
patient, chart review, photographic record of imaging exams, as well as the
techniques used for their treatment and a review of the literature.
ABSTRACTS
Results: The patient was a 68-year-old man with a 3-month history
of jaundice. The first exams revealed hepatites C. Two liver biopsies were
done, in May and June, and the histopathology identified hepatocellular
carcinoma in segment VII. The patient underwent the first radio-ablation
session in July, with curative intent. Subsequently chemotherapy was
performed, and if necessary a rescue operation.
Conclusions: Hepatocellular carcinoma is a primary malignancy of
the liver that stems from mutations suffered by hepatocytes. Its etiology
is diverse, but is mainly due to infection by the hepatitis B virus. Its main
risk factor is the presence of cirrhosis. The diagnosis is by means of laboratory tests, imaging studies and liver biopsy. The best treatment option is
transplantation, but hepatectomy, percutaneous ethanol injection, as well as
radiofrequency ablation (as exemplified in this case) are still used.
029102
Renal clear-cell carcinoma with translocation Xp11.2 with liver
metastasectomy
Souza, M.G.1, Oliveira, P.J.C.2, Falco, C.A.F.3, Henrique, M.D.3,
Oliveira, H.J.4, Pereira, G.C.G.5
1
Surgeon digestive tract and professor of the Faculdade de Medicina Nova
Esperana, FAMENE and UFPB, Joo Pessoa, Paraba, Brazil, 2Surgeon
digestive tract, Joo Pessoa, Paraba, Brazil, 3Student of the Faculdade
de Medicina Nova Esperana, FAMENE, Joo Pessoa, Paraba, Brazil,
4
Anesthesiologist of the municipal government of Joo Pessoa, Joo
Pessoa, Paraba, Brazil, 5Pathologist of the Brazilian Society of Pathology,
Joo Pessoa, Paraba, Brazil
mgscirurgia@ig.com, camillafranca@hotmail.com,
marina_dantas_@hotmail.com
Introduction: The clear-cell tumor is the most common among
neoplasms in renal carcinoma. The chromosomal translocation Xp11.2
renal-cell carcinoma is a rare condition, occurring mostly in children and
young adults. Nephrectomy is an indication for renal-cell carcinoma, the
metastasectomy being held when there are metastatic foci.
Objectives: To present a case of a young patient with renal-cell carcinoma with translocation Xp11.2; the patient presented with liver metastasis
and underwent hepatectomy for resection of the lesions.
Methods: We took as a methodological base a holistic view of the
evolution of the patients condition, as well as bibliographical support
based on PubMed articles.
Results: ASDV, a 31-year-old male, in 2010 presented with upper
abdominal pain; CT showed a tumor in the right kidney. We proceeded
with a total nephrectomy on the side of the lesion, partial resection of the
abdominal cava and hepatic metastasectomy of the right lobe. Pathology
confirmed the presence of renal-cell carcinoma in the kidney and liver
with vascular invasion of the vena cava and right renal vein. His condition
held for 2 years. In 2012, two liver lesions were detected in the right lobe,
and anti-angiogenic therapy was started with pazopanib when the lesions
remained stable. However, in 2015, liver damage increase, so we chose
to perform a right hepatectomy with resection of tumors. The pathology
showed lesions of 0.6 cm and 2.7 cm and histological aspects of renal
clear-cell carcinoma associated with translocation Xp11.2 predominantly
of papillary arrangement, atypical nuclei and psammomatous bodies.
Immunohistochemistry revealed positive markers CD10, EMA (Mk-5),
Pan CK (AE1/AE3), Vimentin (V9) and PAX -8 (BC12). This highlights
the presence of neoplastic vascular invasion foci and free surgical margins.
The patient continues to evolve in the postoperative period.
Conclusions: Radial nephrectomy is the only effective therapy
for Xp11.2 translocation RCC, and liver metastasectomy is indicated in
selected patients with resectable lesions.
ABSTRACTS
029104
Salvage surgery for locally advanced gallbladder cancer with postpalliative chemotherapy: a case report
Barros, A.V.1, Oliveira, F.A.P.F.1, Melo, C.L.A.1, Medrado, P.C.1, Ferro
Neto, O.C.1, Tojal, N.O.1
1
Brazil
aldobarros@ig.com.br,
fapfo.med@uol.com.br,ciceroludgero@ig.com.br,patriciamedrado@hotmail.com,
oscarferro09@gmail.com, nathanatojal@hotmail.com
Introduction: Gallbladder cancer is a disease with a poor prognosis
because many patients are diagnosed only in advanced stages beyond
the scope of surgery, which is the only curative option. A chemotherapy
regimen with gemcitabine and cisplatin has shown satisfactory responses,
even complete responses, but the responses are transient, recurrence
appearing in all patients. The benefits of combining chemotherapy and
surgery has not been tested in gallbladder cancer, but has demonstrated
promising results in other gastrointestinal cancers.
Objective: To describe an interesting case of locally advanced cancer
of the gallbladder who underwent salvage surgery after palliative chemotherapy with cisplatin and gemcitabine.
Methods: The patient was a 58-year-old male with a history of
obstructive jaundice and weight loss. Diagnostic laparotomy showed a well
differentiated adenocarcinoma of the gallbladder. Staging examinations
revealed infiltrating injury to the hepatic hilum without a cleavage plane
with the portal vein, infundibulum of the gallbladder and second portion
of the duodenum, dilated intrahepatic bile ducts and lymphadenopathy in
the celiac trunk. Because of the clinical staging (IVA) and the patients
performance status (ECOG 2) surgical resection was contraindicated, and
the patient underwent percutaneous biliary drainage and palliative chemotherapy. After eight cycles of chemotherapy (gemcitabine and cisplatin), an
MRI of the abdomen showed an excellent clinical response. The situation
was eevaluated by the surgical team and salvage surgery was indicated. The
patient underwent cholecystectomy, hepatectomy (bed of the gallbladder),
resection of the extrahepatic biliary tract, lymphadenectomy of the hepatic
hilum and trunk celiac and hepaticojejunostomy.
Results: The patient showed clinical improvement and was discharged
on the 8th postoperative day. The LHP confirmed adenocarcinoma of the
gallbladder, free margins and the absence of affected lymph nodes. The
patient is well and has been followed up for 9 months without evidence of
recurrence.
Conclusions: In selected cases advanced gallbladder cancer may be
treated, as long as an R0 resection can be achieved with reasonable levels
of morbidity and mortality. Such interventions should be performed only by
experienced surgical teams.
028923
Salvage surgery in cancer of the gallbladder: a case report
Oliveira, F.A.P.F.1, Barros, A.V.1, Melo, C.L.A.1, Ferro Neto, O.C.1,
Rocha, F.T.R.1, Melo, R.S.1
1
Brazil
aldobarros@ig.com.br, ciceroludgero@ig.com.br, oscarferro09@gmail.com,
rochafrederico@uol.com.br, roberiomelo@uol.com.br
Introduction: Gallbladder cancer is a rare disease with high mortality.
It is the fifth most common cancer of the digestive tract. Most of the time
the symptoms are non-specific and the diagnosis is late. Surgical treatment
with complete resection R0 is the only curative treatment. In advanced
disease (local or metastatic), radiotherapy and palliative chemotherapy
S131
have a role in increasing survival and controlling the symptoms, but with
poor response rates and variables.
Objectives: To report a case of advanced gallbladder cancer initially
treated with non-surgical oncology (R2) and palliative radiochemotherapy;
after a partial response the patient was submitted to salvage surgery in our
oncological surgery department.
Methods: A 58-year-old female patient, ECOG 1, was seen in our
surgical oncology clinic with a history of conventional cholecystectomy
(November 2012) and surgery with residual disease (R2), performed at
another institution. The pathological report was adenocarcinoma (G2). The
patient was subjected to the regimen of radiotherapy and chemotherapy with
5FU and lamivudine. Before radiochemotherapy imaging showed lymphadenopathy and liver nodules. After treatment, a PET scan was performed,
and showed a partial response. The patient was taken to surgery and underwent a partial hepatectomy (bed of the gallbladder and V segment), biopsy
of the cystic duct (negative for neoplasia) and lymphadenectomy of the
hepatoduodenal ligament, hepatic hilum and celiac trunk.
Results: The patient had good evolution without complications on the
7th day postoperatively. The anatomicopathological examination revealed
adenocarcinoma with metastasis in two lymph nodes (celiac trunk) of the
ten isolated, and malignancy was absent in the liver supplies and cystic
duct. The patient is currently in clinical follow-up, in effect of chemotherapy, with no signs of recurrence after 4 months.
Conclusion: In selected cases, we can make use of this treatment
strategy, since it achieves an R0 resection by teams experienced in hepatobiliary surgery.
029193
Solid pseudopapillary tumor of the pancreas
Freitas, V.F.1, Bastos, J.L.A.2, Carvalho, W.S.F.3, Tavares, L.P.4,
Ferracini, I.C.F.5, Souza, F.M.C.3
1
Medical student, Federal University of Bahia, Salvador, Brazil,
2
Department of Anesthesiology and Surgery, Federal University of Bahia,
Salvador, Brazil, 3Medical student, Federal University of Bahia, Salvador,
Brazil, 4Medical student, Bahia School of Medicine and Public Health,
Salvador, Brazil, 5Medical Student, College of Technology and Science,
Salvador, Brazil
vdefritas@gmail.com, jorgelabastos@gmail.com,
wsfc1989@gmail.com, lportela_7@hotmail.com, belacff@gmail.com,
felipe.mathiascs@hotmail.com
Introduction: Solid pseudopapillary tumor of the pancreas (SPPT)
is a rare non-secreting pancreatic cystic tumor first characterized in 1970.
It has a benign clinical behavior with low malignant potential, and most
commonly affects young women; when it occurs in men it shows a more
aggressive pattern. It may affect any segment, and a surgical approach is
usually curative. Despite these features, SPPT differs from other cystic
neoplasms of the pancreas, showing an enigmatic pattern of surgical and
oncological perspectives.
Objectives: To report cases of solid pseudopapillary tumor of the
pancreas, describing diagnosis, treatment and evolution.
Methods: Retrospective evaluation of four different and peculiar
cases of solid pseudopapillary tumor with different signs and symptoms,
the surgical approach and tumor evolution.
Results: Patient 1, a 26-year-old female, was asymptomatic, fortuitously diagnosed by USG, with a tumor area at the bodytail of the
pancreas confirmed by MRI. A bodytail pancreatectomy with splenectomy
were carried out, also a posterior hepatic resection because of a metastasis.
Patient 2, a 19-year-old female, presented with persistent pain in the left
hypochondrium, nausea and diarrhea; she was diagnosed by USG and
the diagnosis confirmed by CT: a solid/cystic tumor in the body and tail
of the pancreas. We conducted a bodytail pancreatectomy, splenectomy
S132
and lymphadenectomy, without postoperative complications. Patient 3, a
19-year-old male, was asymptomatic, fortuitously diagnosed by US and
confirmed by MEI as having a tumor in the medial body of pancreas; a
bodytail pancreatectomy was carried out, followed by conservative treatment for pancreatic fistula. Patient 4, a 32-year-old female, featured pain
in the left hypochondrium, diagnosed by USG and later confirmed by CT
as a tumor in the medial body; bodytail pancreatectomy was carried out
without complications.
Conclusions: This kind of neoplasia has a good prognosis and a high
survival rate; the surgical approach yields a good percentage of cures even
when total pancreatectomy is necessary.
028392
Solid pseudopapillary tumors of the pancreas: a review of eight cases
Kalil, A.N.1, Laporte, G.A.1, Remonti, T.P.A.1, Conterno, J.1,
Kwiatkonski, R.V.1, Correa, L.H.L.1, Furtado, J.P.R., de Morais, C.O.2,
Souza, D.L.S.2
1
Servio de Cirurgia Oncolgica do Hospital Santa Rita da Irmandade da
Santa Casa de Misericrdia de Porto Alegre e Universidade Federal de
Cincias da Sade de Porto Alegre, 2Universidade Federal de Cincias da
Sade de Porto Alegre
Introduction: Solid pseudopapillary tumor of the pancreas is a rare
neoplasm that was first described by Frantz et al in 1959.
Objectives: To describe clinical characteristics, surgical strategies and
possible complications of solid pseudopapillary tumors of the pancreas.
Methods: This is a historical cohort study from September 2000 to
December 2011 including patients submitted to surgical treatment for solid
pseudopapillary tumors of pancreas.
Results: Our series included eight female patients with an average age
of 29 years. All treatments included surgical resection: cephalic gastroduodenopancreatectomy in three patients; body-and-tail pancreatectomy, in
another three cases; and central pancreatectomy in one patient. Regarding
the site of the tumor, we found three cases in the body, two cases in the
tail, and three cases in the head of the pancreas. Three patients had postoperative complications, including respiratory tract infection, surgical wound
infection and abdominal abscess. No patient developed diabetes mellitus
during the late postoperative period and no deaths were reported.
Conclusions: Patients presenting solid pseudopapillary tumor of the
pancreas are usually young asymptomatic females. Diagnosis is mostly
made by accident, through imaging exams investigating other causes.
However, its prognosis is excellent if well operated in an oncological
surgical service
028399
Statistical analysis of oncological patients post-pancreatectomy
Barbosa, F.R.A.O.1, Santos, A.C.S.1, Loula, M.D.1, Souza, M.O.1,
Felicio, S.1, Peixoto, E.2
1
Student from Escola Bahiana de Medicina e Sade Pblica, Brazil,
2
Professor Holder of Surgical and Operative Technique Experimental II
from Escola Bahiana de Medicina e Sade Pblica, Brazil
fernandaranielle@hotmail.com, anacarlasantana@outlook.com,
marilialoula@gmail.com, mari19.oliveira@gmail.com,
Introduction: Pancreatic neoplasia (international classification of
diseases ICD 10-25) is fundamentally a genetic disease with hereditary mutations and genes associated with the development of cancer.
According to the American Cancer Society, pancreatic cancer is not usually
identified early, and the main imaging method for detecting pancreatic
masses is computed tomography (CT). The treatments for pancreatic
ABSTRACTS
tumors are: ablative treatment, chemotherapy, radiotherapy and surgery.
Pancreatectomy is done to remove the tumor and affected lymph nodes and
can be total or partial; it offers patients the greatest chance of a cure.
Objectives: To analyze the length of hospital stay and mortality in
patients (according gender and age group) undergoing elective pancreatectomy in the SUS in 2014.
Methods: Data collection was by TABWIN, a tabulator program
previously installed; tabs were conducted with secondary data files from
the Ministry of Health (MS) and the DATASUS (SUS Department of
Informatics).
Results: In 2014, 657 pancreatectomies were conducted in oncology
by the SUS system in Brazil, and in hospitals in Bahia 23 pancreatectomies
in oncology were documented. Regarding the profile of patients who underwent surgery, it was observed that the majority were male (50.2%; women
49.7%), and more patients were over 50 years of age. The frequency of
deaths corresponded to 10.5% of patients undergoing this procedure, and
the number of deaths occurred most often in people aged 50 years.
Conclusion: Pancreatectomy is the curative and palliative treatment
prevalent in pancreatic cancer; the length of hospital stay is prognostic
the highest number of days corresponding to the highest number of
deaths, with no significant differences between the sexes; deaths were most
frequent in patients over 50 years. The same is seen in similar studies in
other countries.
028506
Study of pancreaticoduodenectomies performed during 2014 at the
Hospital Geral Roberto Santos, Salvador, Bahia, Brazil
Canedo, L.F.1, Vieira, I.F.1, Teixeira, G.1, Sena Jr, A.S.1
1
Hospital Geral Roberto Santos, Salvador, Brazil
leo.canedo1@gmail.com, ifvieira86@gmail.com,
contato@giselleteixeira.com.br, senajrfar@gmail.com
Introduction: Considered one of the most difficult surgeries of the
gastrointestinal tract, the pancreaticoduodenectomy (PD) is challenging
because of its number of anastomoses and dissection sites. In the last
couple of decades the laparoscopic PD (LPD) has been developed, with
good results compared with the open technique (OPD).
Objectives: To describe and compare the open and laparoscopic DPs
performed in the first year of introduction of advanced laparoscopy at a
public hepatopancreatobiliary reference hospital in Salvador, Bahia, Brazil.
Methods: Throughout the surgery records of Hospital Geral Roberto
Santos, all the PDs performed from 12/01/2013 to 12/01/2014 were identified. Only the oncologically complete surgeries performed during that
period, open or laparoscopic, were selected.
Results: In total, 15 PDs were performed, with eight LPDs. The
majority of the patients were women, and the mean age was 55.26 years
old. The mean length of hospital stay was 55.2 days for OPD and 35.2 days
for LDP. The conversion rate was 37.5%. The mean length of stay in the
intensive care unit was 11.7 days for OPD and 8.1 days for LPD. The procedure time was 380 min for OPD and 546 min for LPD. Only one patient in
the OPD group needed blood transfusion. The fistula incidence was 14.2%
for OPD and 25% for LPD. Two patients in the OPD group had anastomotic
dehiscence. There was one death in each group, and two reoperations in the
OPD and one in the APG group.
Conclusions: The DP can be performed laparoscopically with good
results when compared with the open technique. In our study, the patients
that underwent LPD had a shorter hospital and ICU stay, less use of
blood transfusion, and lower dehiscence and reoperation rates. The LPD
presented a higher incidence of fistula and a longer time of operation when
compared with OPD. Prospective and comparatives studies will be done
with the purpose of proving the benefits of LPD.
ABSTRACTS
029227
Surgical treatment of liver metastasis of follicular thyroid carcinoma:
a case report
Pereira, V.B.M.1, Tefilo, A.L.O.Q.1, Oliveira, I.R.1, Lima, L.R.C.1,
Marquez, G.J.1, Pereira, A.A.1, Silva-Neto, M.L.2, Rodrigues, A.R.1
1
Pontifical Catholic University of Gois, Goinia, Brazil, 2Santa House of
Mercy Goiania, Goinia, Brazil
vianipereira@gmail.com, analuizateofilo@gmail.com,
izabellajatai@yahoo.com.br, lurian06@hotmail.com, germanajardim@
hotmail.com, anne_gyn@hotmail.com, manoellsm@gmail.com,
andre_rezek@hotmail.com
Introduction: The liver is one of the organs most affected by metastasis, often 25 times greater than the primary cancer. In the past, the presence of liver metastases was incurable; however, knowledge of tumor
biology and decreased morbidity and mortality of hepatectomies has
resulted in an increase in surgical treatment, extending resections.
Objectives: To report a case of liver metastasis of thyroid carcinoma,
emphasizing the possibility of normal survival after surgical treatment.
Methods: JBF, a 71-year-old male, was taken to the liver and pancreas
surgery service for evaluation of liver damage. The tomography and
magnetic resonance imaging revealed solid nodular lesions in segments
II and IV of the left hepatic lobe, the dimensions of which had increased
dramatically (7 cm to 12 cm) over 6 months, also compromising segment
III. The tests did not complete the etiology of the lesion and tumor markers
(CEA, alpha-fetoprotein and CA 199) were normal, as was the serology
for hepatitis B and C. A left hepatectomy with resection of segments II,
III and IV was carried out. Postoperative complications included paralytic
ileus and pneumonia, which responded well to clinical treatment and drug
therapy. After the 6th day of hospitalization the patient was discharged
in good clinical condition. Histopathology revealed the presence of liver
metastases of follicular thyroid carcinoma.
Results: In the case of a localized and resectable liver disease, a
surgical approach was mandatory, as recent studies have shown overall
5-year survival of up to 40% in patients undergoing surgery. Patient
clinical follow-up progressed satisfactorily and the control postoperative scans remained free with no expansive lesions or intra-abdominal
lymphadenomegaly.
Conclusions: The advent of modern liver surgery and early diagnosis
of metastatic liver lesions have allowed more aggressive actions that enable
patients to be cured or have improved long-term survival.
028986
Total pancreatectomy with superior mesenteric-portal vein resection
for a locally advanced main-duct IPMN-associated adenocarcinoma:
a case report
Anghinoni, M.1, Tefilli, N.1, Fin, F.R.1, Campos, E.C.R.1,
Azevedo, B.R.B.1, Castro, M.1
1
Department of Surgical Oncology, Nossa Senhora da Graas Hospital,
Curitiba, Brazil
manghinoni@yahoo.com.br,
nertantefilli@yahoo.com.br, fabiofin@hotmail.com, ecrcampos@uol.com.br,
brunobazevedo@hotmail.com, mari_castro1006@yahoo.com.br
Introduction: Intraductal papillary mucinous neoplasm (IPMN) is
a cystic epithelial neoplasm of the pancreas. It may be benign, with or
without dysplasia, or frankly malignant with an invasive carcinoma. When
IPMN contains invasive lesions, total pancreatectomy is sometimes needed
for curative resection.
Objective: To show an atypical case of total pancreatectomy with
vascular resection in the treatment of a pancreas neoplasm.
S133
Method: We report our experience with a case of a locally advanced
main-duct IPMN associated with an invasive adenocarcinoma with portal
vein invasion that was successfully treated with total pancreatectomy and
portal vein resection.
Results: A 67-year-old Caucasian male patient was admitted with
a large tumor mass (5 x 3 cm) located to the pancreatic body/neck with
Wirsung duct dilatation and superior mesenteric-portal vein confluence
invasion. A multidisciplinary committee for pancreatic cancers established in the hospital ruled in favor of surgical exploration and resection.
After an extensive Kocher maneuver, the tumor appeared to encase the
mesenteric-portal vein confluence. The first operative specimen (pancreaticoduodenectomy) was removed en bloc with 2 cm of portal vein at the
level of the venous confluence. A mesenteric-portal end-to-end anastomosis
was performed. Intraoperative pathological examination revealed papillary growth of high-grade dysplasia in the main and branch duct epithelium compromising the surgical margin. After an additional resection, we
performed a total pancreatectomy. Digestive reconstruction was performed
using a continuous jejunal loop, and anastomosis to the common bile duct
and stomach. The patient had an uneventful postoperative course. The final
pathological report confirmed a main-duct IPMN associated with a 5-cm
ductal pancreatic adenocarcinoma with portal vein invasion.
Conclusion: Total pancreatectomy with portal vein resection is a valid
technical procedure. It should be taken into account after a clinical assessment that includes the technical and anatomical conditions as well as life
expectancy based on the patients cancer prognosis.
029186
Totally laparoscopic right hepatectomy for the treatment of liver
tumors
Lacerda, C.F.1, Bertulucci, P.A.1, DallInha, V.N.2, Meira Neto, C.C.2,
Burgardt, D.2, Oliveira, A.T.T.1
1
Department of Surgery Oncology, Upper Digestive Tract, Barretos
croider@hotmail.com, paulobertulucci@uol.com.br,
oncovnd@gmail.com, claudemironeto@yahoo.com.br,
diego_burgardt@yahoo.com.br, netto123@uol.com.br
Introduction: The first laparoscopic liver resection (LLR) was reported
by Reich in 1991. Subsequently, Gagner (1992) in the United States (USA)
and Azagra (1996) in Belgium performed the first anatomical resection,
followed by Kalil in Brazil (1997), Mondragon-Sanchez in Mexico (2001),
and Cherqui (2002) and Descottes (2003) in France.
Objective: To demonstrate by video one right hepatectomy using
laparoscopic surgery for resection of a liver tumor.
Methods: The patient is placed in a supine position with open legs and
open arms (French position). For right hepatectomy, the patient is placed on
the left lateral decubitus position, with pneumoperitoneum in 1215 mmHg.
The operation is similar to conventional surgery. The falciform ligament,
coronary, triangular and retro-hepatic vessels are sectioned when necessary.
The resection of the gallbladder is accomplished by keeping the gallbladder
attached to the bottom so that it can be used to expose the hepatic hilum.
We seek to identify the structures of the hilum for later ligation with a
laparoscopic linear stapler (white). In all cases, we used the the Echelon
stapler 45 mm or 60 mm. It is dissected and not connected; that we do later
inside the parenchyma. We keep the central venous pressure between 3 and
5 mmHg. We use ultrasonic tweezers (Harmonic ACE), utilized to section
the hepatic parenchyma, and larger structures are transected with clips or
linear staplers. For minor bleeding we use argon gas for hemostasis. The
specimen is extracted through a suprapubic incision (Pfannenstiel) or we
use existing incisions, with the protection of the abdominal wall.
S134
Results: The most frequent type of hepatectomy was right hepatectomy (37.7%). We do not use the maneuvers hemi-Pringle or assisted technique, and we seek to avoid the technical access to the Glissonian pedicle
(intrahepatic). The patient had good evolution, received an oral diet on the
first postoperative day and was discharged on the fourth day.
Conclusion: The extended right hepatectomy is feasible, with benefits
to the patient, but itrequires greater skill and caution by the team for its
realization.
029327
Two-staged hepatectomy for colorectal liver metastases (ALLPS):
initial experience
Santos, L.C.1, Silva, R.T.F.1, Miranda, T.N.A.E.2
1
Departmento de Cirurgia Abdomino-plvica, Instituto Nacional
do Cncer, Rio de Janeiro, Brazil, 2Departmento de Radiologia
Intervencionista, Instituto Nacional do Cncer, Rio de Janeiro, Brazil
leonaldson@gmail.com, rodolfohermes@hotmail.com,
tiago_naem@yahoo.com.br
Introduction: Surgery is the only potential curative treatment for liver
tumors. Only 20% are eligible to undergo complete resection of colorectal
liver metastases (MHCR). The common cause of irresectability is disease
progression (10%) and inadequate hypertrophy of future liver remnant
(FLR) (2%). Resection associated with liver hypertrophy induced by
ALLPS (associating liver partition and portal vein ligation in staged hepatectomy) supplanted the post-hepatectomy liver failure (PHLF) secondary
to an insufficient FLR.
Objective: To demonstrate initial ALLPS experience in a public health
institution in Rio de Janeiro.
Method: The selected patients were from the Instituto Nacional do
Cncer (INCA); they had unressectable CRLM. FLR analysis was carried
out by volumetry preoperatively and 7 days after the first ALLPS stage.
Result: Three patients (two men and one woman) with synchronous
CRLM were candidates for surgery. They underwent neoadjuvant chemotherapy and ALLPS with liver hypertrophy ranging from 61% to 101%.
There was PHLF in two cases, associated with sepsis and other transitory
conditions. There was one death after second-stage ALLPS.
Discussion: ALLPS is a new strategy in the treatment of CRLM with
100% and 100%, respectively, feasibility and R0 resection, corresponding
to the rates of 8698% and 86100% from other studies. Review of other
series revealed hypertrophy ranging from 61% to 93%, which was similar
the data found. The mortality of ALLPS after <90 days in our initial
experience is around 33%, which is above that determined in other series
(923%). The data from the study have low accuracy in terms of morbidity/
mortality because of the small number of cases.
Conclusion: ALLPS is a feasible technique, with mortality around 9%
in some series, and it is necessary to define which criteria are appropriate
for performing ALLPS.
028370
Undifferentiated pancreatic carcinoma with osteoclast-like giant cells:
a case report and literature review
Teixeira, F.J.R.1, Andrade, A.B.1, Faria, E.P.1, Couto Netto, S.D.1,
Costa, F.P.P.1, Perina, A.L.F.1
1
Instituto de Oncologia Santa Paula, Brazil
fredteixeirajr@gmail.com, andrebouzas@yahoo.com.br,
epetribu@gmail.com, sergiodcnetto@gmail.com, fabiopcosta@me.com,
andreperina@gmail.com
Introduction: Osteoclast-like giant-cell tumor is a rare pancreatic
tumor (0.2%), similar to the giant-cell tumor of bone (Tezuka et al, 2006).
ABSTRACTS
The female-to-male ratio is 1:1 with an average age of 61 years; it most
commonly appears at the head of the pancreas, and usually manifests
symptoms and an abdominal mass (Tezuka et al, 2006). The histogenesis
remain controversial whether it has an epithelial or a mesenchymal origin
(Manduch et al, 2008). The tumor can disseminate by lymphatic or hematogenic pathways, and has a poor prognosis although better than that of
ductal carcinoma (Shiozawa et al, 2002).
Objective: To describe a case report and review the literature.
Methods: Case report and literature review.
Results: A 69-year-old male, who was diagnosed with a lung squamous
carcinoma, had a stage PET-CT that found a catchment at the abdominal
cavity (SUV = 10.6). Abdominal CT showed a pancreatic nodule measuring
2.7 cm, with distal atrophy of the pancreas and mild Wirsung dilatation.
Eco-endoscopy was performed and identified an ovoid hypoechoic heterogeneous lesion with well defined limits, measuring 2.7 x 2.3 cm at body of
pancreas. A biopsy was performed and pathology results showed an undifferentiated carcinoma with osteoclast-like giant cells (vimentin-positive
and TTF-1-negative). The patient was submitted to a distal pancreatectomy
associated with a splenectomy. The patient was discharged on the 10th postoperative day without major complications. The final pathological result
confirmed the biopsy: the tumor measured 2.5 cm, without extrapancreatic
invasion; perineural invasion was positive, vascular invasion was negative,
margins were clear, and at the seven lymph nodes dissected there were no
metastases (pT2N0). After consultation with an oncologist the patient was
offered adjuvant chemotherapy with gencitabin that was well tolerated.
Conclusion: We report an incidental finding of a rare tumor of the
pancreas that was treated with surgery and adjuvant chemotherapy.
028509
Vascular resection associated with pancreatic resection: experience of
a single Brazilian center
Marques, M.C.1, Coimbra, F.J.F.1, Diniz, A.L.1, Ribeiro, H.S.C.1, Costa
Jr, W.L.1, Godoy, A.L.1, Farias, I.C.1, Cury Filho, A.M.1
1
Paulo, Brazil
Introduction: Vascular involvement has for a long time been a limit
for curative resection in pancreatic and periampullary neoplasms. The
advances in perioperative care and multimodality treatment have allowed
the performance of more complex resections, including vascular resections,
in these types of tumor.
Objectives: To demonstrate the experience with pancreatic resection
associated with vascular resection in a Brazilian tertiary cancer center.
Methods: A retrospective analysis was performed from the medical
charts of patients who underwent pancreatic resection between 2007 and
2014. Patients in whom any kind of vascular resection was performed were
included.
Results: In the study period 243 pancreatic resections were performed.
Thirty-two of them had a concomitant vascular resection. The gender
distribution was similar (15 males and 17 females), mean age was 59 years
old (7.59) and mean BMI was 24.9 kg/m2 (4.31). Most patients were
ASA I and II (68.7%). Six patients received preoperative biliary drainage.
Vascular involvement was identified in preoperative tests in 65.5% of
patients. Pancreatic adenocarcinoma was the most common neoplasm
(68.7%). Twenty-two patients underwent a cephalic pancreatic resection: six distal, four total and four a multivisceral resection. An isolated
venous resection was performed in 22 patients, arterial resection in five
and combined arterial and venous resection in five. The median operative time was 660 minutes (3001080). Seventeen patients received blood
transfusion. Median hospital stay was 18 days (178). Twenty-nine patients
experienced postoperative complications (90.6%), 15 minor complications
ABSTRACTS
and 14 major complications, including three deaths (9.3%). Five patients
needed reoperation (15.6%) and three patients were readmitted after
hospital discharge (10.3%). The only predictor of the occurrence of major
postoperative complications was an operative time >600 minutes.
Conclusion: Vascular resection associated with pancreatic resection is
a procedure with a high morbidity and mortality and must be performed in
selected patients in high-volume centers.
029258
Bodytail videopancreatectomy: treatment of a serous cystadenoma
Marquez, G.J.1, Rodrigues, A.R.1, Lima, L.R.C.1, Tefilo, A.L.O.Q.1,
Oliveira, I.R.1, Pereira, A.A.1, Pereira, V.B.M.1, Silva-Neto, M.L.2
1
Pontifical Catholic University of Gois, Goinia, Brazil, 2Santa Mnica
Hospital, Goinia, Brazil
germanajardim@hotmail.com, andre_rezek@hotmail.com,
lurian06@hotmail.com,analuizateofilo@gmail.com,izabellajatai@yahoo.com.br,
anne_gyn@hotmail.com, vianipereira@gmail.com, manoellsm@gmail.com
Introduction: The pancreatic cystic neoplasms account for 1015% of
cysts and 1% of pancreatic cancers.They are classified as mucinous cystic
neoplasms composed by mucinous cystadenoma, cystadenocarcinoma,
intraductal papillary mucinous neoplasm and microcystic adenoma (serous
cystadenoma).The latter is characterized by being well located and suggests
being benign; it occurs more commonly in females. Half of the cases are
located on the head or uncinate process, and the other half occur in the
body and tail. Although there is no consensus on the therapeutic approach,
especially in asymptomatic cases, there is an increasing trend in specialized
centers to indicate the resection of cystic lesions >4 cm.
Objectives: Report a case of serous cystadenoma surgically
approached laparoscopically.
Methods: LFLF, a 39-year-old female, presented with diffuse abdominal pain. She underwent computed tomography and magnetic resonance
imaging and was diagnosed with a lesion of microcystic appearance in
the pancreatic body, suggestive of serous cystadenoma 4.7 x 4.6 x 3.9 cm.
Because of the symptoms of the patient, she was submitted to bodytail
videopancreatectomy, with ligation of the splenic vessels and splenic preservation.The patient had an uneventful postoperative evolution, with early
ambulation and without complications.
Results: The realization of pancreatectomy requires large subcostal
incisions to allow a safe approach to the organ. These extended incisions
are associated with intense pain postoperatively as well as increased incidence of wound infection and incisional hernia. Laparoscopy represents an
advance for gastrointestinal surgery, and recent pancreatic resections using
laparoscopy have resulted in lower morbidity and shorter postoperative
recovery time, as well as fewer incision-related complications and better
cosmetic results.
Conclusions: The increase in diagnosed cases of pancreatic cancer
highlights the need for new therapeutic options. Laparoscopic pancreatic
resections have been gaining more and more credence.The laparoscopic
approach is safe and effective for treating pancreatic serous cystadenoma,
providing a better postoperative outcome for the patient.
S135
S136
Colorectal and anal cancer

029095
Advanced sigmoid adenocarcinoma: a case report
Guth, G.Z.1, Martins, J.F.F.1, Loureno, L.A.1, Atade, L.O.1,
Richwin, N.J.1, Oliveira, J.X.1
1
Urgency Surgery Department, Irmandade Santa Casa de Misericrdia de
gguth@uol.com.br, jfelipemartins@hotmail.com,
lara.lourenco@yahoo.com, lillianataide@hotmail.com,
nicolasrichwin@hotmail.com, jairo_xavier@hotmail.com
Introduction: Advanced colorectal cancer is characterized by adherence or tumor invasion of neighboring organs and structures and may or
may not be accompanied by distant metastases.
Objectives: To determine the current benefits of surgery with complete
removal of the primary tumor, organs and locally committed structures as
well as any identified metastases, observing the technical cancer precepts
in patients in stage IV.
Methods: The information was obtained by chart review of a 59-yearold female patient, as well as patient interview, pictures of diagnostic
methods undergone by the patient, and literature review.
Results: The patient was submitted to retrosigmoidectomy in oncology,
as well as retroperitoneal lymphadenectomy, extended hysterectomy,
partial cystectomy, liver lumpectomy and aortobiiliac with prosthesis.
Conclusions: The patient in stage IV who underwent surgery
according to oncological principles with resection of the distance lesions
is asymptomatic and is attending outpatient follow-up.
029156
Alternative surgical technique to total pelvic exenteration for the
treatment of local advanced rectal cancer: a case report
Giorgetta, L.S.1, Sousa, P.F.1, Castro, L.S.1, Paulo, G.G.1, Ferreira, A.G.L.1
1
Department of abdominopelvic surgery, INCA, Rio de Janeiro, Brazil
dskleo@hotmail.com, priscbj@hotmail.com, leonaldson@gmail.com,
giovannagatto003@gmail.com, andrelopes_uff@yahoo.com.br
Introduction: Colorectal cancer is the third most common type
of cancer worldwide and is a leading cause of cancer death. Screening
programs have been largely adopted, leading to an improvement in the
prognosis of this pathology. Using TMN staging and surveillance, 25% of
patients present with stage IV disease. Careful surgical planning is essential, and there are significant factors in determining the optimal surgical
approach, such as the stage of the disease and the presence of synchronous colonic tumors. The goal of primary surgical treatment is to eradicate
the disease in the colon, and to drain nodal basins and contiguous organs.
Resection of colorectal cancer that has invaded adjacent structures involves
en-bloc resection, and a patient who has a margin-negative multivisceral
resection has the same chances of survival as a patient with no adjacent
organ involvement on a stage-matched basis.
Objectives: To show an alternative surgical technique to total pelvic
exenteration as radical treatment for a local advanced obstructive rectal
cancer by performing anterior rectal resection, partial cystectomy and
urinary reconstruction with ileal patch.
Methods: This case is based on a 72-year-old male patient, PS 1, diagnosed with synchronous rectal and sigmoid adenocarcinoma associated
with invasion of the entire posterior bladder wall and enlarged retroperitoneal lymph nodes; he was operated with intestinal subocclusion.
Results: The surgical treatment performed was an en-bloc anterior
rectal resection, partial cystectomy (whole posterior bladder wall including
the bladder trigone), retroperitoneal lymphadenectomy and terminal colostomy. The urinary reconstruction was made with vascularized W ileal patch
ABSTRACTS
forming the neobladder posterior wall and ureteral reimplantation in the
tubular ileal segment. The procedure time was 12 hours, and there were no
major postoperative complications. The length of hospital stay was 30 days.
Conclusions: The surgical procedure was successfully performed,
with R0 surgery creating an embodiment orthotopic ileal neobladder that
preserves the common urinary tract, precluding the need for external
permanent urinary diversion.
029088
Analysis of surgical treatment of rectal cancer: epidemiology and
results in the long term
Lustosa, A.G.1, Lira, G.A.2, Gis, M.C.2, Santos, L.V.S.2, Filho, K.J.C.2,
Pires, T.C.3, Oliveira, I.B.M.D.2, Jnior, F.E.L.P.2, Corra, R.S.2
1
Monsenhor Walfredo Gurgel Hospital, Natal, Brazil, 2Norte Riograndense
League Against Cancer - Dr Luiz Antnio Hospital, Natal, Brazil, 3Onofre
Lopes University Hospital, Federal University of Rio Grande do Norte,
Natal, Brazil
alylustosa@hotmail.com
Introduction: In Brazil, rectal cancer is the second most common
cause of cancer of the gastrointestinal tract and is among the leading causes
of cancer death.
Objectives: To evaluate the epidemiological aspects and long-term
results of surgical treatment of rectal cancer.
Methods: This was a retrospective observational study which involved
135 patients and was performed between 2007 and 2014 at the Dr Luiz
Antonio hospital, a referral center for cancer in Rio Grande do Norte.
Included were patients aged >18 years who had a histological diagnosis of
rectal adenocarcinoma, and had undergone radical surgical treatment with
chemotherapy and/or radiotherapy; other types of cancer were excluded.
Data were collected through review of medical records.
Results: We observed that the average age of the patients was 67.1
years (15.87); 50.3% were male and 49.7% female. Of these, 124 patients
had data regarding neoadjuvant treatment while 56.4% did not; 3.2%
underwent chemotherapy, 3.2% underwent radiotherapy, and 37.2% underwent chemotherapy associated with radiotherapy. Regarding the surgical
procedures, 63.7% underwent abdominal rectosigmoidectomy, 21.7% perineal amputation of the rectum, 6.4% local resection, and 8.06% palliative
procedures. Of adjuvant treatment, 32.25% did not undergo any, 41.12%
underwent chemotherapy, 7.25% radiotherapy, and 19.35% chemotherapy
combined with radiotherapy. Of the total of 135 patients, 25.18% had
recurrence, and 74.81% had no cancer recurrence. From the 124 patients
observed, 34.67% died; of these 74.41% died from the cancer, 11.62% from
its complications, and 13.95% from other causes such as car accident.
Conclusions: We noticed that the elderly are most affected by rectal
cancer, with no gender predilection. Abdominal rectosigmoidectomy is the
most common surgical procedure. Approximately one third of the patients
died, mostly as a direct result of the cancer.
029087
Analysis of the impact of the number of lymph nodes recovered from
surgical sample on survival of patients submitted to rectal cancer
treatment
Lustosa, A.G.1, Lira, G.A.2, Gis, M.C.2, Santos, L.V.S.2, Corra, R.S.2,
Oliveira, I.B.M.D.2, Pires, T.C.3, Jnior, F.E.L.P.2, Souza, W.B.1
1
Natal, Brazil
ABSTRACTS
Introduction: In Brazil, rectal cancer is the second cause of cancer of
the gastrointestinal tract and is among the leading causes of cancer death.
Objectives: To evaluate the impact of the number of retrieved lymph
nodes in the surgical specimen in overall survival and disease-free survival
of patients submitted to the treatment of rectal cancer at the Reference Unit
against Cancer in the state of Rio Grande do Norte, Brazil.
Methods: This was a retrospective observational study of 135 patients
performed between 2007 and 2014. Included were patients aged >18 years
with a histological diagnosis of rectal adenocarcinoma who had undergone
radical surgical treatment with chemotherapy associated with radiotherapy;
excluded were isolated neoadjuvant treatments and other types of cancer.
Results: It was observed that the average age of the patients was 67.1
years (15.87), and 50.3% were male. Of the surgical procedures, 63.7%
underwent abdominal rectosigmoidectomy, 21.7% perineal amputation
of the rectum, 6.4% local resection, and 8.06% palliative procedures. Of
the total of 111 patients undergoing lymphadenectomy during the surgical
procedure, 22.52% had less than seven lymph nodes removed and 77.47%
had seven or more lymph nodes biopsied. For patients who underwent
neoadjuvant chemotherapy combined with radiotherapy, overall survival
over 1, 2 and 5 years was, respectively, 85.6%, 78.4% and 75.8%, and the
disease-free survival at 1, 3 and 5 years was 92.9%, 74.4% and 65.3%,
respectively. There was no evidence of a statistically significant difference
at the 5% significance level with respect to survival (disease-free or overall)
of patients according to the number of lymph nodes removed.
Conclusions: There was no difference in the survival of the population
submitted to treatment with neoadjuvant rectal cancer between the groups
analyzed (less than seven lymph nodes removed and seven or more lymph
nodes removed).
028900
Are the results of magnifying chromoendoscopy evaluation of
extraperitoneal rectal tumors comparable to those of endorectal
tridimensional ultrasound? Results based on pathological comparison
Pinto, R.A.1, Kawaguti, F.S.1, Nahas, S.C.1, Nahas, C.S.1, BustamanteLopez, L.A.1, Cecconello, I.1
1
Hospital das Clnicas da Faculdade de Medicina da USP, Instituto do
Cncer do Estado de So Paulo, So Paulo, Brazil
roambar11@yahoo.com.br, sergionahas@uol.com.br,
caionahas@uol.com.br, leonardoabustamante@gmail.com,
icecconello@hotmail.com
Introduction: Evaluation of rectal wall invasion of early rectal tumors
has a special value in the management of these patients.
Objective: To compare the findings of three-dimensional endorectal
ultrasound (3D-ERUS) with magnifying chromoendoscopy (MC).
Methods: Patients with extraperitoneal rectal tumors evaluated
between September 2010 and June 2014 were included. Rectal wall depth
of invasion (T), tumor extension, and percentage of rectal wall involvement
were evaluated during 3D-ERUS compared to the results of MC and pit
pattern. The results of the exams were blind from each other. Sensibility,
specificity, positive and negative predictive value, accuracy, and kappa
index were calculated for the rectal wall invasion. Also lesion extension
and percentage of rectal wall involvement were analyzed with an intra-class
correlation index.
Results: During the study period 44 patients were prospectively
evaluated using 3D-ERUS and 22 patients also underwent MC prior to
surgery; 27 (61.36%) were female with a mean age of 63.52 (12.23) years.
Surgeries performed were 14 radical anterior resections and 30 local resections by transanal endoscopic microsurgery or colonoscopy (endoscopic
submucosal dissection). Kappa index for the T parameter was 0.64 (95%CI
0.410.86) for 3D-ERUS and 0.69 (95%CI 0.321.1), meaning there was
substantial agreement between the two methods. Lesion extension by
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3D-ERUS was 3.7 (1.8) as compared to 4.7 (2.7) for pathology, having a
moderate intra-class correlation (0.45). A similar intra-class correlation of
0.53 was obtained between MC and histopathology. Bland Altman graph
shows that lesions <5 cm are better estimated with both methods. The
percentage of rectal wall involvement was obtained for the radical resections and the intra class correlation was substantial (0.66) for the 14 cases
analyzed with 3D-ERUS, and also almost perfect for MC (0.96); however,
only four cases were analyzed.
Conclusion: 3D-ERUS and MC had similar results for depth of rectal
wall involvement, meaning that they are similar methods for evaluation of
rectal wall invasion of rectal neoplasms. MC only distinguished between
non-invasive (T) and invasive (T+) lesions as 3D-ERUS differentiated the
invasion of rectal wall layers.
028981
Association between duration of symptoms and prognosis in surgical
patients with colorectal cancer
Frutuoso, A.V.S.1, Souza, H.A.C.2, Sohn, R.V.1, Franco, A.C.1,
Urazaki, M.S.3, Santo, G.F.E.1
1
Department of General Surgery, Federal University of Mato Grosso,
Cuiab, Brazil, 2Department of Internal Medicine, Federal University of
Cear, Barbalha, Brazil, 3Medicine Faculty, Federal University of Mato
Grosso, Cuiab, Brazil
agata.shimizu@gmail.com, hyanneabreu@hotmail.com,
renan.vicente@hotmail.com, annacarolinafranco@hotmail.com,
mariana_stuchi@hotmail.com, santogfe@gmail.com
Introduction: Colorectal cancer (CRC) is the third most frequent
malignant tumor in the world. Despite better methods of diagnosis and treatment recently developed, the incidence of and mortality from CRC shows
a pattern of worldwide growth, especially in the most economically developed regions. Its main clinical manifestations are abdominal pain, weight
loss, anemia and hematochezia. The existence of a connection between the
duration of symptoms (time interval between the appearance of symptoms
and the first consultation), clinical stage, and survival of patients with CRC
has been questioned by several authors in recent decades.
Objectives: To analyze the relationship between the duration of symptoms, staging and prognosis of patients with CRC.
Methods: This was a retrospective study using the database of all
patients diagnosed and treated for colorectal adenocarcinoma in Cuiab
oncology services, Mato Grosso, Brazil, between 2006 and 2013. Of the
131 patients followed, 24 were excluded from analysis due to an inability
to define the duration of symptoms. The 107 remaining patients were
divided into three groups according to the duration of symptoms: group I:
<3 months, group II: 36 months, and group III: >6 months.
Results: The mean duration of symptoms was 7.48 months, ranging
from zero to 72 months. There was no difference in age (P = 0.53), sex (P =
0.11), TNM stage at diagnosis (P = 0.55), complications (P = 0.11), overall
survival (P = 0.1) or disease-free survival (P = 0.24) between the groups.
There was a statistical significance in the fact that palliative surgery was
more frequent in group I (P = 0.02).
Conclusions: The shorter duration of symptoms was related to the
realization of palliative surgery, possibly due to more significant medical
conditions and molecular differences in the disease. There was no association between duration of symptoms and gender, age, or TNM stage at
diagnosis, complications, or rate of survival.
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029191
Colonoscopic findings of non-traversable rectal cancer: is
neoadjuvant therapy safe?
Formiga, F.B.1, Boarini, L.R.1, dos Santos, B.F.1, Oliveira, P.D.1,
Pompeu, B.F.2, Formiga, G.J.S.1
1
Colon and Rectal Surgery Department, Helipolis Hospital, So Paulo,
Brazil, 2Helipolis Hospital, So Paulo, Brazil
drafernandaformiga@gmail.com,
lucasrboarini@hotmail.com,brubb@hotmail.com,pietrodadalto@hotmail.com,
bernardopompeu@hotmail.com, gformiga@ig.com.br
Introduction: Colonoscopic findings of non-traversable extraperitoneal rectal cancer have important risk complications at the beginning of
neoadjuvant chemoradiotherapy, even in moments before surgical treatment. It is known that intestinal obstruction is not common, and the literature has no recommendation based on safe neoadjuvant therapy in these
cases; most papers usually exclude patients with incomplete colonoscopy.
Objectives: To define the risk of intestinal obstruction in patients with
colonoscopic findings of non-traversable rectal adenocarcinoma treated
with neoadjuvant chemoradiotherapy.
Methods: A retrospective cohort study was done based on protocols
collected prospectively. Included were patients with rectal adenocarcinoma
who underwent neoadjuvant chemoradiotherapy from 2012 to 2015. Group
A includes patients whose rectal lesions are traversable to adult colonoscopy (12.2 mm) and group B includes non-traversable ones. Characteristics
such as gender, age, tumor location, clinical symptoms of subocclusion,
abdominal pain, changes in bowel habits, pre-neoadjuvant stage, radiotherapy dose, time of chemoradiotherapy, time for surgery, complications occurring from diagnosis to definitive surgery, surgery technique,
postoperative stage and pathological response were evaluated. Chi square
and Fishers tests were used for nominal variables and Student t-test for
continuous variables.
Results: Seventy patients were included, and six patients were
excluded due to loss of follow-up and lack of data of the protocol. Thus,
50 patients were included in group A and 14 in group B. The two groups
did not differ in complications with neoadjuvant therapy (group A: 4% and
group B: 21.4%, P = 0.065). And when other clinical and pathological variables were compared, there was no difference between the groups.
Conclusion: In conclusion, the study shows that neoadjuvant therapy
is safe for patients with colonoscopic findings of non-traversable rectal
cancer. The risk of obstruction complications are the same for those with
traversable colonoscope tumors.
029129
Colorectal cancer surgical complications applied to the Clavien
Dindo classification
Kool, R.1, Mauro, F.H.O.1, Dallagnol, J.C.1, Targa, G.Z.1, Preti, V.B.1,
Yamashita,T.S.1
1
Department of Abdominal Surgery, Erasto Gaertner Hospital, Curitiba,
Brazil
ronald.kool@yahoo.com.br, fernandohmauro@gmail.com,
jcdallagnol@globo.com, giovannitarga@terra.com.br,
viniciusbp@yahoo.com.br, tszaboyamashita@gmail.com
Introduction: Colorectal cancer is the third most common type of
cancer in the USA and is responsible for approximately 10% of cancerrelated deaths. In developed countries overall survival for colorectal cancer
is about 60%, while in Brazil and other emergent countries this rate is
approximately 40%. Surgery still has an important role in the multimodal
treatment of colorectal cancer not only in early-stage tumors but also in
locally advanced and even metastatic disease.
ABSTRACTS
Objectives: To analyze surgical outcomes and complications based
on the ClavienDindo classification when treating colorectal cancer as this
could help improve the clinical management of these patients.
Methods: We performed a retrospective analysis of all patients
with colorectal cancer diagnosed and treated between January 2000 and
December 2004 at our institution, a tertiary cancer center in south Brazil
regarding clinical and epidemiological data.
Results: A total of 288 patients were included. Mild (ClavienDindo
I, II and IIIa) and severe (IIIb, IVa and IVb) surgical complications were
observed in 13.49% and 18.33% of the patients, respectively, whilst 7.6%
died from surgical complications. Patients facing mild and severe complications had worse global survival (P < 0.001). This was also observed when
considering disease-free survival, although not statistically significant (P =
0.385). Comorbidities were also analyzed, and Zubrod performance status
(P < 0.001) and diabetes (P = 0.037) were associated with a reduction in
survival rates. Lymph-node status and tumor size also showed a negative
effect on survival.
Conclusions: In this selected population, patients who underwent
surgery for colorectal cancer had negative implications for survival when
facing mild and severe complications according to the ClavienDindo
classification. Identifying perioperative risk factors associated with those
complications could improve surgical outcomes and, most importantly,
survival rates.
028170
Colostomy prolapse treated with total prolapsed bowel resection with
manual anastomosis
Quadros, C.A.1, Andrade, M.N.2
1
Aristides Maltez Cancer Hospital, Salvador, Bahia, Brazil, 2Medical
School, Bahia State University, Salvador, Bahia Brazil.
caquadros@gmail.com, manaandrade@hotmail.com
Introduction: Colostomy prolapse is a late surgical complication
consisting of an intestinal protrusion in which the colon telescopes into
itself. The best treatment is closing the colostomy but it is not possible in
some cases, mostly in advanced oncological disease or poor clinical conditions. The prolapsed bulge causes the patient discomfort, makes colostomy
appliance fitting difficult, and requires surgical correction. Colostomy
prolapse can cause a block to blood flow and fluid drainage, edema, pain
and ischemia, and needs urgent surgical treatment. It is more frequent with
loop colostomies, with an incidence as high as 22%. Surgical techniques
have been suggested for prolapse reduction laparoscopically or through
bowel incision using the Dlorme technique. Prolapse resection has been
suggested using stapler devices.
Objective: To describe the surgical technique of total prolapsed
bowel resection with manual anastomosis for the correction of colostomy
prolapse.
Method: Our video shows an effective surgical technique of treating
colostomy prolapse that has not been described previously in PubMed and
MEDLINE central indexes.
Results: Under spinal or epidural anesthesia, an incision is performed
in the base of the colostomy, in the healthy colon mucosa, cutting through
the entire bowel wall of the two prolapsed colon segments. The colon
mesentery is transected and ligated. The prolapsed bowel segment is totally
resected. The healthy ends of the two colon segments are manually sutured
without the need for staplers. The final result is excellent, with early patient
feeding and hospital discharge within 12 hours. The surgical technique
maintains the colostomy without the need of laparotomy, laparoscopy or
skin incisions. It is easy, safe, efficient and economic as it does not require
staplers. The procedure has been used over 10 years in more than 100
patients with no surgery-related complications and no prolapse recurrence.
ABSTRACTS
Conclusion: This technique features advantages such as minimal use
of surgical equipment, hospital discharge within 12 hours, and expected
low prolapse recurrence.
028833
Comparison between an immunochemical fecal occult blood test and
a guaiac-based fecal occult blood test in the detection of adenomas
and colorectal cancer
Aguiar-Junior,S.1, Kupper,B.E.C.1, Nakagawa,W.T.1, Takahashi,R.M.1,
Chulam,T.C.1, Lopes,A.1
1
A.C.Camargo Cancer Center, So Paulo, Brazil
samuel.aguiar.jr@gmail.com,
brucatin@gmail.com, wtnakagawa@uol.com.br, takahashi.rm@gmail.com,
thiagochulam@yahoo.com, ademar-lopes@uol.com.br
Introduction: Brazil does not have an official well established
program for screening for colorectal cancer.
Objectives: To compare the adhesion rate, the positivity ratio, and the
positive predict value (PPV) between the guaiac-based fecal occult blood
test (G-FBOT) and an immunochemical fecal occult blood test (I-FBOT) in
the detection of cancer or high-risk adenoma.
Methods: This was a prospective and cross-sectional study. In 2014,
between March and July, 1500 asymptomatic and average-risk individuals
aged 5075 were invited to participate in an early cancer screening program.
All participants received the two kinds of FBOT kits. Colonoscopy was
recommended if at least one test was positive. The primary endpoint was
positivity rate and the secondary endpoints were adhesion rate and significant endoscopic findings. Among the individuals recruited, 415 (28%)
were men and 1080 (72%) were women; the median age was 58 years. The
adhesion rate of G-FBOT was 756/1500 (50.4%) while for I-FBOT it was
960/1500 (64%). The positivity ratio in the I-FBOT was 94/960 (9.8%) and
in the G-FOBT was 20/771 (2.6%). Among the colonoscopies, 77 occurred
because of the positivity of I-FBOT, 17 because of the positivity of G-FBOT.
Colonoscopy findings for individuals that were I-FBOT-positive numbered
27/77 (35.1%) with low-risk adenoma, 4/77 (5.2%) high-risk adenoma, and
5/77 (6.5%) invasive colorectal cancer, whereas in the G-FBOT-positive
group, colonoscopies evidenced 2/17 (41.2%) low-risk adenoma, 1/17
(5.9%) high-risk adenoma, and 2/17 (11.8%) invasive colorectal cancer.
The PPV for the I-FBOT counted 9 (9.6%) while for the G-FBOT it was 2
(10.0%), considering significant lesions. Regarding colorectal cancer, the
PPV was 5 (5.3%) in I-FBOT and 2 (10.0%) in the G-FBOT. The positivity
for significant neoplasia, considering the number of individuals recruited,
was 8 (0.5%) for I-FBOT and 2 (0.1%) for G-FBOT.
Conclusions: The positivity, adhesion rate, and capacity to detect
significant lesions were higher in I-FBOT. Considering the findings of the
study we could conclude that I-FBOT is superior to G-FBOT.
028843
Double-barreled wet colostomy as an alternative for patients with
semi-intestinal obstruction and severe hydronephrosis caused by
pelvic neoplasm
Vasconcelos, J.L.M.1, Bezerra, D.A.1, Amaral, M.B.M.2, Brando, B.C.2,
Gonalves, P.A.L.H.2, Junior, W.E.M.2, Dourado, G.P.2, Filho, F.S.N.H.2,
Andrade, C.S.2
1
Department of Oncology, Holy Mercy House of Sobral, Sobral, Brazil,
2
Federal University of Ceara, Sobral, Brazil
janssen.loiola@hotmail.com, diegobezerra.onco@gmail.com,
marinabma@yahoo.com.br, brunocavalcantebrandao88@hotmail.com,
paulinhahass@gmail.com, waldethjunior@hotmail.com,
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guilhermep.dourado@gmail.com, savio.nogueira0@gmail.com,
carolinesandrade12@gmail.com
Introduction: Advanced pelvic neoplasia can result in invasion of
locoregional structures with numerous consequences. An alternative, in the
most severe kidney-related and digestive post-obstructions, is the production of a wet colostomy.
Objectives: To report a case of a patient treated with wet colostomy in
radiotherapy for advanced pelvic neoplasm of unknown origin.
Methods: A 59-year-old female patient presented with a recent history
of repeated urinary tract infections associated with changes in bowel
habits and weight loss. The patient developed urinary retention, anasarca
and semi-intestinal obstruction. The patient was admitted for research
and was started on dialysis with no significant comorbidities. She had a
history of subtotal hysterectomy and bilateral oophorectomy at the age of
16; however, she presented no trace of information regarding a surgical
indication or pathological research. Pap tests and digital vaginal examination remained unchanged. CT and MRI of the pelvis area showed a
massive pelvic expansive formation, heterogeneous and with close contact
with the rear wall of the bladder and rectum, and with pelvic segments of
dilated ureters. Cystoscopy showed no evidence of damage to the bladder
mucosa; we had no success in inserting a catheter with a double J. Digital
rectal examination indicated a hardened mass located on the anterior wall,
approximately 7.0 cm above the anal verge. Sigmoidoscopy showing an
ulcerated lesion in the lower rectum and signs compatible with extrinsic
communication to the rectum. Anatomopathology was compatible with a
moderately differentiated squamous-cell carcinoma.
Results: Due to intestinal obstruction and hydronephrosis, the patient
underwent decompression with wet colostomy. This was already functioning by the third postoperative day. The malnourished patient presented
dehiscence of the aponeurosis on the 10th day with no sign of intra-abdominal abscesses. Afterwards, stable results were maintained with improvement and termination of dialysis.
Conclusions: Advanced pelvic neoplasia is challenging when the
digestive and urinary systems are affected. An alternative is the wet colostomy. This case reports successful experience with patients affected by dual
obstruction and dialytic kidney failure.
028901
Efficacy of tridimensional endorectal ultrasound in comparison to
histopathology for evaluation of extraperitoneal rectal neoplasms
Pinto, R.A.1, Nahas, S.C.1, Nahas, C.S.1, Marques, C.F.1, BustamanteLopez, L.A.1, Cecconello, I.1
1
roambar11@yahoo.com.br,sergionahas@uol.com.br,caionahas@uol.com.br,
sparapanmarques@gmail.com, leonardoabustamante@gmail.com,
Introduction: Locoregional staging and treatment of extraperitoneal
rectal neoplasms is still a controversial subject.
Objective: To correlate the findings of three-dimensional endorectal
ultrasound (3D ERUS) with a pathology specimen of extraperitoneal rectal
neoplasia.
Methods: A prospective study was performed in patients with middle
and distal rectal tumors, who underwent 3D-ERUS for preoperative evaluation. The parameters analyzed with 3D-ERUS were compared with pathological findings of the surgical specimen obtained after the procedure. The
authors evaluated sensitivity, specificity, accuracy, positive and negative
predictive values, area under curve, and the kappa index of the 3D-ERUS
as compared to pathological findings, considered the gold standard. For
extension and percentage of rectal wall involvement an intraclass correlation index was applied.
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Results: Over a 3-year period, 44 patients were studied; 27 were
females, the mean age was 63.5 years. There were 12 rectal adenomas
and 32 adenocarcinomas which underwent local resection (30) or radical
resection (14). The value for 3D-ERUS to determine the depth of rectal
wall invasion sensitivity was 77.3% (95%CI 54.692.2%), specificity was
86.4% (95%CI 65.197.1%), positive predictive value was 85% (95%CI
62.196.8%), negative predictive value was 79.2% (95%CI 57.892.9%)
and the area under the curve was 0.82% (95%CI 0.70.96%). The evaluation of the weighted kappa index for the depth of invasion in the rectal
wall (T) was 0.67 (95%IC: 0.49; 0.85), considered to be in substantial
agreement. For lymph node involvement there was no agreement between
3D-ERUS and histopathology, with K = 0.164. Intraclass correlation was
calculated for lesion extension and was moderate (0.45) for extension in
centimeters and adequate (0.66) for percentage of circumference involvement. A BlandAltman graph was performed and showed that tumor extensions up to 5 cm and 50% of wall involvement have a good correlation with
specimen size.
Conclusion: 3D-ERUS was effective for determining rectal wall invasion and evaluation of extension of lesions up to 5 cm and 50% of rectal
wall involvement. However, this method showed a lack of efficacy for evaluation of lymph-node involvement for early rectal tumors in this limited
subset of patients.
028903
Endoscope-assisted colostomy with percutaneous colopexy for
stenosing rectal and anal cancer: an experimental study
Bustamante-Lopez, L.A.1, Sulbaran, M.N.1, Nahas, C.S.1, Marques, C.F.1,
Sakai, P.1, Nahas, S.C.1
1
leonardoabustamante@gmail.com, mariannysulbaran@gmail.com,
caionahas@uol.com.br, sparapanmarques@gmail.com,
paulosakai@terra.com.br, sergionahas@uol.com.br
Introduction: Colostomy in rectal cancer is sometimes necessary.
Some critically ill patients cannot tolerate an exploratory laparotomy and
laparoscopy- assisted colostomy needs general anesthesia.
Objective: To evaluate the feasibility, safety and efficacy of
performing colostomy under colonoscopic visualization and the use of
colopexy without abdominal exploration and with general anesthesia in
laboratory animals.
Methods: Five pigs underwent endoscopy-assisted colostomy with
percutaneous colopexy. All animals were submitted to mechanical ventilation, and maintained under general anesthesia. Transanal introduction to
the descending colon with a gastroscope was performed, the best site for
transillumination of the abdominal wall was identified, and puncture with
the Loop Fixture gastropexy kit . Briefly, this device has two needles,
one which has a suture inserted immediately before the tip of the needle,
and the other which has a suture-holding loop placed on it. Under endoscopic observation, the suture-holding needle was pushed down to form a
loop for holding the suture. The suture was knotted against the abdominal
wall to hold the colon to the parietal peritoneum. After that, a small disc
of skin was removed proximal to the colopexy and a loop colostomy was
performed in the anti-mesenteric wall. Animals were evaluated on postoperative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopies were performed on the animals, followed
by exploratory laparotomy.
Results: Average procedure time was 27 (2154) minutes. Animals
were fed and were able to move on the same day as the procedure.
Position of the colostomy, mucosa color, periostomal skin, and colostomy
functioning were satisfactory in four animals. Retraction of the colostomy occurred in one pig without loss of function. The colonoscopy and
ABSTRACTS
laparotomy control on the 7th postoperative day revealed no abnormality;
the only intraoperative complication was a bladder perforation successfully
repaired through the colostomy incision.
Conclusions: Endoscope-assisted colostomy with percutaneous
colopexy proves to be a safe and effective method with low morbidity for
performing colostomy in experimental animals, and has potential clinical
application in humans.
029080
Factors associated with less than 12 lymph nodes in the specimen of
patients with rectal cancer treated with chemoradiation followed by
total mesorectal excision
Bustamante-Lopez, L.A.1, Nahas, C.S.1, Nahas, S.C.1, Ribeiro Jr, U.1,
Cotti, G.C.1, Cecconello, I.1
1
leonardoabustamante@gmail.com, caionahas@uol.com.br,
sergionahas@uol.com.br, ulyssesribeiro@terra.com.br, gcotti@gmail.com,
Introduction: According to the American Joint Committee on Cancer
(AJCC), a minimum of 12 lymph nodes should be obtained from surgical
specimens in order to stage colorectal cancer appropriately. In rectal carcinoma, this is achieved by total mesorectal excision (TME).
Objective: To evaluate the possible factors associated with a harvest
of less than 12 lymph nodes (LN) in patients with rectal cancer treated by
neoadjuvant chemoradiation (CRT) and TME.
Methods: In a 1-year period, 134 consecutive patients with low or mid
rectal cancer stage T2N0, T3, T4, or N+ underwent CRT followed by TME.
CRT consisted of 5-FU and leucovorin IV bolus on days 1 to 5 concomitant
with radiation in weeks 1 and 5. Total dose of pelvic radiation was 5040
Gys given in 28 sessions. All patients were staged by digital rectal examination, proctoscopy, colonoscopy, CT of abdomen and chest, and MRI of
the pelvis. All patients had curative or potentially curative TME. Specimens
were subjected to histopathological examination. Patients were divided
in two groups: 12 and <12 LN retrieved. The possible related variables
affecting the number of LN were analyzed: gender, age, presence of LN
involvement, tumor size, tumor location, tumor stage, length of specimen,
sphincter preservation, surgical access, and pathological response to CRT.
Results: Ninety-five patients met the inclusion criteria and could be
treated, restaged and operated within the pre-established time intervals.
Mean LN harvest was 23.2 (367); 81 patients (85%) had 12 LN and
14 (15%) had <12 LN retrieved. There was no difference in tumor size,
tumor stage, and length of specimen between the two groups. Gender, age,
presence of LN involvement, tumor location, sphincter preservation, and
surgical access showed no association with number of LN retrieved. Only
pathological complete response showed a statistically significant association with <12 LN (P = 0.002). Patients with pT0N0 had an 88% lower
chance of obtaining 12 LN.
Conclusions: Complete pathological response is associated with a
harvest of <12 LN. Thus, the number of lymph nodes should not be used as
a surrogate for oncological adequacy of resection in patients with a pathological complete response.
ABSTRACTS
028910
Fully intraperitoneal anastomosis technique in laparoscopic right
colectomy: is the initial difficulty worth it?
Spencer, R.M.S.B.1, Oliveira, D.A.M.1, Aguiar Jr, S.1, Bezerra, T.S.1,
Stevanato Filho, P.R.1, Lopes, A.1
1
Department of Pelvic Surgery, AC Camargo Cancer Center, So Paulo,
So Paulo, Brazil
ranyell.spencer@gmail.com, deciomontenegro@gmail.com,
samuel.aguiar.jr@gmail.com
Introduction: Laparoscopic right colectomy is a well established
technique for colorectal surgery, being an oncologically safe method in
patients with right-sided colon tumors. The advantages are controversial
when compared with open surgery, but are based on the shorter hospital
stay, less pain, and an early return to daily activities. The fully intraperitoneal anastomosis, despite appearing to be more expensive, may abbreviate
even more the length of hospital stay and contribute to the esthetics of the
abdominal wall.
Objectives: To show that performing fully intraperitoneal anastomosis
is feasible with a short learning curve and can shorten hospital stay and
improve the esthetic of abdominal wall. We demonstrate the main steps of
the technique, the difficulties, and tips for safe anastomosis.
Method: This is a descriptive prospective study of a single institution,
in which were studied the first 15 patients undergoing laparoscopic right
colectomy with fully intraperitoneal anastomosis.
Results: Fifteen patients underwent right colectomy with total laparoscopic intraperitoneal anastomosis. The main difficulties in the first cases
were positioning the trocars for the anastomosis, ileus positioning at the
time of suture, and which is the best place to start anastomosis. Three
patients had postoperative complications and all required reoperation, but
none because of anastomotic leaks. After ten cases, the elapsed time for
anastomosis was the same as for the open technique.
Conclusions: Performing fully intraperitoneal ileumcolonic anastomosis in laparoscopic right colectomy is safe, with a short learning curve,
and appears to reduce the length of hospitalization. More cases should be
evaluated.
028348
Fully robotic left colectomy with robotic-sewn intracorporeal
anastomosis
Cesar, D.1, Valadao, M.1, Araujo, R.1, Linhares, E.1, Jesus, P.1
1
Department of Surgical Oncology, National Cancer Institute, Rio de
Janeiro, Brazil
danielcesar@live.com, mvvaladao@icloud.com, raraujo@inca.gov.br,
eduardolinhares@globo.com, jpjesus@inca.gov.br
Background: Robotic surgery is thought to be a solution to overcome the limitations of laparoscopy. Indeed, much has been gained with
the improved instrumentation and range of motion achieved with this new
technology.
Objective: To show the feasibility of a robotic-sewn end-to-end
colonic anastomosis after left colectomy.
Methods: A fully robotic left colectomy was performed in a 55-yearold female patient with a T3N1M0 adenocarcinoma of the colon, located at
the splenic flexure. Surgery started with a four-arm single robot docking at
the patients left side. The left colonic artery was dissected and ligated with
preservation of the inferior mesenteric artery and sigmoid branches. The
left branches of the middle colic vessels were then dissected and ligated.
The left colon, the splenic flexure and the sigmoid colon were then mobilized. The transverse colon and the sigmoid colon were then stapled in this
order. A robotic-sewn end-to-end colonic anastomosis was performed with
S141
a running extramucosal single-layer prolene suture. The specimen was then
retrieved through a small left inguinal incision.
Results: The operative time was 85 min, estimated blood loss was 50
mL. The patient recovered uneventfully. Oral diet was started on the first
postoperative day, and the patient was discharged on the on the second
postoperative day. Pathological analysis showed a pT4aN1a and 30 lymph
nodes were harvested, one of which was positive. Surgical margins were
free, with negative surgical proximal (5 cm) and distal (3.5 cm) margins.
Short-term follow-up showed no fistulas, normal oral dietary intake, and
normal bowel function.
Conclusion: Robotic left colectomy with intracorporeal anastomosis
is safe and follows oncological principles with the addition of the benefits
of minimal invasion.
028349
Fully robotic total mesorectal excision with right adrenalectomy for
the treatment of metastatic rectal cancer
1
Janeiro, Brazil
Introduction: Adrenal metastasis of rectal adenocarcinoma is not
common, and therefore no randomized clinical trial (RCT) has been done
to support its surgical treatment. Resection of isolated synchronous adrenal
metastasis seems able to provide a survival benefit for selected patients,
according to previous case reports.
Objectives: To report the feasibility of a fully robotic right adrenalectomy and total mesorectal exision (TME) in a one-stage procedure.
Methods: A male patient with T3N0M1 rectal adenocarcinoma located
at 5 cm from the anal verge, and a synchronous single isolated 4 x 3 cm
right adrenal metastasis shown on positron emission tomography, underwent a fully double-docking robotic right adrenalectomy and TME after
receiving chemoradiotherapy. First the robot was docked facing the back
of the patient who was placed in left side decubitus. The robotic trocar was
placed similarly to laparoscopic right adrenalectomy, and the adrenal resection followed the same steps. Then the patient was placed in a LloydDavis
lithotomy position with 30 Trendelenburg and 20 right lateral inclination.
The robot was docked at the patients left hip at a 45 angle. Then TME
was carried out as per our routine. Sacral, lateral and anterior rectal dissection was carried out in this order. The rectum was divided using an endo
roticulator stapler, the specimen was extracted via a small left inguinal incision, and a circular-stapled coloanal anastomosis was done under robotic
visualization.
Results: Operative time was 320 minutes. Distal and proximal margins
were free, the circumferential resection margin was 0.5 cm. The tumor was
YpT3N0M1. The patient had an anastomotic leak that was treated conservatively. After 12 days the patient was discharged asymptomatic and he
recovered well.
Conclusion: Fully robotic TME with right adrenalectomy for the
treatment of synchronous metastatis of rectal cancer can be safely done
in one stage. Comparative studies with a large number of cases should be
performed to validate this statement, since an RCT addressing this rare
condition is unlikely to happen.
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028928
Gracilis muscle interposition for the management of rectourethral
fistula consequent to radiotherapy
Nahas, S.C.1, Srouri, M.1, Pinto, R.A.1, Soares, D.F.M.1, BustamanteLopez, L.A.1, Marques, C.F.M.1
1
sergionahas@uol.com.br,
souri@uol.com.br, roamabar11@yahoo.com.br, diegofems@gmail.com,
leonardoabustamante@gmail.com, sparapanmarques@gmail.com
Introduction: Rectourethral fistula is a rare pathology consequent to
prostate cancer treatment, such as radiation therapy, cryotherapy, or brachytherapy. Postradiation fistulas are complex and require detailed radiological
studies for a complete comprehension of the anatomy and to identify associated pelvic pathologies.
Objective: To demonstrate the surgical management of rectourethral
fistula due to radiotherapy for prostate cancer.
Methods: An 80-year-old male patient with the diagnosis of a T3b
Gleason 9 metastatic prostate adenocarcinoma underwent an 8000-cGy
radiotherapy treatment. After 2 years he complained of rectal pain associated with episodes of intestinal bleeding and urine output through the anus.
Magnetic resonance imaging confirmed diagnosis of rectourethral fistula.
A multidisciplinary approach was discussed with urology, colorectal and
plastic surgery teams.
Results: Initially a laparoscopic intestinal bypass with a loop ileostomy was performed, followed by insertion of urinary catheter for urinary
diversion. The main correction, held immediately afterwards, consisted of
perineal dissection, separation and closure of the fistula compounds and
interposition of the gracilis muscle between the two defects. The procedure
lasted 400 minutes without the need for blood transfusion, and the postoperative period was uneventful. The urinary catheter was removed after
CT scan control at the 5th week; however, a minimal rectal fistula was still
present. A new CT scan performed at 14 weeks postoperatively showed
complete resolution of the rectal fistula. Loop ileostomy closure had no
complications and the patient evolved without perineal pain and with good
fecal and urinary continence.
Conclusion: Treatment of rectourethral fistulas requires appropriate
investigation with clinical history and preoperative exams. The chosen
surgical technique should be individualized for each case. Sequential steps
should be taken, therefore, to perform surgical correction after intestinal
and urinary diversion, which should only be reversed after control image
exam confirming complete resolution of the fistula. Multidisciplinary
collaboration is critical to treatment success.
029290
Is human papillomavirus infection related to colorectal cancer?
Picanco-Junior, O.M.1, Picanco, T.S.C.1, Vill, L.L.2, Matos, D.3,
Alves, R.M.S.1
1
Federal University of Amapa, Macapa, Brazil, 2PhD in Biological
Sciences from the University of So Paulo (USP), So Paulo, Brazil,
3
Federal University of So Paulo (UNIFESP), So Paulo, Brazil
ompjunior@bol.com.br, thailapicanco@bol.com.br
Introduction: Colorectal cancer is one of the most common types
of neoplasia in the adult population worldwide. Among neoplasms of
the gastrointestinal tract, it is ranked second in relation to prevalence and
mortality, but its etiology is known in only around 5% of the cases. It is
believed that 15% of malignant diseases are related to viral oncogenesis.
Objective: To correlate the presence of HPV with the staging and degree
of cell differentiation among patients with colorectal adenocarcinoma.
ABSTRACTS
Methods: A retrospective casecontrol study was conducted on 144
patients divided between a test group (TG) of 79 cases of colorectal cancer
and a control group (CG) of 65 cases of benign disease. After application of
exclusion criteria, it was possible to analyze 144 patients aged 2585 years
(mean, 57.85 years; standard deviation, 15.27 years and median, 58 years).
Eighty-six patients (59.7%) were male. For both groups, tissue samples
from paraffin blocks were subjected to DNA extraction followed by the
polymerase chain reaction using generic and specific primers for HPV 16
and 18. Dot blot hybridization was also performed with the aim of identifying HPV DNA.
Results: The groups were shown to be homogeneous regarding sex,
age and site of HPV findings in the samples analyzed. Out of the 41 patients
with HPV, 36 (45.6%) were in the TG and five (7.7%) were in the CG (P
< 0.001). All the HPV cases observed were HPV 16, and HPV 18 was not
shown in any of the cases studied. There were no significant differences in
comparisons of sex, age and site regarding the presence of HPV in either
of the groups.
Conclusion: Based on our data, we can conclude that human papillomavirus type 16 is present in individuals with colorectal carcinoma.
However, its presence was unrelated to staging or degree of differentiation
among the patients studied.
028999
Immunohistochemical analysis for mismatch repair proteins as an
initial tool for universal screening for Lynch syndrome
Ferreira F.O.1, Aguiar Jr., S.1, Begnami, M.D.F.S.1, Nakagawa, W.T.1,
Cantin, B.1, Lopes, A.1
1
Ncleo de Tumores Colorretais A.C. Camargo Cancer Center, So Paulo,
Brazil
fabioferreira@uol.com.br, samuel.aguiar.jr@gmail.com,
mariadirlei@gmail.com, wtnakagawa@uol.com.br, brucantin@gmail.com,
ademar-lopes@uol.com.br
Introduction: Testing all colorectal cancers for loss of mismatch
repair (MMR) proteins, known as universal screening, is a strategy used
to identify individuals at risk for Lynch syndrome (LS), an autosomaldominant disorder caused by germ-line mutations in DNA mismatch repair
genes that represents the most common form of hereditary colorectal
cancer (HCRC). Tumors of patients with LS characteristically demonstrate
MMR deficiency, defined as the presence of microsatellite instability (MSI)
or immunohistochemical (IHC) loss of the MMR protein expression, which
is the hallmark of this disorder.
Objectives: To evaluate the IHC expression for MMR proteins as an
initial tool to identify patients at risk for LS.
Methods: We performed a retrospective analysis of tumor immunostaining for the four MMR proteins (MLH1, MSH2, MSH6, PMS2)
in specimens from patients with colorectal adenocarcinoma submitted to
surgical resection between January 1997 and December 2014. Negative
IHC staining was considered to indicate loss of expression. FAP patients
with CRC were excluded.
Results: In the period of analysis, 1519 CRC patients underwent
surgical resection. IHC analyses for MMR proteins were done in pathological specimens of 497 unselected patients (265 male and 232 female).
Median age was 59.2 (23.491.4) years. The loss of IHC expression was
observed in 60 samples (12.1%), according to the following distribution:
MLH1/PMS2 (32; 6.4%), MSH2/MSH6 (14; 2.8%), MLH1 (5; 1.0%),
PMS2 (5; 1.0%), MSH6 (4; 0.8%). There was no difference between the
mean age among patients with and without loss of IHC expression for
MMR proteins (respectively 60.6 versus 58.7 years of age; P = 0.288).
Conclusions: In unselected patients, the use of the IHC test for MMR
as an initial tool for the universal screening of CRC probands can lead to
ABSTRACTS
the identification of patients at risk for LS; otherwise, the majority of LS
cases will remain undetected in the absence of clinical suspicion.
028879
Intersphincteric resection: alternative radical surgery for low rectal
cancer treatment with anus preservation at the Aristides Maltez
Hospital, Brazil
Prisco, E.1, Quadros, C.A.1, Falco, M.F.1, Costa, V.S.M.1
1
Aristides Maltez Hospital, Salvador BA, Brazil
mariofalcao@hotmail.com, vitor_savio@yahoo.com.br
Introduction: Colorectal tumors are the third most frequent abdominal
cancer type in Brazil. Oncologically favorable outcomes are related to free
surgical margins after total mesorectum excision (TME). One centimeter
distal margin may be acceptable when sphincter preservation is intended
for low rectum tumors, wherefore intersphincteric resection may show
similar oncological outcomes as rectal amputation if performed in selected
cases. Intersphincteric resection allows intestinal transit recovery and better
quality of life, avoiding a permanent ostomy.
Objectives: To show that anterior rectal resection with intersphincteric
dissection and hand-sewn coloanal anastomosis results in good functional
and oncological outcomes.
Methods: A retrospective cohort study evaluated six patients with low
rectum tumor (23 cm to anal verge) that underwent intersphincteric resection with TME, coloanal hand-sewn anastomosis and diversion ostomy,
between July 2012 and July 2015 at an oncological center.
Results: Median patient age was 47 (3067) years, and 66% were male.
Average surgical time was 190 (120240) minutes. One patient presented
pelvic abscess treated by perineal draining. Pathological staging was I to
IIIA, with free resection margins of 1 cm. Two patients received adjuvant
chemotherapy. All patients presented some grade of clinically treated anal
incontinence. Anal manometry was done every 3 months, and demonstrated
a progressive increase in sphincter function. Four patients had their ostomy
closed after 1013 (average 11) months. The other patients are <10 months
after surgery; they will also have their ostomies closed soon. There was
only one case of local recurrence after 30 months, and the patient was sent
for palliative chemotherapy. Five patients are alive without evidence of
oncological disease after an average follow-up of 26 (836) months.
Conclusion: Intersphincteric resection is an acceptable procedure to
be performed in selected patients with low rectal tumors. It shows low
morbity and oncological outcomes similar to those of rectal amputation, but
keeps some sphinteric function and avoids a permanent ostomy, providing a
better quality of life for the patients.
028935
Laparoscopic extended right colectomy with intracorporeal
anastomosis
Nahas, S.C.1, Nahas, C.S.1, Pinto, R.A.1, Bustamante-Lopez, L.A.1,
Soares, D.F.M.1, Araujo, S.E.A.1
1
sergionahas@uol.com.br, caionahas@uol.com.br,
roambar11@yahoo.com.br, leonardoabustamante@gmail.com,
diegofems@gmail.com, sergioaraujo@colorretal.com.br
Introduction: Right colectomy with intracorporeal anastomosis is
associated with a lower rate of incisional hernia, a lower rate of wound
infection, and less postoperative pain, in addition to a better cosmetic effect.
Objective: To show the treatment of a patient with proximal transverse colon cancer who underwent laparoscopic extended right colectomy
S143
with intracorporeal anastomosis. Also to detail the technical aspects and
discuss the benefits of this method. The video shows the case of a 65-yearold female with a history of modification of bowel habit and abdominal
pain for the previous 6 months. She had a body mass index of 37, and had
previously undergone cesarean section and cholecystectomy. Colonoscopy
showed a 6-cm tumor in the proximal transverse colon. The patient underwent right hemicolectomy VLP with intracorporeal anastomosis.
Results: The procedure was initiated with the passage of five trocars.
Dissection of the right colon was made medial to lateral. High ligation of
the ileocolic and medial colic vessels was performed. Intracorporeal anastomosis was made isoperistaltic side-to-side with a 60-mm stapler. The
bowel orifice was closed with laparoscopic hand-sewn non-interrupted
suture lines. The specimen was removed by Pfannestiel incision. The
procedure was uneventful and lasted 200 minutes. There was no blood loss.
Patient had no postoperative complications and was discharged 5 days after
surgery.
Conclusion: Laparoscopic right colectomy with intracorporeal anastomosis was done safely and with good oncological, functional and cosmetic
outcomes.
028352
Laparoscopic pelvic posterior exenteration with controlled splanchnic
nerve resection for squamous-cell carcinoma of the rectum
Ribeiro, R.1, Luz, M.A.1, Mattana, J.L.1, Ludwig, V.B.2, Linhares, J.C.1
1
Surgical Oncology Department, Erasto Gaertner Hospital, Curitiba,
Brazil, 2Radiology Department, Diagnostic Image Center, Curitiba, Brazil
reitanribeiro@hotmail.com, muriloaluz@gmail.com,
jafemattana@hotmail.com, cetac@cetac.com.br, linhares@iop.com.br
Introduction: Splanchnic nerve resection is a major issue in oncological pelvic resections as it can cause rectal, sexual and urinary dysfunctions. Anatomical and funcional knowledge of these nerves is fundamental
in surgical decisions and patient orientation.
Objectives: To present a rare case of squamous-cell carcinoma of
the rectum where the splanchnic nerves were resected on one side and
preserved on the other side. The case and technique for this laparoscopic
modified pelvic posterior exenteration and the most important anatomical
aspects of pelvic controlled nerve resection are presented.
Methods: A 34-year-old patient was referred for evaluation due to a
pelvic complex mass diagnosed during infertility and pelvic pain investigation. The cervix was normal, but a painful mass could be felt attached to the
right vaginal wall. On rectal examination the mass showed rectal infiltration
and the anus was normal. Colonoscopy showed rectal external compression and submucosal nodules with normal mucosa (confirmed by biopsy).
Tomography showed an 8-cm right pararectal complex cystic tumor associated with pelvic and retroperitoneal metastatic lymph nodes. Laparoscopic
pelvic mass and retroperitoneal lymph-node biopsy confirmed squamouscell carcinoma associated with HPV infection. Colposcopy, colonoscopy
and proctosigmoidoscopy were performed and confirmed the results of
the first colonoscopy; there was no sign of an anal or cervical tumor. Four
months after chemoradiation a small residual tumor on the right rectovaginal septum, and a 10-cm left obturator (lymph-node positive on PET/CT)
were observed. It was decided to perform the oncological resection of all
residual disease. The video shows the laparoscopic modified pelvic posterior exenteration with controlled splanchnic nerve resection on the right
side and complete nerve preservation on the left side. Parts of the pelvic and
retroperitoneal lymphadenectomy are also presented.
Conclusion: Major anatomical knowledge is essential for oncologically extensive pelvic resections in order to preserve neural function as
much as possible.
S144
028388
Laparoscopic total mesorectal excision and transanal intersphincteric
resection by a single-port device for a low rectal adenocarcinoma
Ribeiro, L.C.B.1, Sabino, F.D.1, Silva, M.V.M.V.1, Araujo, R.O.C.1
1
ABSTRACTS
Conclusions: It is important to diagnose the Lynch syndrome at an
early stage and to initiate an investigation mainly through family history
and some other key points. From the diagnosis of hereditary disease,
surveillance becomes mandatory through serial tests and periodic medical
visits.
lurribeiro@yahoo.com.br, fdsabino@gmail.com,
drmarcusvaladao@gmail.com, rotaraujo@yahoo.com.br
Introduction: Preservation of the anal sphincter is one of the main
goals in the treatment of low rectal tumors. The development of minimally invasive techniques has helped surgeons to face this great surgical
challenge.
Objectives: To show a laparoscopic total mesorectal excision (TME)
associated with transanal intersphincteric resection using a single-port
device for a low rectal tumor.
Methods: The subject was a 60-year-old male patient with a history of
radical prostatectomy. The echoendoscopy revealed a 1-cm polypoid tumor,
located at the anterior wall of the lower rectum 2 cm from the anal verge,
infiltrating the muscle layer. The biopsy revealed an adenocarcinoma.
The patient underwent neoadjuvant chemoradiotherapy and presented a
complete clinical response. After treatment he refused surgery and was
followed for 1 year, when the colonoscopy showed local recurrence.
Results: During the laparoscopy stage, the left and sigmoid colons
were released, the inferior mesenteric vessels were divided, and the
mesorectum was dissected to the level of the prostate. The transanal stage
was performed using a single-port device. The TME was completed while
preserving the external sphincter. A manual coloanal anastomosis was
performed after transanal extraction of the specimen. A protective colostomy was done. The patient recovered uneventfully, except for temporary
urinary retention, and was discharged on the 10th postoperative day. The
mesorectum was completely removed with negative distal and circumferential margins. The final pathological stage was ypT2 ypN1.
Conclusions: The association of laparoscopy and a transanal approach
with a single-port device was shown to be safe, feasible, and possibly a
good alternative for surgical treatment of low rectal tumors.
028250
Lynch syndrome: literature review and a case report
Accordi, C.C.1, Uliano, E.J.M.1, Reis, M.P.1, Bortolini, M.P.1, Breda, J.A.1
1
matheusbig@hotmail.com, estevao.uliano@hotmail.com,
Introduction: The hereditary non-polypoid colorectal cancer known
as Lynch syndrome is the most common form of colorectal cancer. The
increased risk of cancer is related to a dysfunction in DNA repair. Families
that have Lynch syndrome usually have more cases of colon cancer than
would typically be expected. Lynch syndrome also causes colon cancer at
an earlier age than it might in the general population.
Objectives: To report a case of a Lynch syndrome in a 37-year-old
patient.
Methods: The information was obtained by a review of medical
records, patients interview and literature review.
Results: A 37-year-old patient was followed up after being diagnosed with Lynch syndrome. During a doctors visit a rising CEA level
was noticed, indicating cancer progression or recurrence. A colonoscopy
was solicited and showed a vegetating lesion. A biopsy was performed, and
histopathology indicated a severe dysplasia, outlining focal stromal infiltration. The patient was submitted to a radical surgical treatment, which was
successful, and referred for follow-up with clinical oncology.
028848
Assessment of survival in patients with colorectal cancer treated in a
tertiary cancer hospital
Aichinger, L.A.1, Kool, R.1, de Oliveira, F.H.M.1, Preti, V.1
1
Hospital Erasto Gaertner, Brazil
lillyaichinger@gmail.com, ronald.kool@yahoo.com.br,
fernandohmauro@gmail.com, vbpreti@yahoo.com.br
Introduction: Colorectal cancer is one of the most common malignancies, and, if diagnosed and treated properly, has a moderate to good
prognosis. It is the third most common cancer in men and the second most
common in women. The incidence of this disease increases dramatically
with age, occurring especially in people over 4050 years old. In Brazil,
the National Cancer Institute (INCA) estimated that, in 2014, 15,070 new
cases of colorectal cancer in men and 17,530 in women occurred, with an
average 5-year survival of 55%.
Objectives: To evaluate the epidemiology of colorectal cancer in
patients treated in a tertiary cancer hospital, evaluating overall survival and
disease-free survival in accordance with the clinical stages, aiming to establish a clinical profile of patients to improve services.
Methods: This was a retrospective observational study in which
information from patients treated for colorectal cancer in a tertiary cancer
hospital were evaluated by the medical records. They included all patients
diagnosed with colorectal cancer during the period from January 2000 to
December 2004; patients who did not present all the necessary information
from medical records were excluded, as were patients who completed their
treatment, patients with other services, and those lost to follow-up.
Results: The tumors resected were mostly borderless, without the need
for further surgery; the length of hospitalization was a total of 57 days.
The complication rate was 39.10%. The majority (18.75%) were staged
as IIB, followed by stage IIIB (18.06%). The survival rates found were
slightly lower than those in the literature, ranging from 52.1% to 88.6%.
More advanced disease at diagnosis has a poorer prognosis, which is
demonstrated by the correlation between lower overall and disease-free
survival and more advanced staging. Among the factors evaluated, the need
for emergency surgery, presence of residual disease, tumor size, lymphnode involvement, and number of days of hospitalization had a significant
impact on overall survival.
Conclusions: Most data were similar to those of international series
and Brazilian information, which proves that the difficulties and successes
in the treatment of colorectal cancer in this service are similar to those in
other cancer tertiary services.
029108
Pelvic exenteration for treatment of locally advanced or relapsed
colorectal cancer: experience of AC Camargo Cancer Center Hospital
Bezerra, T.S.1, Aguiar Jr, S.1, Stevanato Filho, P.R.1, Spencer, R.M.S.1,
Ferreira, F.O.1, Lopes, A.1
1
Colorectal Tumor Nucleus of the Pelvic Surgery Department. A.C.
Camargo Cancer Center, So Paulo, Brazil
tiagosantoro@me.com, samuel.aguiar.jr@gmail.com,
paulorstevanato@gmail.com, ranyell.spencer@gmail.com,
fabioferreira@uol.com.br, ademar-lopes@uol.com.br
ABSTRACTS
Introduction: The treatment of locally advanced or relapsed colorectal cancer usually involves pelvic exenteration as surgical treatment. This
series shows the experience of a cancer center in the treatment of colorectal
cancer and its results for the definition of clinicopathological factors in
support of patient selection.
Objetives: To evaluate the results of patients who underwent pelvic
exenteration for the treatment of advanced colorectal cancer and to analyze
overall survival, disease-free survival, morbidity and mortality.
Methods: This was a retrospective analysis of patients with advanced
colorectal cancer who underwent pelvic exenteration as surgical treatment.
We evaluated clinical and pathological factors; the main outcome was
overall survival and disease-free survival, and as a secondary objective, we
analyze morbidity and operative mortality.
Results: One hundred and four patients were identified, 57% with
primary tumors and 43 with recurrent tumors; 65% of patients had received
prior radiotherapy and 76.96% had undergone some prior chemotherapy.
The operative mortality rate was 7.69% and morbidity was 70.19%. The
overall survival rate at 5 years was 43%, with a median survival of 47
months. Risk analysis showed that the factors with the greatest impact
on survival were: recurrent disease, palliative surgery, resection, prior
chemotherapy, ASA, blood tranfusion and severe complications. Diseasefree survival at 5 years was 35% with a median recurrence of 24 months.
The recurrence rate was 41.43%, being more common at distant locations.
The main risk factors associated with recurrence were: location (rectum),
recurrent disease, pathological T4, lymph-node involvement, pretreatment,
ASA, blood tranfusion and serious complications.
Conclusions: Pelvic exenteration is still the main treatment in locally
advanced colorectal tumors. The rates of morbidity and mortality are
still high, the overall survival and disease-free survival in our service
are commensurate with those of other cancer centers. We must take into
account the factors identified in this work for better selection of patients.
029185
Perineal continent colostomy: an alternative after abdominoperineal
resection
Igreja Jnior, H.J.1, Carvalho, B.S.V.1, Batista, V.L.1, Coelho, J.G.1,
Brandes, J.L.1
1
Hospital Escola lvaro Alvim, Brazil
haroldoigreja@hotmail.com, brunosvcarvalho@hotmail.com,
vilson_Leite@msn.com, jugoncalvescoelho@hotmail.com,
jaclyrio@gmail.com
Introduction: The abdominoperineal resection, with definitive
abdominal colostomy, remains the standard treatment for lower rectum
adenocarcinoma which affects the anal sphincter. However, the perineal
continent colostomy, proposed by Alcino Lazaro, remains an alternative
option for selected patients, with better acceptance by them.
Objective: To report an unusual approach to abdominoperineal resection with continent perineal colostomy.
Methods: This was a descriptive study based on the analysis of medical
records and the patients clinical state, associated with literature review
Results: The patient was a 52-year-old female, presenting with
hematochezia, fecal vaginal discharge, with onset at 2 months. She was
submitted to clinical workup, presenting at physical examination a lower
rectum tumor with rectovaginal fistula, of 6 cm, and invading the anal
sphincter; colonoscopy didnt revealed any other lesion. MRI and CT
scans revealed mesorectal lymphadenopathy, with no signs of metastasis.
Biopsy revealed adenocarcinoma of the lower rectum, cT4bcN1cM0. The
patient was submitted to neoadjuvant radiochemotherapy, with a partial
clinical response above 50%. Consequently she was submitted to surgical
resection, through D-3 abdominoperineal resection, with posterior colpectomy. Thereafter, digestive continuation was performed through perineal
S145
continent colostomy, after serial seromyotomies, and the denervation of
the colonic mioenteric plexus. Protective colostomy was performed. The
patient was discharged within 4 days after surgery. The restoration of intestinal continuity was perfomed after 10 weeks. The patient remains under
surveillance, and has been disease-free for 28 months, with no fecal loss
after the enemas.
Conclusions: The abdominoperineal resection with continent perineal
colostomy is an effective alternative for the treatment of lower rectal tumor,
providing better quality of life and acceptance by the patient.
028946
Postoperative TEM complications for the treatment of rectal
neoplasia are frequent but mild: risk factors and time behavior study
Marques C.F.1, Nahas, C.S.1, Bustamante-Lopez, L.A.1, Ribeiro Jr, U.1,
Pinto, R.A.1, Nahas, S.C.1
1
sparapanmarques@gmail.com, caionahas@uol.com.br,
leonardoabustamante@gmail.com, ulyssesribeiro@terra.com.br,
roambar11@yahoo.com.br, sergionahas@uol.com.br
Introduction: In 1983, Buess et al introduced a novel surgical
approach for the resection of large rectal adenomas: namely transanal
endoscopic microsurgery (TEM). Since its introduction, many centers have
adopted TEM as the new standard surgical approach to treating both large
rectal adenomas and early rectal cancer.
Objective: To evaluate risk factors associated with postoperative
complications after TEM local resection for rectal neoplasia.
Methods: All patients were treated using a TEO device and harmonic
scalpel according to the Buess technique. We prospectively collected
demographic and tumor characteristics and information on complications
using the ClavienDindo classification.
Results: Fifty-three patients were treated. There was no mortality.
Overall morbidity rate was 50%. Patients with lesions under the first rectal
valve had more complications than those with higher ones (P = 0.034).
Patients submitted to neoadjuvant chemoradiotherapy (CRT) had 24 times
more chance of presenting grade II complications (P = 0.002), and 7.03
times more chance of grade III complications (P = 0.098). When the defect
was treated using the TEM device to perform or help with the rectal suture
there was a 16-fold lower chance of having grade III complications (P =
0.043). There was no specific time behavior of complications.
Conclusions: TEM postoperative complications are acceptable and
usually self-limited. Patients submitted to neoadjuvant CRT, with distal
lesions, and submitted to conventional suture warrant greater attention.
There did not appear to be any time behavior of complications.
029116
Predictors of severe complications in pelvic exenteration in the
treatment of locally advanced or relapsed colorectal cancer
Bezerra, T.S.1, Aguiar Jr, S.1, Stevanato Filho, P.R.1, Spencer, R.M.S.1,
1
Camargo Cancer Center, So Paulo, Brazil.
tiagosantoro@me.com, samuel.aguiar.jr@gmail.com,
paulorstevanato@gmail.com, ranyell.spencer@gmail.com,
Introduction: The treatment of locally advanced or relapsed colorectal cancer usually involves pelvic exenteration as surgical treatment. This
surgery is associated with high morbidity and mortality. This work seeks
S146
to establish factors associated with severe postoperative complications to
improve the selection of patients.
Objectives: To evaluate the morbidity and mortality of patients undergoing pelvic exenteration for colorectal tumors in a cancer center.
Methods: Retrospective analysis of patients with advanced colorectal
cancer underwent pelvic exenteration as surgical treatment. We evaluated
clinical and pathological preoperative, operative and postoperative factors
and statistical analysis of their association with serious complications
(grade 3,4,5 NCI).
Results: One hundred and four patients were identified, 57% with
primary tumors and 43 with recurrent tumors; 65% of the patients had
received prior radiotherapy and 76.96% had undergone some prior chemotherapy regimen. The operative mortality rate was 7.69% and morbidity
was 70.19% and 47.11% respectively, taking into account only serious
complications. The main predictors of complications in the univariate analysis with statistical significance were: male gender, recurrent tumors, prior
treatment with chemotherapy or radiation therapy, ASA 3 and 4, intraoperative clinical instability, performing anastomosis or colostomy types of
exenteration, pathological T4, hemotranfusion and transfusion of crystalloid >6 L. In multivariate analysis, the independent risk factors with statistical significance were ASA 3:04 and blood transfusion.
Conclusions: Pelvic exenteration still has high rates of morbidity and
mortality. The risk factors described can be used to improve patient selection and anticipate those at highest risk for individualization of treatment
and postoperative care.
029060
Primary appendiceal adenocarcinoma mimicking obstructive colon
cancer
Siosaki, M.D.1, Hamdar, F.B.1, Siosaki, A.T.F.2
1
Bauru State Hospital, Brazil, 2Radiotherapy Center of Bauru Region,
Brazil
marcossiosaki@yahoo.com.br, farid_hamdar@icloud.com,
tarsilafonseca@hotmail.com
Introduction: Primary appendiceal tumors are rare entities occuring
in <2% of all appendectomies, with an age-adjusted incidence of 0.12 cases
per 1,000,000 people per year. Primary adenocarcinoma of the appendix
is a rare malignancy that constitutes less than 0.5% of all neoplasms of
gastrointestinal origin.
Case report: A 59-year-old female patient was referred to the surgical
oncology department with clinical presentation of 6 months of intermittent abdominal distention and constipation without nausea or vomiting. She
denied hematochezia. She had already undergone colonoscopy, when an
obstructive vegetating lesion of 6 cm in the ascending colon was identified.
CEA was 4.24. During staging, the patient developed a new episode of
intestinal obstruction and underwent laparotomy; this showed no palpable
mass in the right colon, only a turgid appendix with an enlarged base. Right
hemicolectomy with lymphadenectomy were performed. Pathology showed
adenocarcinoma G3 of the appendix (pT2N0M0, pathological stage I).
Discussion: The majority of primary cancers of the appendix occur
in 5565-year-olds, except for malignant carcinoid, which has a mean age
diagnosis of 38. In a German multicenter study the most common clinical
presentations were signs and symptoms suggestive of acute appendicitis
(37.2%), followed by incidental discovery during surgical procedures
(23%) with no intestinal obstruction symptoms being described. During
laparotomy no anatomical cause for intestinal obstruction was found. The
appendix, however, was turgid as if it were about to perforate.
Conclusion: We describe a rare malignancy with an unusual clinical
presentation.
ABSTRACTS
029161
Primary neoplasms of the cecal appendix in appendectomies
Volpato, G.1, Dagostin, C.C.2, Aveline, P.E.2, Silvestre, J.R.3, BiondoSimoes, R.1, Boareto, A.M.1
1
Department of Oncology, Angelina Caron Hospital, Campina Grande do
Sul, Brazil, 2Santa Catarina Southernmost University, Cricima, Brazil,
3
Department of oncology, So Jos Hospital, Cricima, Brazil
drgabrielvolpato@hotmail.com, cahdagostin@hotmail.com,
pauloaveline@gmail.com, jrscirurgiaoncologica@gmail.com,
rachel_simoes@yahoo.com.br, clinirad@clinirad.com.br
Introduction: Primary malignant neoplasms of the appendix are rare,
but have been presented increasingly in advanced stages of disease, shortening the survival of the patients.
Objectives: To determine the profile of patients diagnosed with
primary malignant tumors of the appendix.
Methods: We conducted a descriptive, retrospective study of case
series, with primary data collection through a survey of the records of
patients who had submitted to an appendectomy in a hospital in Santa
Catarina between July 2008 and July 2014. Of these patients we included
those with pathology of primary malignant tumors of the appendix and
excluded those with another diagnosis, resulting in 17 patients.
Results: There were 17 diagnoses of primary malignant tumors of the
appendix from 3946 appendectomies (0.43%). Of these neoplasms, 64.7%
were of carcinoid type, among which women predominated (72.7%) with
a mean age of 27.3 10.7 years. Of carcinoid still, 54.5% had a lesion
of <1 cm and 36.4% had angiolymphatic invasion. Of those with angiolymphatic invasion, 50% occurred in patients with lesions between 1 and
2 cm. We also observed that 35.3% of the remaining tumors were of the
adenocarcinoma type, which predominated women (66.7%) with a mean
age of 57.5 11.2 years. Of these, the majority (83.3%) came forward with
suspected abdominal mass and had lesions with subserosal invasion (T4b).
Metastases were identified in 83.3%, making them stage as IVb.
Conclusion: We observed that most patients present at an advanced
tumor stage. However, due to the rarity of this disease, there is no indication
for screening and early diagnosis, but our observations have the intention of
indicating appropriate oncological treatment.
028899
Prognostic factors after multivisceral en-bloc resections for colorectal
cancer: results of a single cancer institute
Nahas, C.S.1, Nahas, S.C.1, Bustamante-Lopez, L.A.1, Marques, C.F.1,
Ribeiro Jr, U.1, Cecconello, I.1
1
caionahas@uol.com.br, sergionahas@uol.com.br,
leonardoabustamante@gmail.com, sparapanmarques@gmail.com,
ulyssesribeiro@terra.com.br, icecconello@hotmail.com
Introduction: Of colorectal cancers (CRC) 12% have adhesions to
adjacent structures and demand an en-bloc resection in order to obtain an
R0 resection, which is critical to achieve long-term survival.
Objective: To determine perioperative morbidity and oncological
outcomes of multivisceral en-bloc resection (MVEBR) in patients with
CRC in a single cancer center.
Methods: Between January 2009 and February 2014, patients with
primary (non-recurrent) CRC elected for MVEBR were identified from
a prospective collected database. Clinical and pathological factors and
outcomes were obtained. Estimated local and overall recurrence and
survival were compared using the log rank method and Cox analysis.
Results: Out of 1093 patients with CRC resections, 105 (9.6%) required
MVEBR. Twelve patients (11.4%) had stage IV disease. Median age was
ABSTRACTS
60 years, and 66.7% patients were females; 80% of tumors were located in
the rectum and 20% in the colon. The organs most frequently resected were
annexes (37%), uterus (30%), vagina (26%) and bladder (21%); 30.5% of
the patients underwent an abdominoperineal resection. Median length of
hospital stay was 11 days. True invasion of other organs was confirmed by
pathology in 53.5%. R0 resection was obtained in 72% of patients. Ureter
resection and intraoperative blood transfusion were associated with higher
complication rates, which were confirmed with the multiple logistic regression model (OR = 5.6, and 6.3, respectively). Thirty-day postoperative
mortality was 1.9%. After 27 (557) months of follow-up, mortality and
local recurrence rates were 23% and 17%, respectively. In non-metastatic
patients, positive margins were associated with higher recurrence rate (P =
0.002). On univariable analysis, positive margins, lymph-node involvement, stage III/IV disease, and stage IV disease alone were associated with
lower overall survival. On multivariable analysis, the only factor associated
was lymph-node involvement.
Conclusion: MVEBR for primary CRC can be performed with acceptable morbidity and mortality. It provides good oncological outcomes,
especially in patients without lymph-node involvement and when negative
resection margins are obtained.
028898
Prognostic factors of left colectomy surgery for colon cancer at
academic medical centers: 10 years experience
Nahas, S.C.1, Nahas, C.S.1, Bustamante-Lopez, L.A.1, Pinto, R.A.1,
Campos, F.G.1, Cecconello, I.1
1
Hospital das Clnicas da Faculdade de Medicina da USP, So Paulo,
Brazil
leonardoabustamante@gmail.com, roambar11@yahoo.com.br,
fgmcampos@terra.com.br, icecconello@hotmail.com
Introduction: Colon cancer is among the most common neoplastic
diseases in Western countries. In Brazil, it is the leading cause of cancer in
the gastrointestinal tract.
Objective: To evaluate the prognostic factors from surgery on left
colon cancer patients operated in a period of 10 years in academic services.
Methods: We evaluated the results of surgical treatment of patients
with left colon cancer treated in our service from 2002 to 2012. Data were
collected retrospectively from a prospectively collected database. We
excluded patients with incomplete data, synchronous cancers and benign
disease. Demographic factors (gender and age), tumor factors (site, T stage,
N stage, M stage, histological type and tumor differentiation), and lymphnode yield were extracted to identify those associated with lower overall
survival. Mean overall survival time was estimated according to the characteristics of interest using the KaplanMeier function. Hazard ratios (HR)
with 95% confidence intervals (95%CI) were estimated by bivariate Cox
regression.
Results: A total of 173 patients underwent left colectomy. Males
predominated at 50.9%. The mean age was 60.8 (2287) years. Tumors
were located at the sigmoid colon in 72.8%. The mean length of hospital
stay was 16.9 days; 41.6% had lymph-node involvement, 64.2% were stage
T3. The average number of dissected lymph nodes per patient was 23. T
stage and final stage was associated with lower overall survival (P = 0.023
and P < 0.001 respectively). Patients with stage III or IV had a 3.33 times
higher risk of death independently of other characteristics of the patient.
Lymph-node involvement and distant metastasis were associated with
lower survival time (P < 0.001). Lymph-node involvement (OR = 3.8) and
stage IV (OR = 3.2) were independent negative prognostic factors.
Conclusion: Left-sided colon cancer commonly presents at an
advanced stage. Advanced stage is factor associated with poor long-term
survival.
S147
028893
Prognostic factors of surgically treated patients with cancer of the
right colon: 10 years experience
Nahas, S.C.1, Nahas, C.S.1, Bustamante-Lopez, L.A.1, Pinto, R.A.1,
Campos, F.G.1, Cecconello, I.1
1
Hospital das Clnicas da Faculdade de Medicina da USP, So Paulo,
Brazil
leonardoabustamante@gmail.com, roambar11@yahoo.com.br,
fgmcampos@terra.com.br, icecconello@hotmail.com
Introduction: Colorectal cancer is one of the most common malignancies in the world. There are many controversies in the literature about
the prognostic value of primary tumor location. Many studies have shown
higher survival rates for tumors in the right colon, and worse prognoses for
lesions located more distally in the colon.
Objective: To analyze the results of surgical treatment of right-sided
colon cancer patients operated in one decade period, and to identify the
prognostic factors that were associated with lower overall survival in
patients in stages IIV.
Methods: A retrospective review from the prospectively collected
database identified 178 patients with right-sided colon cancer surgically
treated with curative intent. Demographic factors (gender and age), tumor
factors (site, T stage, N stage, M stage, histological type and tumor differentiation), and lymph-node yield were extracted to identify those associated with lower overall survival. Mean overall survival time was estimated
according to the characteristics of interest using the KaplanMeier function. Hazard ratios (HR) with 95% confidence intervals were estimated by
bivariate Cox regression.
Results: Mean age was 65 (12) years, and 105 (56.1%) of the patients
were female. The most commonly affected site was the ascending colon
(48.1%), followed by cecum (41.7%) and hepatic flexure (10.2%). Mean
length of hospital stay was 14 (2.8) days. T stage distribution was T1
(4.8%), T2 (7.5%), T3 (74.9%), and T4 (12.8%). Nodal involvement was
present in 46.0%, and metastatic disease in 3.7%. Twelve or more lymph
nodes were obtained in 87.2% of the surgical specimens and 84.5% were
non-mucinous tumors. Mean survival time was 38.3 (30.8) months.
Overall survival was affected by T stage, N stage, M stage, and final stage.
Lymph-node involvement (OR = 2.06) and stage III/IV (OR = 2.81) were
independent negative prognostic factors.
Conclusion: Right-sided colon cancer presents commonly at an
advanced stage. Advanced stage and lymph-node involvement are factors
associated with poor long-term survival.
029082
Prognostic value of factors associated with hypoxia (HIF1A and
VEGF) and lipid metabolism (LXRA, LXRB and PPARG) in patients
with colorectal cancer
Costa, A.C.1, Stevanato Filho, P.1, Aguiar Jr, S.1, Begnami, M.D.2,
1
Camargo Cancer Center, So Paulo, Brazil, 2Department of Pathology,
A.C. Camargo Cancer Center, So Paulo, Brazil
adrianocacosta@hotmail.com, paulorstevanato@gmail.com,
samuel.aguiar.jr@gmail.com, mariadirlei@gmail.com,
Background: Colorectal cancer (CRC) is a neoplasm with high incidence and high mortality rates. It has been suggested that the inflammatory
response is an important prognostic factor. The disordered and accelerated
proliferation of neoplastic cells decreases the oxygen and nutrient supply,
generating a microenvironment characterized by hypoxia, necrosis and
S148
inflammation. This study aimed to evaluate the impact of factors associated
with hypoxia, such as HIF1A (hypoxia-inducible factor 1-alpha) and VEGF
(vascular endothelial growth factor), and with lipid metabolism, including
PPARG (peroxisome proliferator-activated receptor-gamma), LXRA (liver
X receptor-alpha) and LXRB (liver X receptor-beta), on the overall survival
(OS) of CRC patients.
Methods: This was a cohort study of patients with high-risk stage II
III (TNM) CRC located above the peritoneal reflection and treated between
1990 and 2004 at the AC Camargo Cancer Center. Immunohistochemical
analyses of HIF1A, VEGF, PPARG, LXRA and LXRB protein expression
were performed using tissue microarrays (TMAs).
Results: There was an association between the presence of vascular
embolization and the lack of VEGF expression (P = 0.028) as well as with
positive HIF1A expression (P = 0.045). The 5-year and 10-year OS rates
were 76.6% and 60.2%, respectively. Patients with PPARG-positive tumors
had a higher OS (P = 0.018). There were no correlations between the
positive expression of VEGF, HIF1A, LXRA or LXRB and OS. The Cox
regression model demonstrated that the risk of death was 2.72-fold higher
in patients with PPARG-negative tumors (95%CI = 1.086.85).
Conclusion: The lack of PPARG expression in tumors is an independent prognostic factor for patients with high-risk stage II and stage III
CRC.
028320
Prone extralevator abdominoperineal excision versus conventional
APR for low rectal cancer
Araujo, R.O.C.1, Cesar, D.1, Valadao, M.1, De Jesus, J.P.1,
Mondragon, J.P.M.2, Albagli, R.1, Linhares, E.1
1
Department of Abdominal and Pelvic Surgery, INCA/MS, Rio de Janeiro,
Brazil, 2Surgical Oncologist of Hospital and Maternity So Jos, Colatina,
ES, Brazil
rotaraujo@yahoo.com.br,danielcesar@live.com,drmarcusvaladao@gmail.com,
jpjesus@uol.com.br, mata_pablo@yahoo.com.br, rafaelalbagli@uol.com.br,
eduardolinhares@globo.com
Introduction: Surgical treatment of low rectal cancer (LRC) is technically challenging. Despite the morbidity related to the Miles operation,
results are inferior compared to those for proximal tumors submitted to
low anterior resection. Despite the introduction of preoperative chemoradiotherapy (CRT) and total mesorectal excision, inadequate circumferential margins (CRM) were reported in 30%, intraoperative tumor perforation
(IOP) in 10% and incomplete total mesorectal excision (TME) in 75% of
cases after conventional abdominoperineal resection (APR). Prone extralevator abdominoperineal excision (PELAPE) was proposed to improve
outcomes.
Objectives: To compare the results of PELAPE to conventional APR
for the treatment of low rectal cancer in our institution.
Methods: Patients with LRC submitted to PELAPE (group 1) were
selected from our prospective database and compared to conventional APR
patients (group 2) from 2002 to 2014 after ethics committee approval. The
variables studied were: age, gender, time interval from CRT, distance from
dentate line (DL), CRM involvement, IOP, perineal mesh insertion and
surgical complications. Statistical analysis used SPSS version 17.0.
Results: Twenty-two patients from group 1 were compared to 67
patients from group 2. Groups were comparable in age (P = 0.68) and
gender (P = 0.58). Mean interval from CRT was superior in group 1 (24
versus 14 weeks, P = 0.04), median tumor height from DL was shorter (P =
0.05) and DL involvement was more frequent (P < 0.01). There was no
difference in CRM involvement (41% versus 35%, P = 0.64) or IOP rate
(18% versus 9%, P = 0.23). There was no difference in pathological stage
(P = 0.32), node retrieval (P = 0.32) and node-positive cases (P = 0.20).
Mesh placement was more frequent in the PELAPE group (90% versus
ABSTRACTS
1.5%, P < 0.01), as were also perineal complications (55% versus 21%,
P < 0.01).
Conclusions: PELAPE does not reduce CRM involvement and intraoperative tumor perforation rates, and it increases perineal complications;
nonetheless it is indicated for lower tumors after a longer interval between
CRT and surgery. It is an option for locally advanced tumors, but risk/
benefit ratios must be evaluated.
028897
Randomized controlled trial for complete clinical response in
patients with locally advanced rectal cancer after neoadjuvant
chemoradiotherapy: observation versus surgical resection
Nahas, C.S.1, Nahas, S.C.1, Marques, C.F.1, Ribeiro Jr, U.1, BustamanteLopez, L.A.1, Cecconello, I.1
1
sparapanmarques@gmail.com, ulyssesribeiro@terra.com.br,
leonardoabustamante@gmail.com, icecconello@hotmail.com
Introduction: Non-operative management of patients with rectal
cancer who achieve complete clinical response after neoadjuvant chemoradiotherapy has been a matter of discussion among investigators, and is still
controversial. No randomized trials have been published up to now.
Objective: To present the preliminary results of an ongoing randomized trial to assess whether non-operative management is similar to total
mesorectal excision (TME) in patients with a complete clinical response
(cCR) after neoadjuvant chemoradiotherapy (CRT) for locally advanced
adenocarcinoma of the rectum.
Methods: This prospective randomized trial includes patients with
rectal adenocarcinoma stage T34N0M0 or T(any)N+M0 located within 10
cm from the anal verge, or T2N0 within 7 cm from the anal verge. Patients
are staged and restaged by digital exam, colonoscopy, pelvic MRI, thorax
and abdominal CT scans. A chemotherapy regimen based on 5-FU and a
total dose of pelvic radiation of 5040 Gy were administered. Restaging
occurs 8 weeks after completion of CRT. Patients with cCR are randomized
1:1 to TME or observation.
Results: From July 2011 to April 2013, 118 patients were treated. Six
patients were considered cCRs: two randomized for surgery (one ypT0N0
and one ypT2N0) and four randomized for observation (three sustained
cCR and one had tumor regrowth). The 112 non-cCR patients underwent
TME and 18 revealed pCR. These 18 cases were not considered cCR at
restaging because they presented at least one of the followings conditions:
mucosal ulceration and/or deformity, and/or substenosis of the rectal lumen
at the restaging digital rectal exam and colonoscopy (n = 16), ymrT14
(n = 16), ymrN+ (n = 2), involvement of circumferential resection margin
on post-CRT MRI (n = 3), extramural vascular invasion on MRI (n = 4),
mrTRG 24 (n = 15), and pelvic side-wall lymph-node involvement on
post-CRT MRI (n = 1). After 31.8 months of mean follow-up, all patients
from the observation arm, surgical arm, and the 18pCR are free of disease.
Conclusions: cCR is an uncommon condition. Evaluation of cCR
according to the currently adopted criteria has low sensitivity, and needs
improvement, since complete pathological response more frequently
presents as non-cCR.
ABSTRACTS
028904
Results of primary non-surgical treatment of epidermoid carcinoma
of the anal canal: a single-institution experience of 325 cases
Huguenin, J.F.L.1, Lajus, J.A.1, Corra, J.H.S.1, Castro, L.S.1
1
Department of Abdominopelvic Surgery, Brazilian National Cancer
Institut (INCA), Rio de Janeiro, Brazil
janinaloureiro@hotmail.com, leonaldson@gmail.com
Introduction: Following the pioneer non-surgical treatment developed by Nigro et al in 1970, the chemoradiotherapy is the gold standard
treatment for epidermoid carcinoma of the anal canal.
Objectives: To analyse the results in terms of recurrence, survival and
toxicity in patients with anal squamous-cell carcinoma, who were treated
with chemoradiation or radiation alone at the same instituition.
Methods: Between 1981 and 2001, 325 patients with epidermoid
carcinoma completed a non-surgical treatment; 227 patients (70%) were
submitted to combined treatment (chemoradiation) and 98 patients (30%)
were submitted to radiotherapy only. Radiation treatment was directed
to the primary tumor region and to the inguinal, perirectal, and internal
iliac nodes with a total dose of 41.4 Gy, divided into 23 fractions; this was
associated with a boost in the tumoral bed of 14.4 Gy divided into eight
fractions. The chemotherapy regimen employed was 5-fluorouracil associated with mitomycin C or cisplatin. The 5-year overall survival (OS) was
determined by the KaplanMeier method and comparisons between curves
by the log rank test.
Results: Patients submitted to chemoradiation experienced more
toxicity than the radiotherapy-only patients, and this difference was statistically significant (P = 0.0002). Age, gender, race, tumor differentiation and
smoking had no influence on overall survival. Between the two groups
there was no statistically significant difference in overall survival (5 years
overall survival for radiotherapy = 75%, chemoradiation = 83%; P = 0.11)
but the radiotherapy alone group developed significantly more local recurrence than the combined treatment group (34.7% and 22% respectively,
P = 0.02). Overall survival was strongly influenced by stage distribution
(P = 0.001). Multivariate analysis showed stage distribution as the only
independent prognostic factor in overall survival.
Conclusion: Despite increasing morbidity, the chemotherapy addition
improved outcomes by reducing the recurrence rates. Our study confirms
the literature findings that chemoradiation should be the primary standard
treatment for epidermoid anal cancer.
028389
Robotic colorectal resection associated with trans-vaginal specimen
extraction for colorectal cancer
Ribeiro, L.C.B.1, Silva, M.V.M.V.1, Cancian, L.T.1, Jesus, J.P.1,
Mello, E.L.R.1, Albagli, R.O.1
1
Janeiro, Brazil
lurribeiro@yahoo.com.br, drmarcusvaladao@gmail.com,
lucancian@gmail.com, jpjesus@uol.com.br, eduardolinhares@globo.com,
rafaelalbagli@uol.com.br
Introduction: A robot-assisted colectomy for cancer as a minimally
invasive procedure is equivalent to open resection in terms of safety and
oncological outcomes, and has superior results in terms of postoperative recovery. This approach, however, requires an abdominal incision,
through which the surgical specimen is extracted and resected. Avoiding a
laparotomy may provide the advantages of the minimally invasive surgery,
but recently natural orifice specimen extraction (NOSE) using the anus or
vagina has become an alternative route to avoid further incisions.
Objectives: To describe the safety and effectiveness of this procedure
in a female patient.
S149
Methods: A 69-year-old female patient had a rectal adenocarcinoma
8 cm from the anal verge occupying 50% of the lumen, predominantly at
the right wall. She was submitted to neoadjuvant therapy (chemoradiation). We performed a robotic total mesorectal excision (TME) by unique
robot docking and through the culdotomy we extracted the specimen. The
culdotomy was closed by robotic suture. Weve performed the anastomosis
with an intraluminal circular stapler and a protective colostomy.
Results: There were no intraoperative complications and no conversion. The procedure was performed with a favorable surgical outcome, with
mesorectal fascia grade 3 and without further incisions, except the ones
from the robotic ports. The patient was discharged in 2 days and had a
satisfactory outcome.
Conclusions: Our case experience, in accord with the results in the
literature, show that the association of robot-assisted surgery with transvaginal specimen extraction for colorectal cancer is feasible and safe.
028347
Robotic total mesorectal excision with partial urinary bladder
resection for the treatment of locally advanced rectal cancer
1
Janeiro, Brazil
Introduction: Robotic total mesorectal excision (TME) is a minimally
invasive technique developed in recent years. Oncological and functional
outcomes have already been assessed and proved to bring benefits. For
locally advanced rectal cancer no randomized clinical trial was performed
to validate the method. Current guidelines for open rectal cancer surgery
recommend en-bloc resection to manage locally advanced adherent rectal
tumors.
Objectives: Since robotic surgery can perform the same oncological
technique with the addition of a magnified view allied with improved
instrumentation, we present this video to demonstrate that robotic TME for
locally advanced lesions can be safely performed.
Methods: A fully robotic TME with partial bladder resection was
performed after neoadjuvant chemoradiotherapy in a 51-year-old male
patient with a T4bN1M0 rectal adenocarcinoma located at 7 cm from the
anal verge. Surgery started with a four-arm single robot docking at the
patients left hip at a 45 angle. The inferior mesenteric artery and vein
were dissected and divided. The left colon, splenic flexure and the sigmoid
were then mobilized. The mesorectum was first approached in its posterior
aspect after dissection, identification and preservation of the hypogastric
and pelvic autonomic nerves. Then the TME was carried out with sacral
rectal dissection and lateral rectal dissection. The anterior dissection was
done en bloc with partial resection of the posterior bladder wall. Surgery
then followed according to our routine.
Results: The operative time was 280 min with an estimated bloodloss of 70 mL. A urinary catheter was left in place for 7 days. The patient
recovered uneventfully and was discharged on the 8th postoperative
day. Pathological analysis showed negative surgical margins. Short-term
follow-up showed no fistulas and normal urinary and sexual function.
Conclusion: Robotic TME with partial bladder resection is oncologically safe and adequate for locally advanced rectal cancer. Good oncological and functional outcomes can be achieved with the addition of the
benefits of minimally invasive surgery.
S150
028345
Short-term oncological outcomes of robotic total mesorectal excision
1
Department of Surgical Oncology, Instituto Nacional do Cancer, Rio de
Janeiro, Brazil, 2Instituto Nacional do Cancer, Rio de Janeiro, Brazil
Introduction: Minimally invasive surgery has changed the surgical
treatment of rectal cancer. Total mesorectal excision (TME) can be safely
performed by robotic, laparoscopic or an open approach. However, results
remain in question about which technique can offer the better oncological
and functional outcomes among these three surgical approaches.
Objectives: To analyse the short-term oncological impact and
outcomes of robotic, laparoscopic and open TME.
Methods: Between May 2012 and July 2013, 36 consecutive patients
underwent robotic TME and were prospectively included in this study. This
group of patients was then compared with a retrospective cohort of 200
open TME and 41 laparoscopic surgeries. Only adenocarcinomas of the
rectum were included, and chemoradiotherapy was offered to every patient
with clinical T3 or N1 tumors. All patients with metastatic disease were
excluded. Clinical and pathological data were analysed and compared using
SPSS 17.1 (IBM SPSS Inc. Armonk, NY, USA).
Results: Demographic, clinical and pathological characteristic (age,
gender, BMI, tumor stage) among the three groups was not statistically
different (P = 0.7). In the robotic and laparoscopic groups, the postoperative
fasting time and hospital stay were shorter than in the open surgery group.
There was no statistically significant difference among the three groups
regarding tumor size, tumor height, distal and proximal margins, number
of harvested lymph nodes, and distal margin involvement. However, the
robotic TME positive circumferential resection margin (CRM) rate was
statistically significantly lower than in the laparoscopic and open groups
(P = 0.034). The median CRM was 1.3 cm in robotic TME, with one (2.7%)
positive margin; 0.6 cm in laparoscopic TME, with four (11%) positive
margins; and 0.5 cm in open TME, with 21 (13%) positive margins. In
the robotic group all specimens had grade 3 mesorectal fascial envelope
intactness.
Conclusion: Robotic TME offers oncological benefit when compared
with open and laparoscopic surgeries, especially regarding CRM and
quality of mesorectal envelope.
029262
Squamous-cell cancer of the anal canal associated with short bowel
syndrome: a case report
Silva, M.T.B.1, Pereira, T.S.S.1, Mierzwa, T.C.1, Schreiner, C.A.1,
Bertuol, J.V.L.2, Westphalen, A.P.3
1
General Surgery Residency, University of Western of Parana, Cascavel,
Brazil, 2Medicine Course, University of Western of Parana, Cascavel,
Brazil, 3Department of Coloproctology, University Hospital of Western of
Parana, Cascavel, Brazil
marianatbs89@gmail.com, talita.siemann@hotmail.com,
ti1601@hotmail.com, andrewestphalen@terra.com.br
Introduction: The incidence of anal carcinoma corresponds to 1.5%
of all tumors of the digestive tract. Epidemiological data show different
risk factors for developing the condition such as sexually transmitted
diseases, anal intercourse, homosexuality, smoking, perianal disease and
immunosuppression. Concerning treatment, radiation therapy is currently
the elected therapy, associated or not with chemotherapy, leaving abdominoperineal resection of the rectum for rescue therapy.
Objectives: To report a case of squamous-cell carcinoma of the anal
canal in patients with short bowel syndrome.
ABSTRACTS
Methods: Medical records review.
Results: A 49-year-old female, receiving outpatient treatment for
short bowel syndrome after emergency bowel resection for internal hernia,
complained of perianal pain, feeling of mass at the anal opening, intermittent bleeding when evacuating, and recurrent drainage of pus through the
anus. Inspection showed an anal abscess that was drained in the outpatient clinic. Later a fistulectomy was performed due to recurrence of the
symptoms. During the surgery a mass in the anal canal was visualized,
with a hardened and infiltrative appearance. An incision biopsy was done.
Histology revealed squamous-cell carcinoma. The patient was submitted to
concomitant chemotherapy and radiotherapy. After completion of chemoradiation she returned again with complaints of feeling a mass at the anal
opening and purulent drainage from the anus. The physical exam revealed
an infiltrative and friable mass in the anal verge. Biopsy confirmed relapse
of the disease. This time, abdominoperineal resection of the rectum Miles
surgery was carried out and the patient was referred again to clinical
oncology.
Conclusions: The relationship between squamous-cell carcinoma of
the anal canal and previous local diseases that cause chronic irritation
such as fistulas, hemorrhoids, warts and abscesses is often described in
the literature. In our case, the patient had a significant local aggression
factor which may have contributed to the appearance of the disease.
028423
Superior rectal artery preservation during rectosigmoidectomy for
rectal cancer
Schraibman, V.1, Padovese, C.C.1, Epstein, M.G.1, Maccapani, G.1,
Bertocco, L.A.S.1, Macedo, A.L.V.1
1
vschraibman@hotmail.com,
camila_padovese@yahoo.com.br, ma_epstein@hotmail.com,
gaba65@hotmail.com, luisbertocco@zipmail.com.br, tala@uol.com.br
Introduction: Rectal anastomotic fistula due to rectosigmoidectomy
remains a major complication during treatment of colorectal cancer. Many
attempts have been made in order to avoid this complication. Preservation
of the superior rectal artery in order to maintain a high blood flow remains
an alternative in selected patients.
Objectives: To demonstrate the feasibility of maintenance of the superior rectal artery during a retosigmoidectomy for rectal cancer.
Methods: Two patients underwent rectosigmoidectomy in a single
institution located in Brazil; one was robotic and the other used the open
technique. An 85-year-old male with coronary disease was diagnosed with
sigmoid cancer and an open-approach surgery was indicated due to his
comorbidities. A 68-year-old male had diagnosed a sigmoid cancer and
the robotic technique was indicated. Preoperative variables included age,
gender, and indication for surgery. Intraoperative variables included operative time and blood transfusion. Postoperative variables included hospital
stay, complications and oncological outcomes.
Results: The surgical time was 90 minutes in the open versus 360
minutes in the robotic approaches; there was no blood transfusion in
either. There were no complications and both left the hospital on the 4th
postoperative day. The anatomical pathology examination showed an adenocarcinoma T3N0M0 (0/24 lymph nodes) in the open case and an adenocarcinoma T2N0M0 (0/41 lymph nodes) in the robotic case.
Conclusions: Maintenance of the superior rectal artery is feasible,
safe and provides the oncological outcomes expected in selected patients.
However, larger studies need to be performed in order to evaluate the real
benefits and outcomes.
ABSTRACTS
029155
Surgical results and study of prognostic factors for survival in
patients with liver metastasis of colorectal cancer undergoing
resection
Chiaradia, C.P.1, Kurtz, G.S.T.1, Rombaldi, M.C.1, Pr, R.B.1, dos
1
crisllipreussler@gmail.com,
guilhermestkurtz@gmail.com, mcrombaldi@hotmail.com,
rochelepra@gmail.com,ferdemarco@yahoo.com.br,fmroliveira@hotmail.com
Introduction: The liver is the most common site of metastasis for
tumor sites that drain via the portal circulation, including colorectal cancer.
Objectives: To evaluate the surgical treatment of hepatic metastasis
of colorectal cancer (HMCCR), analyzing peroperative clinical, pathological and laboratory factors that may influence the overall survival and the
disease-free survival.
Methods: We retrospectively evaluated patients undergoing HMCCR
resection between 2008 and 2014 at our surgical oncology service.
Inclusion criteria were patients with HMCCR undergoing resection. This
analysis was approved by our ethics committee. For statistical analysis,
SPSS 20 was chosen. We considered 5% as the significant level using the
MantelCox test for survival curves.
Results: During the study, 20 patients were submitted to 28 surgical
procedures for hepatic resection via laparotomy. The mean age was 53.9
years. Of these, 55% had primary rectosigmoid disease and 45% colon
disease. At the time of diagnosis of the primary tumor, 75% had positive
lymph nodes, 70% had hepatic metastasis and 20% extrahepatic disease.
The surgical margins analysis, resection R0 was achieved in 23 cases
(82.14%), R1 in four (14.28%) and R2 in one (3.57%); 19 (95%) had postoperative chemotherapy. Recurrence occurred in 13 patients (65%), with
six being submitted to new hepatectomy and four (20%) had more than one
recurrence. The postoperative mortality was just 3%. There was a morbidity
rate of 14% per procedure. Among the prognostic factors, a primary tumor
with synchronous hepatic metastasis had the worst prognosis.
Conclusion: HMCCR resection shows low mortality and morbidity
rates, similar to those in great centers; it also shows a free margin resection
on 82%. Synchronous colorectal hepatic metastasis may suggest a worse
outcome in comparison to metachronic metastasis. Extrahepatic disease
increases the recurrence rates and also decreases the overall survival.
Despite the impact shown by the studied factors on patient outcome, it is
not possible to use it as an isolated exclusion factor for hepatectomy.
028865
Sustained clinical complete response, without surgery, in a patient
with T2N2M0 distal rectum cancer
Firmino, N.L.J.1, Gomes, A.S.A.2, Miranda, E.2, Carvalho, L.A.1,
Silveira, D.L.1, Gomes, G.E.S.1, Diniz, A.F.1, Silva, G.L.R.1,
Teixeira, W.G.3
1
2
UNIONCO, Surgical and Clinical Oncology Institute, Recife, Brazil,
3
nflj_@hotmail.com, alexandre.unionco@gmail.com,
emiranda.onco@gmail.com, let.carvalho.94@gmail.com,
deb.lucena@hotmail.com,glory_sgg@hotmail.com,alana_diniz959@hotmail.com,
gabrielalucena90@gmail.com, letowgtmed@gmail.com
Introduction: Rectal cancer is a major health problem around the
world, representing about one third of the total colorectal cancer cases.
Because of its anatomical location, there is a higher risk of local recurrence
(LR), and treatment often requires a complex multidisciplinary approach
which includes neoadjuvant radiotherapy, chemotherapy, and a radical
S151
surgical procedure that commonly leads to a permanent colostomy. The lack
of a peritoneal covering confers a higher risk of LR of the rectal tumour,
and different medical approaches often including more radical surgical
procedures may be required. In the latter scenario, total mesorectal excision (TME) and neoadjuvant chemoradiotherapy (CRT) have been proven
to effectively treat the disease. In spite of progress in preventing local
recurrence, treatment of distal rectum tumours remains very aggressive.
Objectives: To demonstrate the feasibility of the watch-and-wait
protocol in selected patients.
Methods: Between December 2012 and June 2015 we followed up a
female patient who had a diagnosis of a T2N2M0 distal rectum cancer. The
patient was treated with concurrent chemoradiotherapy that included 54
Gy and 5-fluorouracil (450 mg/m2) and leucovorin (50 mg) for three cycles
every 21 days, during radiotherapy (total of nine cycles), followed by a
further three cycles.
Results: After 8 weeks from completion of CRT, the patient was
reevaluated by an experienced colorectal surgeon to assess tumor response.
During the second and third years after treatment, the patient was advised
to attend follow-up visits every 2 months and 6 months, respectively.
The patient is now in her third follow-up year, with no local or distant
recurrence.
Conclusion: Non-surgical management of rectal cancer is becoming
increasingly accepted as a standard option worldwide. We need to consider
this watch-and-wait approach in patients with clinical complete response as
an alternative to immediate rectal surgery, at least for some patients.
028916
Training model of laparoscopic colorectal surgery applied to medical
residents in training
Spencer, R.M.S.B.1, Oliveira, D.A.M.1, Aguiar Jr, S.1, Bezerra, T.S.1,
Stevanato Filho, P.R.1, Lopes, A.1
1
So Paulo, Brazil
ranyell.spencer@gmail.com, deciomontenegro@gmail.com,
samuel.aguiar.jr@gmail.com
Introduction: Training models in laparoscopic surgery are planned
with focus on operative steps to make the personal learning curve easier.
However, the way to apply these models for teaching medical residents
depends on individual attitudes, technical performance and safety of both
the resident and the physician. Based on a positioning platform and standardized technique, this abstract aims to orientate how the teacher surgeon
can act to develop a better approach and guidance for teaching the technique of colorectal laparoscopic surgery (right colectomy and rectosigmoidectomy) to residents in training.
Objective: To describe the methodology used to guide surgical residents to make better use of the training on laparoscopic colorectal surgery
(right colectomy and rectosigmoidectomy), including the positioning of the
trocars, of the patient, and of the surgical team for the best approach.
Method: This is a descriptive study from a single institution, based on
standardized surgical models but not yet described for this purpose.
Conclusion: We conclude that appropriate positioning of the surgical
team and patient can ease the teaching of laparoscopic colorectal surgery
for medical residents. The method described is safe and reproducible, but
it depends on the staffs experience and the skills of the training resident.
S152
028393
Transanal minimally invasive surgery for total mesorectal excision
(ETM) through the transanal approach (TaETM) with robotic and
transanal endoscopic operations (TEO) combined
Silva, M.V.M.V.1, Mendes, C.R.S.1, Ribeiro, L.C.B.1, Araujo, R.O.C.1,
Jesus, J.P.1, Mello, E.L.R.1
1
Janeiro, Brazil
drmarcusvaladao@gmail.com, proctoramon@hotmail.com,
lurribeiro@yahoo.com.br, rotaraujo@yahoo.com.br, jpjesus@uol.com.br,
eduardolinhares@globo.com
Introduction: In 1982 Heald proposed standardization of the total
mesorectal excision for the treatment of colorectal cancer, with a significant
reduction in the recurrence rate. But the treatment of lower rectal cancers
are still a challenge.
Objectives: To describe the association of a robotic approach by TATA
(transanal abdominal transanal resection), with transanal access using
transanal endoscopic operations (TEO) in the treatment of lower rectal
cancer.
Methods: The TATA performs a robotic abdominal approach, and the
perineal approach used TEO to develop transanal total mesorectal excision
(TaTME).
Results: The TaTME technique was applied in a woman with rectal
adenocarcinoma 5 cm from the anal verge occupying 40% of the side
wall. The patient underwent neoadjuvant chemoradiation. The procedure
was performed with a favorable surgical time and favorable oncological
outcome, with grade III TME. The patient was discharged in 2 days postsurgery with satisfactory follow-up.
Conclusions: This is a minimally invasive procedure quite favorable
after radiation and chemotherapy in patients with rectal tumors, where the
lesion is located in the lower rectum and medium facilitating access to this
site, especially in obese patients.
028881
Use of FOLFOX and Avastin for treatment of colorectal cancer with
the side effect of bilateral vocal fold paresis: a case report
Freitas, E.C.1, Duque, A.C.M.1, Texeira, A.F.2, Carvalho, A.3, Borba, C.3,
Ghirello-Pires, C.1
1
Universidade Estadual do Sudoeste da Bahia, UESB, Brazil, 2Samur e
HGVC, Brazil, 3Otorrinomed; Brazil
erllannya@hotmail.com, clara_mduque@yahoo.com.br,
teixeira_adriano@yahoo.com.br, avicaresther@gmail.com,
carlosborbaorl@gmail.com, carlaghipires@hotmail.com
Introduction: Colorectal cancer is the fourth most common cancer
among men and the third among women, affecting approximately one
million people each year worldwide. The use of bevacizumab in combination with oxaliplatin and fluoropyrimidine is indicated for the treatment of
patients with metastatic carcinoma of the colon or rectum.
Objective: To examine and describe a case of paresis of the bilateral
vocal fold induced by this drug combination.
Methods: We assessed the sudden hoarseness of an 80-year-old
patient who had used the drug combination for 1 year. Laryngoscopy was
performed on May 28th 2015. Initial laryngoscopy and pulmonary function
tests were used to rule out mucosal and submucosal lesions. In addition,
we analyzed recordings of a spontaneous speech section between a speech
therapist and the patient.
Results: In addition to image analysis, the subjects speech section
was 23 seconds. Subsequently, drug withdrawal (over 30 days) improved
speech time to 56 seconds. During these days, there were transient
ABSTRACTS
improvements suggesting a temporary neuropathy reaching the vagus nerve
(recurrent branch), as paresis of the tenth nerve can cause hoarseness.
Conclusions: Over the final days of evaluation there was a transient
improvement, indicating the case as a peripheral neuropathy with drug
etiology (bevacizumab and/or oxaliplatin). Our findings highlight a potential pathogenic mechanism of vocal fold paresis/paralysis; this deserves
further study.
029301
Vermiform appendix carcinoma: clinical presentation, diagnosis and
treatment
Picanco Junior, O.M.1, Picanco, T.S.C.1, Alves, R.M.S.1, Soares, P.C.2
1
Federal University of Amapa, Macapa, Brazil, 2Ophyr Loyola Hospital,
Belm, Brazil
ompjunior@bol.com.br, thailapicanco@bol.com.br
Introduction: Adenocarcinoma of the vermiform appendix is a rare
disease, affecting only 0.010.2% of surgical specimens in patients undergoing appendectomy.
Objective: To report a vermiform appendix adenocarcinoma case
occurring since 2006, emphasizing the clinical presentation, diagnosis and
treatment.
Method: This was a study based on the history, physical examination,
laboratory tests and survey data in the medical record of the patient with her
free and informed consent.
Case report: The patient was a 68-year-old female with a history
of intermittent pain in the right iliac region for about 3 months, with a
sudden worsening and increased pain intensity associated with fever and
general malaise. USG of the abdomen showed no evidence of change. The
diagnosis of acute appendicitis was made and the patient was forwarded
to surgery. On appendectomy a swollen appendix was found that was
hyperemic with hardened areas. Histopathology showed a moderately
differentiated adenocarcinoma. After 20 days, and staging showing a single
pulmonary nodule in the right lung, absence of synchronous tumors, and
colonoscopy with preoperative levels of CEA at 2.7 ng/mL, the patient was
operated again; a right hemicolectomy with transverse ileum anastomosis
in two planes associated with bilateral oophorectomy was performed. There
were no complications and the patient was discharged on postoperative day
7. Pathological examination revealed a moderately differentiated adenocarcinoma with hypertroph in the intestinal muscle wall and absence of nodal
metastases. Subsequently, the patient was referred to oncology for adjuvant treatment and follow-up of thoracic surgery. However, the tumor has
evolved, with poor general condition during chemotherapy; the pulmonary
nodule is waiting pulmonary lobectomy.
Conclusion: In the treatment of patients with adenocarcinoma of the
appendix, right colectomy should be conducted to obtain better survival,
regardless of the degree of invasion, histological subtype or tumor differentiation grade; bilateral oophorectomy should be carried out in menopausal
women because of the high incidence of ovarian metastases.
ABSTRACTS
028983
ypT status and the chance of ypN0 in patients with cT3 rectal
adenocarcinoma submitted to neoadjuvant chemoradiation and total
mesorectum excision
Ferreira, F.O.1, Aguiar Jr., S.1, Begnami, M.D.F.S.2, Nakagawa, W.T.1,
Batista, R.M.S.S.1, Lopes, A.1
1
Ncleo de Tumores Colorretais, AC Camargo Cancer Center, So Paulo,
Brazil, 2Departmento de Patologia, AC Camargo Cancer Center, So
Paulo, Brazil
fabioferreira@uol.com.br, samuel.aguiar.jr@gmail.com,
mariadirlei@gmail.com, wtnakagawa@uol.com.br, ranyell@terra.com.br,
ademar-lopes@uol.com.br
Introduction: The watch-and-wait policy has been widely discussed
in recent years and proposed for patients with cT3 extraperitoneal rectal
adenocarcinoma with clinical complete response after neoadjuvant chemoradiation (CRT). However, the tests used for clinical response assessment
still fail in assessing both the primary site and regional lymph nodes. Local
excision of the scar area has been used to assess pathological response in
the primary site; however, it does not allow evaluation of pathological
lymph-node status, an important feature for decision-making. Therefore,
the identification of true N0 patients is essential for the acceptance of the
conservative approach.
Objectives: To evaluate the correlation between ypT status and the
chance of ypN0 in patients with cT3 rectal adenocarcinoma submitted to
neoadjuvant CRT and TME.
Methods: Between June 2007 and February 2015, 569 patients with
rectal adenocarcinoma were submitted to surgical treatment in our service;
435 of the tumors were located at the extraperitoneal rectum. Among those,
we selected 155 consecutive patients with cT3 lesions (MRI staging)
submitted to neoadjuvant CRT followed by TME.
Results: Among the 155 patients, 63 (40.6%) were cN0 and 92 (59.4%)
were cN+ (MRI pre-CRT). After pathological evaluation, 116 (74.8%) were
ypN0 and 39 (25.2%) were ypN+. pCR rate (ypT0ypN0) was 18% (28/155).
cN+ patients were could have any ypT status: ypT0/cN+ (14/28; 50.0%);
ypT1/cN+ (6/13; 46.2%); ypT2/cN+ (23/43; 53.5%); ypT3/cN+ (45/61;
73.8%); and ypT4/cN+ (4/10; 40.0%). According to ypT status, we found
the following ypN0 rates: ypT0 (28/28; 100%); ypT1 (12/13; 92.3%); ypT2
(37/43; 86.0%); ypT3 (34/61; 55.7%); and ypT4 (5/10; 50%).
Conclusions: In our series of patients with cT3 rectal adenocarcinoma
submitted to neoadjuvant CRT followed by TME, the higher the downstaging observed on the primary tumor the greater the chance of ypN0.
ypT0 patients might be candidates for prospective protocols to prevent
TME.
S153
S154
General oncology
028921
Challenges in the interscapulothoracic (forequarter) amputation for
advanced squamous-cell carcinoma
Rausch, M.1, Salles, P.G.O.1, do Prado, F.R.S.1, de Paula, P.H.M.1,
Lauar, R.A.O.1, Terra, F.S.2
1
Instituto Mario Penna, Brazil, 2Hospital das Clnicas de Minas Gerais,
UFMG, Brazil
marcelorausch64@gmail.com, pgosalles@gmail.com,
f.romeu.med@gmail.com, pedrohansendepaula@hotmail.com,
dr.rachidlauar@gmail.com, filipeterra1989@gmail.com
Introduction: Squamous-cell carcinoma, representing the second
most common skin cancer, is characterized by a low metastasis rate and a
high chance of cure with local surgical resection. Eventually, however, an
unconventional approach is necessary to therapeutic success and damage
reduction, and provides a better quality of life.
Objectives: To demonstrate the importance of early diagnosis, the
correction of the first surgical approach, and the challenges of an invasive
approach, when local and minimally invasive technique are insufficient to
treat squamous-cell carcinoma.
Methods: JCTP, a 35-year-year-old man, presented with a right
forearm lesion, removed by excision biopsy, which was compatible with
squamous-cell carcinoma. Six months after resection, the patient developed an axillary nodule due to a brachial neurovascular bundle invasion. Although submitted to cytoreductive surgery, macroscopic disease
remained, because the resection compromised the vitality of the affected
limb. An adjuvant radiotherapy was tried, but there was no satisfactory
result. After 6 months, at follow-up, he had an axillary ulcerated tumor,
local infection, intense local pain, and a non-functional limb; he required
high doses of opioids. We performed an interscapulothoracic amputation
based on lack of member functionality, necessity of infection cleaning, and
absence of metastasis to other sites.
Results: There was immediate postoperative pain remission, infection
containment, and expressed patient satisfaction for a mutilating operation,
something that overtook the whole teams expectations.
Conclusion: It is necessary to carry out an effective program of skin
cancer prevention, to promote early diagnosis, and to ensure access to
treatament centers with oncological surgeons to avoid extreme surgeries
as occurred with this patient. Despite the morbidity, our patient presented
immediate postoperative pain remission and infection containment, and he
expressed satisfaction about what had been done to improve his quality of
life
028920
De-novo tumors after orthotopic liver transplantation (OLT): a
south Brazilian single-center experience
Diogo, L.C.1, Cerski, T.2, Fleck Junior, A.M.2, Brando, A.B.M.2,
Meine, M.H.M.2, Zanotelli, M.L.2, Cantisani, G.2, Marroni, C.A.2
1
Faculade de Medicina, UFCSPA, Porto Alegre, Brazil, 2Grupo de
Transplante Heptico, Santa Casa de Misericrdia, Porto Alegre, Brazil
Introduction: De novo malignancy after liver transplantation is a
frequent complication in long-term survival recipients. The incidence in
several studies ranges from 3% to 15%, twice that of the general population.
Objectives: To evaluate the incidence, epidemiology, clinical characteristics, outcomes and tumor-specific mortality.
Methods: We reviewed the records of 883 patients who underwent 957
OLTs between 1991 and 2012 in a single centre in the South of Brazil, and
retrospectively identified all patients who developed de-novo malignances.
ABSTRACTS
Statistical analysis was performed using the Chi-square test, regression of
Cox and survival analysis using the KaplanMeier method.
Results: We identified 125 patients (14.1%) in this group with at least
one de-novo malignancy. Multiple tumors occurred in 29 (23.2%) of these
patients, and 185 tumors were diagnosed. The median survival time was
177.7 months and the median follow-up time was 150 months. Malignances
of the upper aerodigestive tract made up 17.3% of the cases, and had a
5-year survival of 76.4%. Lymphoproliferative disorders occurred in 13.6%
of the patients and had a 5-year survival of 41.2%. Non-melanoma skin
cancers were the most frequent malignances (46.4%), and squamous-cell
carcinomas represented 52.8% versus 47.2% of basal-cell carcinomas;
the 5-year survival in this group was 94.8% (P < 0.001 when compared
with other two groups). Other tumors together made up 22.4% and had a
5-year survival of 63.9%. Smokers performed 95% (P < 0.001 against other
groups) of the patients in the upper aerodigestive tract group, and alcoholic
cirrhosis was the cause of transplantation in 50%.
Conclusions: De-novo malignancy is a major problem in OLT recipients, and our data support the previously reported high mortality.
028252
A 5-year experience in oncological surgery in a large hospital
Accordi, C.C.1, Uliano, E.J.M.1, Reis, M.P.1
1
Introduction: Since its beginnings oncological surgery has aimed at
curing the disease; nowadays the quality of life is as important as all other
goals. Surgery has progressed a lot in the last few years. In the oncological
area the better knowledge of the natural history of tumors has allowed
surgeons to perform more conservative surgeries, with better functional and
esthetic results and the same cure rates, which has a considerable impact
on quality life.
Objectives: To demonstrate the experience of the surgical oncology
service in a large hospital.
Methods: Data collection was conducted and medical records of all
patients undergoing cancer surgery between 2011 and 2015 were reviewed,
as was the literature.
Results: Between 2011 and 2015 numerous oncological surgeries
were performed; more than half of these were rectosigmoidectomies for
colon neoplasms, followed by partial hepatectomy and esophagectomy. In
the same period 139 oncological laparoscopic surgeries were performed,
and only four needed to be converted to open surgery. Most patients had
no complications. Tumor recurrence was not too frequent; only 2.8% of
patients had tumor recurrence in surgical anastomses, lung, or the surgical
site. Today 55% of patients are alive without the disease.
Conclusions: We conclude that many of the cancer patients eligible
for surgical treatment have really good results. It is observed that the vast
majority of laparoscopic surgeries were performed successfully and with
very low conversion rates.
ABSTRACTS
028863
A case of primary spinal glioblastoma
Firmino, N.L.J.1, Gomes, A.S.A.2, Miranda, E.2, Oliveira, D.A.3,
Lima, M.B.A.1, Silva, G.L.R.1, Teixeira, W.G.1, Silveira, D.L.1,
Carvalho, L.A.1
1
2
UNIONCO Surgical and Clinical Oncology Institute, Recife, Brazil,
3
emiranda.onco@gmail.com, daniel@oliveiraalexandre.com,
marianebione@gmail.com, gabrielalucena90@gmail.com,
letowgtmed@gmail.com, deb.lucena@hotmail.com,
let.carvalho.94@gmail.com
Introduction: Primary spinal glioblastoma (GBM) is a rare disease
with an aggressive course and a poor prognosis. GBMs represents almost
7.5% of all intramedullary gliomas and 13% of all spinal cord tumours.
Unlike their intracranial counterpart, intramedullary GBMs have received
scant attention in the literature, with <200 cases reported. Even with
aggressive management, these tumours are generally associated with a
dismal outcome.
Objectives: To describe a case of primary spinal glioblastoma.
Methods: A 24-year-old male was transferred to our institution in June
2014 with an 8-week history of pain in the lumbar region, which progressed
to paraparesis associated with urinary retention. The patient underwent
brain and spine magnetic resonance imaging. The alterations were: from
T8 to T10 there was a marked spinal cord signal intensity and morphological alteration, with notable expansion of the spinal cord. The patient
underwent a laminotomy and laminoplasty between T8 and T11 and partial
tumor removal, followed by chemotherapy and radiotherapy.
Results: On follow-up 4 months after surgery, the patient presented
with spinal pain, hearing loss, and greater confusion. Given the disease
progression and the Karnofsky score (30%), we did not consider further
treatment and the patient succumbed to the disease 1 month later.
Conclusion: Primary spinal GBM is an extremely rare entity. Despite
aggressive treatment with radical surgery, radiotherapy and chemotherapy,
this disease progresses rapidly with a poor prognosis and a short survival
time. All current therapeutic measures have produced disappointing results,
and few data concerning their real value are available. Radical surgery is
suggested for confirmation of the diagnosis and for cytoreduction of the
tumour as an adjunct to radiotherapy and chemotherapy; however, no
standard treatment protocol has been established. The extent of surgical
resection and application of radiotherapy vary widely, and various chemotherapeutic regimens have been used in several reports. However, the value
of chemotherapy is still elusive.
029168
Abdominal wall tumor: resection and reconstruction with
monofilament polypropylene mesh
Falco, M.F.1, Vieira, Y.T.H.1
1
Department of General Surgery, Santo Antnio Hospital, Salvador, Brazil
mariofalcao@oi.com.br, yhirakawav@gmail.com
Introduction: Abdominal wall tumors are rare neoplasms which
account for 0.03% of all neoplasms, the desmoid tumor being the most
common histological type. The excision of said tumors may require a
reconstruction of the abdominal wall with the help of alloplastic materials
and/or skin flaps.
Objectives: To describe three cases of abdominal wall reconstruction
using monofilament polypropylene mesh.
Method: Three patients with abdominal wall tumors underwent resection of the tumor. Patient 1 had a CT scan of the abdomen which showed a
S155
hypodense tumor on the right rectus abdominis muscle near the iliac fossa;
the tumor measured 6.6 x 5.4 cm. Patient 2 had a nodule with well-defined
regular borders in the abdominal wall measuring 4.3 x 3.2 cm. Patient 3 had
two tumors restricted to the abdominal wall but without signs of invasion of
the peritoneum on magnetic resonance imaging.
Results: Patients 1 and 2 underwent resection of the right rectus
abdominis muscle with safety margins, while patient 3 underwent the excision of two bulky tumors as well as a big part of the aponeurotic muscle
wall. The abdominal wall was reconstructed with the rectus abdominis
fascia, omentum flap, and pelvic peritoneum with a cover made of monofilament polypropylene mesh. The histopathological study was compatible
with desmoid tumor in patients 1 and 3 and hemangioma with collagenized
stroma in patient 2, both with free surgical margins. All cases proceeded
without postoperative complications and with positive functional and
esthetic results.
Conclusion: The main restriction on the use of monofilament polypropylene mesh is the possibility of adherence to the loops of the bowel as well
as fistula formation. With the use of this technique, a barrier which prevents
this contact is raised. This way, the monofilament polypropylene mesh is
proven to be safe and applicable due to its lower cost and larger availability
in comparison to other alloplastic materials.
029176
Active search for skin cancer in patients with chronic inflammatory
diseases of the skin
Lira, G.A.1, Arajo, M.T.1, Barreto, L.K.D.1, Bisneto, J.B.M.1,
Medeiros, D.B.G.1
1
Potiguar University, Laurete International, Natal, Rio Grande do Norte,
Brazil. Dr Luiz Antnio Hospital, Liga Norte Riograndense Contra o
Cncer, Natal, Rio Grande do Norte, Brazil.
georgelira@hotmail.com, micheleteixeiraa@gmail.com,
laianabarreto@gmail.com, joaobernardomed@gmail.com,
brunoeng@gmail.com
Introduction: Chronic inflammatory skin disease is a risk factor for
skin cancer. Elephantiasis is one of theml this can be caused by a threadworm, Wuchereria bancrofti, or it can be a result of lack of hygiene in
injuries causing infection. It affects the lymphatic circulation, resulting
in thickening and verrucous changes in the skin due to the inflammatory
process and chronic fibrosis. So, preventing skin cancer has to be the main
goal in these patients. The skin alteration can be similar to skin cancer,
and to be distinguished, besides the anamneses, a skin biopsy is sometimes
necessary. This way, the treatment can be done with more accuracy.
Objective: To report a case of well-differentiated squamous-cell carcinoma, according to the first biopsy, in a patient with elephantiasis who has
repeated erysipelas.
Methods: Surgical and oncological monitoring of the patient was
carried out, followed by a review of the medical records and literature that
address the pathology involved.
Results: Case report: PNC, a 55-year-old Brazilian male, presented
with repeated erysipelas through 40 years and elephantiasis in his lower
limbs with infiltrative lesions and multiple nodules. Moreover, he had high
blood pressure and systemic rheumatoid arthritis. A skin biopsy of the
lower limbs was requested, which returned a result of well-differentiated
squamous-cell carcinoma with positive margins. The surgeons decided
that the patient should be subjected to multiple tumor resections, but only
one member at a time. Thus, the total resection of the skin of the left leg
was performed first, with programming for future follow-up with plastic
surgery. After the surgery, the result of the biopsy performed on the surgical
specimen did not show neoplasia. The patient was therefore encouraged to
continue the treatment with physiotherapy and plastic surgery, as well as
preventive follow-up.
S156
Conclusions: Elephantiasis is a chronic inflammatory disease, and is
a strong risk factor for skin cancer; thus it has to be monitored in order to
prevent skin cancer.
028487
Axillary lymph-node metastasis in neuroendocrine tumor of unknown
origin: a case report with review of literature
Moreira, R.C.L.1, Cintra, C.A.1, Salles, P.G.O.1, de Paula, P.H.M.1,
Lima, P.S.C.M.1, Ribeiro, P.M.G.1
1
Instituto Mario Penna, Brazil
renicecilia@me.com, cassioacintra@ig.com.br, pgosalles@gmail.com,
pedrohansendepaula@hotmail.com, paolacml@yahoo.com.br,
mgr.priscila@yahoo.com.br
Introduction: Cancer of unknown primary site is relatively common,
accounting for 45% of all invasive cancers. Of these, neuroendocrine
tumors (NET) comprise <5%. In most cases, NETs are diagnosed with
standard pathological methods such as immunohistochemical staining,
since they have a typical histological appearance.
Objectives: To describe a case of axillary lymph-node metastasis
from a neuroendocrine tumor which had been occult up to this time. We
also describe the steps up to the diagnosis, and present the results of an
extensive literature review to cover all the aspects of neuroendocrine tumor,
including the definition, presentation, classification, diagnostic evaluation,
prognosis, and follow-up.
Methods: Medical record data were used from the period 20102015
and a review of the related literature was carried out, referring to the last 5
years, via UpToDate and PubMed.
Case report: RS is a 90-year-old woman in cancer follow-up due to
multiple resections of epidermoid and basocellular carcinomas in the head
and arms for the last 15 years. In 2015 she presented with a palpable axillary mass, movable, with recent onset of pain, measuring 5.0 x 5.3 cm. The
main diagnostic hypothesis was metastatic epidermoid carcinoma. After
staging, an axillary lymphadenectomy carried out a resection of 23 nodes
and a malignant neoplasm with epithelioid cells without extranodal extension. The patient was referred to adjuvant radiotherapy while waiting for
immunohistochemistry, the result of which was positive for neuroendocrine
markers.
Results: Follow-up is mandatory for successusful oncological tretament. Early diagnosis and a less invasive approach can improve the quality
of life of the patient. We must bear in mind the possibilities of local recurrencence, nodal metastasis, and that new cancers can appear. This patient
frequently returned, and new skin cancers were removed often, always with
free borders. When she presented with the axillary mass our first impression
was metastasis, but with the oncological resection and immunohistochemistry another diagnosis was made.
Conclusion: Considering that NETs of unknown primary site are relatively uncommon, this is a relevant case report which should alert us to
the importance of follow-up and immunohistochemistry in the diagnosis
of metastatic cancer. This patient is still being researched, and the primary
site is not yet identified, but is most likely the gastrointestinal tract and/or
the lung.
029212
Cancer related with work in Salvador, BA, between 2008 and 2014: a
retrospective analysis of secondary data
Strappa, G.B.S.1, Freitas, V.F.2, Silva, I.O.3, Jesus, M.S.4, Matos, R.M.2,
Amaral, J.B.5
1
Nursing student, Federal University of Bahia, Salvador, Brazil, 2Medical
student, Federal University of Bahia, Salvador, Brazil, 3School Labour
YSA Safety Technique, Alagoinhas, Brazil, 4Speech student, Federal
ABSTRACTS
University of Bahia, Salvador, Brazil, 5Department of Community
giorgiabruna-2006@hotmail.com,
vdefritas@gmail.com,israeloliveira198@hotmail.com,mariazuos@live.com,
rayza_matos@hotmail.com, julianabamaral@yahoo.com.br
Introduction: Occupational cancer is caused by exposure to chemical,
physical, or biological agents, classified as carcinogens, present in the work
environment. The proportion of cases of cancer attributed to occupational
exposition is variable, ranging between 4% and 40%, depending on the type
of tumor and the methodology applied.
Objectives: To describe the clinical profiles of patients with cancer
(CA) related to work in Salvador between 2008 and 2014.
Methods: We used data from Sistema de Informao sobre
Hospitalizao (SIH/SUS) about cancer related to work between 2008
and 2014 in Salvador, and from DATASUS. Data were standardized by
age, gender, risk of being sick, and disease termination during the studied
period.
Results: We reported a total of three cases of occupational cancer in
2010, 2013, and 2014, respectively, i.e., one case each year. This means
that the risk of having cancer related to work in Salvador is 4/10,000,000
inhabitants per year. These cases occurred at the age range 2059 years,
33.3% (n = 1) being reported in patients between 20 and 29 years old and
66.7% (n = 2) between 50 and 59 years old. All patients were male. Nearly
33.3% (n = 1) were cured; 33.3% (n = 1) totally or partially not cured, and
in 33.3% (n = 1) the data werent found.
Conclusions: The risk of being sick by CA associated with work may
be underestimated because of the the lack of data notification and the low
incidence. The use of individual protection equipment, now used in most
companies working with raw materials and/or equipment which offer a
risk for the development of CA in the employee, could reduce this kind
of neoplasia.
029251
Metastatic choroidal carcinoma: identification and diagnosis
Machado, D.C.S.1, Dias, J.M.1, Lima, L.R.C.1, Tefilo, A.L.O.Q.1
1
Pontifical Catholic University of Gois, Goinia, Brazil
danielaschroff@hotmail.com, joicemd1@gmail.com,
lurian06@hotmail.com, analuizateofilo@gmail.com
Introduction: The choroid metastatic carcinoma is the most common
intraocular tumor due to its abundant vascular supply. The uveal tract is the
commonest site, with the choroid involved in about 85% of cases due to
its rich vascularization (which provides hematogenous dissemination). The
primary cancers that most commonly lead to choroidal metastasis include
breast cancer (4047%) and lung cancer (2129%).
Objectives: To carry out a literature review of the main clinical manifestations and forms of diagnosis of metastatic carcinoma of the choroid.
Methods: The methodology used to achieve this qualitative study
was carried out through an integrative unsystematic literature review. The
following steps were conducted: identification and delimitation of the
subject using formulated keywords in the literature (metastasis, carcinoma, choroid); analysis of articles and national and international journals
that were developed in the period between 2010 and 2015 and that had
relevance and thematic association; and obtaining information about the
topic under study, capture and storage of data after careful reading.
Results/conclusion: Based on the scientific evidence, it was found
that most patients with choroidal metastases already know the diagnosis
of systemic cancer at the diagnosis of intraocular cancer. However, in 34%
of cases, choroidal metastasis precedes the diagnosis of systemic cancer.
The most common signs and symptoms are: eye pain, exophthalmos,
retinal detachment, mass injury, uveitis, secondary glaucoma, decreased
ABSTRACTS
visual acuity, image distortion, blind spot and diplopia. Ocular tumors are
diagnosed by clinical examination and ultrasonography, and the indirect
ophthalmoscopy photo is the gold standard. A biopsy is reserved for cases
that require diagnostic confirmation.
029242
Case report of squamous-cell carcinoma on the hand of a patient from
the interior of RN without medical care
Lira, G.A.1, Holanda, A.M.2, Silva, R.P.3, Magno, A.W.G.3, Costa, T.R.P.3
1
Department of surgical Oncology, Hospital M.D. Luiz Antnio, Natal,
Brazil, 2Academic of medicine, Federal University of Rio Grande do
Norte, Natal, Brazil, 3Academic of medicine, Potiguar University, Natal,
Brazil
georgelira@hotmail.com
Introduction: The squamous-cell carcinoma originated in the outer
layer of the epidermis and accounts for 20% of all cases of non-melanoma
skin cancer. Generally it appears on the face, ear, mouth, neck and back
of the hand, and may also arise from old chronic wounds or scars of the
skin anywhere on the body. Squamous-cell carcinomas have a higher risk
than basal-cell carcinomas of invading the hypodermis, reaching the lymph
nodes and other organs.
Objectives: To report a case of a patient of the Riograndense Northern
League Against Cancer with squamous-cell carcinoma that arose in a scar,
emphasizing the importance of early medical attention since this patient
was well advanced at the time of surgical approach to its removal.
Methods: This was a case report based on information collected from
PPG patients medical record; the patient was 73 years old, came from
Bom Jesus/RN, and presented with a vegetating lesion on the dorsum of
the right hand wound scar 2 years ago; the lesion hurt, bled and was itchy.
On 11.03.2015 an x-ray examination made at the site of the lesion revealed
a reduction in the distal and proximal interpharangeal joint spaces of the
fingers and first metacarpal joint trapezoid, and increased soft tissue around
the metacarpal of the thumb. A biopsy of the lesion was then performed,
revealing a moderately differentiated squamous-cell carcinoma (grade 2
Broders) with infiltration of soft tissues. The patient was then submitted to
disarticulation of the right hand on 12/06/2015.
Results: Patient diagnosed through clinical examination and biopsy
results undergoing disarticulation of the right wrist surgery with curative
intent.
Conclusions: This case demonstrates the need for early search for
medical care arise suspicious lesions in the skin and the importance of rapid
diagnosis in order to avoid aggressive behavior and possible death.
029257
Case report: a woman patient with expansive spindle-cell neoplasm in
the pelvic region
Lira, G.A.1, Holanda, A.M.2, Magno, A.W.G.3, Silva, R.P.3, da
Costa, T.R.P.3
1
Departmento cirurgia oncologica, hospital Lus Antnio, Brazil,
2
Universidade Federal do Rio Grande do Norte, Brazil, 3Universidade
Potiguar, Brazil;
georgelira@hotmail.com, ayrtonmh@gmail.com,
alexandre_wgm@hotmail.com, rafaelpacheco_s@hotmail.com,
quel.pc@hotmail.com
Introduction: A tumor is classified as spindle-cell when it is impossible to distinguish exactly what type of cancer is occurring, whether due to
abnormal behavior or growth patterns.
Objective: To report Liga Norterriograndense Contra o Cancer hospitals patient case, diagnosed with fusiform-cell cancer and presenting only
S157
a tumor mass in the pelvic region and a uterus prolapse. The importance of
global evaluation of the body segments is highlighted in order to obtain an
early diagnosis in asymptomatic cases like the one described that may pass
unnoticed for lack of a full clinical exam.
Methods: This was a case report with information collected from
patient EMAs records; the patient was 89 years old, diagnosed in June
2015 through study of a CT scan image which showed a voluminous tumor
mass in the right pelvis/adnexial region. The tumor had a necrotic/liquefying component, compressing the rectum posteriorly and dislocating the
bladder anteriorly and the uterus to the left; it measured approximately
11.8 x 11.2 x 10.7 cm. The patient underwent exploratory laparotomy for
lesion resection; the material was sent for a for frozen section exam that
concluded it was a spindle-cell neoplasm. Besides resection of the mass,
a right pelvic and retroperitoneal lymphadenectomy were performed with
total amplified hysterectomy and removal of the vaginas superior third
portion due to a suspicious finding on surgery; freezing showed the presence of a uterine leiomyoma.
Results: The patient was diagnosed via physical examination and laboratory tests, and was submitted to surgery with curative intent afer frozen
section examination results demonstrated spindle-cell neoplasia, reactive
lymphoid hyperplasic lymph nodes, and a leiomyoma.
Conclusion: This case demonstrates the importance of a thorough
physical examination aiming to detect changes that may indicate the need
for a deeper approach to detect the underlying cause and effective interventions aiming at patient survival. The immunohistochemical examination
will guide the follow-up of the patient.
028551
Complete remission of cutaneous angiosarcoma with chemotherapy
Zanotto, M.B.1, Krummenauer, M.L.S.1, Dotto, M.S.3, Balzan, S.M.P.3
1
Facudlade de Medicina, Universidade de Santa Cruz do Sul, Santa Cruz
do Sul, Brazil, 2Departmento Acadmico, Universidade de Sant Faculdade
de Medicina, Universidade de Santa Cruz do Sul, Santa Cruz do Sul,
Brazil, 3Centro de Oncologia Inegrado, Hospital Ana Nery/ Faculdade de
Medicina, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
Introduction: Primary cutaneous sarcomas are uncommon mesenchymal neoplasms. Angiosarcoma is a rare subtype of cutaneous malignant
sarcoma (less than 2% of all soft-tissue sarcomas). It is a vascular tumor,
situated typically in the head and neck (mainly on scalp). Old age, whiteskin, and male gender are risk factors. The optimal treatment is not well
established and depends on the extent of the disease. The current consensus
is the use of combined therapy, including surgical resection with negative
margins plus radiotherapy associated or not with chemotherapy.
Objective: To report a case of a cutaneous angiosarcoma of the face
and scalp in an aged female successfully treated with chemotherapy alone.
Methods: Record review and case report.
Results: An 86-year-old female presenting lesions suggestive of
periorbital cellulitis and erythematous nodular lesions on the scalp was
initially treated for cutaneous infection (60 days antibiotic therapy) with
no improvement. Incisional biopsies of the face and scalp demonstrated
atypical cellular infiltration of the skin. Immunohistochemistry was positive for CD31 and ERG antibodies, confirming endothelial histogenesis of
neoplastic cells and the diagnosis of cutaneous angiosarcoma. Treatment
with a weekly dose of paclitaxel resulted in progressive reduction of the
lesion, and complete disease remission was observed after 5 months.
Therapy was continued for additional 3 months with no evidence of
recurrence.
Conclusion: Complete remission of cutaneous angiosarcoma is
possible with exclusive paclitaxel therapy. This therapeutic approach repre-
S158
sents an option for cutaneous angiosarcoma and could avoid the need for
surgical resection.
028395
Differences and pitfalls in laparoscopic pelvic lymph-node dissection
between male and female patients
Ribeiro, R.1, Luz, M.A.1, Rebolho, J.C.1, Kool, R.1, Kondo, W.2,
Linhares, J.C.1
1
Brazil, 2Gynecology Department, Vita Batel Hospital, Curitiba, Brazil
reitanribeiro@hotmail.com,
muriloaluz@gmail.com,jcrebolho@yahoo.com.br,ronald.kool@yahoo.com.br,
williamkondo@yahoo.com, linhares@iop.com.br
Introduction: Lymph-node dissections are among the most common
procedures performed by surgical oncologists. Differing from all other
anatomical sites, laparoscopic pelvic lymph-node dissection (LPLND)
has a large number of particularities which depend on the gender of the
patient. Familiarity with major differences and pitfalls of this procedure can
help the surgeon in selecting a more suitable surgical strategy according to
patient gender.
Objective: To compare specific characteristics of LPLND according
to patient gender.
Methods: Using surgical videos presented side by side we describe
the LPLND in male and female patients. The differences start during the
patient positioning; while women are placed in the split-leg position, in
men this positioning is not imperative. In women the most usual trocar
placement is the French arrangement, and although the same could be
used for men, usually the trocars are in different places, particularly in prostate cancer. While in women the surgery starts with the round ligament
section, in men there is no such ligament and the spermatic duct runs into
the internal inguinal ring and should not be divided. In women the uterus is
used to help exposure of the paravesical and pararectal spaces. In men, stay
sutures can help with the exposure. A mans pelvis is much narrower than
a womans, and this characteristic makes internal iliac vessel dissection
challenging and the 30 scope becomes more necessary. Differences are
also found during the iliolumbar fossa dissection. The postoperative care
is quite similar and major differences are related to associated procedures
such as prostatectomy or radical hysterectomy and not to the LPLND per
se. In cases of isolated LPLND, diet is resumed in 6 hours after surgery and
patients are usually discharged on postoperative day 1, as long as they have
normal diuresis and good pain control.
Conclusion: LPLND performed in men and women have many
anatomical differences which require specific surgical tactics.
028533
Emotional reactions of nursing professionals who watch children with
cancer
Santos, I.I.A.1, Santos,L.S.B.1, Costa,K.F.L.1, Leite,A.R.1, Rocha,I.D.1,
Gomes,I.C.2, Pinheiro,U.A.M.R.1, Oliveira,A.M.T.S.1, Pereira,K.S.M.2
1
New Hope Nursing Faculty of Mossoro, Mossor, Rio Grande do Norte,
Brazil, 2Institute of education university Lion Sampaio, Juazeiro do Norte,
Cear, Brazil
iarailkas2@hotmail.com
Introduction: Cancer being a disease closely linked to a sense of
struggle, suffering and death, it triggers feelings of sadness, anxiety and
impotence, especially when its a childhood cancer. In this respect, taking
care of children with cancer is a great challenge and a great anguish for
health professionals.
ABSTRACTS
Objective: To analyze the perceived emotional reactions in the nursing
staff who assist children with cancer.
Methods: The survey was conducted with six nurses and four nursing
technicians who assist children with cancer in a cancer hospital. This is a
survey of an exploratory and descriptive type, with a qualitative approach.
For the data collection a semi-structured interview was conducted and
the data analysis used the collective subject discourse. The research was
approved by the Ethics Committee of the Riograndense Northern League
against cancer.
Results: All the study participants were women, single women, mostly
of age between 30 and 40 years and working 110 years with children with
cancer. The interviewed participants reported feeling sadness, anguish,
anxiety, helplessness, frustration, failure and a minority reported feeling
sorry, anger or outrage. Emotional reactions like these occur because it is
a profession that follows directly the children with cancer for a prolonged
time, enabling a greater involvement and training of affective bonds, both
with children and their families. The interviewed participants stated that
they receive emotional support in the institution through the psychologists,
lecturers and work team. This psychological support is a positive thing,
because those professionals deal directly with the struggle, suffering and,
often, with the death of a child with cancer.
Conclusion: Nursing professionals feel some emotional imbalance
because of the suffering of children with cancer who were in their care;
some have shown lack of preparedness to handle this situation; they experience the suffering of the child with cancer, as well as the despair and
anguish of their families.
029306
Endoscopic gastrostomy with an economic kit
Freire, A.N.M.1, Freire, M.D.M.2, Johnson, L.F.P.3, Pereira, L.A.O.S.1, Del
Pozo, F.A.2, Lopes, A.R.C.2
1
Servio de Cirurgia Geral, Hospital Santa Izabel, Santa Casa de
Misericrdia da Bahia, Salvador, Brazil, 2Servio de Nutrio Enteral e
Parenteral, Hospital Santa Izabel, Santa Casa de Misericrdia da Bahia,
Salvador, Brazil, 3Servio de Cirurgia Oncolgica, Hospital Santa Izabel,
Santa Casa de Misericrdia da Bahia, Salvador, Brazil
andreney.freire@gmail.com, marcosdmfreire@yahoo.com.br,
fernando.johnson@uol.com.br, lucianoarthurpereira@hotmail.com,
francodlpz@gmail.com, arclopes@terra.com.br
Background: Gastrostomy for nutritional purposes can be accomplished by laparotomy, laparoscopy or endoscopy. The Enteral and
Parenteral Nutrition Service (SENEP) from Santa Izabel Hospital developed its own kit in order to cause the patient less surgical trauma and reduce
hospital costs.
Purpose: To describe a simplified method of performing endoscopic
gastrostomy with an economic kit.
Methods: The procedure is done with the patient in dorsal decubitus
under sedation. Asepsis and antisepsis are carried out and sterile surgical
drapes are placed. High digestive endoscopy and visualization of the body
and gastric antrum is carried out. Four points are marked in the epigastrium
by drawing a rectangle for percutaneous puncture with Gelco 14 which
permits the passage of two pronele 00 wires and allows the formation
of two U-knots with 2 cm between them. After that, the wires are pulled
up for fixing the stomach wall to the abdominal wall. An incision is made
with an 11-blade scalpel between the points for the passage of curved
Kelly forceps. The process follows with the introduction of a number 20
Foley probe under direct vision. It terminates by fixation of the U knots
and probing with a silicone tube that is attached to the fixation wires in the
abdominal wall.
Results: The procedure lasts about 15 minutes from the anesthesia,
so the patient gets less exposed to anesthetic agents. The smaller incision
ABSTRACTS
causes a minor trauma, which causes an inferior inflammatory response
and a faster recovery. The costs are lower because the instruments used are
cheaper than those utilized in the conventional techniques.
Conclusion: The adaptation of the endoscopic gastrostomy techniques
using a kit, in addition to the advantages over the conventional techniques
such as the shorter time it takes, lower costs and causing less surgical
trauma to the patient, it can also be realized in patients with oropharyngeal
tumors using the thin endoscope.
029184
Evaluation of the growth of Erlich solid tumor under the effect of
leptin
Bortoletto, B.L.1, Aquino, D.R.R.A.1, Silva, I.S.2, Ramalho, R.T.2,
Dourado, D.M.1, Souza, V.J.1, Ferzeli, C.F.1
1
University Anhanguera, UNIDERP (University for Development of State
and Pantanal Region), Campo Grande, Brazil, 2Federal University of Mato
Grosso do Sul, Campo Grande, Brazil
beatrizlongob@gmail.com
Introduction: Several factors are described as carcinogenesis inducers
or promoters, and among them are hormones. Epidemiological studies
have been demonstrating the importance of leptin, a hormone produced
by adipocytes, in breast cancer development. It is involved in the process
of mitosis, metabolic regulation and angiogenesis. Ehrlich tumor was
described as a spontaneous adenocarcinoma of mammary glands in female
mice, and this model has been used in research since then because of its
ease of experimental manipulation.
Objective: To evaluate the effect of the hormone leptin on the growth
of Ehrlich solid tumor.
Methods: We used 12 female mice of the Swiss strain at 60 days of
age, weighing from 25g to 30g, into which was injected subcutaneously a
suspension with 2.5 x 106 tumor cells between the footpads of the left hind
limb. The animals were randomly separated into two groups (n = 6), control
(C) and treatment with leptin (L). All groups received injections of tumor
cells and the L group received, 7 days after tumorigenesis induction, treatment with leptin. A tumor growth curve was determined by measuring the
inoculated paw from the first to the 19th day, when then the animals were
euthanized and necropsied.
Results: Leptin-treated animals showed exponential tumor growth
when compared to the control group, with a significant difference (P
> 0.01), indicating that this substance acted to induce a tumor cellular
response.
Conclusion: This study indicates that leptin promotes a development in the growth of Ehrlich solid tumor, acting like a substance modulating tumorigenesis and as a possible pro-carcinogenic factor. Prospects
for future studies with functional inhibition of leptin may be effective in
preventing and treating cancer.
029309
Technical adaptation of gastrostomy: the use of an endoscopic
gastrostomy kit for open gastrostomy
Freire, A.N.M.1, Freire, M.D.M.2, Johnson, L.F.P.3, Del Pozo, F.A.2,
Silva, I.C.2, Lopes, A.R.C.2
1
Servio de Cirurgia Geral, Hospital Santa Izabel, Santa Casa de
Misericrdia da Bahia, Salvador, Brazil, 2Servio de Nutrio Enteral e
Parenteral, Hospital Santa Izabel, Santa Casa de Misericrdia da Bahia,
S159
Salvador, Brazil, 3Servio de Cirurgia Oncolgica, Hospital Santa Izabel,
Santa Casa de Misericrdia da Bahia, Salvador, Brazil
andreney.freire@gmail.com, marcosdmfreire@yahoo.com.br,
fernando.johnson@uol.com.br, francodlpz@gmail.com,
ianacsilva@yahoo.com.br, arclopes@terra.com.br
Background: Gastrostomy can be carried out by laparotomy, laparoscopy or endoscopy for gastric decompression and/or food intake. The
Enteral and Parenteral Nutrition Service (SENEP) from Santa Isabel
Hospital developed an adaptation of open gastrostomy for providing less
surgical trauma and cost reduction.
Purpose: To describe a simplified method of performing open
gastrostomy.
Methods: The authors applied a technical adjustment to the open
gastrostomy using the endoscopic gastrostomy kit. This procedure should
be performed in those patients in whom the endoscopic device cannot be
passed due to oropharyngeal obstruction. After the opening of the abdominal wall, the point of higher mobility is chosen, and the surgeon proceeds
with a vertical incision about 2 cm long. With the opened stomach, a punch
is done using jelco (outsideinside) of the abdominal wall until the inside
of the stomach is reached. So, the guide-wire is passed into the stomach
and is fixed to the gastrostoma which is pulled to finish the gastrostomy.
After the fixation of the gastrostoma, the stomach is closed using prolene
3.0 in a continuous suture.
Results: This method allows the exchange of the gastrostoma for a
silicon bottom after 6 weeks, instead of the procedure that uses two bags at
the gastric wall with prolene wire.
Conclusions: The adaptation of the open gastrostomy technique
appears to have advantages over the conventional technique.
029117
Giant myopericytoma of the right brachial triceps: a case report
Igreja Jnior, H.J.S.1, Carvalho, B.S.V.1, Mendona, S.B.1,
Mendona, G.B.S.1, Batista, V.L.1, Coelho, J.G.1
1
Sociedade de Beneficncia Portuguesa de Campos, Brazil
haroldoigreja@hotmail.com, Brunosvcarvalho@hotmail.com,
sandro.bichara@gmail.co, gabriel_s_m_@hotmail.com,
vilson_leite@msn.com, jugoncalvescoelho@hotmail.com
Introduction: The myopericytomas may be defined as unusual or
rare perivascular mesenchymal neoplasms. Most cases of myopericytomas
are benign, but atypical or malignant tumors can occur associated with
episodes of local recurrence and, rarely, metastasis.
Objectives: To report the case of a large myopericytoma in a male
patient, presented as a large growth in the right triceps. It was submitted to
incisional biopsy and appeared to be undifferentiated neoplasm; the definitive diagnosis was made after surgical resection.
Results: A 36-year-old man presented with a tumor growth of about
4 years, painless, and without motility disorders. At physical work up, a
semi-fixed bulky tumor was found on the right triceps, measuring 30 cm in
its longest axis, with no signs of axillary or cervical lymphadenopathy, no
signs of sensitivity deficits, and no extensor tone deficit. A radical tumor
resection was performed through partial resection of the brachial triceps,
with preservation of the medial head of the triceps and right radial nerve.
Conclusion: The myopericytoma requires differential diagnosis with
the group of diseases known as perivascular myoid cell neoplasms, which
are rare skin and soft tissue lesions; they most often affect middle-aged
adults and are frequently located in the dermal or subcutaneous tissue,
at the distal portion of the lower limbs. Most myopericytomas behave
benignly (painless and with slow growth); however, rare cases of malignant myopericytoma have recently been reported, and these can be more
aggressive. Recurrent cases or malignant myopericytomas are rarely
S160
reported, supporting treatment with conservative surgery. In our case, there
is no evidence of recurrence during follow-up, and little functional deficit.
Surgical resection is the preferred treatment method, with excellent results
and a low local recurrence rate.
028954
Immature sacrococcygeal teratoma: a case report
Vieira, L.J.1, Lima, A.P.2, Rodrigues, J.V.L.1, Vieira, F.J.1, Assis, E.A.C.P.3
1
Department of Surgical Oncology, ASCOMCER Hospital, Juiz de
Fora, Brazil, 2Faculty of Medical Sciences and Health of Juiz de Fora/
SUPREMA, 3Department of Pathology, Centre for Research and
Diagnosis in Pathology (CIDAP), Juiz de Fora, Brazil
ljvieira@terra.com.br, amandapl.md@gmail.com
Introduction: Neoplastic lesions of the sacrococcygeal region are
very uncommon and are rarely encountered in current surgical practice.
Approximately 4060% of teratomas are located in this region.
Objective: To report a case of a patient with an immature sacrococcygeal teratoma, with emphasis on diagnosis and treatment.
Methods: An electronic search was conducted using the SciELO and
PubMed databases to select relevant studies; medical records were also
review. A 17-year-old girl had a history of significant tenesmus and pain
in the perianal region radiating to the lower limbs. On physical examination, the digital rectal exam detected an extrarectal tumor blocking the
rectum and vagina. Abdominal CT showed a massive pelvic solid-cystic
mass, and MRI of the lumbosacral spine showed a cystic lesion, solid
right adnexal, extraovarian, measuring 10.5 x 8.7 x 7.8 cm. Laboratory
investigation demonstrated normal beta-hCG, alpha-fetoprotein, CA 19-9,
CA-125 and CEA, but higher values of LDH (905 U/L). The patient underwent laparotomy with wide surgical resection of the retrorectal tumor
which adhered closely to the last sacral vertebrae. The tumor was lobulated
measuring 8.0 cm. Microscopy showed a nodule composed of small round
cells, forming rosettes in some areas. Immunohistochemistry (IHC) showed
focal SALL-4 expression for cytokeratin and S-100 protein and synaptophysin, findings suggestive of high-grade malignancy; the tumor resembled
an immature teratoma. The patient underwent chemotherapy, and after 6
months the MRI showed an expansive formation with 2.0 x 2.1 x 2.0 cm
affecting the vertebral body at S4 and S5 with extension to soft tissues.
With the patient in the prone position, with a midline incision a sacrectomy
at the S3 level was held. The pathological study showed residual malignancy, with desmoplastic stroma, 2.5 x 1.5 x 1.0 cm, without morphological
differentiation signals, and free margins. IHC indicated residual neoplasia
with epithelioid focal expression of NSE and vimentin without expression
of other markers.
Conclusions: Complete tumor resection is the main goal in the curative treatment of teratoma. These tumors may be downstaged after a course
of chemotherapy to allow surgery with free margins.
028974
Implementation of a specific checklist protocol for safety in
oncological laparoscopic surgery
Utiyamada, N.L.1, Reis, R.2, Vieira, M.A.2, Andrade, C.E.M.C.2,
Nascimento, T.G.2, Tsunoda, A.T.2
1
Faculdade de Cincias da Sade de Barretos Dr Paulo Prata (FACISB),
Barretos, So Paulo, Brazil, 2Barretos Cancer Hospital, Barretos, So
Paulo, Brazil
nara.lie@hotmail.com, dr.ricardoreis@hotmail.com,
mvieiraonco@gmail.com, mdcarlosandrade@gmail.com,
talita.nap@hcancerbarretos.com.br, atsunoda@gmail.com
ABSTRACTS
Introduction: Laparoscopy offers a number of benefits, but as with
any medical procedure, it may be associated with complications. In 2008,
the World Health Organization published a surgical safety checklist, which
reduced mortality and complications. Few studies regarding a checklist for
safety in laparoscopy have been performed.
Objective: To assess the impact of the implementation of a specific
checklist for laparoscopic surgery.
Methods: From April 2015 to June 2015, in consecutive cases from a
referral cancer center (with laparoscopy as a routine for more than 10 years),
we applied a specific checklist related to laparoscopy, just before the surgical
incision. The scrub nurse answered the items. RB:41821415.7.0000.5437/
Local IRB:921/2015
Results: One hundred and five cases were included, in the following
departments: 34.3% gynecology, 24.8% urology, 22.9% upper gastrointestinal, 16.2% colorectal, and 1.9% thoracic. Mean time and median time for
checklist completion was 2.13 minutes (SD = 1.44), and 2.0 minutes (110
minutes), respectively. In 38.1% of the procedures, sealing devices were
not checked, and in 13.3% they were not available. In 27.6%, the CO2 gas
source was not checked, and in 2.9% monitors were not working. The cables
were disconnected in 4.8%, and in 24.8%, pedals were misplaced. Optical
fiber cables had imperfections (5.7%), and trocars were not checked (9.5%).
A decrease in inadequacies was observed over time, mainly regarding the
trocars not being evaluated (17.6% April versus 3.1% June), and imperfections in the optical fiber cable (11.1% April versus 3.1% June). However, it
was not possible to verify a significant impact in reducing problems during
surgery by the checked items.
Conclusions: The specific checklist identified a significant number of
inadequacies before incision. There was a tendency towards reducing the
inadequacies over time, during the 3 months of implementation of this new
specific checklist. Large numbers are needed in order to measure the impact
of this checklist in reducing problems during laparoscopy.
028574
The importance of individual antibiotic therapy for oncological
patients
Moreira, R.C.L.1, Brazes, F.A.S.1, Silva, S.G.1, Melo, M.C.1,
Salles, P.G.O.1, Jnior, M.G.C.1
1
Mario Penna Institute, Belo Horizonte, Brazil.
renicecilia@me.com, flavia_brazoes@yahoo.com.br,
simony.goncalves@mariopenna.org.br, mariana.melo@mariopenna.org.br,
pgosalles@gmail.com, mariogissoni@hotmail.com
Introduction: Urinary tract Infection (UTI) is one of the most
common causes of infection in the general population. The UTI can be
classified according to location in the lower UTI (cystitis) and in the higher
UTI (pyelonephritis), and according to the presence of complicating factors
in uncomplicated and complicated UTIs.
Objectives: To show the importance of individual antibiotic prophylaxis and therapy in an oncological patient with repeated UTIs caused by
enterovesical fistula due to colon neoplasia; the preoperative preparation of
the skin to avoid infectious postoperative complications is necessary.
Case report: Patient DRM presented with abdominal pain, colic and
melena for months. Colonoscopy was carried out on 04/23/15; this revealed
a vegetating lesion, semi-stenosing the low sigmoid. Histology showed an
adenoma with areas of adenocarcinoma. The patient also reported pneumaturia, and various treatments for repetitive UTIs with Clavulin, cephalexin
and later ciprofloxacin were given without improvement. Preoperative
exams of the urine found the presence of multiresistant Eschericia coli
sensitive to meropenem. We started to bath the patient in preoperative clorhexidine and administered meropenem 2 days before surgery; antibiotic
therapy was continued to 7 days after operation. By 06/16/2015 a rectosigmoidectomy was performed with terminal colonrectal anastomosis and
ABSTRACTS
partial resection of the bladder en bloc. By 06/25/15 urine culture was negative. The patient received hospital discharge with a bladder catheter French
22.
Conclusions: The choice of antimicrobial therapy for UTI varies
with the presentation of the infection, host and agent. Strategies involving
different treatment regimens according to specific patient groups maximize
the therapeutic benefits and reduce costs, incidence of adverse effects,
and emergence of resistant organisms. In contaminated surgeries antibiotic therapy is indicated. A presurgery antibiogram directed us to use
meropenem preoperatively. We discussed with the nosocomial infection
service the antibiotic therapy program which was designed for the referred
patient. Postoperatively there were no infectious complications, showing
the success of the approach taken.
028956
Knowledge about breast cancer in users of a family health center
Oliveira, W.R.1, Taumaturgo, A.I.1, Fonteles, A.F.1, Melo, I.S.1,
Freitas, H.C.1, Silva, T.O.1
1
Faculty of Medicine, Federal University of Cear, Sobral, Brazil
wanessa.r.oliveira@hotmail.com, igortaumaturgo@gmail.com,
amandafonteles81@gmail.com, acd.isadoramelo@gmail.com,
hermanycf@hotmail.com, thaisoliveirasilva27@gmail.com
Introduction: Breast cancer is the second leading cause of death
among Brazilian women and the leading cancer affecting females in Brazil.
According to data from INCA (National Institute of Cancer Jos Alencar
Gomes da Silva), in 2014 the estimated risk was 56.09 cases per 100,000
women. From this perspective it becomes essential to strengthen preventive
education with the aim of early diagnosis.
Objective: To identify and evaluate the knowledge about breast cancer
in users of a family health center (FHP) in the city of Sobral, Cear, Brazil.
Methodology: We interviewed 36 women between 20 and 60 years of
age. Interviews occurred while waiting for some users of the health service.
The survey had closed questions about breast cancer self-examination,
consultation with a gynecologist, prevention campaigns, sources of knowledge and participation of health professionals. The FHP chosen is located in
the neighborhood of Terrenos Novos in the city of Sobral.
Results: Of the respondents, 91.6% said they know what breast
cancer is, 100% think important to conduct campaigns on cancer, 63.8%
had received information on prevention in any campaign, and 72.2% have
received some guidance from a nurse. Although the information on this
cancer reaches lot of respondents, it is clear that it is not a significant
number of those who take preventive measures. The annual consultation
to the gynecologist, for example, is in practice only 47.2% of the women
interviewed, while 30.6% do not perform self-examination. Of those that
do, only 36% do so monthly. Of the 36 respondents, 66.6% answered that
they know how to self-examine their breasts.
Conclusions: Although a large portion of users have knowledge about
breast cancer, it is important to reach more women, stimulate the realization
of preventive measures, and facilitate access to annual appointments with
the gynecologist.
029076
Metastatic leg lesion in pleomorphic adenoma of the parotid
Rabello, C.1, Nunes, L.F.1, De Arajo, M.S.1, Cardoso, M.W.C.1,
Machado, L.M.1, Anginski, M.A.1
1
National Cancer Institute (INCA), Rio de Janeiro, Brazil
crismeduff@gmail.com, lnunes@inca.gov.br, drmarcelosa@gmail.com,
michelcalabria@yahoo.com.br, lucasmediugf@gamil.com,
anginsk@ig.com.br
S161
Introduction: Pleomorphic adenoma constitutes the most common
benign parotid gland tumor. Local recurrence after surgical treatment
(lateral or total parotidectomy) has been described in 15% of cases.
Malignant degeneration has been reported in 29% of cases of pleomorphic
adenoma of salivary gland origin. Metastasizing pleomorphic adenomas
without histological evidence of malignancy have rarely been reported.
Metastatic lesions have been discovered in bone, lymph nodes, the lung,
oral cavity, pharynx, skin, liver, retroperitoneum, kidney, calvarium, and
central nervous system.
Objective: To report a case of pleomorphic adenoma of the parotid
gland metastasizing to legs.
Method: Case report.
Results: A 78-year-old female was evaluated in December 1996 with
a right cervical tumor. The tumor was excised with a superficial parotidectomy that spared the facial nerve and radical cervical dissection in
May 2004. The histopathological diagnosis of the tumor was pleomorphic
adenoma. The patient developed four local recurrences, which were treated
with resection of lesions in 2009, 2010, 2011 and 2013. In November 2014
patient evolved with a large tumor on her left leg. The patient was sent to
resection of the lesion in February 2015 and the histopatological diagnosis
was a pleomorphic adenoma.
Conclusion: Pleomorphic adenomas are not malignant histologically
but probably recur as a result of incomplete excision or inadvertent disruption of the tumors. We believe that disrupted tumor cells may be transported through hematogenous or lymphatic routes, resulting in eventual
metastasis. Metastasis of these benign pleomorphic adenomas is closely
associated with intraoperative implantation of tumor cells through a hematological or lymphatic route, and meticulous resection in the first surgery is
crucial to prevent local recurrence and distant metastasis.
029282
Leiomyosarcoma of the cecum: a case report
Genaro, A.1, Filho, M.A.F.2, Gonalves, M.C.3, Netto, W.J.M.3,
Horie, M.K.S.3, Pereira, L.P.3
1
Department of Oncology, Presidente Prudente Regional Hospital,
Presidente Prudente, Brazil, 2Department of Surgery, Presidente Prudente
Regional Hospital, Presidente Prudente, Brazil, 3University of Oeste
Paulista, Presidente Prudente, Brazil
andregennaro@hotmail.com, franco.80@hotmail.com,
marcella.cgoncalves@gmail.com, willymacedo@gmail.com,
matheus_horie@hotmail.com, larissa_ppereira@yahoo.com.br
Introduction: The leiomyosarcoma is extremely rare among digestive tumors. Of sarcomas of gastrointestinal origin it represents 1% of
cases, divided into various classifications, where leiomyosarcoma occurs
in 510% of cases compared to the entire digestive tract, and of those, only
0.1% are tumors of the colon. Treatment for this type of cancer consists
of surgical resection with clear margins. Metastases occur predominantly
through the blood to the liver and lymph nodes are rarely affected.
Objective: To describe a rare case of source sarcoma in the cecum, one
leiomyosarcoma, surgically treated with R0 resection on 5/18/15.
Methods: This was a case report presentation with description, discussion and conclusion of the case treated surgically with a database search
(PubMed).
Results: A 77-year-old female patient, married, was admitted to our
hospital on April 22, 2015 from the AME (Outpatient Medical Specialties)
with a rapidly progressive complaint of pain in the right iliac fossa (RIF)
starting 3 months earlier and associated with the loss of 10% by weight
during the period without any other complaints. A CT scan of the abdomen
and chest was performed, and total abdominal USG and a colonoscopy
identified an expansive mass in the RIF. The patient was hospitalized and
underwent exploratory laparotomy with right hemicolectomy in oncology
S162
on 05/18/15. The tumor had dimensions of 10.5 cm in its longest axis, free
surgical margins; the absence of angiolymphatic and perineural invasion
confirmed leiomyosarcoma grade 3. The patient recovered uneventfully
and was discharged on 05/27/15.
Conclusion: Leiomyosarcoma of the cecum is rare and difficult
to diagnose, requiring resection for further confirmation. The approach
should, whenever possible, be to perform resection with wide margins, R0,
knowing that local recurrence can be expected if the margins are compromised. Currently adjuvant chemotherapy may be used as an aid in cases of
leiomyosarcomas grade II/III. For patient safety clinical examination and
imaging are essential for detection of neoplastic recurrence or even distant
metastases.
029134
Maffucci syndrome
De Paula, W.T.1, Santos, C.H.F.1, Quinto, F.C.1, Rompinelli, T.K.R.1,
Silva, T.V.1, Siqueira, Y.T.F.1
1
Alloy of Surgical Clinic, University President Antonio Carlos, Brazil
wtassipaula@gmail.com, carloshenriquemedi@gmail.com,
quintaoflavia@gmail.com, thaiskneipp@hotmail.com,
thiago.vidal.182@gmail.com, siqueira.yasmin@yahoo.com.br
Introduction: Maffucci syndrome (or endochondroma with multiple
angiomas) is a rare and non-hereditary disorder characterized by the presence of multiple enchondromas associated with multiple hemangiomas (or
in some cases lymphangiomas). It was first reported by Maffucci in 1881
and, in 1941, Carleton et al proposed the eponym Maffucci syndrome.
The lesions are asymmetrically distributed and there is no race or gender
predilection. Clinical manifestation begins around 45 years of age, with
25% of cases being congenital. Many reports also describe lesions of the
gastrointestinal system (occult microcytic anemia from hemorrhage) and
the upper airways, causing rapid respiratory compromise. Oftentimes, these
enchondromas can cause pathological fractures that lead to bony deformation and shortening, which results in difficulties in manipulating objects or
ambulating.
Objectives: To relate a case of Maffucci syndrome and its
manifestations.
Methods: We carried out a review of the literature and medical records
of a patient admitted on July 9 to hospital, Juiz de Fora-MG in 2013. MLL,
a 29-year-old female, presented with multiple enchondromas and cerebral
hemangiomas. She underwent surgical resection of chest hemangiomas,
groin, abdominal and members, and mediastinal chondroma, performed on
two occasions. She was asymptomatic in most cases.
Results: No specific therapy yet exists to cure this potentially disabling disease. Thus far, surgical therapy is the only available option to treat
complications such as pathological fractures, skeletal lesions, or malignant
transformation. Sclerotherapy, irradiation, and surgery for the vascular
lesions have also been described.
Conclusions: It is important to recognize the diagnosis and to differentiate Maffucci syndrome from clinically similar disorders such as Ollier
disease (multiple enchondromas with asymmetric distribution, without the
presence of hemangiomas) and blue rubber bleb nevus (BRBN) because
of the significant risk for malignant degeneration. The authors advocate
a constant follow-up with an abdominal computed tomography scan and
serial radiographs to monitor disease development.
ABSTRACTS
029206
Myofibroblastic tumor associated with actinomyces: a case report
Pompermaier, C.1, Chiaradia, C.P.1, Rombaldi, M.C.1, Pr, R.B.1, dos
1
crisllipreussler@gmail.com, mcrombaldi@hotmail.com,
Introduction: Inflammatory myofibroblastic tumor (IMT) is a benign
neoplastic lesion that can manifest itself with invasive behavior. A rare
cause for its development is actinomycosis.
Objective: To report a case of IMT associated with actinomycosis.
Methods: GT, a 63-year-old female, presented with diffuse abdominal
pain, a single episode of anal bleeding, and weight loss of 11 kg in 1 year.
She had first-degree relatives with breast and colon cancer. Abdominal
palpation revealed a 12-cm mass in the upper left quadrant which was hard,
mobile and regular. Normal colonoscopy was carried out. Magnetic resonance neurography (MRN) showed a paramedial omental mass 8.9 x 4.5
x 4.3 cm with anterior abdominal wall infiltration and irregular borders,
adjacent to the transverse colon. The patient underwent exploratory laparotomy with omentectomy, partial resection of the left abdominal wall/
rectus abdominis and transverse colon segmental colectomy. A peritoneal
wash was negative for malignancy. Finally pathology revealed an abdominal wall IMT related to actinomycosis with external commitment of the
transverse colon.
Results: The IMT usually originates in soft tissues and predominates
in children and young adults. It is benign, yet it has aggressive behavior,
with fast growth which compresses and invades adjacent structures. It can
affect lungs, mesentery, liver and spleen, bowels being a less common
site. The etiology is unknown, although factors such as trauma, autoimmune conditions and inflammatory/infectious diseases may contribute.
Actinomycosis is caused by the infiltration of Actinomyces spp into injured
tissues and is a chronic and progressive infection. It is characterized by the
formation of abscesses, granulation tissue and dense fibrotic tissue, leading
to the formation of tumors. As with IMT, the treatment for actinomycosis is
surgical resection followed by antibiotics.
Conclusion: The majority of cases undergo surgical procedures before
the diagnosis. The IMT surgical treatment is reserved for extensive masses
in view of the morbidity of the disease. Since it is a multi-organ condition
it is recommended that the procedure is carried out by a multidisciplinary
team with experience in large surgeries, as was represented in our service.
029202
Mortality increase in patients with cancer of the larynx standardized
by gender and age range in a metropolitan region of Salvador, BA
Freitas, V.F.1, Strappa, G.B.S.2, Jesus, M.S.3, Matos, R.M.1, Amaral, J.B.4
1
Medical student, Federal University of Bahia, Salvador, Brazil, 2Nursing
vdefritas@gmail.com, giorgiabruna-2006@hotmail.com,
Introduction: In Brazil, INCA estimated 6870 new cases of cancer
(CA) of the larynx in men and 770 in women in 2014. Tobacco is the major
risk factor. When diagnosed in early stages, it has a great prognosis (cure
of 80% and 100%).
Objectives: To describe the mortality trend of laryngeal CA in
Salvador between 2010 and 2014.
ABSTRACTS
Methods: Data from the Sistema de Informao sobre Mortalidade
(SIM), available on DATASUS, were analyzed. The mortality coefficient
(MC) of CA of the larynx was standardized by age, gender, and death by
neoplasia in general between 2010 and 2014, Salvador, BA.
Results: For 20102014 the risk of death from CA of the larynx was
9 deaths per 100,000 people; when analyzed by year, we noted an increase
from 1.6 (2010) to 2.2 (2013) deaths/100,000 people, with a decrease of
1.6/100,000 people from 2013 to 2014. The risk of death by laryngeal CA
among other neoplasias and general deaths were calculated respectively as
18/1000 and 3/1000. As regards gender, we noted a major rate of death by
CA of the larynx in men (n = 215; 90%) as compared to that in women (n =
23; 10%), the relationship between men and women being 9:1. The major
death rate was in the age range >45 (n = 229; 96%), and particularly in the
age range 5574 (n = 139; 61%).
Conclusion: Lateness of diagnosis couldnt be investigated because
of the lack of data, but with the data we did study we can assume that late
diagnosis is the reason for increase in death rate, because this kind of cancer
has a high rate of cure. The major occurrence in men age >55 may be associated with work routine, or because most of the services operate on work
days, and/or other factors.
028716
Non-Hodgkins lymphoma of bone: a case report and literature
review
Saboia, L.V.1, Delabio, L.C.1, Fukushima, J.I.1, Boareto, A.M.1, BiondoSimoes, R.1, Mari, D.C.D.1
1
Sul, Brazil
clinirad@clinirad.com.br, rachel_simoes@yahoo.com.br
Introduction: Primary non-Hodgkins lymphoma (NHL) of the bone
is a rare condition. The purpose of this report is to describe a case of bone
non-Hodgkins lymphoma with a good response to treatment and a good
outcome.
Case report: A 31-year-old male patient presented with a mass lesion
in the left arm with 4 months of evolution. MRI showed an expansive metadiaphyseal mass of the proximal humerus. Computed tomography showed
micronodules in the right lung. Biopsy revealed an undifferentiated malignant neoplasm. Immunohistochemistry defined the diagnosis of large-Bcell NHL. Chemotherapy led to remission of the lesion. The treatment was
completed with radiotherapy. Recent evaluation with PET scan showed no
residual disease.
Conclusions: Primary NHL of the bone is rare. It represents <5% of
NHL cases and <3% of all malignant bone tumors. It is most prevalent in
men. Treatment includes chemotherapy and radiotherapy. This treatment
may contribute to the occurrence of pathological bone fractures or may
negatively interfere with any reconstruction surgeries required. Symptoms
usually consist of localized bone pain and eventually a palpable mass.
028429
Oncological surgery: care and challenges for nursing staff
Santos, I.I.A.1, Marinho, A.R.S.1, Gomes, I.C.2, Oliveira, A.M.T.S.1,
Alves, M.P.M.1, Silva, W.P.1, Oliveira, G.S.C.1, Costa, K.F.L1,
Pinheiro, U.A.M.R.1
1
Faculdade de enfermagem nova esperana de mossor- FACENE,
2
Faculdade Leo Sampaio- FLS
iarailkas2@hotmail.com, itallo.carvalho@bol.com.br,
ursulaaurelia@hotmail.com
Introduction: Currently, more than 60% of cancer patients are treated
surgically, and surgery is also used for the diagnosis of more than 90% of
S163
all cases. The presence of nursing staff is important during cancer surgery,
in order to clarify the entire procedure and explain the desirable results for
the patient and his/her family.
Objective: To identify the care and challenges for nursing staff to
patients undergoing oncological surgery.
Methodology: This is a literature review elaborated by means of
scientific articles published in Portuguese from 2005 to 2014. The LILACS
database, the electronic library SCIELO and Google Scholar were searched
using the keywords cancer, oncology, surgery and nursing.
Results: Every patient who undergoes oncological surgery requires
the care of nursing staff in the entire perioperative period, and emotional
support must be provided for both the patient and the family; the nursing
staff must evaluate age, nutrition, altered immunity, and so many other
factors that may affect the postoperative situation. During surgery, care is
based on monitoring of vital signs and oxygen saturation; patient safety
and well-being must be provided, as must the coordination of operating
room personnel, those carrying out the activities of technologists and
people circulating. After surgery, the answers of the patient in relation to
the procedure need to be assessed, and also the patient should be monitored
for possible complications. Among some of the challenges for nursing staff
in the process of care is the identification of strategies for the well-being of
the patient, which is of fundamental importance for the planning of nursing
care.
Conclusions: The nursing staff must possess the knowledge about the
clinical picture of the patient and his/her history, in order to prevent any
complications.
029297
Primary Burkitts lymphoma of the uterus and ovaries: a case report
and review of literature
Oliveira, M.C.1, Souza, C.L.M.S.2, Franco, A.C.G.2, Oliva, I.M.A.A.1,
Porto, L.A.1, Johnson, L.P.J.3
1
Department of Medical Oncology, Santa Izabel Hospital, Salvador-BA,
Brazil, 2Department of Hematology, Portugus Hospital, SalvadorBA, Brazil, 3Department of Surgical Oncology, Santa Izabel Hospital,
Salvador, Brazil
Introduction: Primary lymphoma of the female genitals is extremely
rare, accounting for about 2% of extranodal lymphomas and 0.5% of gynecological malignancies. The uterine cervix is the most common site and
diffuse large-B-cell lymphoma is the most frequent histology. There are
few reports of cases of primary uterine Burkitts lymphoma.
Objectives: To report a case of Burkitts lymphoma diagnosed after
total hysterectomy and bilateral adnexectomy due to tumors of the cervix
and ovaries.
Methods: We undertook a review of medical records for clinical case
descriptions and a literature review for primary non-Hodgkin lymphoma of
the uterus and ovaries.
Results: A 65-year-old woman was admitted with pelvic pain and
increased abdominal size since the previous month. Abdominal MRI
showed a tumor in the cervix, two other lesions involving bilateral ovaries,
periaortic and pericaval lymphadenopathy and moderate ascites. The
cervix had no visible lesions at the pelvic examination. Ovarian cancer
was suspected and a total hysterectomy with bilateral adnexectomy was
performed. However, histopathological and immunohistochemical studies
diagnosed Burkitts lymphoma. After 15 days, the patient developed paraparesis, urinary retention, weight loss and a tumor in the right breast. Spine
MRI showed meningeal carcinomatosis with involvement of the cauda
equina. Immunophenotyping of the CSF was negative for neoplasia. USG
breasts showed an expansive formation in the right breast. The patient was
staged as IVBE and, after a cytoreductive chemotherapy cycle of COP,
S164
was subjected to treatment for Burkitts lymphoma with R-CODOX-M/RIVAC, associated with intrathecal chemotherapy. After the first cycle the
breast lesion was reduced and paraparesis improved. Currently the patient
is undergoing an IVAC-R cycle.
Conclusions: This case exemplifies Burkitts lymphoma in an
unusual location, simulating the clinical presentation of other cancers
such as ovarian, cervix and breast cancer. It emphasizes the importance
of histopathological confirmation to determine the prognosis of patients
with disseminated tumors, since the diagnosis of a lymphoma, even one
as aggressive as Burkitts lymphoma, brings the possibility of a curative
treatment.
028565
Primary pulmonary meningioma: a case report
Medina, R.T.1, Ferreira, F.C.S.2, Pires, A.R.C.3, Aras, A.L.B.G.1
1
The Pathology Service, Hospital Naval Marclio Dias, Rio de Janeiro,
Brazil, 2Department of General Surgery, Hospital Naval Marclio Dias,
Rio de Janeiro, Brazil, 3Laboratrio Fonte Medicina Diagnstica, Rio de
Janeiro, Brazil
renatomedina@terra.com.br, flaviaf21@gmail.com
Introduction: The primary pulmonary meningioma is a very rare
neoplasia and is benign in most cases. The majority of the extracranial
meningiomas described until now have been localized in the head and neck
region.
Objective: To present an unusual case of primary pulmonary meningioma in a tertiary general hospital.
Methods: A survey of scientific articles was conducted using internet
databases, the keywords being primary pulmonary meningioma. This
case report is about a 46-year-old man, on active military duty, who
attended the hospital complaining of left posterior chest pain for 20 years.
The patient denied fever, weight loss, coughing, smoking, allergies and
chronic diseases. Chest computed tomography displayed a lump in the left
lower lobe measuring 2.7 x 1.8 x 1.5 cm. Cranial computed tomography
was unchanged.
Results: Macroscopically, the excised lung fragment weighed 19.6
g and measured 7.5 x 3.5 x 3.0 cm, displaying smooth and transparent
pleura. Cutting the surface displayed a nodular lesion, whitish with a
yellowish central area measuring 2.5 x 2.3 cm. The lesion did not touch
the pleura. Microscopic examination diagnosed a spindle-cell neoplasm
with nested arrangements, with mild atypia and focal areas of necrosis.
Immunohistochemistry was compatible with pulmonary meningioma.
Conclusions: The literature reports that most of these lesions are findings during routine examinations; they do not produce symptoms. Usually
the postoperative evolution is favorable and the lesion is not likely to recur.
The main differential diagnoses include metastatic intracranial primary
tumor, neuroendocrine tumor, mesothelioma, neurilemmoma, epithelial
thymoma and primary or metastatic carcinoma. The importance of this
work lies in the fact that it is a disease with limited available literature
because it is extremely rare.
029195
Primary splenic lymphoma: a case report
Bortoletto, B.L.1, Bortoletto, F.L.2, Cabrera Filho, L.H.1
1
and Pantanal Region), Campo Grande, Brazil, 2Federal University of Mato
Grosso do Sul, Campo Grande, Brazil
Introduction: The primary splenic lymphoma (PSL) is a very rare
form of lymphoma presentation, with an estimated incidence of less than
ABSTRACTS
1%. The PSL definition proposed by Das Gupta et al. can be made when the
disease was confined to the spleen or hilar lymph nodes, without recurrence
of the disease for at least 6 months after splenectomy. Some of the symptoms include abdominal discomfort, weight loss, fever and night sweats,
asthenia and anorexia.
Objectives: To present a case report of primary splenic lymphoma.
Methods: An analysis was made of the medical chart of a 63-yearold male admitted to the infectious diseases department of the University
Hospital Maria Aparecida Pedrossian, UFMS; he had a 10-month history
of left upper quadrant abdominal pain, 17 kg weight loss, somnolence,
asthenia and intermittent night fever. On physical examination, splenomegaly of 15 cm was detected, but peripheral nodes were not palpable.
Results: Laboratory work-up revealed some abnormal results: blood
test showed anemia (hemoglobin 7.1 g/dL) and thrombocytopenia (platelets 10,000/mm3), while creatinine was 1.4 mmol/L, and LDH 257 U/L
(135220U/L). Ultrasonography and computerized tomography (CT) of
the abdomen confirmed splenomegaly without abdominal adenopathy.
Protein electrophoresis showed polyclonal increase of -globulin and
2-microglobulin: 6217 g/mL (0.612.37 g/mL). To this point, differential diagnoses excluded conditions common in the Brazilian region: visceral
leishmaniasis, systemic lupus erythematosus, Gauchers disease, hepatitis
B and C, HIV, multiple myeloma and schistosomiasis. A splenectomy and
resection of three nodular formations in the lower and upper tail region of
the pancreas was performed. Histological study demonstrated non-Hodgkin
lymphoma. The patient recovered from the splenectomy and is currently
well and in complete remission 2 years after diagnosis; he received chemotherapy postoperatively.
Conclusion: PSL is a disease difficult to diagnose; it requires a high
degree of suspicion. A splenectomy is the therapy of choice. The research
conducted was proved to be enough to confirm primary splenic lymphoma.
028391
Primitive neuroectodermal tumor (pPNET): a review of three cases
Furtado, J.P.R1., Laporte, G.A.2, Barros, E.D.1, Schnor, O.H.2,
Kwiatkonski, R.V.2, Correa, L.H.L.2, Leonardi, L.A.2, Conterno, J.2,
Polo, R.2
1
Introduction: Peripheral primitive neuroectodermal tumor (pPNET) is
a rare malignant tumor which originates from the neuroectoderm. Its
treatment remains controversial, especially due its low incidence.
Objectives: To describe clinical and pathological characteristics of
surgical patients with pPNET and to report their survival.
Methods: This is an historic cohort study from September 2000 to
December 2011; patients submitted to surgical treatment for pPNET were
included.
Results: This series had three patients. From those, two were female.
The average age was 35 years. All cases had primary treatment: the first
patient had a wide resection, in the second case a limb amputation was
performed, and the last subject underwent a thoracotomy; tumors were
localized in upper limb, lower limb and trunk, respectively. The average
pPNET size was 15 cm, and all had negative margins. Regarding staging:
one case was in stage IIC, the second in stage III and the last one in stage
IV with subcutaneous metastasis; they had 5-year survivals of 40, 7 and 2
months, respectively.
Conclusions: We present a series of young patients with an aggressive
tumor and a poor prognosis.
ABSTRACTS
028537
Retroperitoneal bleeding management during laparoscopic
lymphadenectomy
Reitan R.1, Tsunoda, A.T.2, Kondo, W.3, Andrade, A.E.M.C.2,
Guerreiro, J.A.1, Aichinger, L.A.1, Vieira, M.2
1
Brazil, 2Gynecology Oncology Department, Barretos Cancer Hospital,
Barretos, Brazil, 3Gynecology Department, Vita Batel Hospital, Curitiba,
Brazil
atsunoda@gamil.com,williamkondo@yahoo.com,mdcarlosandrade@gmail.com,
guerreiro@hotmail.com,lillyaichinger@gmail.com,mvieiraonco@gmail.com
Introduction: Bleeding is one the most important complications
during retroperitoneal lymphadenectomy. In laparoscopy, bleeding control
is even more important and challenging. The laparoscopic surgeon must be
familiar with all the bleeding control strategies, especially when performing
retroperitoneal procedures with a high risk of injury to large vessels.
Objectives: To show several methods of bleeding control during laparoscopic retroperitoneal lymphadenectomy.
Methods: Using an educational video we present several cases of
retroperitoneal bleeding and its management using inexpensive strategies.
Small bleeds can usually be controlled by compression, depending on their
site. Hemostatic agents can be used to control small bleeds or consolidate
bleeding controlled by compression. Clips are usually used to control
bleeding in vessels that can be ligated, like lumbar veins, but they can
be used in other situations with great caution. Suture is the most efficient
bleeding control method, but it is demanding, and the surgeon must have
mastered this strategy because it can cause an even more severe bleeding.
Conclusion: There are several methods for bleeding control during
retroperitoneal lymphadenectomy; when correctly applied they can safely
avoid morbidity and conversion to open surgery.
029197
Retroperitoneal fibrosis: a case report of IgG4-related disease
Carvalho, A.M.1, Oliveira, J.C.1, Pracucho, E.M.1, Tomal, K.T.1,
Campos, R.A.1, Zanatto, R.M.1
1
andremcar@gmail.com, juneacaris@yahoo.com.br,
epracucho@yahoo.com.br,karlatomal@hotmail.com,ricardorac2@gmail.com,
renato_zanatto@ig.com.br
Introduction: Retroperitoneal fibrosis (RF) is a rare disease that is
marked by systemic inflammation and the development of a fibroinflammatory mass. The infiltration can occur at any site of body and is often
diagnosed as a tumoral mass. The mass can involve structures such as
ureters and kidney and can invade vessels, leading to urinary complications
and vascular damage. The clinical presentation often includes abdominal
pain and symptoms and signs of renal insufficiency. The physiopathology
is uncertain, but RF has been considered to be an IgG4-related disease.
Treatment is directed to relief of symptoms and complications associated
with mass effects. Corticosteroids and other immunosuppressive agents
are the mainstay of treatment, being associated with mass shrinkage of the
mass in a variable proportion of patients.
Objectives: To describe a clinical case of IgG4-related disease treated
in a tertiary hospital in Brazil.
Methods: We are reporting a clinical case in which a male patient,
presenting with unspecific abdominal complaints, led to diagnosis of RF
with IgG4-related disease.
Results: A 41-year-old male patient was admitted to a tertiary hospital
with unspecific abdominal complaints. Magnetic resonance imaging (MRI)
and laboratory exams demonstrated a large retroperitoneal mass associated
S165
with decreased renal function. Laparoscopic procedure allowed examination of a tissue sample; the biopsy results were compatible with a pseudotumor IgG4-related disease. A systemic treatment with corticosteroid
prednisone (1 mg/kg per day) was promptly started. Symptom relief was
first reported 4 weeks after treatment started. Mass shrinkage and improvement in renal function occurred 2 months later, as confirmed by imaging
and laboratory exams.
Conclusion: Clinicians should have high index of suspicious for RF
in patients presenting with renal insufficiency and an abdominal mass. A
biopsy should be performed to achieve a definitive diagnosis. The fast institution of corticosteroid therapy can be life-saving in patients presenting
with advanced disease.
029289
Schwannoma with malignant transformation in the popliteal fossa of
a young patient: a case report
Genaro, A.1, Pereira, L.P.2, Ferreira, V.H.S.2, Netto, W.J.M.2, Franco, B.V.2,
Marqui, B.A.L.2
1
Presidente Prudente, Brazil, 2University of Oeste Paulista, Presidente
Prudente, Brazil
andregennaro@hotmail.com, larissa_ppereira@yahoo.com.br,
willymacedo@gmail.com, vennabruno@gmail.com,
bruno_040691@hotmail.com
Introduction: Schwannomas are the main tumors of the peripheral
nervous system; they are mostly benign and occur most commonly in the
fifth decade of life. Schwannomas prefer sensitive roots. In the skull, malignant schwannomas occur most often in the vestibulocochlear nerve and,
more rarely, in the sensory root of the trigeminal. In nerves, schwannomas
occur in larger trunks, and in the flexor surface of members near the elbow,
wrist, knee and posterior mediastinum. Schwannomas originating from
roots are always benign, but may rarely be malignant if from the nerves,
being more frequent in cases of neurofibromatosis. Recurrence is rare after
a benign schwannoma has been totally removed.
Objective: To describe a case of soft-tissue tumor in young patients,
treated at the Regional Hospital of Presidente Prudente, presenting a
peripheral-nerve-sheath tumor with a low degree of malignancy.
Method: This was a medical record survey, case report description,
and discussion based on books and online database review (PubMed, Web
of Science, SpringerLink).
Results: A 27-year-old female patient sought our services in August
2014 because of a slow-growing nodule present in the posterior thigh for
about 5 years, with painful palpation and difficulty in performing dorsiflexion of the right foot. A biopsy was performed in October 2013 and
revealed a benign mesenchymal neoplasm of neural origin, measuring 12
x 7 x 5.5 cm, in the popliteal fossa on the right leg. A tumor resection was
performed on May 21 2014, with no surgical complications. The anatomopathology of the surgical specimen confirmed plexiform neurofibromatosis with a peripheral-nerve-sheath tumor with a low degree of malignancy.
Conclusion: Malignant schwannomas in the second decade of life are
rare. The treatment is surgical, and when adequate resection is possible
the removal is usually curative. If not excised in its entirety the chances of
recurrence increase, prognosis is worse, and there is no response to radiotherapy due to the slow growth rate of the tumor.
S166
029078
Surgical approach to an adrenocortical carcinoma: a case report
Winkelmann, C.P.1, Pompermaier, C.1, Kurtz, G.S.T.1, Pr, R.B.1, dos
1
clapw@terra.com.br, carolpompermaier@gmail.com,
guilhermestkurtz@gmail.com, rochelepra@gmail.com,
Introduction: The adrenocortical carcinoma is a rare and aggressive
neoplasm that leads to a low 5-year survival rate and an overall mortality of
7590%. It is usually diagnosed by abdominal symptoms due to the large
size of the tumor. For localized tumors, surgery is the best treatment option.
Objective: To describe the surgical procedure performed on a patient
diagnosed with advanced adrenocortical carcinoma.
Methods: Patient RTNP, a 52-year-old male, was referred because of
a retroperitoneal mass revealed on an abdominal CT. MRI of the upper
abdomen showed a solid, heterogeneous lesion on the topography of the
adrenal gland, 13 cm in diameter, involving the retrohepatic segment of the
inferior vena cava and inferiorly displacing the right kidney. Percutaneous
biopsy of the lesion guided by CT scan revealed adrenal neoplasia with a
low mitotic index. The patient underwent right adrenalectomy, requiring
pericardiotomy to control the vena cavas insertion by the right atrium,
vena cava suture and cava clamping above the insertion of renal vessels
in an interdisciplinary surgical approach, with teams of oncological, cardiovascular and vascular surgeons. The operating time was about 6 hours.
The pathology revealed adrenal neoplasia compatible with adrenal cortical
carcinoma.
Result: At diagnosis, up to 70% of adrenal tumors are stage III and IV,
while 30% are isolated in the gland. The local tumor invasion commonly
affects the kidney and inferior vena cava, while the metastatic disease
affects the retroperitoneal lymph nodes, lungs, liver, and bones. Tumors
may come from the adrenal cortex or the spinal region; the cortex ones are
usually non-functioning tumors. The invasion of the inferior vena cava is
common, as in the present case.
Conclusion: As a multivisceral approach, it is ideal that the surgery is
performed by a multidisciplinary team highly trained in major surgery, as
was done here. The patient had a good postoperative course due to surgical
treatment.
029163
Surgical finding of neoplasia of the appendix for staging of a uterine
body tumor
Lira, G.A.1, Arajo, M.T.1, Barreto, L.K.D.1, Bisneto, J.B.M.1,
Medeiros, D.B.G.1
1
Brazil, Dr Luiz Antnio Hospital, Liga Norte Riograndense Contra o
Cncer, Natal, Rio Grande do Norte, Brazil
georgelira@hotmail.com, micheleteixeiraa@gmail.com,
laianabarreto@gmail.com, joaobernardomed@gmail.com,
brunoeng@gmail.com
Introduction: Appendicular malignant tumors are rare findings, being
diagnosed by histopathological exam; they occur with a frequency of
around 1% of appendectomies. The disease is a very non-specific clinical
presentation, the most common symptoms being acute abdomen such as
acute appendicitis or abdominal mass. It less often presents with urological
complaints, menorrhagia and melena. Because of the non-specific and late
clinical manifestations, certain diagnosis is possibly only by histopathology.
The appendicular cancer can be primary or metastatic, and metastasis may
be synchronous or metachronous. There are three histological types of
appendiceal tumor: adenoma, adenocarcinoma, and carcinoid. The latter is
ABSTRACTS
the most common and derives from neuroendocrine cells. Adenomas and
adenocarcinomas have a mucinous component and a tendency to intraperitoneal dissemination. In a clinicopathological study, adenocarcinoma with
a mucinous component has been divided into mucinous neoplasm of low
grade and mucinous adenocarcinoma.
Objective: To report a case of appendiceal mucinous neoplasm of low
degree, a surgical finding during resection of a uterine body tumor, carried
out in a referral center for cancer surgery.
Methods: The patient was monitored surgically and oncologically,
followed by a review of medical records and literature addressing the
pathology involved.
Results: Case report: the subject was MDT, a 64-year-old female,
retired and menopausal. During adjuvant chemotherapy for breast cancer,
symptoms of left upper quadrant pain with menorrhagia begin. Pelvic ultrasonography showed endometrial thickening (>17 mm) and a shaved specimen showed mixed adenocarcinoma. She underwent surgery for uterine
body staging, with total hysterectomy, enlarged pelvic lymphadenectomy
and appendectomy. The result of the histopathology showed mixed adenocarcinoma of the uterine body (70% well differentiated and 30% clear
cells), cecal appendix with a low-grade mucinous neoplasm, and pathological staging pT1bN1.
Conclusions: The report shows an unusual illness, a tumor of the
appendix, which was associated with uterine body cancer, found during
surgery and diagnosed with pathology.
028841
Surgical oncologist workforce profile in Brazil 20142015
Vieira, H.C.1, Moreira, R.C.L.1, Tedde, M.L.2, Lopes, A.3, Miyata, S.1,
Cintra, C.A.1
1
Oncological Surgery, Mario Penna Institute, Belo Horizonte, Brazil,
2
Department of Thoracic Surgery, Heart Institute, University of So Paulo
School of Medicine Hospital das Clnicas, So Paulo, Brazil, 3Treatment
and Research Center of Hospital do Cncer A. C. Camargo, So Paulo,
Brazil
hcvieira@gmail.com, renicecilia@me.com,
tedde@usp.br, ademar-lopes@uol.com.br, seijisilvana@terra.com.br,
cassioacintra@ig.com.br
Introduction: Awareness of the workload is essential to analyse the
current situation, plan future resources, and propose measures to improve
working conditions and patients access to heath care.
Objectives: To draw the profile of the Brazilian oncological surgeon
from graduation and training, migration, research activities, satisfaction
with specialty and practice experience.
Methods: We analysed data collected from the answers of a web-based
questionnaire sent by email to the members of the Brazilian Oncological
Society of Surgery (SBCO) and doctors who are certified as oncological
surgeons by the Federal Council of Medicine.
Results: The estimated level of participation was 72% (n = 336/466).
The average age of the active surgeon is 41.2 years. Women comprise 10%
(34) of respondents, and 62% (218) of the participants had graduated from
public medical schools. Four states nationwide trained 82.4% of surgeons
(280); 60.6% (203) work in cities formerly over 1,000,000 people, 80.9%
(271) work in reference centers. The public health system is the main
income provider. Almost 85.3% (280) answered that the time from suspicion of cancer to first treatment was <60 days. Just 51.19% (172) work
where there is palliative care. Only seven of 27 states have an adequate,
although poorly distributed, number of oncological surgeons.
Conclusions: Brazil has insufficient number of oncological surgeons,
improperly distributed throughout the country; they are centered in reference centers, hindering the approach of the population to earlier treatment
and diagnosis. The results of this study show that the government needs to
ABSTRACTS
carry out administrative decentralization, seeking to redistribute the workforce. Also needing to be considered are support teams, infrastructure and
working conditions.
028237
Surgical procedures in oncology: how does it differ from other
surgical procedures?
Nascimento, L.S.1
1
Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil
lu.cas.s_nascimento@hotmail.com
Introduction: Surgical procedures in oncology are essential in the
treatment, diagnosis or palliation on suspicion of or presence of tumors.
Objectives: To analyze what are the main epidemiological differences
between cancer surgical procedures and other surgical procedures.
Methods: This was an epidemiological study of 28,702,563 admissions related to surgical procedures, with 666,562 corresponding to surgical
procedures in oncology. Data collection and variables (total value, permanence, and mortality) covered the period January 2008 to December 2014,
and were obtained from the DATASUS system; the design is in graphics
and spreadsheets after statistical calculations in SPSS 22.
Results: It was found that cancer surgical procedures represents 2% of
all surgical procedures performed, being unevenly distributed by regions.
It was observed that there was a progressive annual increase in surgical
procedures and oncosurgery. It was noticed that the total value of oncological surgical procedures corresponded to 4% of the total amount spent
on surgical procedures, with an average value of R $ 2,533.30. There was
an average stay of 3.8 days for surgical procedures in general compared
to 4.6 for oncological surgical procedures. Mortality rates were 1.6 for
surgical procedures in general compared to 1.99 for oncological surgical
procedures. The curve of annual progression of surgical procedures and
surgical procedures in oncology have a similar distribution throughout the
study period. There is a significant cost difference, explained by the high
complexity of most cancer surgical procedures, which will represent a high
cost to public health. Inpatient cancer surgery requires a longer hospital
stay. Finally, the mortality rates showed a statistically significant difference, being higher in oncological surgical procedures.
Conclusions: The real cost of surgical procedures in oncology is more
burdensome and expensive than that of surgical procedures in general;
hospital stay and mortality rate are also greater.
028965
Surgical safety checklist: surgical team awareness and main barriers
to its application
Utiyamada, N.L.1, Andrade, C.E.M.C.2, Vieira, M.A.2, Cintra, G.F.2,
Nascimento, T.G.2, Tsunoda, A.T.2
1
Faculdade de Cincias da Sade de Barretos Dr Paulo Prata (FACISB),
Barretos, So Paulo, Brazil, 2Barretos Cancer Hospital, Barretos, Brazil
nara.lie@hotmail.com,
mdcarlosandrade@gmail.com,mvieiraonco@gmail.com,georgia.fc@gmail.com,
talita.nap@hcancerbarretos.com.br, atsunoda@gmail.com
Introduction: In 2008, the World Health Organization (WHO)
published a surgical safety checklist, targeting a reduction in surgical
mistakes and complications. It was the simplest, most replicable, and most
significant measure towards improvement of surgical outcomes of recent
decades.
Objectives: To analyze the actual knowledge and the main barriers to
implementation of the surgical safety checklist among professionals in the
operating room.
S167
Methods: This was an observational/transversal study held in a cancer
center; data were collected from March 2015 to June 2015. An anonymous
and self-administered questionnaire regarding the awareness of and the
main barriers to the implementation of a surgical safety checklist was
directed to all the teams related to surgery. IRB:41821415.7.0000.5437/
Local IRB:921/2015.
Results: This analysis included 106 consecutive participants (56
surgeons, ten anesthesiologists, three nurses and 34 nurse technicians).
Among them, 44.3% were female and 54.7% were male. The average time
on service was 11.3 years, and the average age was 37.9 years; 58.9% of the
surgeons and 50% of the anesthetists considered their knowledge regarding
the WHO checklist as insufficient, while 85.3% of technicians and 100%
of nurses answered they are experts in this field (P < 0.001). Regarding the
educational level, the majority of the postgraduates (55.3%), and a minority
of the technicians (14.3%) described their knowledge as insufficient (P <
0.003). Most of the professionals (77.4%) affirmed that the checklist is
very important. Major barriers to its implementation included: individual
resistance (33%), it takes time to apply (16%), and others (14.2%,
including lack of attention and lack of teamwork).
Conclusion: Surgeons and anesthetists demonstrated less knowledge
of the WHO surgical safety checklist than those in other categories. This
result is probably related to the lack of training of the medical staff in this
area. The main barrier to its use is individual resistance, although most
recognize the importance of this instrument.
029180
The importance of social aspect in the quality of life of cancer patients
among 5- to 18-year-olds treated in reference centers in Mato Grosso
do Sul
Bortoletto, B.L.1, Alvarenga, A.C.V.1, Valle, A.S.1, Ferzeli, C.F.1,
Sperotto, M.F.R.M.1, Souza, W.F.1
1
and Pantanal Region), Campo Grande, Brazil
Introduction: Pediatric cancer requires complex treatment with a
holistic approach. This approach may be done through evaluation of the
childs quality of life (QL); QL can be defined as the gathering of objective
and subjective well-being in multiple domaines considered important in the
persons culture.
Objectives: To identify the patients sociodemographic profile from
reference centers of pediatric cancer treatment in Mato Grosso do Sul,
Brazil; to identify the types of neoplasia and their prevalence in the sample;
to measure and evaluate the QL of the patients; and to analyse the importance of the social aspect in children and adolescents QL.
Methods: Forty-three patients were included, between 5 and 18 years
old, who were under treatment or cancer control. All patients belonged to
the pediatric oncology sector of Hospital do Cncer Alfredo Abro, Santa
Casa de Misericrdia e Associao dos Amigos das Crianas com Cncer/
MS. Patients and proxies answered two questionaires: the identification
chart, common to both, which includes sociodemographic data; and the
PedsQL 4.0 Cancer Module, which evaluates a patients QL and the proxys
perception of the patients QL.
Results: The majority of patients were male, with an average age
of 10.9 years. Leukemia was the most frequent neoplasia. Proxies were
mainly women and married. The measured patients QL was evaluated as
regular to good. There was a significant (P < 0.001) relationship between
social aspect and patients global quality of life.
Conclusions: Social aspects investigated with PedsQL had a straight
influence on patients quality of life, and that makes this a possible component to be worked on with children and their families during and after treatment, making it easier for both to go through the whole experience.
S168
028532
The intestinal ostomy and its relationship with the quality of life of
patients with colorectal cancer
Santos, I.I.A.1, Pereira, K.S.M.2, Pedrosa, K.S.C.1, Oliveira, P.C.1,
Costa, K.F.L.1, Oliveira, G.S.C.1, Lima, J.P.1, Oliveira, A.M.T.S.1,
Pinheiro,U.A.M.R.1
1
New Hope Nursing Faculty of Mossoro, Mossor, Rio Grande do Norte,
Brazil, 2Institute of education university Lion Sampaio de Juazeiro do
Norte, Cear, Brazil
iarailkas2@hotmail.com
Introduction: Colorectal cancer is among the five most frequent
cancers in the population. Many patients are unaware that surgery is a
first treatment option, and results in the need for an intestinal ostomy. The
cancer and intestinal ostomy have a great impact on patients lives, since
they are stigmatized and cause suffering.
Objective: To evaluate the relationship between intestinal ostomy and
the quality of life of patients with colorectal cancer.
Methods: This is a descriptive and quantitative exploratory study
carried out in the areas of eight basic health units (BHU) located in the
municipality of Mossoro, Rio Grande do Norte, Brazil. For data collection we used the World Health Organization Quality of Life Group Bref
(WHOQOL-bref). Data were analyzed using Students t test and Pearson
correlation test, with significance level established in 5%, analysed using
the software SPSS (Statistical Package for the Social Sciences) version 21.
The research was approved by the Committee of ethics in research with
protocol number 982,581.
Results: Statistical differences were observed in the comparison
between the quality of life of patients with colorectal cancer and intestinal
ostomy and healthy patients through the physical domains, psychological,
social and environmental relations. The psychological and the physical
domains obtained P-value and presented a strong positive correlation. This
allows us to say that the psychological and physical spheres influence each
other. The P-value was also significant in the correlation between the areas
of evaluation and the physical self, showing a moderately positive correlation. This allows us to say that the domains of self-assessment of quality of
life and physical domain influence each other.
Conclusions: It was concluded that individuals who have colorectal
cancer have a lower quality of life than healthy patients. It is hoped through
this analysis that professionals expand their knowledge to provide improvements in the quality of life of individuals.
028964
A totally implantable catheter for chemotherapy (PORT-A-CATH):
the use of an alternative route with improved cosmetic outcomes
Andrade, W.P.1, Bomfim, G.A.Z.1, Cruz, M.R.C.2
1
Instituto de OncoMastologia, So Paulo, Brazil, 2Hospital So Jos/
Beneficncia Portuguesa de So Paulo, Brazil
wesley.andrade@hotmail.com, marcelo.cruz.md@gmail.com
Introduction: Classically, the Port-A-Cath can be placed in many
sites. The anterior chest area is the most common site. Implantation of PortA-Cath in the chest involves a brief surgical procedure with a skin incision
in the infraclavicular region where a space (pocket) to accommodate this
device is made. Many of these patients will be cured of cancer and, sometimes, these incisions are in a visible area with an unesthetic scar. Even after
removal of the Port-A-Cath chamber patients will be left with visible scars
which can certainly be embarrassing, especially for female patients.
Objective: To describe a new methodology for the placement of PortA-Cath by axillary incision to improve cosmetic results.
Methods: The technique consists in performing an axillary incision
with a surgical aseptic technique, with the patient under local anesthesia
ABSTRACTS
by sedation. The subclavian vein puncture is made as usual. Through
the axillary incision, the subcutaneous dissection is performed with a
fiberoptic retractor to make the tunnel and the pocket is placed at a site of
the surgeons choice. A rigorous hemostasis is performed. The catheter size
is adjusted according to the location of the chamber and is connected to
the reservoir. With a long forceps this reservoir is positioned and fixed on
the anterior side of the chest with the help of a fiberoptic retractor. Surgery
proceeds with radioscopic control and testing the functioning of the catheter as usual. After this, the surgeon makes a suture in the axillary wound.
With this technique the incision is placed in the axillary region, but the
catheter may be positioned in any region of the thorax, avoiding incisions
in the anterior chest wall.
Results: This technique was performed with very good cosmetic
results and with great satisfaction from patients; however, it required a
slight longer surgical time.
Conclusion: This technique provides esthetic gain for the patient, but
it requires more effort from the surgeon. We believe that this modality may
be useful mainly in a group of patients who require a catheter for adjuvant
chemotherapy, and in whom a scar on the anterior chest wall could bring
some personal, psychological or occupational discomfort.
028860
Tumors of the diaphragm: a report of two rare cases
Silva, P.F.A.1, Falco, M.F.1, Cettolin, Q.C.1, Melo, P.T.N.1, Guerra, S.C.1
1
Hospital Santo Antnio, Obras Sociais Irm Dulce, Salvador, Bahia,
Brazil
priscilafasilva@gmail.com, mariofalco@hotmail.com,
pablo.tnm@gmail.com, qcettolin@hotmail.com, solon.guerra@hotmail.com
Introduction: Tumors of the diaphragm are rare entities with only a
few cases described in the literature. These tumors can be classified into
primary or secondary, either benign or malignant.
Objectives: To report two rare cases of patients with tumors of the
diaphragm, one metastatic (secondary to a cervical cancer) and the other
primary (a giant lipoma).
Methods: Data were obtained through medical history, physical exam,
imaging, intraoperative documentation and results of the anatomopathological study. The literature review was performed by searching for articles
indexed in the PubMed database.
Results: The first case refers to a 42-year-old female patient who was
asymptomatic in follow-up after treatment of cervical squamous-cell carcinoma stage IIB. In outpatient treatment, a CT scan was performed, and
this showed an oval image in the right subdiaphragmatic region with a soft
tissue density and underlying after contrast. A laparotomy was conducted
and showed a hardened diaphragmatic lesion. Surgical resection was
performed with diaphragm reconstruction. The anatomopathological study
demonstrated squamous-cell carcinoma metastasis to the diaphragm. The
second patient, a 70-year-old male, presented complaining of non-specific
abdominal pain. On diagnostic investigation by abdomen CT, a bulky heterogeneous mass with the density of fat was identified; the mass extended
from the diaphragm to the iliac bone limits. On laparotomy, a lesion originating from the diaphragm was found. On surgical resection the mass was
found to weigh 3.25 kg and measure 26 x 15 x 13 cm; simple reconstruction
of the diaphragm segment was carried out. Anatomopathological analysis
showed a lesion compatible with lipoma.
Conclusions: There are few cases of diaphragm tumors described in
the literature. They are tumors with similar prevalence between genders,
mostly benign, usually asymptomatic and are, in many cases, occasional
complementary exam findings. The treatment generally involves surgical
resection, histopathological analysis of the injuries, and complementation of treatment according to the origin of the tumor. It is important that
ABSTRACTS
surgeons be prepared for dealing with these lesions and that they know the
reconstruction techniques.
029154
Use of formalin to 2.5% in severe actinic proctitis resistant to
conventional treatments: a case report
Sousa, A.R.1, Vaz, L.A.1, Borges, L.C.1, Silva, L.M.C.1, Azevedo, M.M.1,
Mangueira Jnior, P.E.A.2
1
Instituto Tocantinense Presidente Antnio Carlos, Araguana, Tocantins,
Brazil, 2Department of Proctological Surgery of the Hospital Regional de
Araguana, Araguana, Tocantins, Brazil
anggellita16@gmail.com, laizzavaz@hotmail.com,
macarioazevedo@hotmail.com, pedromangueirajr@gmail.com
Introduction: Actinic proctitis (AP) is a complication resulting from
radiation therapy used for treating neoplasms located in the pelvis, such as
prostate and uterine carcinoma. This complication occurs in about 520%
of patients receiving this type of irradiation, and 8% develop severe hemorrhagic RP form. The use of intrarectal 4% formalin solution has been
reported to be successful in severe cases.
Objective: To report a case of a patient undergoing therapy with 2.5%
formalin for actinic retite therapy with good outcome after the procedure,
as well as a brief review of the literature.
Methods: Data were obtained through reviews of medical records,
interview with the patient, photographic records of diagnostic methods to
which the patient was submitted, and a review of the literature.
Development: FAR, an 82-year-old male patient, was subjected to 24
sessions of radiotherapy for treatment of prostatic neoplasia, developing
hematochezia after 2 years. A colonoscopy was performed to investigate
the bleeding, which showed a degree-3 AP, with active bleeding. Treatment
with messalazina and prednisone was instituted, and 6 months later the
patient returned denying clinical improvement. In the light of the refractoriness to conventional treatment, it was decided to try 2.5% formalin. The
procedure was performed without complications and the patient does not
have recurrent rectal bleeding so far.
Conclusion: In this case the chemical cauterization with formalin at
2.5% proved to be effective for the treatment of severe actinic proctitis
refractory to conventional methods. The use of this specific dilution was not
founded on our literature research, so discussion of this case is important,
especially because of the good outcome after the procedure.
S169
S170
GIST and neuroendocrine tumors

028970
Gastrointestinal stromal tumors (GISTs) of the stomach in the south
of Bahia: a histopathological study of eight cases.
Moreira Junior, D.N.1, Queiroz, A.C.1, Santos, F.P.1, Maia, W.S.1,
Barreto, R.O.1, Moreira, L.C.1
1
LAPPAQ-Pathology Laboratory of Santa Casa, Itabuna, Brazil
dariomoreira@yahoo.com.br,
acheto10@hotmail.com, francine.biofarm@gmail.com,
wesllenmaia@hotmail.com,rafael_barreto@hotmail.com,lilian_lcm@hotmail.com
Introduction: GIST is the most common primary mesenchymal
neoplasm of the gastrointestinal tract and may have a benign or malignant
clinical behavior. Generally in immunohistochemistry, GIST is positive
for KIT (CD117) and has to be considered as a tumor with a potential for
biologically aggressive behavior; this depends mainly on the size and the
mitotic index of the tumor. Gastric GISTs have a better prognosis.
Objectives: To study the main aspects of eight stomach GISTs diagnosed through 5 years of work in our pathology service.
Methods: All the cases of stomach GIST over the last 5 years in
our region were studied, including just the cases confirmed by immunohistochemistry (CD117+). Pathocontrol software was used. The mitosis
numbers were recounted, using a Nikon E200 microscope, to check for
risk of progression; classification of the disease was made by tumor size.
Results: From the eight patients studied, five were females and three
were males; the age varied from 28 to 115 years five out of the eight
patients were >50 years old. Considering the size of the tumor and its
mitotic index, according to the risk of disease progression table one of the
cases was classified as no risk of progression (zero risk), three as low risk
of progression, two as moderate risk and another as high risk of progression of the neoplasia. Most of the tumors were of a prevailing fusiform type
(six out of eight), one of them was mixed (epithelioidfusiform), and the
last was exclusively epithelioid. In all the cases the margins were excised;
there were no necrotic areas. The width of the surgical margins varied from
0.1 to 2.5 cm.
Conclusion: GIST may recur even after several years of initial retreat.
Therefore all GIST must be considered as potentially malignant. Most of
the tumors were classified between zero risk of disease progression and
low risk of disease progression (62% of the cases).
029234
Gastrointestinal stromal tumors (GISTs) of the stomach: a
videolaparoscopic approach
Marquez, G.J.1, Rodrigues, A.R.1, Pereira, A.A.1, Oliveira, I.R.1,
Lima, L.R.C.1, Tefilo, A.L.O.Q.1, Pereira, V.B.M.1, Neto, M.L.S.2,
Lima, L.R.C.1
1
Pontifical Catholic University of Gois, Goinia, Brazil, 2Santa Mnica
Hospital, Goinia, Brazil
germanajardim@hotmail.com,
anne_gyn@hotmail.com, izabellajatai@yahoo.com.br,
lurian06@hotmail.com,analuizateofilo@gmail.com,vianipereira@gmail.com,
manoellsm@gmail.com
Introduction: The GIST is the most common mesenchymal neoplasm
of the gastrointestinal tract, the stomach being the most affected. The
lesions affect the outer muscular layer of organs with exophytic growth.
Immunohistochemistry is essential for diagnosis, and C-kit (CD117) is
expressed in 95% of the tumors. The patients are asymptomatic in 70% of
cases; iron deficiency anemia is the most common clinical manifestation.
Upper gastrointestinal endoscopy (EDA) is the first requested examination,
as it allows the diagnosis and a biopsy. Computed tomography (CT) of
ABSTRACTS
the abdomen presents a circumscribed as well as vascularized mass, with
central areas of hemorrhage and necrosis. Resonance is useful to evaluate
the involvement of adjacent structures.The main prognostic factors are the
size of the lesion, mitotic index and location. Surgery is curative option.
Systemic treatment is done with imatinib mesylate.
Objective: To report a case of GIST submitted to laparoscopic partial
gastrectomy.
Methods: The case was a 42-year-old female with iron deficiency
anemia for 11 months; she was diagnosed with metrorrhagia. There was no
improvement after oral and intravenous replacement of iron with ferrous
sulphate, so the patient was subjected to EDA. This evidenced an exophytic
mass in the gastric body, with mucosal ulcerations. Biopsy and immunohistochemistry confirmed the diagnosis. The patient submitted to laparoscopic partial gastrectomy, with free margins and preservation of 75% of
the organ. Pathology showed a 7 cm lesion, high-grade, with 17 mitoses/
CGA, 10% of necrosis and 1.5-cm free margins. The patient is taking imatinib 400 mg, and is in follow-up for 6 months; there are no signs of relapse.
Results/Conclusion: Imatinib is used in the treatment of adjuvant
patients with worse prognostic factors. Studies with longer follow-up
are necessary to define the impact on survival and duration of treatment.
Laparoscopic treatment of GIST was previously considered only for lesions
of up 2 cm, because of the potential of tumor spread by excessive handling,
but its use for larger lesions can already be considered a reality. With the
advancement of the available techniques, there are reports of an increase of
up to 60% in long-term survival of patients who underwent laparoscopic
treatment when compared to patients who underwent laparotomy.
028896
Gastrointestinal stromal tumor (GIST) of the rectum treated with
neoadjuvant therapy followed by transanal endoscopic microsurgery
Nahas, C.S.1, Nahas, S.C.1, Marques, C.F.1, Bustamante-Lopez, L.A.1,
Ribeiro Jr, U.1, Cecconello, I.1
1
sparapanmarques@gmail.com, leonardoabustamante@gmail.com,
ulyssesribeiro@terra.com.br, icecconello@hotmail.com
Introduction: The GIST is a rare type of tumor that expresses the
CD117 oncogene which can be detected by immunohistochemistry. The
most common sites of GISTs are the stomach (70%) and small intestine
(20%), while the rectum is affected in only 3% of the cases. Although a rare
condition, the GIST located in the distal rectum may require an abdominoperineal resection. There are no data to support the use of imatinib
(Gleevec from Novartis, Basel, Switzerland), a selective inhibitor of tyrosine kinase, as neoadjuvant therapy. However, the last session consensus
for the treatment of GIST suggests that this form of therapy can be used in
some cases where the anal sphincter is involved.
Objective: To describe a case of distal rectum GIST in the rectovaginal
septum with partial invasion of the anal sphincter, which was successfully
treated by neoadjuvant therapy with imatinib followed by the technique of
transanal endoscopic microsurgery (TEM).
Methods: The TEM suturing technique could not be used in this case
since it was not possible to keep the gas insufflation at the anal verge (the
TEM rectoscope could not seal the anus). The vaginal wall was also closed
primarily with a transvaginal running suture. A laparoscopic loop ileostomy
was created to prevent rectovaginal fistulae.
Results: The postoperative period was uneventful and the patient was
sent home on the 4th day. The loop ileostomy was taken down 4 months
later and the patient recovered normal defecation with minimal transient
fecal incontinence. Pathological analysis of the surgical specimen identified a white firm, 3.5 x 3.0 x 3.0 cm, well delimited rectal mass, occupying
ABSTRACTS
the adjacent soft tissue close to the vagina interface. The specimen margins
were free of tumor. The lesion expressed CD34 or CD117 and showed
no mitotic activity (zero mitoses in 50 HPF). So far, the patient has not
presented any evidence of recurrence of disease after a follow-up period
of 46.2 months.
Conclusion: The use of neoadjuvant imatinib should be considered in
patients with GIST of the distal rectum in order to make sphincter preservation possible.
028984
Gastrointestinal stromal tumor (GIST): a case report
Lustosa, A.G.1, Lira, G.A.2, Pinto, F.E.L2., Gis, M.C.2,
Oliveira, I.B.M.D.2, Pires, T.C.3, Medeiros, K.M.O.T.2, Corra, R.S.2,
Souza, W.B.1
1
League Against Cancer, Dr Luiz Antnio Hospital, Natal, Brazil, 3Onofre
Natal, Brazil;
Introduction: Gastrointestinal stromal tumors (GISTs) are rare
neoplasia that come from interstitial cells of Cajal.
Objectives: To demonstrate through case report the clinical aspects,
diagnosis and treatment of a patient with GIST.
Methods: Patient JAT, a 77-year-old male from Parnamirim (RN)
presented complaining of dysuria, difficult urination and micturition for
2 months; physical tests show prostate alteration. The PSA test, prostate
biopsy via transrectal ultrasonography, and abdomen tomography found
perigastrium damage. The abdomen CT was analyzed, and CEA, CA 19.9
measured; there are no known cancer cases in the family. The test results
were: PSAt 14 ng/mL; transrectal prostate USG and biopsy showed acinar
adenocarcinoma, Gleason 7 (3+4); total abdomen ultrasonography showed
gallbladder polyps; hypoechogenic pancreatitis; surgery risk II; FE: 69, CA
19.9: 5, CEA: 1, Hb: 12.7, Ht: 35, Leu: 6700, Gl: 80, U: 45, C: 0.96, Na:
131, K: 5; coagulogram: TP: 12, TTPA: 20, Plaq: 340,000 and blood type:
O negative. Total abdomen and pelvis show heterogeneous nodes in the
epigastrium (in close contact), the low stomach curve, and little contact
with the left hepatic lobe, but risk of neoplastic damage; a nodule in the
hepatic segment V had characteristics that suggested hemangioma; there
was polipiform thickening in the gallbladder, simple cysts in the right
kidney (Bosniak I), and atheromatosis aortoiliac disease. With this report,
we chose abdominal surgery via exploratory laparotomy.
Results: The surgical treatment involved gastrectomy with
freezing, pedunculated gastric damage without invading contiguous
organs; histopathological test shows spindle-shaped tumor cells.
Immunohistochemical diagnosis was stromal gastrointestinal tumor.
Conclusions: We conclude that some patients can be non-symptomatic
but tumors can be found via high-quality tests.
028380
Giant duodenal gastrointestinal tumor: an atypical presentation
Kalil, A.N.1, Laporte, G.A.1, Remonti, T.A.P.1, Seitenfus, R.1, Polo, R.1,
Kwiatkonski, R.V.1, Correa, L.H.L1, Conterno, J.1, Souza, D.L.S.2
1
Servio de Cirurgia Oncolgica do Hospital Santa Rita da Irmandade da
Santa Casa de Misericrdia de Porto Alegre e Universidade Federal de
Cincias da Sade de Porto Alegre, 2Universidade Federal de Cincias da
Sade de Porto Alegre
Introduction: Gastrointestinal stromal tumors are the most common
mesenchymal tumors of the gastrointestinal tract, the duodenum being the
third most common location.
S171
Objectives: To report a case of a giant duodenal gastrointestinal tumor
and to review the literature.
Methods: We report a rare case of a giant duodenal gastrointestinal
tumor operated at the Surgical Oncology Service of Hospital Santa Rita of
Irmandade da Santa Casa de Misericrdia de Porto Alegre
Results: This report describes a 72-year-old woman presenting
abdominal discomfort associated with nauseas and vomiting. She went
through an abdominal CT scan which revealed a giant mass in the mesogastric area. This mass had contact with the duodenum, pancreatic head and
great vessels of the abdomen. CT also showed two giant cystic lesions on
the liver. The biggest cyst was located in the VIII segment, measuring 10.4
x 9 cm. Therefore, this patient was submitted to a resection of the second
part of the duodenum with primary anastomosis, partial colectomy, cholecystectomy and gastroenteroanastomosis with pyloric exclusion. She had a
good postoperative period, with no complications. Afterwards, pathological exam revealed a lesion measuring 15 cm, and immunohistochemical
analysis confirmed a low-grade gastrointestinal stromal tumor.
Conclusions: Duodenal gastrointestinal stromal tumor is infrequent,
and giant lesions are extremely rare nowadays. The literature has no other
cases of giant lesions in the duodenum. The prognosis depends on the size
and grade of the lesion and how responsive it is to targeted therapy.
028566
Incidentally diagnosed carcinoid tumor of the appendix: a case report
Maroun, J.J.1, Medina, R.T.2, Sobrinho, J.F.P.1, Ferreira, F.C.S.1
1
Janeiro, Brazil, 2The Pathology Service, Hospital Naval Marclio Dias,
Rio de Janeiro, Brazil
jamiljorge@hotmail.com, renatomedina@terra.com.br,
flaviaf21@gmail.com
Introduction: The appendix is the most common site of carcinoid
tumors. Usually found incidentally in appendectomy, it is considered the
most common type of malignant lesion of the appendix. Diagnosis is made
after histopathological analysis.
Objectives: To report a case of a 23-year-old female incidentally diagnosed with carcinoid tumor of the appendix after laparoscopic
appendectomy.
Methods: This was a case of a patient presented to the Emergency
Department (ED) of our hospital. She came to the ED complaining of
onset of abdominal pain in the right iliac fossa, associated with nausea,
for 24 hours. There was no history of vomiting, hyporexia, diarrhea,
fever or urinary symptoms. Two years before she had had a laparoscopic
right oophorectomy because of an asymptomatic benign dermoid cyst.
Abdominal examination revealed rebound tenderness in the right iliac
fossa. Gynecological examination was normal. Laboratory tests showed a
white blood cell count of 11,500/mm with a neutrophil prevalence of 81%
and C-reactive protein of 1.7 mg/dL. On CT a moderate amount of free
fluid in the pelvis was observed, without other alterations.
Results: The patient was submitted to diagnostic laparoscopy, which
revealed free blood in the pelvis caused by right adnexal torsion. A right
salpingectomy was performed. Although no signals of acute appendicitis
were observed, appendectomy was also done because of the adhesions seen
between the appendix and cecum. Histopathological examination showed
a carcinoid tumor infiltrating up to the subserosa layer, localized at the tip,
with <1.0 cm diameter and a low mitotic index (<2%, seen with Ki-67).
Also, it was observed that a right Fallopian tube infarct was present in the
other specimen. The patient was discharged on the 2nd postoperative day,
and had no symptoms 2 months later.
Conclusion: Although relatively rare, carcinoid tumors are the most
common tumors of the appendix. Diagnosis is difficult because of the poor
S172
clinical manifestations; histopathological analysis is therefore fundamental
for a conclusion.
028326
A laparoscopic transgastric approach to posterior wall gastric
gastrointestinal stromal tumors (GISTs)
Ribeiro, R.1, Brandalize, G.G.2, Mattana, J.L.1, Tsumanuma, F.K.2,
Rebolho, J.C.1
1
Brazil, 2Surgery Department, Cruz Vermelha Hospital, Curitiba, Brazil
giovanagugelmin@gmail.com, jefemattana@hotmail.com,
ferkt@hotmail.com, jcrebolho02@yahoo.com.br
Introduction: Gastrointestinal stromal tumors (GIST) are uncommon
gastric tumors typically treated by surgical excision. Tumors located on the
posterior wall of the stomach are more difficult to find, expose and resect.
Performing an anterior gastrotomy allows the surgeon to approach the
tumor anteriorly, facilitating the exposure, margin definition and resection.
Objective: To describe the laparoscopic anterior approach for posterior wall gastric GIST.
Methods: The surgery of a 60-year-old male with a 2.6-cm typical
GIST lesion in the posterior wall of the body of the stomach is presented.
Results: The patient is placed in the split leg position with 15 reverse
Trendelenburg position. The surgeon stands between the legs of the patient,
with the first assistant on the patients left side and the second assistant
on the right side. One 10-mm trocar (30 optic) is placed 4 cm above the
umbilicus, one 12-mm trocar (surgeon right hand and staplers) 8 cm lateral
to the first trocar. One 5-mm trocar is placed on each hypochondrium. After
abdominal evaluation, anterior gastrotomy is performed to access the posterior wall. Lesion-lifting traction sutures at the normal stomach wall around
the tumor are placed. Resection with a clear operative margin using a linear
stapler is performed. The surgical specimen is placed inside a surgical bag.
The anterior gastrotomy is closed in two planes using running absorbable
sutures. Bag extraction is performed through the supraumbilical trocar
after enlargement of the incision. Operative time was 80 min. The patient
was discharged on the 1st postoperative day on a liquid diet. Seven days
after surgery he resumed a normal diet and had no complications. Final
pathology confirmed a GIST with 2.7 cm clear margins.
Conclusion: A laparoscopic transgastric approach to posterior wall
GISTs is feasible and can be used for selected cases.
029106
Multiple endocrine neoplasia associated with benign metastasizing
leiomyomatosis: a case report
Medeiros, M.F.1, Jacob, G.G.1, Leite, F.A.V.1, Nogueira, J.F.L.1
1
Department of General Surgery, Hospital Universitrio Cincias Mdicas,
Belo Horizonte, Brazil
marinafontesm@gmail.com, gjacob@cirurgia.med.br,
fernandovleite@hotmail.com, jflimanogueira@gmail.com
Introduction: Benign metastasizing leiomyomatosis (BML) is a rare
disease in which the lung is the most affected extrauterine organ. The BML
histology is compatible with benignity and similar to that found in the
myometrial leiomyoma. A history of surgically treated uterine myomatosis
is reported by most of the patients with metastatic disease. Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited tumor
syndrome characterized mainly by parathyroid, endocrine pancreas, and
pituitary tumors. According to the MEN Consensus (2001), the diagnosis
of this condition is based on the concomitant occurrence in a patient of at
least two of these three major MEN1 related tumors.
ABSTRACTS
Objectives: To report the unusual case of a 58-year-old female patient
with uterine metastazing leiomyomatosis associated with MEN1.
Case report: A 58-year-old female patient was submitted to an investigation because of episodes of stomach pain and an increase in abdominal
volume. Thoracic and abdominal computed tomography (CT) showed
multiple masses at the lower lungs and another mass at the pancreas close
to the duodenum. After a biopsy of the lung mass that showed leiomyomatosis, and a pancreatic mass biopsy revealed gastrinoma, an investigation
of MEN was initiated. The patients serum total gastrin and intact parathyroid hormone levels were found to be elevated. Parathyroid scintigraphy
revealed tissue hyperplasia. Magnetic resonance imaging (MRI) of the head
showed a pituitary cyst. The diagnosis of MEN1 was concluded and the
enucleation of the parathyroids was proposed.
Conclusions: This case is unique due to the presence of multiple
endocrine abnormalities and the particularities of the BML that made the
diagnosis of MEN1 more difficult than usual. Multiple challenges in one
patient demand the knowledge, by the oncologist and the surgeon, of all
the obstacles and their interactions in order to devise strategies to control
and treat them.
028570
Multiple organ resection in the treatment of gastric GIST: a case
report
Ferreira, F.C.S.1, Maroun, J.J.1, Guimares, R.S.1, Sobrinho, J.F.P.1
1
Janeiro, Brazil
flaviaf21@gmail.com, jamiljorge@hotmail.com
Introduction: Gastrointestinal stromal tumor is the most common
mesenchymal tumor in the gastrointestinal tract and most frequently occurs
in the stomach. The incidence of this tumor is estimated to be as high as 25%
of the population when all small and asymptomatic tumors are included.
The surgical principles comprise an R0 resection with a normal mucosa
margin, no systemic lymph-node dissection, and avoidance of perforation,
which results in peritoneal seeding even in cases with otherwise low risk
profiles. While some clinical trials are still ongoing, neoadjuvant imatinib is
suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.
Objectives: To present an unusual case of a multiorgan resection for a
gastric GIST in a tertiary general hospital.
Methods: The subject was a 75-year-old woman with a gastric GIST
who presented with a bulky abdominal mass, symptoms of abdominal pressure such as abdominal distension, a feeling of fullness, food intolerance
and vomiting. She also had anemia and malnutrition. The symptoms had
lasted for 5 months before the consultation.
Results: The patient underwent surgical resection that included partial
gastrectomy with caudal pancreatectomy and splenectomy en bloc with
the 30-cm mass. She did not receive neoadjuvant therapy with imatinib
because she was very symtomatic and so we perfomed the surgery; she
did not receive chemotherapy or radiotherapy. No operative complication
was found.
Conclusions: Surgical resection is still the gold standard treatment
for GISTs, allowing a cumulative survival of almost 50% at 3 years and
35% at 5 years. The surgical procedures in this patient were performed
in relation to the tumor size and location. If gastric GISTs have infiltrated
the surrounding organs, as in this case, combined multiple organ resection
may be performed to avoid rupturing the tumor. In this case there was no
cleavage plane with the tail of the pancreas and spleen, so she received an
atypical gastrectomy combined with caudal pancreatectomy and splenectomy. The patient survived and has no postoperative complications.
ABSTRACTS
029100
Multivisceral surgery for a duodenal GIST: a case report
Barros, A.V.1, Santos, C.M.M.1, Oliveira, F.A.P.F.1, Melo, C.L.A.1,
Rocha, F.T.R.1, Medrado, P.C.1
1
Brazil
aldobarros@ig.com.br,
claritamms@gmail.com, fapfo.med@uol.com.br, ciceroludgero@ig.com.br,
rochafrederico@uol.com.br, patriciamedrado@hotmail.com
Introduction: The gastrointestinal stromal tumor (GIST) is a mesenchymal neoplasia, originating in the Cajal cells, which accounts for only
3% of malignant neoplasms of the digestive system. Duodenal involvement is rare, with the highest incidence in the stomach. Clinically it may be
accompanied by abdominal pain, palpable abdominal tumors, episodes of
intestinal subocclusion and gastrointestinal bleeding. Imaging tests can help
the diagnosis, especially endoscopic ultrasound. Immunohistochemistry is
essential for diagnostic confirmation. The treatment is surgical, consisting
of resection with a safety margin. Lymphadenectomy is not mandatory,
because lymph node spread is uncommon. In the case of the duodenum,
several approaches are described, depending on the tumor location, ranging
from endoscopic resections or segmental more complex procedures such as
pancreaticoduodenectomy.
Objective: To demonstrate the success of multivisceral surgery in
cases of duodenal GIST against a resection area with greater safety and less
risk of recurrence.
Methodology: The patient was a 36-year-old female with tumor
emergence in the upper right quadrant 4 months previously, associated
with weight loss and sporadic episodes of vomiting. Physical examination showed good performance status, a palpable abdominal mass and
anicterus. Abdominal CT scan showed an expansive lesion with a cystic
component in the duodenum; there was no cleavage plane with the head
of the pancreas and colon, and no elevated tumor markers. The patient
underwent laparotomy with freezing biopsy and resection of the mesenchymal neoplasm; pancreaticoduodenectomy with segmental colectomy
were performed.
Results: The patient showed a good postoperative course and was
discharged from hospital on the 16th POD. Immunohistochemistry
confirmed GIST. She took imatinib mersylate for 6 months; she is now in
outpatient follow-up for 18 months without evidence of recurrence.
Conclusions: The extensive surgical resection should be the treatment
of choice where possible, in the treatment of locally advanced GIST. In
the case of duodenal injury to pancreaticoduodenectomy is an excellent
alternative in controlling the disease when performed at referral centers.
028979
Periampullary neuroendocrine tumors coexisting with small bowel
GIST in patients with von Recklinghausens disease: a report of two
cases
Teixeira, F.J.R.1, Couto Netto, S.D.1, Arakaki, M.S.1, Scapini, G., Akaishi
E.H.1, Utiyama, E.M.1
1
Surgical Oncology Group, Division of Surgical Clinical III. Clinics
Hospital, University of So Paulo, So Paulo, Brazil
fredteixeira@gmail.com,sergiodcnetto@gmail.com,mariarakaki@hotmail.com,
eduardoakaishi@gmail.com, eutiyama@hotmail.com
Introduction: Neurofibromatosis type 1 (NF1) or von Recklinghausens
disease is an autosomal dominant disease that occurs in 13000 live births.
It is characterized by cutaneous neurofibromas and caf-au-lait stains. The
NF1 can be associated with gastrointestinal tumors in around 25% of cases.
S173
Objective: To report two patients diagnosed with NF1 with simultaneous involvement of the digestive tract: periampullary tumors and small
bowel gastrointestinal stromal tumor (GIST) and their management.
Methods: We describe a series of two patients, their diagnosis,
management and a review of the literature on NF1 patients with intestinal
GIST and periampullar neuroendocrine tumor.
Results: The subject was a 37-year-old man with a history of NF1,
admitted due to abdominal pain and jaundice. Duodenoscopy revealed
stenosis of the duodenum and irregular papilla. A biopsy showed a small
grouping of neuroendocrine cells in the lamina propria of the duodenal
mucosa. Chromogranin stained positive. Magnetic resonance cholangiopancreatography demonstrated stenosis in the periampular region and a solid
hypervascularized tumor in the jejunum. A gastroduodenopancreatectomy
and segmentar proximal enterectomy were performed. The histopathological examination showed a well differentiated neuroendocrine carcinoma in
the periampullary tumor and gastrointestinal stromal tumor in the jejunum.
The second case is a 45-year-old woman diagnosed with NF1, who was
submitted to a thigh sarcoma resection. Follow-up abdominal computed
tomography showed a polyp in the second duodenal portion. Endoscopy
revealed a duodenal tumor of approximately 2 cm. The biopsy revealed
well differentiated tubular adenocarcinoma with a neuroendocrine pattern.
Immunohistochemical study was somatostatin-positive. On the wall of
proximal jejunum there was a vascularized nodule. A pancreaticoduodenectomy with pyloric preservation and segmentar proximal enterectomy
was performed. The histopathological study showed GIST of the jejunum.
Follow-up of both of these patients showed no recurrence or metastasis.
Conclusion: Although rare, we reported two cases of an association
between a neuroendocrine tumor and a small intestine GIST. Although its
a rare association, NF1 patients might have other primary tumors.
028930
Surgical treatment of liver metastases of small bowel GIST: a case
report
Oliveira, F.A.P.F.1, Barros, A.V.1, Melo, C.L.A.1, Ferro Neto, O.C.1,
Mota, B.R.1, Silva, R.A.T.A.1
1
Brazil
aldobarros@ig.com.br, ciceroludgero@ig.com.br, oscarferro09@gmail.com,
drbrunormota@bol.com.br, d_andrada@hotmail.com
Introduction: Gastrointestinal stromal tumors (GISTs) are rare tumors
of the digestive tract of mesenchymal origin, from Cajal interstitial cells
that express the c-KIT. The standard treatment is complete surgical resection, and chemotherapy with imatinib mersylate is indicated for unresectable or metastatic disease. The liver and peritoneum are the main sites of
recurrence after complete surgical resection of the primary tumor.
Objectives: To report a case of an unresectable GIST of the proximal
jejunum submitted to neoadjuvant chemotherapy and surgical resection, who developed liver metastases treated with surgery later in our
Oncological Surgery Department.
Methods: A female patient, 44, ECOG 0, was seen in our surgical
oncology outpatient clinic. She had a biopsy and underwent abdominal
mass laparotomy for a tumor deemed unresectable in 2011. She was diagnosed with GIST and underwent neoadjuvant chemotherapy with imatinib
mersylate for 30 months; there was a partial response on imaging and a
posterior surgical approach was made (extended resection R0) to excise
the GIST in the proximal jejunum. During follow-up the disease evolved
with the appearance of liver tumors in segments II and III of the liver,
documented in MRI of the upper abdomen. The patient was subsequently
submitted to surgical treatment with lateral liver left segmentectomy and
cholecystectomy in March 2015.
S174
Results: The patient had a good evolution and was discharged on the
7th postoperative day. Anatomicopathological examination confirmed the
diagnosis of GIST. The patient is currently in clinical follow-up, with no
signs of recurrence after 4 months.
Conclusion: Surgical resection is the mainstay of treatment of GIST,
but surgery alone is currently insufficient for advanced lesions, in which
the use of chemotherapy is indicated. The liver is one of the main sites of
GIST recurrence and surgical treatment is mandatory in resectable lesions.
ABSTRACTS
ABSTRACTS
Gynecologic oncology
028862
A successful treatment of clear-cell carcinoma arising from the
abdominal wall
Firmino, N.L.J.1, Gomes, A.S.A.2, Miranda, E.2, Lins, P.I.A.B.3,
Almeida, M.M.1, Costa, F.C.R.1, Arajo, I.V.3, Nascimento, A.C.S.3,
Jesus, C.G.3
1
2
3
Emiranda.onco@gmail.com, pedroablins@gmail.com,
marcella.markman13@gmail.com, fernandacecile@hotmail.com,
irlavalenca_20@hotmail.com, aidacarla.acsn@gmail.com, caroline.
graciliano@hotmail.com
Introduction: Clear-cell carcinoma originating in the abdominal wall
is a rare phenomenon, and the most likely mechanism is malignant transformation of endometriotic foci within the abdominal wall. The frequency
of malignant transformation of endometriosis is unknown, but it is estimated that up to 1% of women with endometriosis develop endometriosisrelated neoplasms. Furthermore, malignant transformation of extragonadal
endometriosis is rare and the most frequently reported sites are rectovaginal septum, colon, and vagina; only 5% of carcinomas arising in ectopic
endometriosis are of clear-cell origin.
Objectives: To report a case of clear-cell carcinoma arising from the
abdominal wall.
Methods: A 51-year-old female underwent MRI which showed an
11-cm soft tissue mass in the anterior abdominal wall. Her past surgical
and obstetric histories were significant for one cesarean section. In January
2011 the patient underwent an incisional biopsy that was inconclusive.
After that was conducted a resection of the abdominal wall tumour with
freezing biopsy. Pathology report showed a clear-cell carcinoma measuring
13 cm. Residual endometriosis in the specimen wasnt identified. Patient
underwent adjuvant chemotherapy with six cycles of carboplatin and paclitaxel, followed by adjuvant radiotherapy.
Results: After 4 years of follow-up, the patient remains disease-free.
Conclusion: Here, we report a case of primary clear-cell adenocarcinoma arising from the abdominal wall. Although similar cases have been
reported, there is as yet no established treatment regimen for this disease.
A combination of debulking surgery followed by chemotherapy and radiotherapy has been suggested for the treatment of tumors. To establish an
effective treatment regimen for this pathology, a review of a larger number
of cases is still needed.
029281
Adaptation of a waiting list management system in gynecologic
oncology to the Brazilian context
Campbell, L.M.1, Filho, A.X.F.1, Motta, L.A.C.R.2, Primo, W.Q.S.P.1
1
Unidade de Ginecologia Oncolgica, Hospital de Base do Distrito
Federal, Braslia, Brazil, 2Fundao de Ensino e Pesquisa em Cincias da
Sade, Braslia, Brazil
leo.m.campbell@gmail.com, adalberto.ferro@yahoo.com.br,
lacasulari@unb.br, walquiriaprimo@gmail.com
Introduction: Surgical waiting times after diagnosis of gynecological
cancers are considered a benchmark for quality assessment of specialized
services in the developed world. Health services organization in the third
world is different and needs transcultural, technological and budgetary
adaptations in order to turn waiting list prioritization into a locally valid
management tool.
S175
Objectives: To demonstrate the experience of setting up a locally
adapted waiting list prioritization assessment system in a developed country
setting, and its preliminary results in a gynecological cancer hospital unit.
Methods: A waiting list prioritization was set up based on internationally renowned systems, available in peer-reviewed articles and published
guidelines. Milestones were used to measure compliance to the waiting
list timeline quality targets: (1) date of first histological or radiological
evidence of disease (diagnosis date); (2) first consultation in the unit with
the current cancer diagnosis; (3) time from first consultation to date when
preoperative exams were ready inclusion in the waiting list; (4) time from
inclusion in waiting list to surgery. These milestones and the patient data
were plotted on a spreadsheet so that each patient had their timeline readily
accessible. The waiting list prioritization list itself was divided in four
major priority groups: (1) immediate (oncological emergencies); (2) 60-day
priority (locally advanced operable gynecological cancers); (3) high-grade
precancerous cervical and endometrial lesions, as well as low-risk ovarian
masses (evaluated by the risk-of-malignancy index); (4) low-grade precancerous lesions; (5) non-cancerous surgeries.
Results: Staff and patient compliance were qualitatively improved
after implementation of the list. Waiting times are considerably lower, with
100% of confirmed cancer cases operated within the 60 days timeframe.
Conclusions: The waiting list system seems to be adaptable to developing countries and their specific needs. It may lead to improved health
service quality perception and outcomes measured by patient, staff and
objective management data.
028443
Adenomyoma mimicking a malignant pelvic mass
Marques, R.M.1, Barbosa, G.B.2, Kuster, M.G.B.2, Teixeira, A.M.S.2,
Rodrigues, J.F.3, Lemos, N.B.M.2
1
Hospital Israelita Albert Einstein, Brazil, 2Universidade Federal de So
Paulo, Brazil, 3Laboratrio Salomo & Zoppi, Brazil
rmorettimarques@gmail.com,
bicudoepm70@gmail.com, gabikuster@yahoo.com.br,
andressa.dra@gmail.com, jr81128@gmail.com, nucelio@gmail.com
Introduction: Uterine adenomyoma is a benign condition and could
mimic a malignant pelvic mass. It presents as a nodular aggregated form
of adenomyosis composed of heterotopic endometrial or endometrium-like
structures in the myometrium, with adjacent myometrial hyperplasia.
Objective: To show the laparoscopic strategy in a pelvic mass suspicious of malignancy.
Methods: We report a 34-year-old nulliparous woman complaining of
pelvic pain, dysuria and urinary frequency. The MRI showed a heterogeneous adnexal mass with multiple cystic areas infiltrating myometrium and
bladder wall measuring 15 cm. The CA125 was measured as >5000mg/dL.
At laparoscopy, a complete pelvic blockade was found caused by a heterogeneous uterine lesion. The tumor, which infiltrated the bladder wall and
omentum, presented mural and subserosal growth.
Results: Due to the patient age, ovarian preservation was opted before
the frozen section result, which was negative for malignancy, on the specimen obtained from the laparoscopic hysterectomy with partial cystectomy
and bilateral salpingectomy. Definitive histological study confirmed the
benign condition with diagnosis of an adenomyoma mimicking a gynecological malignant mass both on laparoscopic and radiological aspects. The
patient was discharged on the second postoperative day with no short- or
long-term complications.
Conclusions: Adenomyoma is not extremely rare, although reports of
adenomyoma showing exophytic subserosal growth are limited. In young
patients, it represents a hypothesis to explain the origin of a pelvic mass.
Despite the large volume and suspicion of malignancy, the minimally inva-
S176
sive surgical approach could be useful both to planning and, eventually,
definitive surgical treatment.
028878
Association of age and pathological factors with lymph-node
metastases in cervical cancer
Spader, M.B.1, Silveira, G.P.G.2, Pessini, S.A.2
1
Santa Casa de Misericrdia de Porto Alegre, Brazil, 2Universidade
Federal de Cincias da Sade de Porto Alegre e Santa Casa de
Misericrdia de Porto Alegre, Brazil
michelespader@hotmail.com, g_py@terra.com.br, spessini@terra.com.br
Introduction: The influence of age in the prognosis of cervical cancer
remains controversial. The clinical impression of a more aggressive presentation at the moment of diagnosis in young females prompted the investigation of the association of age and histopathological factors with the
presence of lymph nodal metastases.
Objectives: To determine the association of age, tumor size, lymph
vascular space invasion (LVSI) and stromal invasion with lymph-node
metasteses.
Methods: This was a retrospective study of 187 female patients with
cervical carcinoma stages IA2, IB and IIA treated by radical hysterectomy
and pelvic lymphadenectomy. Group 1 patients were <40 years old (n = 74)
and group 2 patients 40 years old (n = 113).
Results: There was no significant difference between the two groups
regarding clinical staging, type and histological grade, tumor size, LVSI
and depth of stromal invasion. A higher incidence of lymph-node metastases was observed in young patients (group 1), however without statistical
significance (P = 0.068). Tumor size ( 2 cm), LVSI and stromal invasion
10 mm were shown to be associated with the presence of lymph-node
metastases in both age groups.
Conclusions: Younger patients present a higher incidence of lymphnode metastases, without statistical significance. The pathological factors
associated with lymph-nodes metastase were tumor >2 cm, LVSI, stromal
invasion 10 mm.
029233
Case report of vulvar basal-cell carcinoma (BCC)
Teixeira, R.L.1, Lima, L.W.R.1, Ruvio, V.B.1, Silva, L.C.1, Alves, R.M.S.2,
Nazima, M.T.S.T.3
1
Universidade Federal do Amap, graduanda em Medicina, Brazil,
2
Mdico especialista em Cancerologia Cirurgica; professor auxiliar de
cirurgia geral da Universidade Federal do Amap(UNIFAP), Brazil,
3
Possui graduao em Medicina pela Faculdade de Cincias Mdicas
da Santa Casa de Misericrdia de So Paulo, doutora em Oftalmologia
(UNIFESP); Profa. Adjunta da Universidade Federal do Amap e do
Programa de ps graduao em Cincias da Sade da UNIFAP e co, Brazil
railalinhares@hotmail.com, lana_wrl@hotmail.com,
vitor_benevides@hotmail.com, robertomacelsa@yahoo.com.br,
mairatongu@gmail.com
Introduction: Vulvar cancer represents less than 1% of the malignant
neoplasms in women, with a higher incidence in the age group >70 years.
The basal-cell carcinoma (BCC) corresponds to the minority, 1.4% of the
cases, being considered a rare neoplasia, with local invasive behavior and
frequent post-treatment relapses, causing significant morbidity. The main
risk factor for BCC is the exposure to UV radiation, which is evidenced
by its main occurrence in photoexposed areas and populations located in
low latitudes.
Case report: This paper describes a case of vulvar BCC, highlighting
the importance of the gynecological examination for early detection of this
ABSTRACTS
disease, even in the absence of risk factors. The information was obtained
through interviews with the patient, chart review, and photographic records
of the diagnostic methods. The data were collected by the rules of the Ethics
Committee. Patient MNAM, 59 years old, came from Afu an island in
the Amazon area with complaints about vaginal itch and hypochromic
stain. At the gynecological examination, she presented a vulvar lesion on
the left labia minora, near the vaginal introitus, wider than 2 centimeters,
and hypochromic-scaly. The anatomopathological examination concluded
that it was a case of infiltrative BCC. The patient was submitted to leftsided hemivulvectomy, and the histopathological examination confirmed
the BCC with infiltration until the deep dermis and free margins. Currently,
after 1 year of evolution, the patient remains asymptomatic and with unaltered gynecological exam. The literature shows the importance of the early
detection of this type of neoplasia in order to have correct conduct with
each patient and their relatives, with the goal to modify the prognosis of
this disease.
Conclusion: This paper describes a case of vulvar BCC, the adopted
conduct, associating it with other cases described in literature to enlarge
the comparative, analytical, retrospective studies, establishing a proper
conduct with theoretical and practical basis.
029254
Case report: a young woman patient with poorly differentiated
adenocarcinoma in the right ovary with capsular infiltration
Lira, G.A.1, Costa, T.R.P.2, Silva, R.P.2, Magno, A.W.G.2, Holanda, A.M.3
1
Department of surgical Oncology, Hospital M.D. Luiz Antonio,
Natal, Brazil, 2Academic medicine, Potiguar University, Natal, Brazil,
3
Academic medicine, Federal University of Rio Grande do Norte, Natal,
Brazil
georgelira@hotmail.com, quel.pc@hotmail.com,
rafaelpacheco_s@hotmail.com, alexandre_wgm@hotmail.com,
ayrtonmh@hotmail.com
Introduction: Ovarian cancer is silent, slow to show symptoms, and
can grow quite large before being detected. Unfortunately, approximately
75% of cases are diagnosed when the disease is already advanced; 10% of
the cases have a genetic component, and may be related to breast cancer.
The most common ovarian cancer starts in epithelial cells (80%). Ovarian
tumors are more prevalent in women in menopause, and contraceptive use
reduces the risk of its development.
Objectives: To evaluate the importance and effectiveness of the initial
approach within the oncological surgical therapy in ovarian cysts with
features that suggest neoplastic genesis, overlapping the standard therapy
for laparoscopic surgery.
Methods: The information was obtained through chart review, interview with patient, and photographic register of diagnostic methods to
which the patient has undergone.
Results: FJSR, a 26-year-old female nulliparous patient, was diagnosed by physical examination and imaging with ovarian cyst characteristics suggestive of malignancy which unfortunately was addressed initially
with laparoscopic surgery. After this initial approach, the patient came to
our service complaining of irregular menstrual cycles, presence of bleeding
between menstrual cycles associated with abdominal distension. She was
diagnosed with poorly differentiated adenocarcinoma in the right ovary
with capsular infiltration and absence of neoplastic involvement of right
oviduct. She underwent total abdominal hysterectomy with lymphadenectomy with fast and efficient in-hospital postoperative recovery (in 2 days).
Conclusions: The initial therapeutic approach with total abdominal
hysterectomy with lymphadenectomy is effective compared to laparoscopic
surgery for ovarian cysts that through physical examination and imaging
studies suggest neoplastic features.
ABSTRACTS
028376
Cervical adenocarcinoma in a patient with familial NEM2B
syndrome: a case report
Laporte, G.A.1, Reis, R.J.1, Nonnenmacher.B.1, Conterno, J.1, Polo, R.1,
Kwiatkonski, R.V.1, Zoletti, F.1, Souza, D.L.S.2, de Morais, C.O.2
1
Cincia da Sade de Porto Alegre, Brazil
laportegustavo@gmail.com,rjreis@terra.com.br,laportegustavo@gmail.com,
jonatasconterno@yahoo.com.br,rogerpolo@me.com,rafaelvk@hotmail.com,
dante_lucas92@hotmail.com, kcamilinha.26@gmail.com
Introduction: Familial NEM2B syndrome is normally characterized
by medullary thyroid carcinoma, pheochromocytoma, mucosal neuroma
and marfanoid body habitus. Thus, cervical adenocarcinoma is considered
an atypical presentation.
Objectives: To report a case of familial NEM2B syndrome with
cervical adenocarcinoma and to perform a review of the literature.
Methods: We report on a woman with familial NEM2B syndrome
with cervical adenocarcinoma. This patient was treated by the Surgical
Oncology Service of Hospital Santa Rita of Irmandade da Santa Casa de
Misericrdia de Porto Alegre.
Results: We describe a 36-year-old female patient with familial
NEM2B syndrome presenting marfanoid body habitus. She underwent a
routine gynecological examination which revealed a lesion in the uterine
cervix. Then, a biopsy was performed and revealed an adenocarcinoma.
Additionally, physical examination revealed a lesion T1c confirmed by
pelvic nuclear magnetic resonance. Afterwards, a conization was made
which showed the same result with positive margin, and the patient underwent a videolaparoscopic WertheimMeigs operation. Pathological exam
revealed a moderately differentiated cervical adenocarcinoma T1bN0p.
In 2004 she was submitted to a thyroidectomy due a medullary thyroid
carcinoma; in 2011, she underwent a right adrenalectomy due to pheochromocytoma and, in 2014, she had a left adrenalectomy also due to
pheochromocytoma.
Conclusions: NEM2B is a genetic disease that causes multiple tumors
in mouth, eyes, and endocrine glands. It is caused by variations in the RET
proto-oncogene. Moreover, presentation with cervical adenocarcinoma is
rare and has no reports in the literature.
029174
Cervical cancer epidemiology since 1986 at the Department of
Gynecological Oncology of Hospital Nossa Senhora da Conceio
Damiani, P.A.1, Ungethuem, Y.H.1, Tosin, R.C.1, da Rosa, M.D.1,
Cruz, R.P.1, Rodini, G.P.1
1
Hospital Nossa Senhora Conceio, Brazil
yurihermmann@gmail.com
Introduction: Cervical cancer is associated mainly with low socioeconomic conditions; therefore it is a pathology of relevance to public
health measures. The precursor phase usually takes about 10 years, usually
associated with well-known risk factors (HPV coinfection, early sexual
debut, multiparity, smoking). In the USA approximately 60% of women
who develop cervical cancer have never been screened, or the last screen
was over the previous 5 years. This shows the importance of universal
screening.
Objectives: To analyze the cervical cancer profile in our
Oncogynecology Department, and to compare the results with the literature.
Methods: A retrospective study based on 2217 cases diagnosed with
cervical cancer between 1986 and now, comparing these data to CDCs
S177
database. The characteristics analyzed were: age, clinical stage at diagnosis
and histological type.
Results: In our department 86.82% of squamous-cell carcinoma and
10.28% of adenocarcinoma were diagnosed, contrasting with the CDC data
that showed 72.24% and 19.33%, respectively. Diagnoses were made in
33.91% of the patients between 21 and 39 years old; in the CDC, though,
only 26.64% of the diagnoses were made in the same age period. The clinical stage presentations were 39.55% in stage I, 26.75% in stage II, 26.75%
in stage III, and 4.55% in stage IV. The CDC database shows 46.84%,
23.35%, 19.61%, and 10.20%, respectively.
Conclusion: Our population had a trend of higher number of diagnoses at younger ages when compared to CDCs data. Stage I diagnoses
had lower rates when compared to CDCs data. These results suggest that
our population is more exposed to risk factors and access to prevention
screening is unsatisfactory.
028880
Cervical cancer with pelvic recurrence and pleural metastasis with
favorable results after pelvic exenteration: a case report
Valena, L.B.1, Fontes, A.A.1, Asfora, F.S.P.1, Carvalho, A.L.1, Boente, P.1
1
Centro de Hematologia e Oncologia da Bahia (CEHON), Salvador, Brazil
loanavalenca@yahoo.com, angelofamed@hotmail.com,
fernandaasfora@bol.com.br, pboente@terra.com.br
Introduction: Cervical cancer (CC) is a public health problem and the
fourth most common type of female cancer worldwide. The major cause of
death is the growth pelvic disease. Pelvic exenteration (PE) with palliative
or curative intention is a surgical option for treatment.
Objectives: To describe a case of recurrent pelvic CC and metastatic
disease with favorable outcome after PE.
Results: A 66-year-old woman presented with squamous-cell carcinoma of the cervix stage IIIB; she was treated with concurrent chemoradiation from March to May 2012. After 1 year, she developed local recurrence.
In October 2013, the patient underwent a PE with ureteroileostomy and
protective colostomy with anal sphincter preservation. Pathology report
showed a tumor 9 x 4.5 cm in the cervix with extension to the uterine body,
posterior vaginal wall and bladder. A few days after surgery, pleural effusion was noted, and biopsy confirmed metastatic disease. Chemotherapy
with carboplatin and paclitaxel was administered for 6 cycles (until April
2014) and she achieved complete clinical response. She has been in followup since then with no evidence of disease. Colostomy reversal surgery was
done in January 2015, improving her quality of life (QoL). In recent series
reports, mortality and morbidity rates associated with PE were around 24%
and 1562%, respectively. The intention of the surgery may be curative, in
selected patients, or even in palliative in some. In this case, the surgery had
curative intention. Despite the early development of metastatic disease, PE
most likely improved disease-free survival after palliative chemotherapy
(15 months so far) with low impact on her QoL.
Conclusion: For selected patients with recurrence or persistent pelvic
disease after chemoradiation, PE is a reasonable option for treatment.
029319
Chemoradiaton as a treatment for the BuschkeLowestein tumour: a
case report
Santos, M.H.1, Di Tommaso, R.A.S.1, Haji Junior, A.C.1, Medeiros, F.Q.1,
Baldino, L.1, Ricci, M.A.1
1
Fundao Centro de Controle de Oncologia do Estado do Amazonas,
Manaus, Brazil
oncomhs@gmail.com
S178
Introduction: The BuschkeLowenstein tumour (BLT) or giant
condyloma acuminata (GCA) is a rare sexually transmitted disease caused
by human papilloma virus (HPV) and characterised by invasive growth.
The BLT generally presents as an exophytic tumour of the genital or perianal area, preferentially in men with immunodeficiency diseases; it rarely
occurs in woman. We present a case report of an 18-year-old woman with a
giant BLT of the vulva succesfully treated with chemoradiation.
Objectives: To report a rare case of a BuschkeLowestein tumour of
the vulva treated with chemoradiaton.
Case Report: A female patient, 18 years old, referred to the pelvic
surgery service of our hospital with large warty lesions, vegetating,
affecting the vulva and extending to the lower third of the vagina and
perineum. There was no history of sexually transmitted diseases (STDs)
and she was seronegative for HIV; she reported four months evolution.
The lesion was unresponsive to topical treatment with trichloroacetic acid
solution and cryotherapy. She complained of unpleasant odor, local pain
and occasionally bleeding. Physical examination showed bilateral inguinal
lymph node; vaginal and rectal examination were not tolerated because of
the local pain. Biopsy and microscopy revealed the diagnosis of condyloma
acuminata. After multidisciplinary discussion, treatment was initiated with
radiation associated with platinum-based chemotherapy. It showed excellent response, with complete remission of the lesion.
Discussion: Giant condyloma acuminatum (GCA), first described by
Buschke and Lowenstein in 1925, is a large, exophytic, cauliflower-like
lesion, which can be found on any anogenital mucosal surface. There is no
consensus in the literature regarding the standard treatment, which includes
surgery, topical medications, cryotherapy, radiotherapy and chemotherapy.
Generally radical excision is performed to avoid malignant transformation,
although there is a high number of recurrences.
Conclusions: Chemoradiation is an interesting alternative treatment,
showing a good response and avoiding a mutilating surgical intervention.
029119
Clinical and epidemiological study of endometrial carcinomas treated
in a tertiary cancer center from southern Brazil
Kool, R.1, Ribeiro, R.1, Minari, C.L.1, Aichinger, L.A.1, Ferreira, M.T.M.1,
Linhares, J.C.1
1
Department of Gynecological Surgery, Erasto Gaertner Hospital,
Curitiba, Brazil
ronald.kool@yahoo.com.br,
reitanribeiro@hotmail.com,claudiane@lpcc.org.br,lillyaichinger@hotmail.com,
dr_marianatais@yahoo.com.br, linhares@iop.com.br
Introduction: Endometrial cancer is the most common gynecological cancer in developed countries and the fourth most common cancer in
women. In Brazil there is lack of epidemiological studies about the disease
and even basic information about these patients is scarce.
Objectives: To investigate clinical and epidemiological information of
the Brazilian women presenting with endometrial cancer, and to compare
these data with the literature.
Methods: We performed a retrospective analysis of all patients with
endometrial cancer diagnosed and treated between January 2008 and
December 2013 at our institution, a tertiary cancer center in south Brazil,
regarding clinical and epidemiological data.
Results: A total of 150 patients were included. The mean age of the
patients analyzed was 66.4 years. They were mostly white (97%) and obese
(mean BMI 32.5). The main symptom was vaginal bleeding (74%) and more
than half of the patients had a previous diagnosis of systemic hypertension
and/or diabetes. Mean endometrial thickness was 19.7mm. Endometrial
curettage was the main method of diagnosis (92%). Adenocarcinoma was
the histological subtype in 139 patients (94%) and early stages (FIGO IA
ABSTRACTS
and IB) represented 76% of the cases. Laparoscopy was the surgical choice
in 19 patients, while 131 had standard open surgery (87%).
Conclusions: In this selected population, staging, histological type,
symptoms, BMI and comorbidities were similar to those in European and
American patients, probably due to the majority of patients coming from
families with Caucasian ascendance.
029089
Clinical and epidemiological characteristics of cases of uterine cervix
cancer precursory lesions treated through high-frequency surgery
Lustosa, A.G.1, Filho, K.J.C.2, Gis, M.C.2, Corra, R.S.2, Silva, R.P.2,
Pires, T.C.3, Oliveira, I.B.M.D.2, Lira, G.A.2, Souza, W.B.1
1
Natal, Brazil
Introduction: High-frequency surgery (HFS) is a simple outpatient
procedure, performed under local anesthesia, without hospitalization and
at low cost; it enables healing of the lesion while preserving most of the
internal genital organs and avoiding the spread of the cancer.
Objectives: To verify the clinical and epidemiological characteristics
of cases of precursor lesions of cervical cancer treated by HFS.
Methods: An exploratory, descriptive and transversal study, with a
quantitative approach and a technical procedure, performed in the gynecology service of the reference service in the city of Natal in the state of
Rio Grande do Norte for the treatment of cervical cancer. We used the
records of women undergoing such treatment; the sample represented by
the records that meet the criteria for inclusion and exclusion was established in the search. A form drawn up from information from the files of
records was used as a data collection instrument. The project followed the
norms of Resolution number 196 of October 10th, 1996, established by the
National Health Council.
Results: The risk factor observed was the onset of sexual activity at
<18 years of age, corresponding to 60.68% of women, and the presence
of HPV in 27.35% of cases. The cytological examination was performed
in 94% of women, previously HFS, having presented results compatible
with STI in 34% of cases. All women underwent colposcopy for the HFS
procedure; 57.3% had CIN lesions in varying degrees, and 43.3% CIN I,
6% CIN II, and 50.7% CIN III (56.7% of these are considered high-grade
lesion). The HFS was resolutive in 80.3% of cases, and 15.4% continue to
be monitored.
Conclusions: Women and more and more young people are being
affected by HPV, and consequently by CINs in degrees of commitment.
It verified the effectiveness of the HFS treatment of precursor lesions of
cervical cancer.
029150
Comorbidities after surgical treatment and radiotherapy in a patient
with cervical cancer attending Palmas, TO: a case report
Gomes, D.B.1, Arago, P.S.1, Oliveira Jnior, I.R.A.1, Correia, C.S.1,
Nascimento-Rocha, J.M.2, Coelho, P.F.R.3
1
Medical school, Tocantinense Institute President Antnio Carlos ITPAC,
Porto, Porto Nacional, Brazil, 2Laboratory Coordination, Tocantinense
Institute President Antnio Carlos ITPAC, Porto, Porto Nacional, Brazil,
3
Medical school, Federal University of Tocantins, Palmas, Brazil
daystn@hotmail.com, paulaaragao2210@gmail.com,
iran_jr12@hotmail.com, carmem_correia@hotmail.com,
nascimentojmn@hotmail.com, drpedroflorindo@gmail.com
ABSTRACTS
Introduction: Cervical cancer is the second most frequent neoplasia
among women of 65 years of age and is the most common cause of death
from gynecological cancers worldwide. The IB1IIA stages of the disease
are adequately treated by surgery or radiotherapy. However, the early recurrence of cervical cancer is associated with risk factors such as patient age
and tumor size and appearance. In addition, treatments with radiotherapy
can result in comorbidity, such as vaginal stenosis, which causes emotional
stress and functional damage.
Objectives: To present the case of a patient attended by the oncology
department of the General Hospital of Palmas TO, Brazil, who after
cervical cancer recurrence was treated with radiation therapy presenting
other comorbidities.
Methods: The patient was NCO, a 24-year-old married woman
residing in Palmas, TO, G0, P0, A0. In 2008, she reported postcoital
bleeding and through the speculum examination it was noticed that she had
a friable vegetating lesion of 4 cm in the posterior lip of the cervix. After the
diagnosis of IB1 cervical cancer, she was referred for total hysterectomy
(WertheimMeigs). The case study was authorized by the patient through
the Informed Consent (IC) procedure.
Results: Nine months after surgery, the patient reported dyspareunia and presented cancer recurrence with compression of the rectum.
Radiotherapy was indicated. After treatment, the patient did not progress
satisfactorily, other comorbidities came up, such as vaginal stenosis and the
persistence of dyspareunia.
Conclusions: Adverse effects of radiotherapy are characterized by
organic changes that affect the quality of life of the patient. Some of the
changes found are dyspareunia and vaginal stenosis, which are intensified
by the absence or reduction of ovarian function induced by radiotherapy.
The occurrence of these adverse effects is probably related to the treatment
with radiotherapy after cervical cancer recurrence, since other risk factors
for developing these conditions were not detected.
028985
Conservative treatment of microinvasive cervical squamous-cell
cancer stage IA1: recurrence and survival
Alberton, D.1, Silveira, G.P.G.2, Luzzatto, R.1, Gottlieb, D.1, Pessini, S.A.3
1
Santa Casa de Misericrdia de Porto Alegre, Brazil, 2Universidade
Federal de Cincias da Sade de Porto Alegre e Santa Casa de
Misericrdia de Porto Alegre, Brazil, 3Santa Casa de Misericrdia de
Porto Alegre e Universidade Federal de Cincias da Sade de Porto
Alegre, Brazil
danialberton@hotmail.com, g_py@terra.com.br, ruiluzzatto@terra.com.br,
daianegottlieb@hotmail.com, spessini@terra.com.br
Introduction: Cervical cancer is the most frequent genital cancer in
women in Brazil. Stage IA1, diagnosed by microscopy, is defined by a
maximum invasion depth of 3 mm and a maximum horizontal spread of 7
mm, with or without lymph vascular space invasion (LVSI).
Objective: To evaluate the outcomes of cervical conization as a
conservative management for microinvasive cervical squamous-cell cancer
(SCC) stage IA1 without LVSI.
Methods: This was a retrospective cohort study, with 44 patients diagnosed with microinvasive cervical SCC without LVSI. Follow-up, recurrence, survival and subsequent treatments were analyzed.
Results: Of the 44 patients at stage IA1 SCC without LSVI, 25 (56.8%)
were conservatively treated (loop eletroctrosurgical excisional procedure or
cold knife conization). Patient ages ranged from 23 to 61 years, and mean
patient age at diagnosis was 40 years. Follow-up was performed with Pap
smear, colposcopy, and biopsy when necessary. Mean follow-up time was
3.8 years (15.7 years). One patient recurred with cervical intraepithelial
neoplasia (CIN); none recurred with carcinoma.
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Conclusions: Conization represents a safe treatment for microinvasive cervical SCC without LVSI. It is a minimally invasive surgery
and preserves fertility. Appropriate selection of patients, advice on the
therapeutic approach and follow-up are strongly recommended for these
conservatively treated patients.
028856
Embolization to inferior vena cava of totally implantable catheter for
chemotherapy: a case report
Vieira, S.C.1, Brando, D.C.B.S.1, Silva, R.O.P.2, Mesquita, A.B.G.1
1
Department of General Internal Medicine, Federal University of Piau,
Teresina, Brazil, 2So Marcos Hospital, Brazil
sabas.vieira@uol.com.br, daianaclara@hotmail.com,
rops.vascular@gmail.com, anndya_@hotmail.com
Introduction: Fracture with embolization of a totally implantable
catheter for administration of chemotherapy accounts for less than 1%
of complications related to this procedure. Catheter fracture is caused by
compression of the catheter between the clavicle and the first rib, known
as the pinch-off syndrome. Searching the PUBMED database and using
the uniterms embolization, catheter, chemotherapy and fracture,
we found only 25 cases of fracture and embolization of catheters used for
chemotherapy. Catheter migration to the inferior vena cava occurred in
only one case.
Objective: To describe a rare case of embolization of a totally implantable catheter to the inferior vena cava in a patient with ovarian cancer.
Method: Data were collected from patient medical charts, and the
following information was obtained: age, gender, underlying disease, diagnosis, treatment of embolization and clinical course of the patient after
treatment.
Result: A female 57-year-old patient underwent hysterectomy and
salpingoophorectomy for ovarian cancer in January 2010. Histopathological
analysis revealed G3 ovarian adenocarcinoma. In February 2010, a totally
implantable catheter was transcutaneously implanted into the right
subclavian vein for administration of chemotherapy. The procedure was
uneventful. The distal catheter segment was placed in the superior vena
cava close to the entry of the right atrium. The patient underwent platinumand taxol-based adjuvant chemotherapy, and had good tolerance. However,
a routine radiological examination in October 2013 diagnosed fracture and
embolization of the distal segment of the catheter. The catheter fragment
had embolized to the retro and suprahepatic inferior vena cava, with no
patient symptoms. Catheter retrieval was performed through the femoral
vein using the loop-snare technique, without any complications. The
patient is doing well 24 months after the procedure.
Conclusion: Fragments of a central venous port catheter totally
implanted into the right subclavian vein may embolize to the inferior vena
cava and be asymptomatic. Treatment of choice is catheter removal by an
endovascular approach.
029300
Endometrioid adenocarcinoma: WertheimMeigs (WM) radical
hysterectomy in surgical treatment associated with radiotherapy
Oliveira Jnior, I.R.A.1, Arago, P.S.1, Gomes, D.B.1, Correia, C.S.1,
1
Medical school, Tocantinense Institute President Antnio Carlos Porto
Ltda, Porto Nacional, Brazil, 2Coordination laboratories, Tocantinense
S180
Institute President Antnio Carlos Porto Ltda, Porto Nacional, Brazil,
3
iran_jr12@hotmail.com, paulaaragao2210@gmail.com,
daystn@hotmail.com, carmem_correia@hotmail.com,
nascimentojmn@hotmail.com, drpedroflorindo@gmail.com
Introduction: Among all the types of womens cancer, endometrial
cancer is the seventh most common worldwide. When compared with
other types of tumor it has a high survival rate since most patients are
diagnosed early. Type I endometrial adenocarcinoma (EAC) or endometrioid adenocarcinoma represents approximately 90% of cases of EAC,
and the major factor responsible for its pathogenesis is the excessive exposure to estrogen. It is more prevalent in Caucasians, the peak incidence
is between 55 and 65 years, and it may occur in the premenopause, perimenopause or postmenopause periods. Factors such as hormone therapy
with estrogen and progesterone, early menarche, late menopause, obesity,
nulliparity and estrogen-secreting tumors are associated with endometrioid
adenocarcinoma.
Objectives: To report the recovery of postmenopausal patients diagnosed with endometrial cancer who underwent WM radical hysterectomy.
Methods: Case report given by the Department of Gynecology
Oncology at the General Hospital of Palmas, authorized by Informed
Consent (IC). The case was MHS, a 56-year-old married female from
Palmas, TO.
Results: The anatomopathological examination showed signs of
malignancy with atypical stratification nuclei, loss of glandular architecture, atypical mitotic figures, foci of necrosis and stromal invasion.
Diagnosis was a poorly differentiated endometrioid adenocarcinoma. The
patient underwent the WM procedure and radiotherapy. She has shown no
clinical complaints up to the present time. Ultrasound was performed periodically and showed no changes.
Conclusions: Although the preservation of the ovaries in postmenopausal patients is recommended, it has been found that ovarian failure
occurs in up to 2 years after the surgery, causing the same effects of endocrine bone disease. Thus, the radical hysterectomy proves to be a safe
choice in postmenopausal women, with low complication rates and high
survival rates. It has been 5 years since the surgery and the patient remains
asymptomatic and free of changes in imaging examinations.
028957
Genetic polymorphism of glutathione-S-transferase p1 and markers
of oxidative stress in patients infected by human papillomavirus
Almeida, G.F.G.1, Almeida, J.C.2, Arajo, R.F.F.2, Cabral, J.G.V.3,
Galvo, A.M.4, Lopes, A.V.Q.3, Maia, B.K.F.3, Oliveira, D.A.3,
Silveira, L.L.3
1
Clinical Hospital, HC, Recife, Brazil, 2Laboratory of Immunopathology
Keizo Asami, University of Pernambuco, Recife, Brazil, 3University
Center Mauricio de Nassau, Recife, Brazil, 4Laboratory of
Immunopathology Keizo Asami, University of Pernambuco, Recife,
Brazil and University Center Mauricio de Nassau, Recife, Brazil
jessicagvcabral@yahoo.com.br, andremgalvao@hotmail.com,
annavanessaql@gmail.com, brucekepler@hotmail.com,
daniel@oliveiraalexandre.com, luanalls87@gmail.com
Introduction: Human papillomavirus (HPV) is responsible for the
development of tumors, and the redox imbalance has an important role
in the pathogenesis of the disease. Glutathione-S-transferase belongs to
a family of enzymes that prevent redox imbalance, preventing damage to
DNA.
Objective: To analyze the genetic polymorphisms of GSTP1 in
patients infected with HPV, and oxidative stress markers.
ABSTRACTS
Methods: For genotypic analysis, DNA extraction was performed
in the serum of 84 individuals (33 HPV51 HPV-positive and -negative),
followed by PCR, enzymatic digestion and agarose gel electrophoresis.
Oxidative stress markers were analyzed: lipid peroxidation, carbonyl, thiol
groups and catalase activity.
Results: HPV-positive patients had a 76% increase in lipid peroxidation and 60% in the carbonyl groups. In addition, there was a reduction of
78% in the thiol group levels and 57% in the enzymatic activity of catalase.
Regarding the frequency distribution of mutant genotypes, the frequency
of HPV-positive patients was higher (42% heterozygous, and homozygous
14/33 12% 4/33) than the wild-type genotype (45%, 15/33).
Conclusion: The results showed that there is an association between
the presence of the mutant gene GSTP1 in HPV-positive patients, with
increased levels of oxidative stress markers.
029188
Giant ovarian serous cystadenoma: a case report
Frutuoso, A.V.S.1, Franco, A.C.1, Sohn, R.V.1, Medeiros Filho, W.V.1,
Donini, C.M.F.1, Ferreira, A.A.S.1
1
Department of General Surgery, Julio Muller Teaching Hospital, Federal
University of Mato Grosso, Cuiab, Brazil
agata.shimizu@gmail.com, annacarolinafranco@hotmail.com,
renan.vicente@hotmail.com, wilsonvilela.msn.com,
cinthiadonini@gmail.com, aurelio.abdias@gmail.com
Introduction: Giant ovarian serous cystadenoma is a type of tumor
derived from the surface epithelium (celomic), formed by cystic areas. This
type of mass is rarely described but is the most prevalent among the ovarian
giant masses.
Objectives: To illustrate how this kind of tumor can have silent growth,
and to call attention to ovarian epithelial cysts in the outpatient clinics and
primary care services, contributing to a decrease in any underdiagnosis,
misdiagnosis and underreporting that might occur.
Case report: We report the case of a 65-year-old patient who
presented with an increase in abdominal girth, of 6 months evolution, first
asymptomatic and then associated with dyspnea and postprandial distension. Imaging studies showed a giant abdominal-pelvic mass with probable
origin in the left ovary; Cancer antigen-125 was elevated, while carcinoembryonic antigen was normal. Total abdominal hysterectomy, bilateral salpingoophorectomy and omentectomy were done and a giant tumor of 15 kg
was removed. The diagnosis was confirmed by histopathology as a benign
ovarian serous cystadenoma.
Conclusion: This huge tumor evolved for a long time unsuspected and
without symptoms in a patient from a developing region. The diagnostic
and management challenges posed by this unexpected and unusual presentation of an ovarian cystadenoma are discussed.
029270
Inflammatory pseudotumor of lymph nodes in the inguinal canal: a
case report
Bacha, O.M.1, Hillmann, E.2
1
Hospital Charles LeMoyne, Universidade de Sherbrooke, Greenfield
Park, Canada, 2Hospital Charles LeMoyne, Greenfield Park, Canada
om.bacha@usherbrooke.ca, elisehill@gmail.com
Introduction: Inflammatory pseudotumor is a rare benign cause of
lymphadenopathy previously reported in several anatomical locations that
can simulate malignant neoplasm.
Objectives: To present a case of this rare disease that can be confused
with malignant disease in the inguinal canal.
ABSTRACTS
Results: A postmenopausal patient presented with inguinal and abdominal pain on the right side. A 10-cm tumor was felt on rectovaginal examination. Computed tomography of the abdomen and pelvis demonstrated an
ill-defined, inguinal soft-tissue density. Magnetic resonance demonstrated
an ill-defined tumor present in the inguinal canal. The patient underwented
exploratory surgery with complete resection of this inguinal tumor; a transoperative frozen section did not suggest carcinoma. The final histological
examination revealed inflammatory pseudotumor of lymph nodes. One
year after the surgery, the patient remains asymptomatic, without evidence
of disease.
Conclusions: Inflammatory pseudotumor is a rare entity and should
be included in the differential diagnosis of patients with soft tissue tumors.
029241
Intraperitoneal chemotherapy for ovarian tumors in a single center
in Canada
Bacha, O.M.,1 Hillmann, E.2
1
Hospital Charles LeMoyne, Universidade de Sherbrooke, Greenfield
Park, Canada, 2Hospital Charles LeMoyne, Greenfield Park, Canada
om.bacha@usherbrooke.ca, elisehill@gmail.com
Introduction: Ovarian cancer is one of the most common and deadliest gynecological cancers, with about 75% of the patients presenting in
advanced stages. The concept of delivering chemotherapy directly to the
tumor led to the use of intraperitoneal chemotherapy in ovarian cancer.
Early clinical studies indicate that intraperitoneal chemotherapy delivery
achieves a dose to the tumor 1020 times higher than that by the systemic
delivery route. The randomized study GOG 172 in 2006 led to a 16-month
improvement in the overall survival. However, catheter-related complications and the complexity of the procedure have deterred use of the intraperitoneal route as the preferred route of treatment.
Objectives: To describe the experience of intraperitoneal chemotherapy in a single center in Canada.
Methods: Description of the cases in a single center. Tables of frequencies and medias were calculated.
Results: From 2006 to 2015, 23 patients were treated with intraperitoneal chemotherapy in our center. In the last years theres been a tendency
of increasing the number of patients treated with this method as our experience increases. Cisplatin and taxol were the principal drugs used. The
schema used in the study GOG 172 were used, taxol IV day 1, cisplatin
IP day 2, taxol IP day 8. Some patients received some cycles of chemotherapy IV before the IP treatment and differently from the original study,
we administered taxol in 3 hours; also most of our patients received 75 mg/
m2 of cisplatin (instead of 100 mg/m2). The patients were well selected,
and most of them completed at least six cycles, but others received only
one cycle.
Conclusion: Intraperitoneal chemotherapy is a feasible method
of treatment for ovarian cancer. The improvement in survival with this
method compensates for the complexity of the procedure and the higher
number of complications. The use of intraperitoneal chemotherapy should
be stimulated.
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028982
Is para-aortic lymphadenectomy always necessary in endometrial
cancer staging?
Baiocchi, G.1, Camaro, W.R.1, Faloppa, C.C.1, Mantoan, H.1,
Kumagai, L.Y.1, Badiglian-Filho, L.1
1
glbaiocchi@yahoo.com.br,
wrcamarco@msn.com, ccfaloppa@hotmail.com, hemantoan@gmail.com,
lykumagai@hotmail.com, levonbfilho@gmail.com
Introduction: Para-aortic lymph-node (PALN) metastasis in endometrial cancer is an uncommon event and para-aortic systematic lymphadenectomy is still under debate.
Objectives: To analyze the risk factors related to PALN metastasis in
endometrial cancer.
Methods: We analyzed a series of 297 patients, treated at AC Camargo
Cancer Center from July 1991 to May 2014, who had pelvic and para-aortic
lymphadenectomy. Patients who had only pelvic lymphadenectomy were
excluded.
Results: Median age was 60 years (range, 2985). Regarding histological grade, 42.1% (n = 104/247) had grade III, 16.9% (n = 45/271)
lymphovascular space invasion (LVSI), and 39.4% (n = 138/280) myometrial invasion >50%. Median number of pelvic lymph nodes (PLNs) and
PALNs dissected was 22 (range, 190) and 12 (range, 145), respectively.
Fifty-four patients (18.2%) had PLN metastasis (median two LNs, range,
129), and 36 (12.1%) PALN metastasis (median two LNs, range, 118).
Of the patients with PALN metastasis, ten (27%) had preoperative enlarged
PALN or signs of extrauterine disease on imaging. During surgical procedure, 16 patients (43.2%) had enlarged PLN and/or PALN, four (10.8%)
had carcinomatosis and one (2.7%) ovarian metastasis. Only six (16.2%)
patients did not have extrauterine disease or enlarged LN found during
surgical procedure. Notably, only six (2.5%) in 243 patients without PLN
metastasis had PALN metastasis, and only two patients (0.8%) had neither
suspected extrauterine disease nor enlarged LN preoperatively or during
surgical procedure. PALN metastasis was statistically related to PLN
metastasis (P < 0.001), LVSI (P < 0.001), grade III tumors (P = 0.002), and
deep myometrial invasion (>50%) (P < 0.001). In multivariate analysis,
only pelvic LN metastasis (HR 26.4, 7.592.2; 95%CI: P < 0.001) and deep
myometrial invasion (6.32, 1.2432.0; 95%CI: P = 0.026) maintained as
independent risk factors for PALN metastasis.
Conclusions: PLN metastasis and deep myometrial invasion are risk
factors for PALN metastasis. Our series support that PALN metastasis is a
very rare event with the absence of pelvic LN metastasis or clinically suspicious extrauterine disease.
029216
Laparoscopic anterior exenteration: a case report of a recurrent
vaginal adenocarcinoma
Zanvettor, P.H.1, Neves, A.R.S.1, Filho, D.F.1, Souza, T.A.1, Palmeira, L.O.1
1
Department of Gynecology, Aristides Maltez Hospital, Salvador, Brazil
phzanvettor@terra.com.br, adsonneves@ufba.br, dfalcao@gmail.com,
tiagofamed@yahoo.com.br, dr.leonardo@ymail.com
Introduction: Laparoscopy classically reduces morbidity and invasiveness. To decrease the operative morbidity associated with exenteration,
we considered the possibility of performing an anterior exenteration by the
laparoscopic approach
Objectives: To describe the case of laparoscopic anterior exenteration
Methods: A 57-year-old woman presented with a vaginal cancer
relapse, treated previously with chemoradiotherapy. The preoperative
workup was done with contrast-enhanced computed tomography of the
S182
abdomen-pelvis; no distant metastasis were shown. A coloanal anastomosis
and an ileal-loop conduit for urinary tract diversion were made.
Results: The operative time was 305 minutes and blood loss was
200 mL, as measured by the amount of blood in the suction machine. No
blood transfusion was necessary. The bladder, urethra, and vagina were
mobilized en bloc from the pelvic sidewall. We used an ultrasonic device
for the control of vaginal vessels and anterior branches of internal iliac
vessels. The specimen was removed through the vulva. The urinary diversion chosen was a Bricker reconstruction made totally laparoscopic. The
product was delivered through the vagina. The patient was discharged
without major complications.
Conclusion: Laparoscopic anterior exenteration is feasible. With
laparoscopic surgical knowledge and an ultrasonic device, laparoscopic
pelvic exenteration procedure is feasible.
029152
Laparoscopic hysterectomy and lymphadenectomy for endometrial
cancer: is there benefit?
Araujo, R.O.C.1, Valado, M.1, Sabino, F.D.1, Barbosa, C.A.1, Ziller, C.F.1,
Ferreira, F.C.S.1
1
Pasteur Oncology Center, Hospital Pasteur, Rio de Janeiro, RJ, Brazil
rotaraujo@yahoo.com.br, drmarcusvaladao@gmail.com,
fdsabino@gmail.com, cibele.aquino@gmail.com, carolinaziller@gmail.com,
flaviaf21@gmail.com
Introduction: Endometrial cancer is a highly curable disease if
adequately treated. Minimally invasive surgery reduces postoperative
pain, promotes early recovery, and has better cosmetics. The extent of
lymphadenectomy is still debatable due to lack of survival benefit despite
the fact that it offers a more accurate staging and selection for adjuvant
therapy.
Objectives: To evaluate the benefits of the laparoscopic approach
to endometrial cancer and the pattern of node disease in our surgical
population.
Methods: Patients submitted to surgical treatment for endometrial
cancer in our institution from April 2013 to June 2015 were selected for our
prospective database and analyzed for the following variables: laparoscopic
access versus open, length of postoperative stay, extent of lymphadenectomy, nodal disease, FIGO stage, and surgical complications. Categorical
variables were compared using the chi-square test, student T test was used
to compare means and the MannWhitney test for continuous variables.
Results: Twenty-seven patients were submitted to hysterectomy for
endometrial cancer in this period; 16 were laparoscopic and 11 were open.
The mean age was 60 years with no difference between groups (P = 0.48).
In the laparoscopic group the mean length of stay was 1.8 days versus 2.7
days in the open group (P = 0.23), but mean laparoscopic surgical time
was longer (188 versus 120 min, P = 0.001). No serious complication
occurred in either group, except for one postoperative ileus (open) and
one lower limb numbness. The mean number of resected nodes was 8.9
versus 8.1 (P = 0.32). Only one patient had positive pelvic nodes. Twelve
patients were FIGO IA, eight were IB, two stage II and one stage IIIC and
groups were comparable in stage (P = 0.45). No recurrences were seen.
Radiotherapy was not offered for low-risk node-negative patients (stage I).
Conclusions: Laparoscopic hysterectomy didnt affect radicality but
increased surgical time. Lymph-node metastasis is rare in our study population, but lymphadenectomy offered accurate staging, thus avoiding radiotherapy side effects in low-risk patients.
ABSTRACTS
028496
Laparoscopic nerve-sparing radical parametrectomy for occult earlystage invasive cervical cancer after simple hysterectomy: two videos
Marques, R.M.1, Barbosa, G.B.2, Gomes, M.T.V.1, Vieira, M.A.3,
Sato, L.M.2, Kuster, M.G.B.2, Litwinzuk, A.F.A.2, Garcia, C.M.M.4,
Lemos, N.B.M.2
1
Paulo, Brazil, 3Hospital de Cncer de Barretos, Brazil, 4Hospital Regional
do Vale do Paraba, Brazil
bicudoepm70@gmail.com, mariano.tamura@einstein.br,
mvieiraonco@gmail.com,lmsato85@gmail.com,gabrielakuster@gmail.com,
anaflavia70@gmail.com, carolmaga2003@gmail.com, nucelio@gmail.com
Introduction: The incidental cervical cancer after hysterectomy for
benign disease represents the lack of adequate investigation of cervical
cancer. The standard of treatment for this oncological situation remains
controversial and includes chemoradiation therapy or conventional surgery
with radical parametrectomy and pelvic lymphadenectomy. The most of
gynecological oncologists prefer the clinical treatment due the technical
difficulties and complications related to surgery. Bladder dysfunction has
been reported in up to 1032% of patients after the radical parametrectomy. These negative consequences are results of damage to the autonomic
nerves, both sympathetic and parasympathetic.
Objectives: To show the surgical steps and the importance of deep
avascular spaces dissection.
Methods: Two videos describing step-by-step the technique of the
laparoscopic nerve-sparing radical parametrectomy.
Results: Two young patients underwent simple hysterectomy due in
situ cervical carcinoma and menorrhagia. The histopathological analysis
revealed IB1 pathological stage with no risk factors (<4.0 cm, no LVI,
superficial invasion) cervical SSC. The operating time was 240 minutes
with little blood loss. The patients were discharged on the second postoperative day. There are no relevant complications related to the radical
parametrectomy. The pathological analysis showed no residual disease or
lymph-node involvement. There is no bladder dysfunction or local recurrence in either patient.
Conclusion: The laparoscopic radical parametrectomy provided
adequate results with regard to recovery of bladder voiding function and
local cancer control. Despite being a complex surgery with technical difficulties, and having surgery-related complications, the development of the
deep avascular spaces make it easier and safer, avoiding the nerve injuries and consequent bladder dysfunction. The gynecological oncologist
should be aware of the advanced pelvic anatomy to decide the best treatment option. When there is no evidence of pathological worse prognostic
factors, the laparoscopic radical parametrectomy seems be a well tolerated
treatment for the incidental cervical cancer.
028535
Laparoscopic pelvic exenteration for gynecological cancers: report of
three cases and review of literature
Sousa, T.A.1, Neves, A.R.S.1, Filho, D.F.F.1, Zanvettor, P.H.1
1
Aristides Maltez Hospital, Salvador-Bahia, Brazil
tiagofamed@yahoo.com.br, adsonneves@ufba.br, dfalcao@gmail.com,
phzanvettor@terra.com.br
Introduction: Laparoscopic pelvic exenteration has emerged as a new
treatment option for central recurrent gynecological cancers infiltrating
bladder or rectus, after prior radiotherapy. However, current scientific
evidence is very limited and consists of case reports or small case series.
Objectives: To describe three cases of anterior laparoscopic pelvic
exenteration and review the literature.
ABSTRACTS
Methods: A review of literature was made using the key words laparoscopic pelvic exenteration. Three female patients were admitted between
2011 and 2014 at the Department of Gynecology of Aristides Maltez
Hospital. They were 45, 24 and 57 years old and had initial stage FIGO
IIIB, IIA2 and IIB, respectively, previously treated with concurrent radiochemotherapy with a recurrent central squamous-cell carcinoma (case 1)
or adenocarcinoma of cervix (cases 2 and 3) with extension to vagina and
urethra (cases 1 and 3) or bladder (case 2).
Results: The surgeries lasted 510, 480 and 305 minutes, respectively.
No blood transfusion was necessary. The urinary diversion chosen was
Bricker reconstruction made extracorporeally through the trocar incision
in the right flank in cases 1 and 2, but totally laparoscopic in case 3. The
ileal anastomosis was made extracorporeally (case 1) or totally laparoscopic (cases 2 and 3). The product was delivered through vagina. The
patients were discharged without major complications, except a urinary
benign fistula in case 2. The first case report of a laparoscopic total pelvic
exenteration was made by Pomel in 2003, attesting to its feasibility. In
2006, Puntambekar published the first series of 16 cases of laparoscopic
anterior pelvic exenteration.
Conclusion: Anterior laparoscopic pelvic exenteration is feasible.
We showed three different surgical techniques with improving experience of the surgical team and good results. However, current available
data of laparoscopic pelvic exenteration appear to result in similar clinical
outcomes when compared to the classical approach, and oncological safety
needs to be further investigated. Meanwhile, laparotomy approach remains
the standard of care.
028967
Laparoscopic radical hysterectomy: technical tips from a teaching
center
Diniz, F.D.1, Simioni, E.B.1, Tsunoda, A.T.1, Andrade, C.E.M.C.1,
Reis, R.1, Vieira, M.A.1
1
daldegan_felipe@hotmail.com,
elisasimioni83@gmail.com,atsunoda@gmail.com,mdcarlosandrade@gmail.com,
dr.ricardoreis@hotmail.com, mvieiraonco@gmail.com
Introduction: Laparoscopic radical hysterectomy is frequently associated with a long learning curve. Teaching advanced procedures can be
challenging. Technique standardization may improve reproducibility with
safety in training centers.
Objectives: To demonstrate a laparoscopic radical hysterectomy (type
C1) performed by a surgical oncology resident in training, with a standardized technique.
Methods: A 51-year-old patient underwent a laparoscopic radical
hysterectomy (C1) for stage FIGO IB1 cervical cancer. The patient was
positioned with arms along the body, and lower limbs on Allen stirrups.
Four trocars were placed: one 11-mm umbilical trocar and three 5-mm
trocars in the lower quadrants. A uterine manipulator was introduced.
The procedure started with a comprehensive pelvic lymphadenectomy.
Pelvic lateral spaces and anatomical landmarks were identified. A delicate
dissection of the uterine artery and vein was performed, and the ureter
was tunneled. The uterine vessels were sectioned and medialized over
the ureter, on both sides. Infundibulopelvic ligaments were dissected and
sealed with bipolar coagulation. Posterior dissection of the cul-de-sac was
performed. Section of the uterosacral ligament, cardinal ligament, and anterior parametrium with autonomic preservation was performed with an
ultrasonic device and bipolar coagulation. Colpotomy with pure cut energy,
with specimen retrieval, was followed by a vaginal cuff 2.0 polygalactine
continuous suture.
Results: Total operative time was 150 minutes, with blood loss of 20
mL. There were no intraoperative complications. A resident assisted by a
S183
senior surgeon performed the entire procedure. The patient was discharged
next morning, without bladder catheter, after a voiding test of 65 mL. Final
pathological report: squamous-cell carcinoma (2.0 x 1.4 cm), parametrium
size: 3.2 x 2.5 x 1.2 (right side) and 3.5 x 3.4 x 0.8 cm (left side). Pelvic
lymph nodes: 0/11. 30 days postoperative time was uneventful.
Conclusions: Standardization of the laparoscopic radical hysterectomy may improve reproducibility, safety and effective teaching, as demonstrated in this video.
028343
Laparoscopic retroperitoneal lymphadenectomy for gynecological
malignancies: tips and tricks
Brandalize, G.G.1, Kool, R.2, Ribeiro, R.2, Guerreiro, J.A.2, Minari, C.L.2,
Linhares, J.C.2
1
Surgery Department, Cruz Vermelha Hospital, Curitiba, Brazil, 2Surgical
Oncology Department, Erasto Gaertner Hospital, Curitiba, Brazil
giovanagugelmin@gmail.com,
ronald.kool@yahoo.com.br, reitanribeiro@hotmail.com,
guerreiro@iop.com.br, clauzinha08@hotmail.com, linhares@iop.com.br
Introduction: The retroperitoneal lymphadenectomy is an important
part of the staging and treatment of gynecological tumors. The laparoscopic
approach can reduce the complications rate, but it is demanding with lots of
technical details that make this a difficult procedure.
Objective: To describe the laparoscopic retroperitoneal lymphadenectomy to gynecological malignancies with special attention to the most
important tips and tricks in difficult situations, allowing standardization of
the technique.
Methods: The patient is placed in the split leg position with 15
Trendelenburg position. The surgeon stands on the patients right side, the
first assistant between the patients legs and the second assistant on the left
side. A 10-mm trocar is placed on the umbilicus, one 10-mm trocar (30
optic) just above the pubis. Three 5 mm are placed in line half way from
the 10-mm trocar. Surgery starts with opening of the peritoneum along the
retroperitoneum. Lifting traction sutures are placed on the peritoneal edges
helping to expose the retroperitoneal area. The right ureter is identified and
the paracaval lymphadenectomy is performed from distal to proximal until
the level of the left renal vein. Then, the intercavoaortic lymphadenectomy
is performed to the same level, with special caution with the lumbar vessels.
The left ureter is dissected and the para-aortic lymphadenectomy is accomplished with hypogastric nerve preservation or not. Once finished, great
care must be taken to avoid postoperative bleeding. A liquid diet is resumed
6 hours after the procedure. Postural hypotension is expected to happen
on the first postoperative day, but walking must be stimulated. Patients are
usually discharged on the first postoperative day, once they have no sign
of complications and have normal diuresis, pain control, and resumed diet.
Conclusion: The laparoscopic approach to retroperitoneal
lymphadenectomy is a standardized option for staging and treatment of
gynecological malignancies.
029057
Laparoscopic surgical approach of endometrial serous
adenocarcinoma with extensive para-aortic involvement
Tsunoda, A.T.1, Cintra, G.F.1, Simonsen, M.1, Vieira, M.A.1, Reis, R.1,
Andrade, C.E.M.C.1
1
atsunoda@gmail.com,
georgia.fc@gmail.com, msimonsen@ig.com.br, mvieiraonco@gmail.com,
dr.ricardoreis@hotmail.com, mdcarlosandrade@gmail.com
S184
Introduction: Metastatic spread to lymph nodes in endometrial cancer
has prognostic and therapeutic implications, and is mainly related to the
depth of myometrial invasion and/or degree of differentiation.
Objectives: To present a surgical video of a patient diagnosed with
serous endometrial cancer which, despite the superficial myometrial invasion, had bulky para-aortic lymph-node involvement.
Methods: The systematic approach of the retroperitoneal space was
the key strategy for the successful removal of all bulky nodal disease,
including retro-aortic node involvement, which firmly adhered to these
main vessels. The surgery initiates with resection of affected mesenteric
coalescent lymph nodes, after prior identification of the important landmarks. Due to firm adhesions, restoring the pelvic anatomy was a crucial
and challenging step before initiating iliac-obturator lymphadenectomy and
hysterectomy. We used ultrasonic energy for adhesiolysis between uterus
and parietal peritoneum, uterus and sigmoid, and finally between uterus
and bladder. Laparoscopic suture of the sigmoid serosa was necessary. The
pelvic lymphadenectomy was also a laborious step: fibrosis of peritoneal
surface and enlarged pelvic nodes increased the complexity of the procedure, but nervertheless, as the paravesical space was successfully established and all the anatomical landmarks were identified, the nodes could be
systematically removed. Hysterectomy proceeded uneventfully. The abundant vascularization and enlarged uterus were managed with proper use of
energy and efficient uterine manipulation. It was not possible to remove
the organ through the vagina and a 7-cm Pfannenstiel incision was needed,
through which the vaginal cuff was sutured. Total blood loss was 75 mL.
Results: The patient was discharged on the 2nd postoperative day,
started adjuvant chemotherapy on the 21th postop day, followed by pelvic
radiation therapy. She is now in the 14th month of follow-up, without
evidence of disease.
Conclusion: Total laparoscopic debulking surgery in advanced stage
endometrium adenocarcinoma due to extensive nodal disease is feasible
and provides a low morbidity and improved surgical recovery.
028883
Laterality of inguinal lymph-node metastasis in patients with vulvar
cancer
Baiocchi, G.1, Mantoan, H.1, Kumagai, L.Y.1, Faloppa, C.C.1, BadiglianFilho, L.1, de Brot, L.1
1
hemantoan@gmail.com, lykumagai@gmail.com, ccfaloppa@hotmail.com,
levonbfilho@gmail.com, loudebrot@gmail.com
Introduction: Although sentinel-node procedure has become a safe
treatment option for early-stage disease, the current standard evaluation of
groin involvement in vulvar squamous-cell carcinoma (VSCC) is uni- or
bilateral lymphadenectomy.
Objectives: To analyze the pattern of inguinal lymph-node metastasis
in VSCC in relation to the site of the primary lesion.
Methods: We analyzed a series of 146 individuals who underwent
bilateral inguinal lymph-node dissection for VSCC from January 1980 to
June 2009. The cohort was divided in three subgroups by primary lesion
location: unilateral, bilateral and midline.
Results: Of the 75 patients (51.3%) with positive groin lymph-node
involvement, 47 (62.7%) presented with unilateral and 28 (37.3%) with
bilateral inguinofemoral involvement. Of the 100 patients presenting with
only unilateral vulvar lesions, 50 had inguinofemoral involvement; 33
(66%) had only ipsilateral nodal metastasis; and 17 (34%) had bilateral
lymph-node metastasis. None of the patients with a unilateral vulvar lesion
that was either 2 cm in biggest diameter or with invasion 5 mm had bilateral groin node involvement. No patient with a unilateral lesion presented
contralateral metastasis without concomitant ipsilateral involvement.
ABSTRACTS
Conclusions: Ipsilateral lymphadenectomy is suitable for patients
with unilateral lesions, distant from the midline, and either negative ipsilateral nodes, or with positive ipsilateral nodes with lesions <2 cm.
028952
Metastatic breast cancer presented as an ovarian mass on
an abdominal hernia laparoscopic approach and repair with
polyglecaprone mesh
Simioni, E.B.1, Tsunoda, A.T.1, Reis, R.1, Andrade, C.E.M.C.1,
Cintra, G.F.1, Vieira, M.A.1
1
elisasimioni83@gmail.com,
atsunoda@gmail.com,dr.ricardoreis@hotmail.com,mdcarlosandrade@gmail.com,
georgia.fc@gmail.com, mvieiraonco@gmail.com
Introduction: Adnexal masses may be found in inguinal, umbilical or
incisional hernias. Until now, there has been no case report of a complex
ovarian mass as the content of a spontaneous abdominal hernia.
Objectives: To demonstrate a laparoscopic approach for a complex
ovarian mass in an abdominal hernia, including a laparoscopic hernioplasty
technique.
Methods: A 38-year-old woman had a previous diagnosis of stage IIIA
estrogen-positive breast cancer in 2012. She was referred with a spontaneous abdominal hernia with progressive increase in 18 months, associated
with weight gain (BMI: 35). During her follow-up, a CT scan evidenced a
complex left ovarian mass, with 10 cm in the largest diameter, encarcerated
in the abdominal hernia. We performed a laparoscopic approach, starting
with a Palmers point Veress puncture for the pneumoperitoneum, and then
a 10-mm trocar was used for the optic. Three other 5-mm trocars were
placed, as demonstrated. After identification, dissection and sectioning of
the left infundibulopelvic ligament, the specimen was extracted through
a low left transverse incision. A polyglecaprone mesh was placed (sublay
meshplasty), by laparoscopy, to repair the abdominal wall defect. Frozen
section reported an ovarian breast metastasis (adenocarcinoma).
Results: The procedure was uneventful, total operative time was 270
minutes, with no blood loss. The patient was discharged next morning.
Conclusions: The laparoscopic approach with the sublay meshplasty
technique allowed fast recovery and no postoperative complications in an
obese patient.
029229
Mitotically active cellular fibroma of ovary: a case report and review
of literature
Johnson, L.F.P.1, Oliva, I.M.A.A.O.1, Andrade, R.G.1, Oliveira, M.C.1,
Porto, L.A.1, Moreira, M.2
1
Department of Surgical Oncology, Santa Izabel Hospital, Salvador,
Brazil, 2Department of patology, Silvany Studart Laboratory, Salvador,
Brazil
fernando.johnson@uol.com.br, isabelaalmeidaoliva@yahoo.com.br
Introduction: Mitotically active cellular fibroma is an ovarian fibrous
tumor identified which behaves differently from the malignant potential of
ovarian fibrosarcoma, with less risk of recurrence and possibility of cure
with surgery only. Therefore, this classification is important to make a
correct diagnosis and avoid excessive treatment.
Objectives: To present one case report about a subtype of ovarian
fibrous tumor and to discuss this entity.
Methods: We reviewed the medical records and literature.
Results: We report a case in which a 54-year-old Brazilian woman
started a progressive increase in abdominal volume and weight loss for 4
months. A magnetic resonance imaging of her pelvis indicated evidence of
ABSTRACTS
a pelvic mass measuring 130 x 113 x 90 mm. Laparotomy was performed
and both adnexa were removed. Microscopic examination of the left
ovary identified a fusocellular neoplasm measuring 40 x 30 mm, with 5
mitotic figures (MFs) per 10 high power fields (HPF) and atypical mitoses.
Immunohistochemically, the tumor cells were positive for WT-1, calretinin,
PR and CD56, and negative for CD10. The patient did not receive any adjuvant therapy. After a review of literature, we noticed this ovarian tumor was
not cited in the 2003 WHO histological classification, but some authors
identified that it had more than 3 MFs/10 HPF, but no severe nuclear atypia
and an increase in cellular density. They observed that it did not have
aggressive behavior when compared with ovarian fibrosarcoma, which had
the same score of mitotic figures. With these characteristics, a new category
was suggested denominated mitotically active cellular fibroma. This
class was recently included in the last WHO histological classification.
Conclusions: The mitotically active cellular fibroma is a kind of
ovarian tumor characterized as having elevated mitotic activity without
severe nuclear atypia or malignant behavior. It is always necessary to
obtain more detail and review carefully the criteria of classification to a
more specific diagnosis and appropriate treatment.
029240
Mucinous cystadenocarcinoma of the ovary: a case report
Oliveira, M.L.S.1, Ramos, U.O.1, Jnior, E.C.N.N.2
1
Universidade Estadual do Sudoeste da Bahia, Brazil, 2Hospital Geral
Prado Valadares, Brazil
marciolao86@hotmail.com, zuendson@hotmail.com,
evandro.celio@hotmail.com
Introduction: Ovarian cancer represents 6% of all female cancers
and in women it is the third cause of death due to cancer. The mucinous
cystadenocarcinoma is a malignant tumor which derives from the ovarian
epithelium and often reaches large sizes. Risk factors for the development
of ovarian cancer are being Caucasian, infertility, nulliparity, family history
of endometrial cancer, breast or ovarian cancer in the family. On the other
hand, protective factors are use of oral hormonal contraceptives, multiparity, tubal ligation, hysterectomy and breastfeeding history.
Objectives: To describe a case of a female patient, 68 years old, with
complaints of dyspnea, diffuse pain in right and left upper quadrant regions
and progressive abdominal size increase since 1 year ago.
Methods: To present the case report a literature review was performed
on the platforms Pub Med, Bireme, Lilacs besides renowned textbooks in
the area addressed; the medical records to link the review to the condition of the patient will be also reviewed. This study will be submitted to
the Research Ethics Committee. The same serves Resolution 466 of 2012
which provides ethical issues in research with human beings. It notes that
data collection will start after the approval of the CEP.
Results: The abdomen was distended due to a stiff, mobile, palpable
mobile mass which expanded from the xiphoid process to the pubic symphysis. Additional tests and exploratory laparotomy were performed and total
hysterectomy with bilateral salpingo-oophorectomy was also performed.
The surgical specimen was submitted to clinical pathology analysis. The
right ovary tumor measured 38 x 30 x 26 cm (approximately 17784 cm3
of volume).
Conclusions: The diagnosis was papillary mucinous cystadenocarcinoma ovarian cancer.
S185
028088
Open versus laparoscopic radical hysterectomy for early cervical
cancer: epidemiology and surgical outcomes
Reitan R.1, Bereza, B.1, Foiato, T.F.1, Luz, M.A.1, Guerreiro, J.A.1,
Linhares, J.C.1
1
reitanribeiro@hotmail.com, brunobereza@hotmail.com,
tarianefoiato@msn.com, muriloaluz@gmail.com, guerreiro@hotmail.com,
linhares@iop.com.br
Introduction: The radical hysterectomy (RH) associated with pelvic
lymphadenectomy (PL) is the treatment of choice for most of the patients
with initial cervical cancer. The laparoscopic approach has emerged as a
safe and effective choice for those patients, but Brazilian studies about this
subject are still rare.
Objectives: To compare the epidemiology, feasibility and surgical
morbidity of the laparoscopic RH and PL with abdominal RH and PL for
initial cervical carcinoma.
Methods: This was a retrospective observational study. All patients
submitted to RH and PL for initial cervical cancer between October
2009 and December 2014 were included. Epidemiological data, surgical
outcomes and clinical data of perioperative periods were analyzed to
compare the laparoscopic and open techniques.
Results: In total 173 patients were included, with a mean age of 40.7
for the laparoscopic group and 43.3 for the open group. The epidermoid
carcinoma was found in the majority of the patients in both groups. Most
of the patients were stage IB1 and all other tumor factor were similar in
both groups. Of the 47 patients of the laparoscopic group, 31 (66%) were
submitted to modified radical hysterectomy (type II) and 16 (34%) to the
radical (type III), most of them using nerve-sparing techniques. In the open
group (126 patients), 115 (91.3%) were submitted to the MRH. No significant difference was found between groups when the blood transfusion,
numbers of the pelvic lymph nodes resected, urinary retention and surgical
were compared. There was a significant surgical stay reduction and overall
complication rate in favor of the laparoscopic group.
Conclusions: The LRH is a safe technique for the treatment of the
initial cervical carcinoma with similar results when compared to the open
approach. The surgical outcomes are very similar in both groups, but the
laparoscopy resulted in shorter hospitalization time and fewer perioperative complications. Larger multicentric studies are necessary to address the
external validity of this data.
029127
Overall survival after pelvic exenteration for cervical cancer
Souza, M.C.M.1, Sousa, T.A.2, Filho, D.F.F.2, Zanvettor,P.H.2, Neves, A.R.2
1
Universidade Federal da Bahia, Salvador, Brazil, 2Hospital Aristides
Maltez, Salvador, Brazil
mir.lai.ne@hotmail.com, tiagofamed@yahoo.com.br,
dfalcao@gmail.com, phzanvettor@terra.com.br, adsonneves@ufba.br
Introduction: Cervical cancer is the second most common cancer
among women and its diagnosis is often very late. Central recurrent gynecological cancers infiltrating bladder or rectus, after prior radiotherapy,
remain the primary indication for pelvic exenteration a radical surgery
that removes the pelvic viscera in bloc representing the best chance of
cure.
Objectives: To study possible prognostic factors affecting the survival
of patients with cervical cancer who undergo pelvic exenteration.
Methods: A retrospective study of medical records of patients operated between November 2009 and January 2013. For statistical analysis we
used the chi-square technique of KaplanMeier and Fischers test.
S186
Results: A form was applied to 20 medical records. Total pelvic
exenteration was performed in 85% of patients, anterior in 10% and posterior in 5%. Surgical margins were free in 70% of patients. Overall survival
(OS) was 40% and 50% of patients died in the first 12 months after surgery.
Survival was 33.3% in patients >60 years and 41.2% in those <60 years.
Comparing histological types: OS was 29.4% in patients with squamouscell carcinoma and 100% in those with adenocarcinoma. OS was 25% in
patients who received blood supplies, and 62.5% in those who did not.
According to the stage, survival was 100% for IB, 40% for IIIB, 37.5% for
IIB and 0% for IVA. Despite the demonstrated results, statistical analysis
did not reveal any significant prognostic factor related to survival in these
patients. In recent literature the 5-year OS of patients submitted to pelvic
exenteration is 56%.
Conclusion: No variable could be considered as a prognostic factor
because of the small number of patients. This study showed a smaller OS
than recent literature which probably reveals an unfavorable profile of the
patients admitted and is partially explained by the advanced initial stages
of disease in these patients.
028882
Parametrial involvement in early-stage cervical cancer
Baiocchi, G.1, Kumagai, L.Y.1, Mantoan, H.1, Faloppa, C.C.1, BadiglianFilho, L.1, Fukazawa, E.M.1
1
lykumagai@gmail.com, hemantoan@gmail.com, ccfaloppa@hotmail.com,
levonbfilho@gmail.com, elzafukazawa@gmail.com
Introduction: There is an increasing amount of data to suggest that
a subgroup of patients with early-stage cervical cancer have a low risk of
parametrial involvement (PI) and may benefit from less radical surgery.
Objectives: To analyze clinical and pathological factors related to PI
and to identify a subgroup of patients at low risk of PI.
Methods: We analyzed a series of 236 patients who had PI described
from a cohort of 406 patients who had had radical hysterectomies for
cervical cancer from May 1982 to December 2008 at AC Camargo Cancer
Center. Thirteen patients (5.5%) had PI, eleven (84.6%) unilateral and two
(15.4%) bilateral.
Results: The median age was 47 years (range 2773). The median
tumor size and depth of invasion were 2.7 cm (range 0.410) and 9 mm
(0.345), respectively. Forty cases (17.1%) were adenocarcinoma, ten
(4.3%) adenosquamous, and 184 (78.5%) squamous-cell carcinoma.
Eighty-three (41.3%) of 201 patients had lymphovascular space invasion
(LVSI), 20.6% (41/199) perineural invasion, 23.5% (47/200) histological
grade III, and 18.6% (44/236) patients lymph-node metastasis. Regarding
tumor size, from the 179 patients, 30.7% this was 2 cm (n = 55), 46.4%
between >2 cm and 4 cm (n = 83), and 22.9% >4 cm (n = 41). From 201
patients with depth invasion described, in 41.3% this was >10 mm (n = 83).
Patients with histological type adenocarcinoma or adenosquamous were
more likely to have PI (12% versus 3.8%; P = 0.036), and presence of LVSI
was also correlated to PI (12% versus 0.8%; P = 0.001). Tumor size (P =
0.27), depth invasion (P = 0.66), histological grade III (P = 0.68), perineural
invasion (P = 0.12), and lymph-node status (P = 0.072) did not correlate
to PI. LVSI (HR 21.5, 2.5179; 95%CI, P = 0.005) and histological type
(HR 6.5, 1.724.9; 95%CI, P = 0.006) remained as risk factors for PI in
multivariate analysis. Notably, only one patient (1.8%) with tumor size of
2 cm had PI, but also had lymph-node metastasis and LVSI. Furthermore,
all 24 patients (10.2%) with tumor <2 cm and absence of LVSI had no PI,
despite other variables.
Conclusions: Our series suggests that histology and presence of
LVSI correlate to parametrial invasion. Furthermore, no patient with
tumor <2 cm and absence of LVSI had parametrial invasion. Our data may
ABSTRACTS
contribute to selection of patients for a more conservative approach, such
as simple hysterectomy or simple trachelectomy associated with pelvic
lymphadenectomy.
029189
Pelvic exenteration in gynecological cancer: morbidity and survival in
a referral cancer center
Gurgel, M.V.S.A.1, Andrade, C.E.M.C.1, Vieira, M.A.1, Reis, R.1,
Cintra, G.F.1, Tsunoda, A.T.1
1
vinicius.gurgel@hotmail.com, mdcarlosandrade@gmail.com,
mvieiraonco@gmail.com, dr.ricardoreis@hotmail.com,
georgia.fc@gmail.com, atsunoda@gmail.com
Introduction: Pelvic exenteration (PE) is associated with a significant morbidity, and should be indicated in selected cases. Better surgical
outcomes and severe morbidity rates (23% to 44%) have been observed at
referral centers, with larger numbers of cases.
Objective: To evaluate the outcomes of patients submitted to PE due
to gynecologic cancer, from a single referral center.
Methods: This was a retrospective analysis of patients with gynecological cancer submitted to PE between May 2008 and May 2015. Clinical,
surgical and pathological data were collected and correlated with morbidity,
recurrence and survival.
Results: Forty-six patients were included, with a mean age of 47.1
years and mean BMI of 26.9 kg/m2. Primary tumors were located in the
cervix (n = 27), ovary (n = 10), endometrium (n = 6), vagina (n = 2) and
vulva (n = 1). Most tumors were stage III (n = 17). The main reason for PE
was persistent (41.3%) or recurrent (30.4%) disease after primary treatment. PE was total (n = 23), anterior (n = 8) or posterior (n = 15). Tumor
largest diameter ranged from 1.5 cm to 10 cm (mean 5.5 cm). Morbidity
rate was 67% (all grades), and 14 patients (30.4%) required any kind of
readmission and/or reoperation within 30 days after surgery. Recurrence
occurred in 24 patients, systemic in 62.5% (n = 15) and local in 37.5% (n =
9). Mean follow-up was 16.5 months (167.7 months), overall survival is
69.6%, and 17 patients are currently free of disease (37%).
Conclusion: Morbidity was significant in our series, though comparable to that in the literature. Recurrence was predominantly systemic.
Despite being a salvage procedure, post-PE overall survival was acceptable
in this series.
029160
Pelvic lymphadenectomy of the nerve-plane-sparing radical
hysterectomy for cervical cancer.
Ferreira, V.A.C.1, Ribeiro, R.1, Bereza, B.R.1, Foiato, T.F.1,
Rosario, R.R.L.1, Kool, R.1
1
Hospital Erasto Gaertner, Curitiba, Brazil
vitoracf@icloud.com, reitanribeiro@hotmail.com,
brunobereza@hotmail.com, tarianefoiato@hotmail.com,
romilton08@gmail.com, ronald.kool@yahoo.com.br
Introduction: This video shows a pelvic lymphadenectomy of the
nerve-plane-sparing radical hysterectomy, type III C1, for cervical cancer.
Objectives: To demonstrate the dissection of the ureter, hypogastric
nerve identification with Latzko and Okabayashi plane dissection.
Methods: The video was edited to show the dissection of the sentinel
lymph node followed by pelvic lymphadenectomy as a part of a laparoscopic nerve-sparing radical hysterectomy type III C1.
Results: Pelvic lymphadenectomy is a step in the radical hysterectomy.
When performed respecting the anatomical structures, damage is decreased
ABSTRACTS
at the pelvic autonomic nerves and this avoids considerable morbidity, i.e.,
impaired bladder function, defecation problems, and sexual dysfunction.
Conclusions: Nerve-plane-sparing radical hysterectomy is an option
of a minimally invasive approach for early-stage invasive cervical cancer
treatment.
029253
Peritoneal asymptomatic spread in locally advanced cervical
carcinoma: is it rare or neglected?
Marques, R.M.1, Lemos, N.1, Barbosa, M.G.1, Falcao Filho, D.F.2,
Zanvettor, P.H.2, Tsunoda, A.3, dos Reis, R.3, Barbosa, G.B.1,
Nicolau, S.M.1
1
Universidade Federal de So Paulo, Brazil, 2Hospital Aristides Maltez,
Brazil, 3Hospital de Cncer de Barretos, Brazil
nucelio@gmail.com, mgranadobarbosa@gmail.com, dfalcao@gmail.com,
phzanvettor@terra.com.br,atsunoda@gmail.com,dr.ricardoreis@hotmail.com,
bicudoepm70@gmail.com, smancini@terra.com.br
Introduction: Cervical cancer is widely known as a locoregional
disease. The evaluation of diseases extension is clinical and based in the
FIGO statements. In Brazil, most of the patients are diagnosed as having
locally advanced disease (LACC), FIGO IB2IVA, therefore undergoing
concurrent platinum-based chemoradiation. Compromise of the peritoneum in LACC is rare. It most commonly arises from ovarian, tube and
endometrial cancers. There are few reports regarding primary peritoneal
compromise in advanced cervical cancer. Some of these patients experience
recurrence as metastatic disease during or a few months after treatment due
to an unknown peritoneal metastasis.
Objective: To describe a series of cases of primary compromise of
the peritoneal cavity in LACC underdiagnosed by both the FIGO clinical
staging system and CAT scan, and to show the oncological outcomes.
Methods: We analyzed the medical reports of 348 patients with
LACC, without obvious peritoneal or aortic metastasis, who underwent
surgical staging before definitive chemoradiation between February 2008
and August 2015. We considered peritoneal compromise in the metastasis
identified in ovaries, tubes, peritoneal fluid, and both peritoneal surfaces
and organs.
Results: Out of 348 LACC patients who underwent surgical staging,
19 cases (5.5%) of peritoneal compromise were identified in four brazilian
cancer centers between 2008 and 2015. Patients had an average age of
42.38 years and an average BMI of 29.36. The most frequent histological
type and FIGO stages were: SCC (89%) and III (63%), respectively. The
majority of patients received platinum-based concurrent chemoradiotherapy to pelvic control and 26.3% received palliative chemotherapy. The
overall survival was 16.77 months.
Conclusions: Primary peritoneal compromise in LACC is a rare
condition and associated with poor prognosis. Pretreatment PET-CT or
surgical staging increase the chance of the detection of peritoneal metastases, although its effect on survival is still controversial. New treatment
modalities are necessary in this patient group.
029204
Plasmocytoma in the vulva: a case report
Lustosa, A.G.1, Filho, K.J.C.2, Xavier, P.M.2, Medeiros, K.M.O.T.2,
Resende, T.C.2, Pires, T.C.3, Bezerra, C.F.2, Corra, R.S.2, Souza, W.B.1
1
S187
Natal, Brazil
Introduction: Plasma-cell neoplasia is caracterized by the proliferation of a single cell clone, producing typically one type of monoclonal
immunoglobulin. It can present as a single lesion (plasmocytoma) or
multiple lesions (multiple myeloma). Men are diagnosed twice often as
women, and the incidence is higher in Black people and lower in Asian and
Pacific Islands populations.
Objectives: To demonstrate through a case report the clinical features,
diagnosis and treatment of plamocytoma.
Methods: Review of medical records.
Results: Patient MFGS was a 31-year-old married woman, born and
raised in So Rafael, RN. She had a consultation on 21/01/2015 at the
Norterriograndense League Against Cancer; she felt a painful tumor in the
perineal region, which had grown rapidly in about 4 months. After resection
of the lesion on 22/01/2015, the histopathological results showed malignant round cells and plasmocytoid cells; immunohistochemistry showed
plasma-cell neoplasia plus the expression of free chain kappa; serology
for HIV was positive, and she was sent to the hematology department on
05/05/2015. She was pale, presenting a 20-cm diameter exophytic ulcerated
tumor with a purulent secretion in the perineal region. She was admitted
to the hospital for 11 days. In this period she had antibiotic treatment with
cefalexin, dexamethasone, and thalidomide, and has begun antiretroviral
therapy. She started a set of 20 sessions of radiotherapy on 21/05/2015 and
finished on 18/06/2015. She came for a consultation asyimptomatic a week
later, but there was still an exudative erythematous perineal lesion. She was
referred to Giselda Trigueiro Hospital for antiretroviral follow-up.
Conclusions: Plasmacytomas most often occur in the bone, but may
also involve soft tissues. Why some patients develop multiple myeloma
and others plasmacytoma is not understood but may be related to the differences in cell adhesion molecules, or the expression profile of malignant
plasma cells chemokine receptor.
028962
Potential biomarkers for cervical carcinogenesis: clinical use
Fin, F.R.1, Anghinoni, M.1, Campos, E.C.1, Azevedo, B.R.B.1,
Loureiro, M.P.2, Castro, M.3
1
Department of Surgery Oncology, So Vicente Hospital, Curitiba, Brazil,
2
Department of Surgery, Institute Jacques Perissat, Curitiba, Brazil,
3
Resident of Department of Surgery Oncology, So Vicente Hospital,
Curitiba, Brazil
fabiofin@hotmail.com
Introduction: The implementation of a tracking system based mainly
on the examination of uterine tissue for cervical oncology (CO) together
with detection techniques for human papillomavirus (HPV) decreases the
incidence and mortality of cervical cancer. However, due to the high rates
of HPV infection in women, cytology and HPV testing are not sufficient to
specify which patients will develop cancer.
Objective: To discuss the main biomarkers that are oncoproteins
targeted by HPV, and their evaluations for clinical use in cervical cancer
carcinogenesis.
Methodos: We review methodology in recent research studies on cell
cycle molecules deregulated by HPV infections, as well as their potential
use for cervical cancer screening.
Results: Although the process is not fully understood, molecular
mechanisms caused by HPV infection are necessary for its development
and reveal a large number of potential biomarkers for diagnosis and prognosis. Detailed analysis of the HPV oncoproteins and their interactions with
their cellular targets can define new biomarkers. An example is the presence
S188
of E6 and E7 of high-risk HPV specificity and increases the sensitivity
of these tests for screening lesions with increased risk of progression to
malignancy. The consequence of the presence of this marker is increased
expression of the inhibitory protein of cyclin-dependent kinases p16ink4a.
As HLA-G, p53, Ki-67, and p16ink4a, when present, could help identify
dysplastic cells in histological samples and smears.
Conclusion: Considering the rapid evolution and the improvement of
techniques and studies that allow us to analyze modifications and cellular
changes on a large scale, it is believed that simultaneous analysis using
various biomarkers may help to determine their efficiency in the near future.
028868
Predicting lymph-node metastasis before lymphadenectomy in
endometrial cancer: a scoring system based on preoperative and
intraoperative risk factors
Teixeira, A.M.S.1, Marques, R.M.1, Kuster, M.G.B.1, Litwinczuk, A.F.A.1,
Pdua, J.B.2, Ribeiro, R3., Kool, R.3, Filho, D.F.F.4, Nicolau, S.M.1
1
Gynecologic Oncology Division, Department of Gynecology, Federal
University of So Paulo, So Paulo, Brazil, 2Department of Gynecology
and Obstetrics, Federal University of Manaus, Manaus, Brazil, 3Oncologic
Surgery Department, Erasto Gaertner Hospital, Curitiba, Brazil,
4
Department of Gynecology Oncology, Hospital Aristides Maltez, Brazil
andressa.dra@gmail.com, rmorettimarques@gmail.com,
gabikuster@yahoo.com.br,anaflavia70@gmail.com,jonasbpadua@gmail.com,
reitanribeiro@hotmail.com,ronald.kool@yahoo.com.br,dfalcao@gmail.com,
smancini@terra.com.br
Introduction: Lymphadenectomy remains controversial as a fundamental step in surgical staging of endometrial cancer. Most patients are
diagnosed in early stages with no evidence of lymph-node metastasis and
are exposed to unnecessary risk of complications.
Objective: To identify pre- and intraoperative risk factors for
predicting lymph-node metastasis in patients with endometrial cancer, and
to build a simple scoring system that can help the surgeon to decide whether
to perform lymphadenectomy.
Methods: This retrospective and multicenter study enrolled patients
who underwent hysterectomy, bilateral salpingoophorectomy and
lymphadenectomy for endometrial cancer from 2003 to 2014. Pre- and
intraoperative risk factors for lymph-node involvement were analyzed by
univariate and multivariate logistic regression. The relevant factors were
used to build a scoring system to predict lymph-node metastasis.
Results: Three hundred and thirty-two patients were eligible for the
study. The characteristics statistically significant for lymph-node metastasis in univariate analysis were CA-125, endometrial thickness, preoperative histological grade, tumor size, tumor extension, and tumor located in
the isthmus of uterus. After multivariate logistic regression analysis, the
following parameters remained relevant: preoperative histological grade,
tumor extension and isthmus involvement. This method as a predictor of
lymph-node metastasis and its correspondent score model presented good
accuracy with area under the receiving operating curve of 0.865 (95%CI
0.810.92) and 0.86 (95%CI 0.800.91), respectively.
Conclusions: This study developed a scoring model with high accuracy based on three pre- and intraoperative risk factors for predicting
lymph-node metastasis that can assist the lymphadenectomy decisionmaking at the time of surgical treatment.
ABSTRACTS
028909
Prevalence of steroid receptors p53 and Ki-67 in the endometrioid
endometrial adenocarcinoma and their relationship with recurrence
Mazzarino-Bassols, K.P.1, Zettler, C.G.2, Silveira, G.P.G.2, Pessini, S.A.2
1
Santa Casa de Misericrdia de Porto Alegre, Brazil, 2Santa Casa de
Misericrdia de Porto Alegre e Universidade Federal de Cincias da
kmazzarino@hotmail.com, zettler@terra.com.br, g_py@terra.com.br,
spessini@terra.com.br
Introduction: Endometrial cancer is the most frequent pelvic cancer
among women in developed countries. Some tumor markers have been
pointed out as prognostic factors, and the most important seem to be
estrogen receptors (ER), progesterone receptors (PR), p53 and Ki-67.
Objectives: To determine the prevalence of ER, PR, p53 and Ki-67
in endometrial cancer patients in Southern Brazil, and to correlated these
markers with recurrent disease.
Methods: Sixty-four patients who underwent surgical staging and
treatment for endometrioid endometrial carcinoma were studied. The prevalence of ER, PR, p53 and Ki-67 was determined by immunohistochemistry. Findings were correlated with tumor recurrence. A chi-square test was
used for statistical analysis (P 0.05).
Results: The prevalence of tumor markers in the sample was: ER =
60.9%; PR = 75%; p53 = 3.1%; and Ki-67 = 23.4%. Nine patients (14.1%)
had disease recurrence during follow-up; 44.5% of them had positive
results for ER and PR, 22.2% for Ki-67, and none for p53.
Conclusion: The prevalence rates of ER, PR and Ki-67 were similar to
those found in the literature, but p53 prevalence was lower. Disease recurrence was not associated with the immunohistochemical profile of patients,
maybe due to sample size. ER and PR expression was more prevalent than
p53 and Ki-67 expression. Multivariate analysis revealed an association
between absence of Ki-67 and G2 tumors.
028266
Primary extrauterine endometrial adenocarcinoma arising from
endometriosis
Ribeiro, R.1, Kondo, W.2, Trippia, C.H.3, Zomer, M.T.2, Hayashi, R.M.2,
Cavalcanti, T.C.S.4
1
Erasto Gaertner Hospital, Brazil, 2Vita Batel Hospital, Brazil, 3Roentgen
Diagnostic Institute, Brazil, 4Citolab, Brazil
williamkondo@yahoo.com,trippia@ig.com.br,monicatzomer@yahoo.com.br,
renatahayashi@hotmail.com, tecava@yahoo.com.br
Introduction: Malignant transformation of gonadal endometriosis has
been well described in 0.30.8% of patients with ovarian endometriosis,
whereas only a few studies have reported on malignant tumors arising from
extragonadal endometriosis.
Objectives: To describe a case of endometrioid adenocarcinoma
arising from retrocervical endometriosis.
Case report: A 42-year-old woman diagnosed with deep infiltrating
endometriosis of the retrocervical area and rectum was submitted to laparoscopic hysterectomy and double discoid retal resection. The pathological
examination showed extensive endometriosis in many peritoneal specimens
resected and an incidental endometrioid carcinoma clearly arising from a
deep infiltrating endometriotic nodule of the retrocervical area. Despite
comprehensive endometrial examination, no other primary site of the tumor
was found. A transition between endometriosis and malignant epithelium
was also evident, fulfilling the Sampsons criteria for malignant transformation of endometriosis. It was decided to complete the surgical staging
with laparoscopic pelvic and retroperitoneal lymphadenectomy, resection
of previous ports peritoneum and parametrectomy. Final pathology showed
ABSTRACTS
no residual tumor in the parametrectomy specimen nor in the 27 pelvic and
17 retroperitoneal lymph nodes resected, nor in the peritoneal specimens or
on cytology. The patient was referred for adjuvant treatment.
Conclusion: Endometrioid adenocarcinoma arising from non-uterine
extragonadal endometriosis is a rare condition and treatments have to be
individualized.
028963
Profile of patients with neoplastic lesions on uterine cervix treated at a
hospital in the south of Brazil
Fin, F.R.1, Anghinoni, M.1, Campos, E.C.1, Loureiro, M.P.2,
Sagrillo, G.D.3, Ferreira, R.P.3
1
Department of Surgery Oncology, So Vicente Hospital, Curitiba,
Brazil, 2Department of Surgery, Institute Jacques Perissat, Curitiba,
Brazil, 3Medicine Academic of Faculdade Evanglica do Paran College,
Curitiba, Brazil
fabiofin@hotmail.com
Introduction: Uterine cervical cancer is a preventable lesion, unlike
other cancers, as it involves a pathology with long periods of precursor
lesions.
Objective: To describe the demographic and clinic characteristics of
the population with cervical cancer attending the public/private service at
So Vicente Hospital in Curitiba, Brazil.
Methodology: This was an observational study and descriptive analysis of women attending So Vicente Hospital in Curitiba, Brazil, between
2013 and 2014, with precursor lesions and cervical cancer.
Results: One hundred and six women were treated, with an average
age of 37.8 years (1782 years). The diagnosis of low-grade dysplasia was
performed in 33% of patients and 37.7% had high dysplasia. Thirty-one
women were diagnosed with cancer at the time of care, histology of which
showed predominantly squamous-cell carcinoma; 70.9% of these women
had advanced stage (IIB), 51.8% had some type of surgical treatment.
Half the women who had hysterectomy had associated chemotherapy and
45.8% had radiotherapy. Most of the patients had had one or more children
(62.2%). Of nulliparous women, 58.5% were diagnosed with low-grade
dysplasia; 43.4% of the patients were smokers, and most women with
squamous-cell carcinoma smoked.
Conclusion: The findings show that most of the women were young
and diagnosed with premalignant lesions. The profile also highlighted the
importance of early diagnosis in order to avoid invasive treatments.
028233
Profile of patients with ovarian cancer in Brazils National Institute of
Cancer (INCA): would a different approach be required?
Silva, L.C.1, Bizzo, S.M.D.1
1
National Institute of Cancer, Rio de Janerio, Brazil
liliti.silva@hotmail.com
Introduction: Although it accounts for less than 30% of gynecological
cancers, ovarian cancer is undoubtedly the cause of death of over 50% of
deaths in this group of neoplasms. The median 5-year survival is approximately 65 months today, but the disease recurrence rate still remains high.
Objectives: To evaluate the profile and the survival of patients treated
at a comprehensive National Cancer Institute.
Methods: With observational methods, cross-sectional, descriptive, and retrospective, the study examined the medical records of 793
patients who were diagnosed with ovarian cancer between 2005 and 2009.
The data were evaluated for type and histological grade, family history,
social history, and the type of treatment received; the institution analyzed
the recurrence rates and local disease-free intervals. This analysis was
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performed after approval of the Research Ethics Committee; the results
were presented anonymously in aggregated form, preserving the anonymity
of each patient.
Results: The data analysis found that, of the 793 records analyzed,
0.08% (67 records) discontinued treatment after the first consultation. In
the initial sample, 84% were >40 years of age, and were identified with
advanced stages (III and IV) more frequently than those at the time when
their medical records were opened. In addition, 48% gave a family history
of cancer, while 6% did not know and 41% refused the question; 88% of
the sample said that they drank alcohol, and 62% said they were smokers.
Surgery was the treatment of choice in 45%, while only 25% had chemotherapy as first choice. The median 5-year survival was >35%.
Conclusions: The data confirm that the manifestation of the disease
occurs at a later stage, so it is necessary to strengthen preventive screening
measures in patients at high risk for ovarian cancer.
028885
Prognostic factors after ovarian cancer recurrence
Baiocchi, G.1, da Costa, A.A.B.A.1, Mantoan, H1., Amorim, C.V.V.1,
Faloppa, C.C.1, Badiglian-Filho, L.1
1
glbaiocchi@yahoo.com.br, alexandreandredacosta@gmail.com,
hemantoan@gmail.com, dr.camilavaladares@yahoo.com.br,
ccfaloppa@hotmail.com, levonbfilho@gmail.com
Introduction: Nearly 70% of patients with advanced epithelial ovarian
cancer have a recurrence in up to 5 years after primary treatment.
Objectives: To evaluate the prognostic role of secondary cytoreductive surgery (SCS) and other variables for patients with epithelial ovarian
cancer after the first recurrence.
Methods: We analyzed a series of 232 patients with recurrent epithelial ovarian cancer treated from January 1992 to June 2013 at AC Camargo
Cancer Center. The median progression-free interval (PFI) was 17 months
(range 1237) and the median follow-up time after recurrence was 19.5
months.
Results: Sixteen patients (7.3%) had FIGO stage I disease at diagnosis, 17 (7.8%) had stage II, 143 (66%) had stage III and 41 (18.9%)
had stage IV. Median age was 58 years (range 2087) and median CA125
was 82 (range 8.44859). Ninety-five (54.6%) of 174 patients had one
site recurrence and 79 (45.4%) two or more sites. Twenty-one (14.6%) of
144 patients had ECOG 2 and 123 (85.4%) had ECOG 01. Eighty-four
(41.2%) of 204 patients had PFI 12 months and 120 (58.8%) PFI <12
months. Ninety-one patients (39.2%) had SCS and 141 (60.8%) chemotherapy. From the patients that had SCS, 53 (66.2%) had PFI 12 months.
The median overall survival was 32.1 months (95%CI 26.038.1). A better
survival was found in SCS (17.0 versus 89.8 months; P < 0.001), PFI 12
months (17.5 versus 58.2 months; P < 0.001), CA125 < 80 (21.6 versus
40.0 months; P = 0.002), ECOG 01 (8.7 versus 36.1 months; P < 0.001),
one recurrence site (26.3 versus 54.9 months; P = 0.001), age <65 years
(21.3 versus 38.2 months; P = 0.006), and primary stages I and II compared
to III and IV (26.3 versus 79.7 months; P = 0.001). In multivariate analysis,
receiving SCS (HR 0.30; 95%CI 0.150.61; P = 0.001), PFI 12 months
(HR 0.44; 95%CI 0.230.85; P = 0.015), and ECOG 01 (HR 0.44; 95%CI
0.210.89; P = 0.027 were the prognostic factors independently related to
better outcome.
Conclusions: Our series suggest that after epithelial ovarian cancer
recurrence, the prognostic factors related to better survival were SCS, PFI
12 months and ECOG 0-1. Our data may help to stratify patients at risk of
death after ovarian cancer recurrence.
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029305
Quality of life questionnaires for cervical cancer survivors are not
stratified by staging
Campbell, L.M.1, Motta, L.A.C.R.2, Primo, W.Q.S.P.1
1
Unidade de Ginecologia Oncolgica, Hospital de Base do Distrito
Federal, Braslia, Brazil, 2Fundao de Ensino e Pesquisa em Cincias da
Sade, Braslia, Brazil
leo.m.campbell@gmail.com, lacasulari@unb.br,
walquiriaprimo@gmail.com
Introduction: Quality-of-life questionnaires for cervical cancer survivors are a useful tool to evaluate the long-term burden of the processes
of disease and cure to which cancer patients are subject. Disease-specific
gynecological cancer questionnaires give sexuality more weight in their
quantitative evaluation. However, stage-specific side effects are not a
primary assessment and vary considerably among the various stages of
each gynecological cancer.
Objectives: To demonstrate the need for stage-specific assessment in
gynecological cancer quality-of-life questionnaires.
Methods: The most important and comprehensively used cervical
cancer quality-of-life assessment questionnaires were evaluated. They
are the Female Sexual Function Index (FSFI), the European Organization
for Research and Treatment of Cancer Quality-of-Life Questionnaire
Cervix Module 24 (EORTC QLQ-CX24), the Leiden Questionnaire, and
the Sexual Function Vaginal Changes Questionnaire (SVQ). These are
mostly dimension-specific tools, which target sexuality as their main
assessment objective. Unlike the other three questionnaires, mostly concentrated on sexuality, the EORT QLQ-CX24 is subdivided in four sections:
(1) sexual activity; (2) sexual function; (3) body image; (4) sexual fulfillment. It also has a symptom scale (symptoms experience, lymphedema,
peripheral neuropathy, sexual worries, and menopausal symptoms). These
questionnaires were evaluated for their assessment criteria, according to the
dimensions they encompass.
Results: None of the four questionnaires stratify their quantitative
results according to disease stage before treatment. Huge discrepancies in
the questionnaires list of possible answers arise when stratified by stage.
The EORTC QLQ-CX24 is the only one of the four questionnaires that
is multidimensional and comprehensively evaluates dimensions other than
sexuality.
Conclusions: A careful reading of studies using cervical cancer quality-of-life questionnaires must include a detailed table of the results stratified by stage. This stratification can potentially improve precision of the
studies that use this kind of tool to evaluate quality of life in cervical cancer
survivors.
029093
Quality of profile of patients submitted to uterine cervical cancer
treatment
Lustosa, A.G.1, Corra, R.S.2, Gis, M.C.2, Santos, L.V.S.2,
Nascimento, H.L.S.2, Pires, T.C.3, Lira, G.A.2, Jnior, F.E.L.P.2,
Souza, W.B.1
1
Natal, Brazil
Introduction: In Brazil, it is estimated that cervical cancer is the third
most common malignant neoplasm among women.
Objectives: To observe the quality of life at the end of surgical treatment, chemotherapapy and radiotherapy for cervical cancer.
ABSTRACTS
Methods: This was an observational and prospective study of 32
women aged >18 years, with a histological diagnosis of cervical carcinoma
with an indication for radical surgical treatment and adjuvant radiotherapy,
exclusive or combined with chemotherapy. We excluded patients with
a prior or current history of other cancers, cases of metastasis, previous
treatment with chemotherapy or radiotherapy, or any who had evident
impairment of cognitive ability. We used the sociodemographic questionnaires of women undergoing radical surgical treatment and radiotherapy
in cervical cancer, and the shortened version in Portuguese of the World
Health Organization instrument to evaluate quality of life: WHOQOL-100.
Results: The average age of the patients was 47.4 years ( 12.77); of
the total, 28.1% were single, 56.2% married, 6.25% widowed, and 9.37%
divorced. Mixed-race patients comprised 81.25%, and 18.75% were Black.
According to the staging for cervical cancer adopted by FIGO, we observed
that 68.7% were in advanced stages of disease (II, III and IV). With regard
to quality of life of the patients, the scores for questions 1 and 2 (relating to
personal evaluation of quality of life and satisfaction with health) were 3.28
and 3, respectively. On the other hand, the score on the physical domain
was 3.21, psychological domain was 3.42, social relations 3.50, and for
environment 3.33; this was classified as regular quality of life.
Conclusions: After the end of treatment the analysis of the quality
of life was classified as regular, probably due to lack of information for
patients about the disease.
029275
Radical robotic trachelectomy
Lustosa, E.1, Castro, B.1, Kowloski, B.1, Guitmann, G.1
1
guitmann@superig.com.br
Introduction: Radical trachelectomy is an alternative treatment for the
initial stage of cervical cancer for patients who wish to preserve fertility.
With the advances in minimally invasive surgery the robotic approach has
became an alternative for this techniche.
Objectives: To show by video the step-by-step technique of a robotic
radical trachelectomy.
Methods: This video is a case report of a women diagnosed with stage
IB1 cervical cancer who was submited to radical robotic trachelectomy.
Conclusions: Radical trachelectomy can be done safely by the robotic
platform with the same results as the vaginal and abdominal approaches.
029177
Randomized clinical trial comparing two methods of hemostasis after
LEEP conization
Simioni, E.B.1, Paula, T.M.1, Cintra, G.F.1, Tsunoda, A.T.1,
Andrade, C.E.M.C.1, Reis, R.1
1
elisasimioni83@gmail.com, talitha_mendes@yahoo.com.br,
georgia.fc@gmail.com,atsunoda@gmail.com,mdcarlosandrade@gmail.com,
dr.ricardoreis@hotmail.com
Introduction: The incidence of bleeding after a conization is around
15%. The techniques for hemostasis usually used are: cautery, Monsels
solution and vaginal tampon. Actually, there is no consensus about the best
technique and there is not much information that validates the use of some
of them. At this moment, there is no clinical trial comparing the use of a
vaginal tampon with Monsels solution versus the use of the solution alone
after LEEP conization.
Objectives: To compare two methods of hemostasis after loop
diathermy for management of cervical intraepithelial neoplasia.
ABSTRACTS
Methods: A randomized clinical trial was conducted at Gynecology
Oncology Department/Barretos Cancer Hospital, Brazil. After local IRB
approval we compared patients without (group 1, GP1) and with (group 2,
GP2) vaginal tampon after LEEP conization. The Monsels solution was
used in all patients. Forty-one patients were allocated in each arm (n = 82).
We evaluated intraoperative and postoperative outcomes.
Results: The average of operative time was 13.07min (525min) in
GP1 and 11.9min (325min) in GP2. One patient in GP1 had more intraoperative bleeding than usual (4.87%). Operative complications were related
as infection (4.87% in GP1 and 2.43% GP2) and vaginal laceration (2.43%
in both groups). Related days of vaginal bleeding after conization were
11.32 days in GP1 (031) and 14.96 days in GP2 (030) with no statistical
difference between the groups (P = 0.644). The final histology was cervical
intraepithelial lesion (CIN) 2/3 82.92%, CIN1 9.75%, adenocarcinoma in
situ 2.43% and 4.87% with no lesion in GP1; in GP2 histology was CIN2/3
67.5%, squamous-cell carcinoma 12.5%, CIN1 7.5%, no lesion 7.5%, and
adenocarcinoma in situ 5%.
Conclusion: Comparing the two methods of hemostasis (with or
without vaginal tampon) after LEEP conization, we did not find any differences in the intraoperative or postoperative outcomes.
028884
Recurrence after pelvic exenteration for cervical and vaginal cancer
Baiocchi, G.1, de Oliveira, R.A.R.1, Mantoan, H.1, Faloppa, C.C.1,
Kumagai, L.Y.1, Guimaraes, G.C.1
1
glbaiocchi@yahoo.com.br, oliveira.rar@hotmail.com,
hemantoan@gmail.com, ccfaloppa@hotmail.com, lykumagai@hotmail.com,
guimaraesgc@gmail.com
Introduction: Data regarding patterns of recurrence after pelvic
exenteration (PE) are lacking.
Objectives: To evaluate the patterns of recurrence and survival for
cervical and vaginal cancer that recurred after PE.
Methods: We reviewed a series of 78 individuals who underwent PE
for cervical or vaginal cancer from January 1980 to December 2010 in AC
Camargo Cancer Center, Brazil.
Results: Fifty-four patients (69.2%) had cervical and 24 (30.8%)
vaginal cancer. Mean age was 54.5 years (range 2887). Fifty-seven
(73.1%) had squamous-cell carcinoma and 21 (26.9%) adenocarcinomas.
Median tumor size was 5 (115) cm. We performed 43 (55.1%) total, 18
anterior, eight posterior and nine lateral extended PEs. Median follow-up
was 13.7 (1.09114.3) months. Five-year OS and cancer-specific survival
were respectively 24.4% and 37.1%. Thirty-four patients (43.6%) recurred.
The median follow-up time from PE to recurrence was 6.25 (1.028.1)
months. Seventeen patients (50%) had local, 12 (35.3%) distant and five
(14.7%) both local and distant recurrences. Sixteen (47.1%) patients had
no treatment after recurrence and 18 (52.9%) had palliative treatment
(surgery, chemotherapy or radiotherapy). The median follow-up time after
recurrence was 6.2 (1.0572.8) months. The median OS after recurrence
was 19.9 months. Three patients had survival of >30 months after palliative treatment. The site of recurrence (local or distant) did not correlate
with the risk of death (P = 0.91). Interval time between PE and recurrence
of more than 12 months correlated with better survival (26.2 versus 11.2
months), however without statistical significance (P = 0.07). The patients
with palliative treatment after recurrence had statistically better OS than
patients without treatment (24.2 versus 9.5 months).
Conclusions: Patients with recurrence after PE have a very poor prognosis. Nearly half of the patients have only distant recurrence and some of
those patients may benefit from a trial that includes chemotherapy after PE.
S191
029143
Robot-assisted laparoscopic radical parametrectomy: step-by-step
surgical technique
Simioni, E.B.1, Andrade, C.E.M.C.1, Vieira, M.A.1, Reis, R.1, Cintra, G.F.1,
Tsunoda, A.T.1
1
elisasimioni83@gmail.com, mdcarlosandrade@gmail.com,
mvieiraonco@gmail.com, dr.ricardoreis@hotmail.com,
georgia.fc@gmail.com, atsunoda@gmail.com
Introduction: Radical parametrectomy is a challenging operation indicated after a simple hysterectomy, when a cervical cancer stage I is found
in the final pathological report. It is commonly related to significant postoperative morbidity, due to frequent surgical lesions during the dissection
of the fibrosis in the autonomic pelvic plexus. The robotic platform has the
potential to improve this surgical technique and to reduce complications.
Objectives: To demonstrate a step-by-step parametrectomy procedure
with a robotic system.
Methods: A 53-year-old patient underwent a simple hysterectomy,
with a pathological finding of a squamous-cell cervical carcinoma, FIGO
IA1, with lymphovascular involvement. She refused adjuvant radiation
therapy. A surgical approach, with a robotic system, was then indicated.
Initially, a systematic pelvic lymphadenectomy was carried out. Since the
nodes were negative at frozen section, a level C1 parametrectomy was
performed.
Results: This video demonstrates the entire step-by-step procedure.
After a standard pelvic lymphadenectomy, with all landmarks adequately
exposed (genitofemoral nerve, obliterated umbilical artery, obturator
nerve), the pelvic lateral spaces were identified. Then, both ureters were
dissected and tunneled, so uterine vessels were identified and ligated medially, setting the parametrium limits. The parametrium was resected with a
vaginal cuff, in order to improve the margins. Both bipolar and monopolar
energy was used. All specimens were removed. Operating time was 285
minutes, and blood loss was 22 mL. There were no intraoperative complications, and neuropreservation was uneventful. The patient was discharged
next morning, after a urinary residual test of 10 mL, with normal voiding.
There was no evidence of any residual disease at the final pathology report.
Parametrium measured 4.3 x 2.6 x 1.2 cm (right side) and 7.0 x 2.7 x 0.8 cm
(left side), 0/10 pelvic lymph nodes. The patient remained asymptomatic,
without complications, after 30 days.
Conclusions: A step-by-step robotic-assisted radical parametrectomy
was demonstrated, with low morbidity, and without necessity for adjuvant
therapy.
028887
Secondary cytoreducton in epithelial ovarian cancer
Baiocchi, G.1, da Costa, A.A.B.A.1, Mantoan, H.1, Amorim, C.V.V.1,
Kumagai, L.Y.1, Faloppa, C.C.1
1
glbaiocchi@yahoo.com.br, alexandreandredacosta@gmail.com,
hemantoan@gmail.com, dr.camilavaladares@yahoo.com.br,
lykumagai@hotmail.com, ccfaloppa@hotmail.com
Introduction: The standard of care after epithelial ovarian cancer
recurrence is chemotherapy. However, some retrospective reports suggest
a potential outcome benefit in favor of secondary cytoreductive surgery
(SCS), and two prospective randomized trials are ongoing.
Objectives: To evaluate the prognostic factors among patients with
recurrent ovarian cancer undergoing SCS.
Methods: We analyzed a series of 88 patients with recurrent epithelial
ovarian cancer who received SCS between November 1996 and January
2014 at AC Camargo Cancer Center, Brazil. The median progression-free
S192
survival (PFS) prior to SCS was 22.8 months (range 2174) and the median
follow-up time after recurrence was 33.9 months.
Results: Nine patients (11.1%) had at diagnosis FIGO stage I disease,
11 (13.6%) had stage II, 54 (66.7%) had stage III and seven (8.6%) had
stage IV. Median age was 57 years (range 3580) and median CA125 was
61.5 (range 82041). Thirty-seven (46.3%) had carcinomatosis, 24 (30%)
one site peritoneal recurrence, 12 (15%) more than one site peritoneal
recurrence, and seven (8.8%) in pelvic and/or retroperitoneal lymph node.
Twenty-six patients (29.5%) also had tertiary and seven (8%) quaternary
cytoreduction. Fifty-seven (69.5%) had complete SCS, 14 (17.1%) had
residual disease 1 cm, and 11 (13.4%) residual disease >1 cm. Nineteen
(21.8%) had chemotherapy before SCS. The overall median survival after
SCS was 92.6 months (05%CI46.8138.4). The prognostic factors that
negatively impacted survival were chemotherapy before SCS (37.1 versus
109 months; P = 0.005), PFS < 12 months (26.9 versus 92.6 months; P =
0.005), presence of any residual disease (36 versus 115.3 months; P =
0.01), and presence of carcinomatosis (36 versus 109 months; P < 0.01).
CA125 level, primary FIGO stage III and IV, and age >65 years were not
statistically significant in outcome. Furthermore, in multivariate analysis,
PFS < 12 months (HR 2.65; 95%CI 1.07-6.58; P = 0.035) and chemotherapy before SCS (HR 2.63; 95%CI 1.116.20; P = 0.027) remained as
prognostic factors that negatively impacted survival
Conclusions: We found better survival for patients with PFS >12
months, and chemotherapy before SCS correlated with worse outcome.
Our series corroborates previous data that suggest complete cytoreduction
as the surgical objective.
029291
Sentinel lymph-node identification and pelvic lateral space dissection
in robot-assisted radical hysterectomy: a useful pathway to tailor
radicality
Tsunoda, A.T.1, Simioni, E.B.1, Vieira, M.A.1, Cintra, G.F.1, Reis, R.1,
Andrade, C.E.M.C.1
1
atsunoda@gmail.com,
elisasimioni83@gmail.com,mvieiraonco@gmail.com,georgia.fc@gmail.com,
dr.ricardoreis@hotmail.com, mdcarlosandrade@gmail.com
Introduction: Robot-assisted radical hysterectomy (RRH) with evaluation of sentinel lymph nodes (SLNs) is a common procedure in the global
literature. Nevertheless, few reports and videos describe a standardized
approach to pelvic lateral spaces as a tool for faster SLN identification and
nerve preservation.
Objectives: To demonstrate an efficient SLN identification and pelvic
space development with a robotic platform, and adequate exposure for a
tailored RRH.
Methods: A 35-year-old female patient, G4, BMI 24.8, had a stage IA1
poorly differentiated squamous-cell carcinoma, with lymphovascular space
involvement, in a staging conization. This video presents a standard pelvic
lateral space development, with efficient bilateral SLN identification, and
pelvic preparation to tailor radicality.
Results: The patient was positioned over a foam cushion, in a low
lithotomy position, with arms along the body. Furthermore, she was
attached to the table with 2 tapes along the thorax, in order to permit a 27o
Trendelemburg. Trocar placement included: a 12-mm (epigastrium), three
8-mm (two right side, one left side), and an 11-mm in the left upper quadrant. Two milliliters of patent blue die were injected at 3 h and 9 h into the
cervix, and a manipulator tube was inserted into the vagina. The operation
started with sectioning of the round ligament, followed by development
of the lateral pelvic spaces. The SLN was clearly identified as a blue node
with afferent blue channels in the right internal iliacs and in the left external
iliacs. All anatomical landmarks were identified. After a confirmation of
ABSTRACTS
no parametrial, rectal or bladder involvement, and finding by peroperative pathological analysis SLN was negative, the radical hysterectomy was
performed. Total surgical time was 215minutes, and blood loss <5 mL.
Patient was discharged next morning, without a bladder catheter, after a
negative urinary residual test, and with normal voiding.
Conclusion: SLN assessment and pelvic lateral spaces development
with the robotic system was demonstrated. These steps were important
tools in order to tailor resection and preserve important landmarks.
029090
Social epidemiological profile of patients submitted to uterine cervix
cancer treatment
Lustosa, A.G.1, Corra, R.S.2, Gis, M.C.2, Santos, L.V.S.2, Silva, R.P.2,
Pires, T.C.3, Lira, G.A.2, Filho, K.J.C.2, Souza, W.B.1
1
Natal, Brazil
Introduction: In Brazil, it is estimated that cervical cancer is the third
most common malignant neoplasm among women.
Objectives: To point out the sociodemographic characteristics of
patients stricken by cervical cancer treated at the reference unit against
cancer in the state of Rio Grande do Norte.
Methods: This was an observational and prospective study with 32
women, aged >18 years, who had a histological diagnosis of cervical carcinoma, with indication for radical surgical treatment and adjuvant radiotherapy, exclusive or concomitant with chemotherapy.
Results: The average age of patients was 47.4 years ( 12.77); of
the total, 28.1% were single, 56.2% married, 6.25% widowed, and 9.37%
divorced. The predominant color was brown (81.25%). Regarding the most
common signs and symptoms associated with cervical cancer, 46.87%
presented sinusorragia, 65.62% with abnormal vaginal bleeding (50% with
watery vaginal discharge, purulent mucoid and foul-smelling), 43.75%
hypogastric pain, 40.62% with urinary manifestations, 43.75% with back
pain, and 40.62% with pelvic pain. The average age of menarche was 13.03
years ( 1.63), 29.37 years menopause ( 22.80); number of pregnancies
4.46 ( 2.68), and childbirths 4.03 ( 2.70). The average age of first sexual
intercourse was 16.15 years ( 2.28) and the number of partners was 2.81
( 1.71). As to the pathological background, 9.37% reported cases of sexually transmitted diseases and 31.25% reported a family history of cervical
cancer. When asked about their living habits, 25% said they consumed
alcohol and 40.62% were smokers. According to the staging for cervical
cancer adopted by FIGO, we noted that 25% of patients had stage IB1,
3.12% IIA, 37.5 IIB, 3.12% IIIA, 21.87% IIIB, and 6.25% IVA.
Conclusions: Despite fact that cervical cancer is easily preventable,
allowing early detection, unfortunately we are still observing young women
who are diagnosed in the late stages of the disease.
029141
Socioeconomic and clinical profile of patients with cervical cancer
who underwent surgical treatment in a reference hospital in Salvador
Filho, D.F.1, Ribeiro, G.S.2, Anjos, R.O.3, Zanvettor, P.H.1
1
Department of Gynecology, Aristides Maltez Hospital, Salvador, Brazil,
2
Collective Health Institute, Federal University of Bahia, Salvador, Brazil,
3
Nursery School, Federal University of Bahia, Salvador, Brazil
dfalcao@gmail.com, gsribeiro@gmail.com, rosaa.oliveira@hotmail.com,
phzanvettor@terra.com.br, dfalcao@gmail.com
ABSTRACTS
Introduction: Cervical cancer is a slow and progressive disease which
starts with intraepithelial lesions; if untreated it can develop within 1020
years into invasive carcinoma. Surgery is the treatment of choice for cases
diagnosed in the early stages.
Objective: To describe the socioeconomic and clinical profile of
patients with cervical cancer who underwent surgical treatment in a reference hospital in Salvador.
Methods: We conducted a cross-sectional study from May 1st 2011
to April 30th 2014 at the referral hospital for neoplastic diseases of the
state of Bahia. Inclusion criteria were: histopathological diagnosis of
cervical cancer, age 18 years, and never having been treated for this
cancer. Data were collected through interviews and medical record review,
with a standardized questionnaire. To define the economy class we used
the socioeconomic classification criteria, the Brazilian Association of
Research Companies. The clinical stage was in line with the International
Federation of Gynecology and Obstetrics. The characterization of patients
was performed by absolute and relative frequencies and central tendency
and dispersion measures. This study was approved by the ethical board
of the hospital. All patients included were informed about the study and
signed a consent form.
Results: We included 881 patients in the study. Of these, only 146
(16.6%) had the disease in early stages. We submitted 99 women (67.8%)
to surgical treatment. As for the sociodemographic and clinical characteristics, most resided in interior municipalities of Bahia (81.8%) and belonged
to economic class C (54.5%). They were, on average, 42.5 years of age
(IQR [36.0; 51.5]), had 6.5 years of schooling (IQR [4.5; 11.0]) and household monthly per capita income of R$ 27.2 (IQR [185.8; 458.3). The most
frequent staging was IB1 (69.4%), and the histological type was squamouscell carcinoma (73.7%).
Conclusion: The results of this study describe the socioeconomic and
clinical profile of patients with cervical cancer, identified in a reference
hospital in Salvador.
029261
Splenosis in the differential diagnosis of adnexal masses
Leite, A.B.C.1, Grillo, B.C.1, Delunardo, L.G.C.1, Noda, M.C.1,
Nogueira, M.P.M.1, Leite, H.G.A.2
1
Department of Gynecology, Federal University of Esprito Santo, Vitria,
Brazil, 2Department of Endocrinology, Estadual University of Rio de
Janeiro, Rio de Janeiro, Brazil
abcleite@hotmail.com, brunellagrillo@hotmail.com,
luizcariello@yahoo.com.br, mayumi45fmb@yahoo.com.br,
mapamuno@hotmail.com, hirlena_almeida@hotmail.com
Introduction: Splenosis is an autotransplantation of splenic tissue
after splenic capsule rupture due to trauma or surgery. Splenosis is not an
uncommon disease, it occurs in up to 67% of patients with splenic rupture.
The implants are found most commonly in the mesentery, peritoneum, and
omentum. Autotransplanted splenic tissue can derive its blood supply from
surrounding tissues in any site of the abdomen or thorax. For that reason, it
is often misdiagnosed as malignant tumors in radiological examination or
diagnosed incidentally during laparotomy.
Objectives: To present a case of a 40-year-old premenopausal woman
with a history of an automobile accident and an urgent splenectomy 30 years
previously; she presented with hypermenorrhea, pelvic pain, myomatous
uterus and cystic/solid mass in the left adnexa on transvaginal ultrasound.
Methods: Case study and a review of the literature.
Results: The abdominal laparotomy revealed multiple foci of splenosis and a solid, firm, oval tumor approximately 3 cm in diameter on the
left parametrium in close contact with a 2-cm simple cyst on the surface of
the left ovary. The patient underwent a hysterectomy, left ovarian cystectomy, and resection of the parametrial nodule; two other 2-cm nodules in
S193
the anti-mesenteric portion of the small bowel were resected with a full
thickness elipse. Closure was performed with a transverse running suture to
prevent intussusception. The microscopic analyses showed normal splenic
tissue and confirmed splenosis and a simple cyst of the ovary.
Conclusions: Pelvic masses can represent a benign or malignant
gynecological and non-gynecological entities. Ultrasound is relatively less
expensive than other imaging modalities and its diagnostic performance is
similar. Transvaginal ultrasound provides better resolution of pelvic structures with fewer artifacts than abdominal ultrasound. Despite the fact that
splenosis is a benign condition, it should be considered in the differential
diagnosis of adnexal masses.
029181
Squamous-cell carcinoma of the cervix the importance of prevention
in menopausal women: a case report
Arago, P.S.1, Gomes, D.B.1, Oliveira Jnior, I.R.A.1, Correia, C.S.1,
1
Medical school, Tocantinense Institute President Antnio Carlos ITPAC
- Porto, Porto Nacional, Brazil, 2Laboratory Coordination, Tocantinense
Institute President Antnio Carlos ITPAC - Porto, Porto Nacional, Brazil,
3
paulaaragao2210@gmail.com,daystn@hotmail.com,iran_jr12@hotmail.com,
carmem_correia@hotmail.com, nascimentojmn@hotmail.com,
drpedroflorindo@gmail.com
Introduction: Cervical cancer is the second most frequent malignancy
in Brazil. Its incidence is bimodal, with a peak around 3539 years of age.
The reasons for the second rise in prevalence are unknown in menopausal
women. It is believed to be related to the time they seek medical care
because of symptoms of that period, and they are occasionally screened for
cervical cancer. However, some mechanisms may be considered, such as:
(1) reactivation of latent infection by gradual loss of type-specific immunity, and (2) the period is characterized by gradual reduction in the production of ovarian steroid hormones, causing effects in the urogenital system
and predisposing to a higher risk for the outbreak of infections.
Objectives: To report a case of squamous-cell carcinoma of cervix,
demonstrating the importance of early diagnosis in postmenopausal
patients in order to prevent surgical treatments.
Methods: Patient MNPS signed the informed consent (IC) form; she
was single, 51 years old, G4P4A0, Caucasian, a housewife, menopaused at
49, and came from Palmas, TO.
Results: The histopathological exam reported squamous-cell carcinoma of the cervix. When she was referred to gynecological oncology she
denied bleeding and presented a free abdomen, apparently free fornices,
and rectal examination revealed the parametrium free also. Colposcopy
showed a tumor lesion in the cervix of 3 cm. Three months later, the MRI
showed involvement of the posterior vaginal fornix and free parametrium.
By staging it was diagnosed as IIA1 cervical cancer. The treatment was
radiotherapy, brachytherapy and chemotherapy.
Conclusions: There is a substantial concern that menopausal women
do not receive preventive cytology, especially those who use hormone
replacement therapy. The cytological examination, when widely held,
should be done every 3 years after two normal or negative screenings for
cancer. Thus, women in the menopausal period should undergo preventive
tests for detection of early diagnosis.
S194
028414
Squamous-cell carcinoma originated at the mature cystic teratoma: a
case report
Sousa, A.R.1, Dias, E.N.1, Vaz, L.A.1, Silva, L.M.C.1, Lopes, E.P.D.2
1
laizzavaz@hotmail.com, luiza_marianacs@hotmail.com,
epdlopes@hotmail.com
Introduction: Germ-cell tumors account for 30% of ovarian tumors.
The cystic teratoma is the most common of these, accounting for 2744%
of primary ovarian tumors. Malignant transformation is a rare complication of a mature cystic teratoma; it occurs in approximately 1% of cases,
being most frequently oral squamous-cell carcinoma (83%). The prognosis depends on the stage, grade and vascular invasion. The treatment of
choice is either surgery or lymphadenectomy which improves survival in
advanced stages.
Objectives: To report a clinical case of a patient with invasive squamous-cell carcinoma which originated in a mature cystic teratoma, and to
conduct a brief review of the literature.
Methods: Retrospective appointments with records of this case which
occurred at the surgical oncology department were used. Also, studies of
scientific research and articles published in the database PubMed, and
MEDLINE BIREME were used.
Results: MASA was a 61-year-old female, G2P2nA0, menopaused
during her 50s, and had bilateral tubal ligation for 32 years; she complained
of moderate pain in the left iliac flank starting 6 months previously, with
no changes in intestinal or urinary habits. The abdomen was flaccid, painful
to deep palpation in the left iliac fossa without peritoneal irritation and no
palpable masses. Gynecological examination: atrophic, mobile cervix, left
painful mobile mass. Rectal examination: anterior wall bulged (extrinsic
cause). US-TV: adnexal mass in the left region with defined contours
and precise limits of 75 x 70 x 50 mm without ascites. CA125 standard.
Total hysterectomy and bilateral salpingo-oophorectomy were carried out;
bilateral cystic lesions were found which were compatible with mature
teratoma, 10 cm in diameter. Histopathology showed a little area of invasive squamous-cell carcinoma originated in the dermoid cystic component of a mature cystic teratoma.
Conclusion: The importance of this case is due to the rarity of malignant transformation of mature cystic teratoma, which is the most common
germ-cell tumor in squamous-cell carcinoma. Surgical resection is the
treatment of choice, followed by adjuvant chemotherapy.
029269
Synchronous tumors of the cervix and endometrium: a case report
Teixeira, R.L.1, Lima, L.W.R.1, Ruvio, V.B.1, Silva, L.C.1, Pires, A.L.P.1,
Alves, R.M.S.2
1
Medical student from Universidade Federal do Amap, Macap, Amap,
Brazil, 2Medical specialist Surgical Oncology and Auxiliary Professor of
general surgery at the Universidade Federal do Amap (UNIFAP), Brazil
railalinhares@hotmail.com, lana_wrl@hotmail.com,
vitor_benevides@hotmail.com, robertomacelsa@yahoo.com.br
Introduction: Synchronous tumors of the female genital tract are rare,
accounting for 0.71.8% of all cases; the majority are ovarian and endometrial in origin. Synchronous tumors of the cervix and endometrium are even
rarer, highlighting the importance of the description of such clinical case.
Objective: To report a case of a patient diagnosed with synchronous
primary tumors of the cervix and endometrium, treated at Hospital das
Clnicas Dr Alberto Lima Macap-AP, between 2014 and 2015.
ABSTRACTS
Case Report: We present a case of a 47-year-old patient who had had
three pregnancies and three births; she had had abnormal uterine bleeding
for about 15 years; this worsened with efforts and after intercourse, and was
partly improved after tranexamic acid administration. In July 2014, after
investigation with biopsies, two histopathologies were obtained: cervical
cancer and endometrial cancer. After staging tests, radical WertheimMeigs
hysterectomy with para-aortic lymph-node dissection was indicated.
Discussion: The diagnosed cancers are the most frequently found
among cancers of the female genital tract. It is known that the risk factors
and pathophysiology of these diseases are very different. HPV and
prolonged estrogen stimulation are the most important agents in cervical
and endometrial oncogenesis.
Conclusion: The simultaneous diagnosis of two tumors with disease
duration, risk factors and pathophysiology fully distinct makes documentation of this case important in focusing on the possibility of synchronous
tumors which interfere directly with each other and affect the therapeutic
management of these patients
029208
The importance of oncological surgical follow-up: a case report of a
patient with ovarian cancer presenting a cutaneous metastasis and a
second primary cancer in the thyroid
Viana, R.F.R.1, Lopes, P.V.A.1, Vieira, H.C.2, Moreira, R.C.L.1,
Salles, P.G.O.2, Cintra, C.A.2
1
Department of Surgery, Group of Coloproctology and Small Intestine
of Institute Alfa de Gastroenterologia of Hospital das Clnicas UFMG,
Belo Horizonte, Brazil, 2Oncological Surgery, Mario Penna Institute, Belo
Horizonte, Brazil
renanfrv@gmail.com, paulovinicius.lopes@gmail.com,
hcvieira@gmail.com, renicecilia@me.com, pgosalles@gmail.com,
cassioacintra@ig.com.br
Introduction: Ovarian cancer is the most lethal gynecological cancer,
presenting an overall survival of 40% in 5 years. Cutaneous metastasis is
reported in 4% of cases; it generally appears late and is associated with a
survival rate of 4 months. Papilliferous thyroid cancer is the most common
cancer in the thyroid, corresponding to 80% of thyroid cancers. It develops
in follicular cells and grows slowly.
Objectives: To discuss the importance of specialized follow-up in the
early diagnosis and development of a therapeutic plan for the complications
of a patient with cancer.
Methods: A 36-year-old women was sent to specialized services
with an extensive skin lesion in her back. She was submitted to excisional
biopsy. Postoperatively, she presented intense abdominal pain, and a CT
showed a broken adnexial mass. The patient underwent WherteimMeigs
surgery in 1999. The analysis of a sample showed that the skin lesion was
a metastasis of a poorly differentiated malignant neoplasia, and the patient
was submitted to adjuvant chemotherapy. In the 14th year of follow-up the
patient presented with a thyroid nodule, examination of which confirmed it
to be a papilliferous thyroid cancer. A total thyroidectomy was performed,
but the patient needed iodotherapy with I-131 because of nodal invasion.
Results: Cutaneous metastasis of ovarian cancer is rare and shortens
the patient survival. In this study, the patient was followed for 14 years
without cancer complications. The second primary cancer probably has no
link with the first, but early diagnosis and treatment are part of holistic care.
Conclusion: An adequate specialized follow-up is important for early
diagnosis and for appropriate treatment of new primary lesions.
ABSTRACTS
029149
Total laparoscopic hysterectomy with sentinel-lymph-node technique
in endometrial cancer: a procedure performed by a surgical oncology
resident
Couto, U.V.O.1, Simioni, E.B.1, Cintra, G.F.1, Tsunoda, A.T.1,
1
ugovicente@gmail.com,
elisasimioni83@gmail.com, georgia.fc@gmail.com, atsunoda@gmail.com,
mdcarlosandrade@gmail.com, dr.ricardoreis@hotmail.com
Introduction: The use of sentinel-lymph-node technique in lowrisk endometrial cancer has the potential to decrease the morbidity of
lymphadenectomy while maintaining the ability to adequately evaluate the
pelvic lymph nodes. This procedure was developed by a resident of surgical
oncology in the second year of residence.
Objective: To demonstrate a step-by-step laparoscopic hysterectomy
with sentinel-lymph-node technique in low-risk endometrial cancer.
Methods: A 53-year-old patient with endometroid endometrial cancer
grade 1 underwent laparoscopic hysterectomy with sentinel-lymph-node
mapping. At the beginning of the laparoscopic procedure, 2.5% Patent Blue
(2 mL diluted in 2 mL of saline) was injected into the uterine cervix (at the
3 oclock and 9 oclock positions). Intraoperatively, the pelvic nodes were
examined. The examination started by the opening of the pelvic peritoneum, and after the avascular paravesical, pararectal, and obturator spaces
(fossae) were carefully dissected, the pelvic sentinel lymph nodes were
identified by staining with Patent Blue dye (blue-stained) bilaterally.
Results: This video shows the whole step-by-step process with 120
minutes of operative time. The blood loss was less than 20 mL. There were
no intraoperative complications. The uterus, fallopian tubes and ovaries
were sent for pathology of frozen sections, and the pathology analysis was
FIGO IAG2. The patient was discharged the morning after the procedure.
Conclusion: The use of sentinel-lymph-node mapping in cases of lowrisk endometrial cancer can evaluate the lymphatic drainage of the tumor,
and this procedure can prevent all possible complications related to systematic pelvic lymphadenectomy, without changing the patients prognosis. It
is a fully reproducible procedure when taught by a tutor with a complete
learning curve.
029144
Total laparoscopic surgery staging for fallopian-tube cancer
Couto, U.V.O.1, Schmidt, R.L.1, Vieira, M.A.1, Tsunoda, A.T.1,
1
ugovicente@gmail.com,
ronaldolsc@hotmail.com, mvieiraonco@gmail.com, atsunoda@gmail.com,
mdcarlosandrade@gmail.com, dr.ricardoreis@hotmail.com
Introduction: The use of laparoscopy for surgical staging of tumors
of the ovary and fallopian tubes has the potential to ensure proper staging
of these tumors with a reduction in surgical morbidity compared to
laparotomy. Therefore, the cancer surgeons skills are very important for
the prognosis of these patients.
Objective: To demonstrate the surgery step by step for the staging of
ovarian/fallopian tube cancer apparently in the initial stage.
Method: A 44-year-old patient was diagnosed with an endometrioid
cystadenocarcinoma infiltrating the fallopian tube after laparoscopic resection outside of our hospital. The patient was subsequently submitted to a
total laparoscopy hysterectomy with bilateral salpingo-oophorectomy,
bilateral pelvic and para-aortic lymphadenectomy, and omentectomy. All
procedures were performed by laparoscopy and the products were removed
vaginally.
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Result: The video shows the whole process step by step, with 300
minutes of total operative time. Blood loss was 60 mL. There were no intraoperative complications. The patient was discharged the morning after the
surgery. The final histopathological analysis showed no residual disease in
ovaries, tubes, uterus, pelvic and para-aortic lymph nodes and omentum
(stage IA). Therefore, adjuvant chemotherapy was not indicated and the
patient is in follow-up. There have been no postoperative complications in
the first 30 days.
Conclusion: The complete staging for the fallopian tube tumor was
essential to avoid adjuvant chemotherapy. The use of laparoscopy for
staging is very important because it improves the patients quality of life
by allowing them to return to baseline functioning sooner. This case also
shows the importance of oncological surgeon skills in the prognosis of this
patient.
029111
Total pelvic exenteration with double-barreled wet colostomy in
locally advanced endometrial cancer: a case report
Barros, A.V.1, Tojal, N.O.1, Oliveira, F.A.P.F.1, Melo, C.L.A.1,
Santos, C.M.M.1, Silva, R.A.T.A.1
1
Brazil
aldobarros@ig.com.br, nathanatojal@hotmail.com,
fapfo.med@uol.com.br, ciceroludgero@ig.com.br, claritamms@gmail.com,
d_andrada@hotmail.com
Introduction: The endometrial adenocarcinoma comprises 97% of
malignant neoplasms of the uterine body. This is the type of unterine tumor
that occurs most often in patients, and postmenopausal vaginal bleeding
presents as the single first symptom. The high-risk group includes patients
with recurrent tumors invading more than half of the myometrium with
high histological grade (GIII) and invasion of the perivascular space. Pelvic
exenteration has been the best treatment option for locally advanced pelvic
tumors primary or recurrent without distant metastases; this is the only
curative treatment for patients who have previously undergone chemotherapy or radiotherapy and have a good performance status. When the
tumor involves both the bladder and the rectum, total pelvic exenteration is
indicated, making it necessary to carry out simultaneous fecal and urinary
diversions. One option is the double-barreled wet colostomy, considered a
technique of low complexity without intestinal anastomosis; thus surgical
time is reduced and the patient has an acceptable quality of life.
Objective: To analyze the results of total pelvic exenteration with
urocolostomy in patients with endometrial cancer with central pelvic
recurrence.
Methods: The patient was a 60-year-old female with endometrioid
adenocarcinoma GIII, FIGO stage II, who underwent total hysterectomy
radical Piver II, bilateral pelvic lymphadenectomy and adjuvant radiochemotherapy. Eight months after the end of treatment, the patient developed a
recurrence in the vaginal vault with invasion of the bladder and rectum but
without distant metastases. She was subjected to total pelvic exenteration,
with abdominoperineal amputation, full colpectomy, and vulvectomy, and
a urocolostomy was constructed.
discharged from hospital on the 7th postoperative day. After multidisciplinary assessment, it was decided that she should continue to be followed up
without adjuvant therapy. After 14 months of surgery, the patient is well
adapted to the wet colostomy; she has a good quality of life and there is no
evidence of recurrence.
Conclusion: The total pelvic exenteration with double-barreled wet
colostomy constitutes a feasible option in the treatment of locally advanced
pelvic cancer in selected patients, and can offer local control of the disease
and a better quality of life.
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028433
Treatment of a patient with endometrial cancer: laparoscopic paraaortic and pelvic lymphadenectomy
Sousa, P.F.1, Giorgetta, L.S.1, Lustosa, E.1
1
Department of Gynecologic Oncology, INCA, Rio de Janeiro, Brazil
ABSTRACTS
Conclusions: Radical hysterectomy has been performed as the gold
standard treatment for early-stage cervical cancer. Our service does this
surgery with conventional, laparoscopic and robotic approaches; we prefer,
when possible, to use minimally invasive surgery for its lack of compliations, safety, and better postoperative outcomes.
priscbj@hotmail.com, dskleo@hotmail.com, ericolustosa@hotmail.com

Introduction: Endometrial carcinoma is the most common gynecological cancer in many developed countries such as the United States. The
treatment of this pathology based on factors such as tumor size, histological type and grade includes pelvic and para-aortic lymphadenectomy.
Nowadays, oncological treatment is performed in a safe manner with minimally invasive surgery.
Objectives: To show feasibility of laparoscopic para-aortic and pelvic
lymphadenectomy as a treatment for endometrial cancer.
Methods: The video is based on the case of a 48-year-old female
patient with a diagnosis of grade II endometrioid adenocarcinoma of
endometrium with more than one-half myometrial invasion. The patient
was submitted to a conventional total hysterectomy out of our institution.
She came to our department 4 months later; we offered her laparoscopic
bilateral salpingo-oophorectomy with para-aortic and pelvic lymphadenectomy to complete her treatment.
Results: Pelvic and para-aortc lymphadenectomy was performed via
laparoscopic approach in our institution 4 months after the first surgery.
The procedure time was 4 hours and there were no peri- or postoperative
complications. The length of hospital stay was 1 day. The anatomopathological result was one metastatic para-aortic lymph node without pelvic
lymph-node involvement. The patient was sent for adjuvant treatment with
chemoradiotherapy.
Conclusions: The laparoscopic approach is safe in the treatment of
endometrial cancer even in teaching institutions. Complete surgery with
laparoscopic lymphadenectomy is feasible in these cases, with an acceptable operating time and minimal complications.
028434
Treatment of a patient with stage IA2 cervical cancer with
laparoscopic type II radical hysterectomy
Giorgetta, L.S.1, Sousa, P.F.1, Cordero, F.L.1
1
Department of gynecologic oncology, INCA, Rio de Janeiro, Brazil
dskleo@hotmail.com, priscbj@hotmail.com,
fernandocordero@uol.com.br
Introduction: Worldwide, cancer of the cervix is the second most
common cancer in women, and is the leading cause of death of women from
cancer in developing countries. The pattern of spread is usually predictable
and can be through direct extension, via the lymphatics, or hematogenous.
The FIGO staging system is universally accepted for its prognostic significance and its importance in guiding treatment. Early-stage disease is better
treated with radical hysterectomy, while chemoradiation is the treatment of
choice in advanced stage cases.
Objectives: To demonstrate type II hysterectomy as a treatment for
early uterine cervical cancer in a minimally invasive approach.
Methods: The video is based on the case of a 33-year-old female
patient with a diagnosis of low-grade epidermoid carcinoma of the cervix.
The patient presented with a cervical epidermoid carcinoma stage IA2.
Results: Surgical treatment was based on a laparoscopic type II hysterectomy, bilateral pelvic lymphadenectomy, right salpingo-oophorectomy
and left salpingectomy. The duration of the procedure was 4 hours, and
there were no peri- or postoperative complications. The length of hospital
stay was 2 days. The anatomopathological result was absence of residual
disease in the cervix and no pelvic lymph-node involvement. The patient is
now in follow-up with no need for adjuvant therapy.
028875
Using the tensor fascia lata flap to closure a large wound in the
perineal region after vulvar cancer resection
Campelo, B.C.1, Silva, R.L.1, Moura, K.C.F.1, Hortegal, L.B.1,
Alencar, B.F.P.1, Pereira, A.H.L.M.1
1
UniCeuma, So Lus, Brazil
brunoccampelo@hotmail.com,
rodrigo.1979@hotmail.com,karolcfm@hotmail.com,liciahortegal@yahoo.com.br,
benjamin.alencar@gmail.com, henriquemilhomem@hotmail.com
Introduction: Vulvar cancer accounts for approximately 2 4% of
malignant tumors in the lower genital tract, affecting two of every 100,000
women in developing countries. The most frequent histological type is the
squamous-cell carcinoma. The vulvar intraepithelial neoplasm has been
considered the main cause of preneoplastic vulvar lesion for which surgical
procedures are indicated. At the end of 1970s, vulvar reconstruction gained
real progress with skin flaps based on vascular regions. After this, fasciocutaneous flaps based on internal pudendal vessels proved to be advantageous
for partial or total vulvar reconstruction.
Objectives: To describe a case of a 32-year-old woman who presented
with a longstanding history of chronic HPV infection in the perianal
and vulvar areas; she developed a large squamous-cell carcinoma which
required extensive local resection and two-stage reconstruction
Methods: In February 2014, the patient underwent extensive vulvectomy requiring resection of the external anal sphincter. The sample
measured 17 x 12 cm and the pathology report confirmed a moderately
differentiated squamous-cell carcinoma. Attempts to immediately approach
the edges of the surgical wound were ineffective, causing suture dehiscence and the need for debridement and protective colostomy 1 week after
completion of the first procedure. After formation of appropriate granulation tissue at the surgical site and resolution of local infection 20 days
after resection of the primary tumor we opted to close the wound with a
tensor fasciae latae musculocutaneous flap.
Results: The patient responded well and was discharged 7 days after
the procedure; she has now finished radiotherapy.
Conclusions: The use of a tensor fasciae latae musculocutaneous flap
in the repair of the vulvoperineal region was well established in this patient,
in terms of reduction in surgical morbidity and length of hospital stay. It has
been a valid alternative to reconstructive microsurgery techniques.
029308
Vesicoperitoneal fistula due to adjuvant intraperitoneal chemotherapy
after cytoreductive surgery in ovarian cancer patients as a cause of
uroperitoneum
Marques, R.M.1, Gomes, M.T.V.1, Podgaec, S.1, Callegaro, D.1,
Barbosa, G.B.2, Kuster, M.G.B.2, Lemos, N.2
1
Paulo, Brazil
rmorettimarques@gmail.com, mariano.tamura@einstein.br,
sergiopodgaec@me.com,docallegaro@yahoo.com.br,bicudoepm70@gmail.com,
gabikuster@yahoo.com.br, nucelio@gmail.com
Objectives: To show the role of laparoscopy in different stages of
ovarian cancer treatment, and to report a very rare catheter-related complication after optimal surgical laparoscopic debulking.
ABSTRACTS
Methods: Edited video showing the laparoscopic diagnostic and
optimal debulking followed by vesicoperitoneal fistula correction.
Results: A 25-year-old woman with stage IIIC epithelial ovarian carcinoma was initially treated with laparoscopic optimal cytoreduction surgery
with no gross visible residual disease; the patient underwent adjuvant paclitaxel 135 mg/m2 IV over 3 h followed by cisplatin 75 mg/m2 IP on day 1
and paclitaxel 60 mg/m2 IP on day 8 of a 21-day cycle. Treatment was
well tolerated until 1 week after day 8 of the third cycle, when the patient
required hospitalization due to acute abdominal pain associated with renal
insufficiency. The protocol was modified and she received three additional
cycles of weekly carboplatin AUC2 mg/mL per min IV and paclitaxel 80
mg/m2 IV on days 1, 8 and 15 of a 21-day cycle. Two months after the
completion of treatment, she again experience an acute abdominal pain
associated with a vesical fistula that was corrected laparoscopically. No
evidence of disease was detected, and no sequelae were observed after
treatment.
Conclusion: Intraperitoneal chemotherapy is one of the most effective treatment options for women with newly diagnosed optimal debulked
epithelial carcinoma. A subcutaneous single-lumen intravenous access port
with a silicone catheter of a large size (910 Fr) is related to a lower rate
of catheter-related complications than previously reported. We report a rare
catheter-related complication and the role of minimally invasive surgery
in different stages of ovarian cancer treatment to promote faster patient
recovery.
028831
Videolaparoscopic debulking lymphadenectomy in a recurrent
endometrial cancer patient
Cintra, G.F.1, Simonsen, M.1, Vieira, M.A.1, Andrade, C.E.M.C.1,
Reis, R.1, Tsunoda, A.T.1
1
Barretos Cancer Hospital, Brazil
georgia.fc@gmail.com, msimonsen@ig.com.br, mvieiraonco@gmail.com,
cem.andrade@ig.com.br, dr.ricardoreis@ig.com.br, atsunoda@gmail.com
Introduction: Even though most patients with endometrial carcinoma
do not experience recurrence or die of the disease, the recurrence rate in
the advanced stage reaches up to 50%. A recent meta-analysis suggests that
among patients with recurrent disease, surgical cytoreduction to no gross
residual disease may confer a survival advantage.
Objectives: To present a videolaparoscopic debulking lymphadenectomy in a recurrent endometrial cancer.
Methods: A 56-year-old patient with a history of endometrial adenocarcinoma IIIAG2, treated with hysterectomy and BSO, presented after 6
years of follow-up after a locoregional recurrence in the left internal iliac
lymph node measuring 3.7 x 2.7 cm; there was no evidence of distant metastasis. We used Palmers point for laparoscopic entry due to a previous infrasupra-umbilical midline incision. After the adhesiolysis of the sigmoid to
the pelvic wall, the bulky lymph node could be identified by its intimate
contact with the ureter and iliac vessels. The initial strategy was to securely
free the ureter and sigmoid. After this step, we could improve visualization
by moving the sigmoid cranially and fixing it with a suspension device,
a maneuver which freed the assistants hand. To determine the extent of
dissection we analyzed through frozen section the most cranial lymph node
in the external iliac chain, which was negative. Freeing the bulky lymph
node from the external iliac vein was the most challenging step, because of
the firm adhesion to its thin wall. The specimen was removed in an endobag
through enlargement of the umbilical incision.
Results: The operative time was 2 h 50 min and blood loss was 60 mL.
The patient was discharged the next day. The pathology report revealed
involvement of one lymph node (measuring 4.3 cm) out of the five nodes
dissected. The patient underwent adjuvant pelvic radiotherapy and is now
on the 16th month of follow-up without evidence of disease.
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Conclusion: Videolaparoscopic salvage debulking lymphadenectomy
is feasible and could improve patient outcomes.
029199
Vulvar cancer with faster evolution in a 56-year-old woman: a case
report
Medeiros, D.B.G.1, Lira, G.A.1, Bisneto, J.B.M.1, Barreto, L.K.D.1,
Arajo, M.T.1
1
Potiguar University Laurete Internacional, Natal, Rio Grande do Norte,
diogoeng@gmail.com,georgelira@hotmail.com,joaobernardomed@gmail.com,
laianabarreto@gmail.com, micheleteixeiraa@gmail.com
Introduction: Vulvar cancer is a rare type of cancer that evolves
slowly and has its peak of prevalence between 70 and 80 years of age.
The usual symptoms are a lump in the vulva, vulvar itching or tenderness,
bleeding and changes in the vulvar skin such as color changes or growths
that look like warts or ulcers. The diagnosis is through biopsy and the treatment depends on the extension of the disease.
Objectives: To describe a vulvar cancer that evolved faster than usual
in a patient with a mental disorder, and to compare the positive and negative findings with those in the literature. Also to study the best treatment
according the particularities of a patient.
Methods: Weve been surgically and oncologically monitoring this
patient from April 2015 until now (July 2015), doing all the steps available
to diagnose and treat the patient. We also reviewed the medical records and
literature that address the pathology involved.
Results: Case report: MJM is a 56-year-old married female. The
patient reported pain and an extensively bleeding tumor in the vulvar region
that has been evolving for 5 months, with dysuria and high frequency of
urination. The patient is a psychiatric patient with mental disability; she
has multiple episodes of rash in the inguinal and vulvar region due to the
daily use of diapers and difficult self-care. Gynecological examination
showed hyperemia plate with infiltration and ulceration, and painful palpation bilaterally in the vaginal opening region. Biopsy showed a moderately
differentiated squamous-cell carcinoma with positive surgical margins. The
treatment established was radical vulvectomy and lymphadenectomy.
Conclusions: Each patient should be evaluated individually; the
search for diagnoses and treatment should be as fast as possible, since the
diseases can evolve faster than predicted in some cases, and the treatment
can get more aggressive according to extension of the disease.
027455
Yolk sac tumor of the ovary: a case report
Brito, F.P.B.1, Vieira, S.C.1, Morais Jnior, M.A.1, Freitas, Y.M.M.1,
Silva, I.F.1, Nobre, V.K.A.1
1
Uninovafapi, Teresina/PI, Brazil
Introduction: Ovarian tumor yolk sac is a rare germ-cell tumor which
comprises approximately 1% of malignant ovarian tumors. It usually
occurs unilaterally and grows fast in young women. The standard treatment
consists in surgery (preserving fertility) and three or four courses of adjuvant chemotherapy in combination.
Objectives: To clearly describe this disease because of its rarity, to
facilitate diagnosis and treatment.
Methodology: This is a case report conducted by analysis of records.
Patient signed informed consent authorizing the publication and presentation of the case, according to the ANS resolution that regulates research
involving human subjects.
S198
Results: A 31-year-old female patient was referred to the oncology
service after presenting with prolonged diarrhea, 38C fever with chills,
dysuria, use of antibiotics for 3 days for treatment of a urinary tract infection, and increased abdominal size. She denied a history of alcoholism,
smoking, hypertension, diabetes and tubal ligation; she had also had two
pregnancies. In her family history an aunt had a history of cervical cancer.
Laboratory tests showed alpha-fetoprotein increased, and CT of chest and
abdomen showed predominantly a solid lesion located in the pelvis, measuring about 20 cm, associated with ascites; physical examination revealed a
pelvic tumor that extended to the umbilical scar. Diagnosed with an ovarian
tumor, the patient underwent right oophorectomy with pelvic and paraaortic lymphadenectomy, epiploectomy and biopsy in the collateral ovary;
the uterus was preserved. AP diagnosed a tumor in the yolk sac of 20 cm
with capsule invasion and necrosis, but without lymphatic or blood invasion; a fibroma also presented in the left ovary, the omentum was without
disease, and pelvic and para-aortic lymph nodes were without cancer. The
patient progressed well postoperatively and underwent adjuvant chemotherapy. Currently, 6 months after completion of treatment, she has no
evidence of active disease.
Conclusions: This case was treated with conservative surgery and
adjuvant chemotherapy.
ABSTRACTS
ABSTRACTS
HIPEC
028534
Anesthesia in patients undergoing cytoreductive surgery (CS) and
intraoperative hyperthermic chemotherapy (HIPEC)
Albuquerque, T.L.C.1, Von Sohsten, A.K.A.1, Rodas,A.K.F.1,
Weinstein, L.1, Reis,T.J.C.C.1
1
Hospital Universitrio Oswaldo Cruz-Recife/PE, Brazil
tcr@hotlink.com.br
Introduction: Cytoreductive surgery (CS) with intraoperative hyperthermic chemotherapy (HIPEC) is a complex procedure that involves
significant blood, fluid and protein loss, besides important electrolyte and
hemodynamic changes associated with coagulopathies. Therefore, its intraoperative anesthetic management is a major challenge.
Objectives: To report our initial experience, through the discussion
about the first patients operated on in a public university institution.
Methods: This was a retrospective study of patients operated on in the
institution between March and June 2015.
Results: After hospitalization, all patients underwent preanesthetic
evaluation, and were classified as ASA physical status 2 (n = 6) and ASA 3
(n = 1). Upon admission to the operating room, all patients were monitored
with pulse oximeter, cardioscope, non-invasive pressure, and bispectral
index. Continuous thoracic epidural anesthesia with ropivacaine 0.1% was
performed in six patients. Anesthesia was induced with fentanyl 35 g/kg,
propofol 23 mg/kg, rocuronium 0.6 mg/kg, and maintained with sevoflurane (n = 5) or profofol and remifentanil (n = 2). After anesthetic induction, patients underwent invasive hemodynamic monitoring, central venous
access, esophageal thermometer installation, urinary catheterization and
thermal blankets installation. Arterial and venous blood gas measurements
were obtained before, during and after HIPEC. They showed an increase
in blood lactate concentration, pH decline, and consumption of bicarbonate levels. Invasive hemodynamic monitoring showed early changes in
the variation of stroke volume and systemic vascular resistance, cardiac
index and central venous oxygen saturation, especially during HIPEC,
requiring continuous infusion of norepinephrine and dobutamine. Blood
temperature varied between 36.4C and 41C, and three patients required a
beta-blocker (metoprolol). For volume replacement Ringeralbumin solution (4%) and buffered saline solution (Plasmalite) were used; four patients
received blood transfusion. After the procedure, patients were sent to ICU
with continuous epidural analgesia; only one patient required mechanical
ventilation for 6 hours after the procedure.
Conclusions: Multimodal monitoring, maintenance of normovolemia, normothermia, diuresis and lactatemia are HIPEC critical points.
Continuous epidural analgesia demonstrated great importance in intraoperative hemodynamic management and postoperative analgesia. It could also
be related to successful operating room extubation and minor postoperative
respiratory complications
028226
Malignant peritoneal mesothelioma: a case report
Vieira, H.C.1, Viana, R.F.R.2, Lopes, P.V.A.2, Moreira, R.C.L.1,
Rausch, M.1, Salles, P.G.O.1
1
Oncological Surgery, Mario Penna Institute, Belo Horizonte, Brazil,
2
Department of Surgery, Group of Coloproctology and Small Intestine of
Instituto Alfa de Gastroenterologia of Hospital das Clnicas UFMG, Belo
Horizonte, Brazil
hcvieira@gmail.com,
renanfrv@gmail.com,paulovinicius.lopes@gmail.com,renicecilia@me.com,
marcelorausch@terra.com.br, pgosalles@gmail.com
S199
Introduction: Malignant mesothelioma is the main primary cancer of
the peritoneum in developed countries, and the peritoneum is the second
most frequently involved site, while pleura is the first. Its aggressive
behavior has encouraged efforts to achieve better treatment and survival.
Objectives: To describe a case of a man with malignant mesothelioma
of the peritoneum and to discuss the early diagnosis.
Methods: A 61-year-old man was send to oncological surgery, ambulatory after an emergent umbilical hernioplasty. In this procedure, he had
his epiplon and peritoneum biopsied and the results were compatible with
metastatic poorly differentiated adenocarcinoma. The man complained of
loss of 9 kg in 5 months. At physical exam, there was a hernioplasty scar
but no other abnormalities. No clues of malignance were found either in
the biomarkers or by endoscopies. The CT showed a right pleural effusion,
ascites, and an omental mass. The imunohistochemical analysis of the biopsied sample confirmed an epithelioid malignant mesothelioma. An exploratory laparotomy was performed to evaluate the possibility of peritonectomy
and intraoperative hyperthermic chemotherapy. There were implants in
the celiac trunk, root of mesentery, hepatic hilum and in the serosa of the
small intestine. Surgery could not be performed and the patient was send
to chemotherapy.
Results: There is evidence that patients undergoing peritonectomy
and intraperitoneal hyperthermic chemotherapy combined achieved longer
survival than when they received another therapy. This therapy is offered
to patients with adequate performance status, low peritoneal cancer index,
and without unresectable lesions. This patient already had unresectable
implants in the hepatic hilum, root of mesentery, celiac trunk, and diffuse
lesions at the serosa of small intestinal. He was referred for chemotherapy.
Conclusions: Patients with malignant mesothelioma of the peritoneum may benefit from the combined therapy. Early diagnose is essential
to permit adequate cytoredution surgery. Additional studies are needed to
discover biomarkers for this condition.
028905
A succesful case of HIPEC in a peritoneal mesothelioma patient
Firmino, N.L.J.1, Soares, M.C.2, Miranda, E.3, Azevedo, L.W.2,
Gomes, G.E.S.1, Diniz, A.F.1, Lima, M.B.A.1, Oliveira, D.A.2,
Gomes, A.S.A.3
1
Oswaldo Cruz Hospital, Pernambuco University, Recife, Brazil, 2League
of Oncology of Pernambuco, 3UNIONCO, Surgical and Clinical Oncology
Institute, Recife, Brazil
nflj_@hotmail.com, marianacs_5@hotmail.com,
emiranda.onco@gmail.com, laiswa.med@gmail.com, glory_sgg@
hotmail.com, alana_diniz959@hotmail.com, marianebione@gmail.com,
daniel@oliveiraalexandre.com, alexandre.unionco@gmail.com
Introduction: Peritoneal mesothelioma is a rare disease with around
250 cases per year in the USA. There will be an annual mortality of 510%
until 2020. This disease is also interesting due to occupational and medicolegal implications related to its occurrence. Exposure to asbestos is the
main cause related to this cancer, and it is estimated that at least 8 million
people were exposed to this substance in the last 50 years in the USA.
Conventional treatments, including intraperitoneal catheter chemotherapy,
proved to be ineffective.
Objectives: To describe a clinical case of peritoneal mesothelioma
treated with HIPEC.
Methods: A 52-year-old patient with postprandial fullness of 12
months evolution underwent investigation. Exams showed an elevation of
CA125 and ultrasound showed slight ascites. Magnetic resonance imaging
of the abdomen showed moderate diffusely distributed ascites. No solid
lesions were found.
Results: The patient was submitted to systemic chemotherapy with
cisplatin and pemetrexed. He was submitted to videolaparoscopy in June
S200
2014 with findings of numerous nodules in the parietal peritoneum of
approximately 1 cm and diffusely scattered. Biopsy of the parietal peritoneum revealed epithelioid malignant mesothelioma. IHC: calretinin, CK7+,
WT1 and CK20 and negative PAX8, consistent with epithelial epithelioid
mesothelioma. In January 2015 the patient was submitted to HIPEC surgery
with full parietal peritonectomy and hysterectomy. HIPEC was performed
with cisplatin 50 mg/m2 and adriamycin 15 mg/m2 to 42C for 60 minutes.
Total duration of HIPEC: 9 h 30 min.
Conclusion: The patient is now without evidence of disease and is
living a normal life.
029049
Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal
chemotherapy (HIPEC) for treatment of advanced ovarian cancer:
the first two cases of a pioneering clinical trial in Brazil
Oliveira, D.N.A.1, Batista, T.P.2, Carneiro, V.C.G.2, Tancredi, R.2,
Badiglian-Filho, L.3, Leo, C.S.1
1
Instituto de Medicina Integral Professor Fernando Figueira, Recife,
Brazil, 2Instituto de Medicina Integral Professor Fernando Figueira e
Hospital de Cncer de Pernambuco, Recife, Brazil, 3AC Camargo Cancer
Center, So Paulo, Brazil
diegonunes.ao@gmail.com, t.paulo@bol.com.br,
vandrecarneiro@yahoo.com.br, rodrigotancredi@yahoo.com.br,
levonbfilho@gmail.com, cs10leao@uol.com.br
Introduction: HIPEC is a promising therapeutic option for ovarian
cancer.
Objective: To describe the first cases of a pioneering clinical trial in
Brazil exploring the safety and efficacy of HIPEC for treatment of advanced
ovarian cancer patients.
Methods: This is a casereport of the first two cases of a single-arm,
open-label, phase II clinical trial recruiting patients from our public
health system (i.e., SUS/PE). HIPEC protocol was performed according
to the closed-abdomen technique, using cisplatin (25 mg/m/L) in 46 L
of dextrose perfusate for 30 min at 4143C. The Performer HT device
(RAND Srl, Medolla, MO, Italy) was used for extracorporeal circulation
of hyperthermic fluids. This study was reviewed by the CONEP (National
Research Ethics Committee) (CAAE: 04016212.5.0000.5201) and registered at ClinicalTrial.gov (NCT02249013). Funding sources were from
Decit/SCTIE/MS - CNPq/FACEPE/SES-PE (APQ:0187-4.01/13) and
FAPE.
Results: Case 1: 41 years old, ASA1, PS1, CA125 = 6550 U/mL,
serous adenocarcinoma (G3), FIGO IIIC, treated with three cycles of
neoadjuvant chemotherapy (carboplatin and paclitaxel). At the time of CRS
plus HIPEC, the peritoneal cancer index (PCI) was 9 and completeness
of cancer resection (CC score) was 0. Case 2: 63 years old, ASA2, PS1,
CA125 = 618.5 U/mL, endometrioid adenocarcinoma (G1), FIGO IIIB,
treated with two cycles of neoadjuvant chemotherapy (carboplatin and
paclitaxel). At the time of CRS plus HIPEC, PCI was 3 and CC score was
0. Neither case presented any postoperative complications, and the patients
were discharged from ICU the morning after the procedure and from the
hospital on the third postoperative day. The equipment proved to have an
extremely simple user interface, allowing the operators to easily and immediately learn all functions for the performance of the treatment.
Conclusions: Our protocol seems to be feasible and safe, and the first
two cases presented no short-term complications. This is a pioneering clinical trial in Brazil and also the very first to use the Performer HT device.
ABSTRACTS
028371
Cytoreductive surgery and HIPEC: experience of the first patients
operated in a public hospital
Reis,T.J.C.C.1, Ramalho,W.C.1, Barreto, C.L.1, Rodas, A.K.F.1,
Albuquerque, T.C.L.2, Weinstein, L.2, Junior, N.F.L.2, Soares, M.C.2,
Karimai, J.1
1
Hosp Universitrio Oswaldo Cruz-Recife/PE, Brazil, 2Liga
Pernambucana de Oncologia, Brazil
tcr@hotlink.com.br
Introduction: It has been 25 years since Paul Sugarbaker first described
cytoreductive surgery and HIPEC. Since then, many health services across
the world have been using this therapeutic modality. However, only a few
Brazilian health services have consolidated this practice. Generally, most
difficulties are related to morbidity, multidisciplinary team engagements,
and the high cost of the procedure.
Objectives: To report our 6-month preliminary experience by
discussing the data related to the first patients operated on in a public
university.
Methods: Observational study of ten patients operated on by the institution from March 2015.
Results: Nine patients were female and one was male. The mean age
was 54 years (range 4464 years). Most patients (60%) were carriers of
ovarian cancer early stage IIIC, followed by appendiceal carcinoma origin
(40%). The mean operative time (including infusion time) was 6 hours
(4.58 hours). The chemotherapy scheme used was cisplatin and doxorubicin (ovary) and oxaliplatin (colon, appendix). All patients received
perfusate solution heated at 43C. There was no necessity to interrupt the
infusion in any patient. Eight patients left the operating room already extubated. This is possibly related to the combined anesthesia choice (epidural
and intravenousinhalation). The epidural catheter was maintained postoperatively for up to 48 hours to infuse anesthetics and opioids. The average
ICU stay was 2 days (17 days); only one patient was readmitted after
21 days of the procedure on account of nosocomial pneumonia (patient
number 3). There were no deaths within 30 days of follow-up. Currently,
nine patients are alive; there was a late death from pneumonia caused by
KPC-producing bacteria (patient 3). None of the others had any complications and are showing good clinical outcome.
Conclusion: Our case series has shown that is possible to perform CS/
HIPEC safely in a public educational institution.
028892
Cytoreductive surgery and HIPEC for peritoneal metastasis by colon
and appendix carcinoma
Cordeiro, E.Z.1, Baretta, R.1, Silva, C.S.2, Bordinhao, R.W.1
1
Department of Surgery, Caridades Hospital, Florianpolis, Brazil,
2
Department of Surgery, Federal University of Santa Catarina,
Florianpolis, Brazil
contato@dreduardooncologia.com.br, rodrigobaretta@hotmail.com,
carlasimonesilva@yahoo.com.br, bordinhao@hotmail.com
Introduction: Peritoneal dissemination of abdominal malignancy
(carcinomatosis) characteristically does not have a good systemic chemotherapy response and is associated with palliative surgical procedures. This
therapeutic approach has little impact in changing the natural history of the
disease, which has a poor prognosis with median survival of 68 months.
The combination of cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been recognized as a treatment able to
positively modify the survival rates and limit morbidity in patients with
carcinomatosis from gastrointestinal neoplasia.
Objectives: Our goal is to present a series of four patients undergoing CS followed by HIPEC for advanced neoplasia of the appendix
ABSTRACTS
and colon from September 2014 to June 2015 in the Caridades Hospital,
Florianpolis, SC, Brazil.
Methods: Patients underwent CS followed by HIPEC with mitomycin
at 42C (90 min), cisplatin (90 min) or oxaliplatin (60 min). All patients
underwent extensive preoperative investigations, which included physical
examination, clinical data, and imaging study.
Results: Of the patients undergoing CS and HIPEC, ages ranged from
51 to 65 years, and 75% were female. The primary tumor was appendiceal
carcinoma in two patients (50%) and colon carcinoma in the remaining
50%. The peritoneal cancer index (PCI) ranged between 4 and 30 points
with complete cytoreduction (CC0) in all cases. Operation time was an
average of 11.25 h. Hospital stay was between 6 and 75 days. Cases with
a greater peritoneal dissemination index were associated with a longer
operative time, increased morbidity, and increased need for multivisceral
resection.
Conclusion: The CS followed by HIPEC is a challenging therapeutic
modality for both the patient and the surgeon since it requires a multidisciplinary team with adequate training in surgical oncology and multivisceral
resections. Despite the morbidity related to the procedure, survival gains
over conventional treatments are evident and the method is feasible to be
used and applied safely even out of reference centers.
028373
Economical feasibility of cytoreductive surgery and HIPEC by SUS
Reis,T.J.C.C.1, Ramalho, W.C.1, Rodas, A.K.F.1, Albuquerque, T.C.L.1,
Weinstein, L.2, Gomes, G.E.S.2, Nascimento, A.C.S.2, Carvalho, L.A.2,
Oliveira, D.A.2
1
Hosp Universitrio Oswaldo Cruz-Recife/PE, Brazil, 2Liga de Oncologia
de Pernambuco, Brazil
tcr@hotlink.com.br
Introduction: The CS/HIPEC has been with us for over 15 years,
especially in private surgical services and philanthropic organizations. Few
public initiatives for the use of the method have been made. The biggest
limiting factors in the context of SUS appear to be financial (insufficient
remuneration for hospitals and teams), difficulty in acquiring the equipment
needed to carry out the procedure, and the need for services of excellence
able to accomplish it.
Methods: The Oncological Surgery Service of the Oncology Center at
the University of Pernambuco sought to evaluate the institutional economic
feasibility of the DC/HIPEC procedure in late 2014. Together with the
hospitals medical bills, we tried to analyze the SUS payment table. In
parallel, formal consultation was held with Hon Mr Secretary of State
for Health (who is a clinical oncologist) about the interest to the State of
carrying out the procedure under the SUS, and the guarantee of payment
for procedures actually made, without any undue retainments being taken.
Results: From early May to August 2015, ten consecutive patients
underwent the procedure. The analysis showed that accounts could be
charged an average of 12 surgical codes (ranging from 7 to 16), with an
average remuneration for the hospital of 40,000 reais (ranging from 25,000
to 45,000). On the other hand, the direct spending on necessities (perfusion
kit, staplers, advanced bipolar scalpel, pneumatic boots, sensors and thermometers, and medications) had an average cost of 17,000 reais. Also, we
tried to deal with the various companies of suppliers for a price adjustment
consistent with a public hospital, holder of the only source of financing
(SUS). So, we received the support of these companies, including loans and
donations of equipment (Wendy Med , Edwards , Ethycon).
Conclusions: It was possible to demonstrate that, even in the face of
SUS payment table values lag, the procedure CS/HIPEC can be performed
in public hospitals with no financial loss to the institution, since they are
carried out in hospitals prepared and qualified to perform such complex
procedures.
S201
028293
Intraperitoneal hyperthermic chemotherapy with high PCI and
disease-free survival after 5 years: a case report
Brito, F.P.B.1, Vieira, S.C.1, Morais Jnior, M.A.1, Silva, M.C.A.1,
Lopes, A.S.1, Ribeiro, M.M.M.1
1
Uninovafapi, Teresina/PI, Brazil
Introduction: Ovarian cancer is difficult to diagnose, has a lower
chance of cure, and when relapsed shows poor prognosis. Complete
surgical cytoreduction is commonly chosen as the surgical treatment, and
can be obtained with peritonectomy and multivisceral resection associated with intraperitoneal hyperthermic chemotherapy which considerably
improves the survival of patients.
Objectives: To report a case treated with HIPEC showing its importance in the survival of patients.
Methodology: Its a case report conducted by medical record review.
The patient signed informed consent authorizing the treatment.
Results: The patient was a 52-year-old female with ovarian cancer
diagnosed in 2007; the cancer was classified as serous adenocarcinoma stage
IV with a single liver metastasis and diffuse peritoneal carcinomatosis. She
underwent bilateral oophorectomy and six cycles of chemotherapy with
cisplatin, achieving a complete response. She also submitted to second
look surgery and underwent hysterectomy, epiplectomy, and pelvic and
para-aortic lymphadenectomy, after which there was no residual disease.
The patient has continued on semiannual monitoring, with no complaints,
CA125 and normal exams, until April 2010, when she presented with rapid
and progressive increase in abdominal volume and poor general condition. CA291 was detected, and on resonance pelvic thickening compatible
with relapse without evidence of liver or lung disease was demonstrated.
She progressed to ascites and impaired general condition, but with good
performance status. She was submitted to salvage surgery which involved
extensive peritonectomy, rectosigmoidectomy, resection of multiple peritoneal implants and small intestine, bowel resection, splenectomy, emptying
of the hepatic pedicle, appendectomy and right chest drain. She presented a
PCI of 29. She received intraperitoneal infusion with cisplastin at 42C for
90 minutes. She presented postoperatively with partial intestinal obstruction
which was treated clinically. After 15 days in hospital she was discharged
and underwent over six cycles of cisplatin. Five years after surgery there is
no evidence of disease activity.
Conclusion: Patients with relapsed ovarian tumors may have a
prolonged survival when they are offered aggressive surgical approaches,
such as peritonectomy associated with intraperitoneal hyperthermic chemotherapy.The patients should be well selected and provide adequate performance status to support such a procedure, treatment being contraindicated in
the absence of such indications.
028332
Morbidity and mortality of patients undergoing cytoreductive surgery
and intraperitoneal chemotherapy (HIPEC) at So Rafael Hospital
between 2011 and 2015
Velasquez, A.R.E.1, Quadros, C.A.1, Vieira, L.V.1, Prisco, E.1,
Canguss, H.C.1, Silva, R.G.M.1, Reis, J.M.S.1
1
Surgical Oncology Team, So Rafael Hospital, Salvador, Brazil
arianne_velasquez2@hotmail.com,
caquadros@gmail.com, lucasvelame@hotmail.com,
emersonprisco@hotmail.com,hcangussu@gmail.com,ramirogmsm@gmail.com,
jadsonreis@yahoo.com.br
Introduction: Surgical cytoreduction (SC) associated with intraperitoneal hyperthermic chemotherapy (HIPEC) has been performed in
patients with peritoneal pseudomyxoma, mesothelioma and peritoneal
S202
carcinomatosis of colorectal and ovarian cancers. Studies have shown good
results, showing an increase in survival rates at 5 years in patients undergoing the procedure when complete SC is performed (CC0).
Objectives: To evaluate the hospitals institutional protocol, identifying factors related to surgical morbidity and mortality.
Methods: A retrospective cohort study evaluated 25 patients with peritoneal carcinomatosis intending to be submitted to SC plus HIPEC; ten
had ovarian adenocarcinoma, nine had colorectal adenocarcinoma, and six
had appendiceal pseudomyxoma. Six patients were excluded due to the
impossibility of performing complete CRS. In one patient the procedure
was carried out twice. CRS plus HIPEC was evaluated in 20 procedures
performed in 19 patients. Mitomycin C (35 mg/m2) was used for the colorectal and appendiceal cancers, cisplatin (75 mg/m2) for the ovarian tumors.
Results: Mortality rate was of 10%, but one death was not attributed to
the procedure as it was the result of an intercostal artery injury after chest
drainage for pleural effusion treatment on the 19th postoperative day. The
other death was related to anastomotic leakage. Mean internment period
was 31.5 days and intensive care unit stay was 9.5 days. Mean age was of
55 years (3872 years). Peritoneal carcinomatosis index ranged from 1 to
29 (mean: 15, median: 16). Oral intake started between the first and third
postoperative day; 30% required parenteral nutrition related to a 30% function of the ileus. Six patients (30%) had an infection (bloodstream, urinary,
pulmonary, or abdominal focus); 25% had bleeding and coagulopathy,
and the blood transfusion rate was 35%. There was thrombocytopenia in
20% of the patients, leucopenia in 15%. Pleural effusion occurred in 15%,
pneumothorax and atelectasis in 5%, DVT in 5%, anastomotic leakage in
5.9%(1/17).
Conclusions: Morbidity and mortality rates in patients undergoing
CRS and HIPEC are within an acceptable range, indicating the maintenance of the institutional protocol.
029092
Ovarian cancer with carcinomatosis: a case report
Cereser Junior, C.H.1, Giordani, D.S.N.1, Weston, A.C.1, Pessini, S.A.1,
Sugarbaker, P.H.2, Meinhardt Junior, J.G.3
1
Santa Casa de Porto Alegre, RS, Brazil, 2Medstar Washington Hospital,
Washington, USA, 3Hospital Ernesto Dornelles Porto Alegre, RS, Brazil
jrcereser@gmail.com,diegogiordani@yahoo.com.br,drweston@terra.com.br,
spessini@terra.com.br, Paul.Sugarbaker@medstar.net, jgmjr9@hotmail.com
Introduction: Ovarian cancer affects more than 200,000 women
around the world and causes 125 thousand deaths. The incidence and
mortality of this disease has been increasing in recent years. According to
INCA (Brazilian National Institute of Cancer) ovarian cancer is the most
difficult gynecological tumor to diagnose and the one with the least chance
of being cured. About 75% of cancers are in an advanced stage by the
time of diagnosis. In view of this, we must look for treatments to provide
disease-free survival with a good quality of life, and must seek protocols
that may lead to a cure for this disease.
Objectives: To report a patient with relapsed ovarian cancer treated
with cytoreductive surgery and perioperative chemotherapy, and to discuss
new forms of treatment for patients with ovarian cancer and peritoneal
metastasis.
Methods: Surgery performed in the cancer institute in Medstar
Washington Hospital Center. The information was obtained from patient
chart review, interview with the patient, and a review of the literature.
Conclusions: A 65-year-old woman came to our office with recurrent
fallopian tube malignancy. In April 1980 she had an in situ malignancy in
the right breast, and in June 2012 she underwent a uterine biopsy which
showed papillary serous adenocarcinoma. In August 2012 she had a total
abdominal hysterectomy and bilateral salpingo-oophorectomy. There
was only a small focus of disease within the uterus, but there was also a
ABSTRACTS
fallopian tube malignancy. FIGO stage II. In April 2015 she had a peritoneal carcinomatosis index (PCI) of 3 (calculated in CT), and for this she
was submitted to surgery. During surgery we noticed that some lesions had
not appeared in the preoperative CT. The new PCI was 23. The surgery
was considered to be r0, without residual disease. The patient progressed
well postoperatively. We report this case and literature review to illustrate
that we must carry out more studies in connection with ovarian cancer and
peritoneal metastasis.
028372
Positive impact of nutritional, anti-inflammatory and antihistamine
therapy preoperatively in patients undergoing cytoreductive surgery
and HIPEC
Reis,T.J.C.C.1, Ramalho, W.C.1, Miranda,A.C.G.1, Pereira,C.G.S.1,
Weinstein, L.2, Lima, M.B.A.2, Silva, G.L.R.2, Lins, P.I.A.B.2,
Almeida, M.M.2
1
Hospital Universitrio Oswaldo Cruz-Recife/PE, Brazil, 2Liga de
Oncologia de Pernambuco, Brazil
tcr@hotlink.com.br
Introduction: The literature has demonstrated benefits of nutritional
therapy in surgical patients, leaving no doubt about the advantages of this
therapeutic modality. However, this coupled with the use of anti-inflammatory and antihistamine therapy have not yet been studied. Our study
attempts to ecourage discussion of the introduction of these last two treatment methods in the preoperative care of patients who will be submitted
to CS/HIPEC, as this treatment modality triggers intense perioperative
inflammatory activity.
Objectives: To evaluate the potential benefits of nutritional, antiinflammatory and anti-histamine therapy preoperatively in patients undergoing cytoreductive surgery and HIPEC, and to propose a preoperative
protocol.
Methods: The first ten patients operated by our team were divided into
two groups. Group A, the first five patients, didnt receive any preoperative therapy; they were admitted 2 days before surgery for preparations and
the usual checks. Group B, the last five patients, were submitted preoperatively to nutritional, anti-inflammatory and anti-histamine therapy; they
were admitted 5 days before surgery to early immunomodulatory nutritional therapy, and introduced 2 days before surgery to corticotherapy with
prednisone 40 mg/day and dexchlorpheniramine 12 mg/day, both until the
morning of the procedure. Preoperative dosages were performed for the D1
and D5 of serum albumin and C-reactive protein, as well as postoperatively
for D1, D5 and D10. The measurement of D10 occurred in patients who
remained hospitalized beyond 7 days. All the patients in group B showered
daily with chlorhexidine 2%.
Results: The values of albumin and PCR werent significantly
different in the preoperative measurements (P > 0.05%), with averages of
3.7 g/% and PCR of 45 mg/dL. However, postoperatively, the averages of
the PCR differences were statistically significant (P < 0.05%). In group A
the average postoperative PCR was 245 mg/dL and in group B 67 mg/dL
for D1. The values were also lower for D5 (167 mg/dL, group A, 42 mg/
dL, group B, P < 0.05%). There were no differences in the averages of the
albumin measurement. Subjectively, on the occasion of multidisciplinary
visits both in the ICU and in the infirmary, better postoperative evolution of
the group B patients was perceived, including lower average postoperative
hospitalization time (17 versus 12 days, P < 0.05%)
Conclusion: We propose that preoperative therapy can positively
impact on the postoperative outcome of patients undergoing CS/HIPEC
and should be considered as an option in the surgical protocol.
ABSTRACTS
028958
White-blood-cell count, lactate and C-reactive protein postoperative
measures are associated with major complications following
cytoreductive surgery and hyperthermic intraperitoneal
chemotherapy
Takahashi,R.M.1, Aguiar-Junior, S.1, Lopes,A.1, Nakagawa,W.T.1,
Calsavara,V.F.1, Ferreira,F.O.1
1
A.C.Camargo Cancer Center, So Paulo, Brazil
takahashi.rm@gmail.com, samuel.aguiar.jr@gmail.com,
ademar-lopes@uol.com.br, wtnakagawa@uol.com.br, vfc@ime.usp.br,
fabioferreira@uol.com.br
Introduction: Metabolic and inflammatory markers are used to
monitor the consequences of surgical trauma, but have been less studied
following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CS-HIPEC) a high-risk procedure indicated for patients with
peritoneal surface malignancy.
Objective: To evaluate laboratory changes in metabolic and inflammatory markers and their association with postoperative complications
following CS-HIPEC.
Methods: Metabolic and inflammatory markers pH, bicarbonate,
base excess (BE), coagulation, lactate, C-reactive protein (CRP), whiteblood-cell count, neutrophillymphocyte ratio, platelet count and serum
albumin level were retrospectively evaluated at different times during the
perioperative period associated with CS-HIPEC procedures: (1) preoperative; (2) pre-HIPEC; (3) post-HIPEC; (4) admission in the Intensive Care
Unit; (5) 1st postoperative day; (6) 3rd postoperative day. We also analyzed
the association between the findings and the severity grade of postoperative complications (NCI CTCAE v3.0), divided into two groups group
1: no complications/minor complication (NCI 0III), and group 2: major
complication (NCI IIIIVV). Repeated measures ANOVA test was used
and statistical significance was assigned for P values < 0.05.
Results: Two hundred and forty CS-HIPEC procedures were done in
229 patients between March 2001 and July 2014. Postoperative morbidity
and mortality rates were 62.9% and 2.5%, respectively. Minor and major
complication rates were 38.7% and 24.2%, respectively. In the group of
patients with major complications, at time 5 (1st postoperative day), we
found lower mean values of leukocytes (9656 versus 9735; P = 0.021);
lower mean values of neutrophils (9542 versus 9642; P = 0.021) and higher
mean values of lactate (26.04 versus 21.24; P = 0.002). At time 6 (3rd postoperative day), we found higher mean values of CRP (15.95 versus 10.78;
P = 0.004). There were no postoperative differences in laboratory measures
between groups for other markers or other times.
Conclusion: Lower white-blood-cell counts and higher levels of lactate
and CRP during the initial postoperative period following CS-HIPEC
procedures were associated with the risk of major complications.
S203
S204
Melanoma and sarcomas

029317
A retroperitoneal dedifferentiated liposarcoma treated at FCECON:
a case report
Di Tomaso, R.A.S.1, Santos, M.H.1, Haji junior, A.C.H.1, Santos
junior, P.R.M.1, Sanz, C.J.V.1, Silva, E.S.1
1
Manaus, Brazil
bekinha_santos@hotmail.com, oncomhs@gmail.com,
caoru.junior@gmail.com
Introduction: Liposarcoma is one of the most common subtypes of
soft-tissue sarcoma, accounting for 45% of retroperitoneal (RP) soft-tissue
sarcomas. RPs are rare tumors (0.1% of all malignancies). Dedifferentiated
liposarcoma (DDLPS) are high-grade, aggressive tumors with a systemic
metastatic rate of 520% and a poor prognosis.
Objectives: To report an RP DDLPS treated at FCECON.
Case report: A 32-year-old female presented with 4 months of
abdominal pain and the presence of a mass in the right flank. There was
no weight loss, alcoholism, smoking or comorbidities. CT scan showed
a mass with the density of soft tissue and calcification, heterogeneous by
contrast enhancement, 12 x 15 x 12 cm, located in the pararenal space prior
to the right edge level extending to the pelvis. On MRI, an extensive lesion
was found, with cystic/necrotic areas, pervading superiorly and medially
the right kidney and colon. Patient underwent an en-bloc abdominopelvic
mass resection and appendectomy, extrafascial hysterectomy and bilateral
salpingo-oophorectomy, infra-colic omentectomy, and cholecystectomy.
The patient evolved with a urinary fistula diagnosed at CT scan, and underwent relaparotomy with right ureteral reimplantation because of necrosis
of the distal third of the right ureter. She was discharged on postoperative
day 10. Histopathology was suggestive of carcinosarcoma, a malignant
Mullerian mixed tumor; immunohistochemistry diagnosed a dedifferentiated liposarcoma.
Discussion: DDLPS frequently manifests as a painless, slow-growing
mass. Most patients die of locally aggressive tumors rather than distant
metastases. Surgery remains the cornerstone of potentially curative treatment and may be a challenging procedure because of the involvement of
vascular structures or vital organs. Complete resection is associated with
optimal outcome; therefore, an aggressive approach including en-bloc
resection of adjacent organs is indicated. R0 resection, tumor specimen
integrity and high tumor grade are independent predictors of both worse
progression-free survival and worse overall survival.
Conclusion: RP DDLPS typically presents as a large tumor. Adequate
local tumor control with complete surgical resection determines the incidence of local recurrence and overall outcome in RP DDLPS.
028247
A three-stage resection technique for giant sacral chordomas
Miyata, S.1, Michalick, I.D.1, Malheiros, J.A.1, Dias, J.C.S.1
1
Instituto Mrio Penna, Brazil
seijisilvana@terra.com.br, igor.michalick@gmail.com,
zeugusto@globo.com
Introduction: The sacral chordoma is a rare slow-growing cancer that
originates from remnants of the notochord in the sacrococcygeal region.
This lesion accounts for 1% of bone tumors, in which 5% are malignant.
These tumors are chemo-/radioresistant, which leaves surgery as the main
treatment option. In cases of large-volume tumors, surgery becomes a true
challenge with high morbidity and mortality levels.
Objective: To describe a three-stage resection technique for giant
sacral chordomas.
ABSTRACTS
Methods: The study covered six cases of giant sacral chordoma,
starting from S2, employing a three-stage surgical strategy. The proposed
technique involved multidisciplinary medical interactions between oncological surgery, radiation therapy and neurosurgery. The first surgical stage
was to perform an anterior-approach laparotomy with an intestinal transit
deviation (Hartmann procedure), tumor alcohol injection, and internal iliac
arterial plexus ligation. The next step involved tumor cytoreduction by an
intense schedule of radiotherapy lasting 30 days, with a 60 Gy limit. Finally,
there was the sacrectomy, limited by a posterior approach, preserving and
preparing adjacent tissues, and targeting future reconstruction.
Results: In 100% of the cases, there was a reduction of >60% of the
tumors volume following the first and second steps. Further sacrectomy
(3rd stage), along with preservation of the main nerve roots, was possible
in all patients. There was no need for perioperative blood transfusion. A
1-year follow-up measuring life quality and Karnovski index displayed
satisfactory results.
Conclusion: The three-stage resection of giant sacral chordoma can
show satisfactory results with respect to morbidity and quality of life.
029086
Abdominal desmoid tumor: a review of 32 years of treatment
Couto Netto, S.D.1, Teixeira, F.J.R.1, Perina, A.L.F.2, Andrade Lima, T.M.1,
Ferreira, F.O.2, Pires de Camargo, V.3, Munhoz, R.R.3, Akaishi E.H.1,
Utiyama, E.M.1
1
Surgical Oncology Group, Division of Surgical Clinic III, Clinics
Hospital, University of So Paulo, So Paulo, Brazil, 2Sarcoma and
Melanoma Group, So Paulo Cancer Institute (ICESP), So Paulo Brazil,
3
Clinical Oncology, So Paulo Cancer Institute (ICESP), So Paulo Brazil
sergiodcnetto@gmail.com,fredteixeira@gmail.com,andreperina@gmail.com,
tiberiodeandradelima@yahoo.com.br, fabioferreira@uol.com.br,
munhozrs@gmail.com,eduardoakaishi@gmail.com,eutiyama@hotmail.com
Introduction: Desmoid tumor is a benign mesenchymal neoplasia,
with uncertain growth and high chances of recurrence. Until recent
years, complete radical removal was the optimal treatment; however, this
management has been changing to a more conservative one, including even
a watch and wait policy. We have been treating these patients for over 30
years, especially those with tumors located at the abdominal wall.
Objectives: To evaluate the treatment of abdominal wall desmoid
tumor during this 30-year period.
Methods: We performed a retrospective analysis of patients submitted
to surgical treatment or hormonal/chemotherapy for abdominal wall
desmoid tumor between 1982 and 2014.
Results: In the period of analysis, 32 abdominal wall desmoid tumor
patients were submitted to surgical or pharmacological treatment. The study
considered 27 patients who had surgery upfront; 89% were women, median
age was 33 years, mean tumor size was 9 cm (SD = 5 cm), there were
92% with free margins at the final pathological status, and 11% had tumor
recurrence. Median relapse-free survival was 24 months. Univariate analysis showed correlation between frozen section, final pathological margins
and recurrence status (P = 0.0001) and multivariate analysis demonstrated
final pathological margins (P < 0.001) and frozen section (P = 0.032) as
independent factors for recurrence.The non-surgical group consisted of five
patients; median age was 33 years, median tumor dimension before treatment was 16 centimeters, and all presented a partial response by RECIST.
None of these patients has been operated so far. The median major tumor
dimension was 7 cm after treatment, and we noted a median tumor volume
reduction of 54.8% after pharmacological treatment.
Conclusion: Desmoid tumor treatment has been changing during the
past decade towards to a more conservative approach. Here we present a
historical perpective of this management. Prospective studies might help to
determine the sequence of steps in a multidisciplinary approach.
ABSTRACTS
029259
Alveolar rhabdomyosarcoma of the abdominal wall: therapeutic
strategy
Teshirogi, E.Y.2
1
Introduction: Rhabdomyosarcoma (RMS) is a malignant childhood
tumor of mesenchymal origin; it is the most common soft-tissue sarcoma
and the fourth most common pediatric solid tumor. The fact that the tumor
arises in a wide variety of primary sites some of which are associated
with specific patterns of local invasion, regional lymph node spread, and
therapeutic response requires physicians to be familiar with site-specific
staging and treatment details. Multimodal therapy that includes surgery,
chemotherapy, and usually radiotherapy can be used, targeting the best
approach to optimize the chance of cure, and with respect to quality of life.
Objectives: To focus on the therapeutic strategy in case of 17-year-old
patient.
Results: The abstract reports a patient who was admitted due to a mass
in the abdominal wall; immunohistochemistry confirmed the diagnosis.
D33 and F5D were positive. The tumor (clinical stage III) arose from the
left abdominal rectus muscle and extended to the pelvic floor, displacing
the bladder and rectum.The periaortic and iliac lymph nodes were involved,
as seen on the computed tomography images.Bilateral hydronephrosis,
deep-vein thrombosis, lymphedema of the left lower limb, and swelling of
the external genitalia were present. The chemotherapy regimen used was
ifosfamide, vincristine and dactinomycin; a significant therapeutic response
was observed. The surgical approach was lymphadenectomy of the periaortic and iliac chain and complete resection of the tumor. Double-sided
mesh was used in the abdominal wall reconstruction. A complete response
was observed in the anatomicopathological examination. The patient
underwent adjuvant chemotherapy and radiotherapy.
Conclusions: The goal of cure is realistic and depends on staging of
the tumors. The management of these patients remains challenging. Within
the multimodality treatment, the surgeon plays a vital role in determining
risk stratification for treatment and local control of the primary tumor for
RMS.
029325
Anterior myocutaneous flap hemipelvectomy: two case reports and a
literature review
Johnson, L.F.P.1, Bocanegra, R.E.D.1, Lopes, A.2, Neves, A.1,
Francischetto, T.1
1
Department of Surgical Oncology, Santa Izabel Hospital, Salvador,
Brazil, 2Department of Pelvic Surgery, A.C. Camargo Cancer Center,
Brazil
Introduction: An external hemipelvectomy or inter-ilioabdominal
disarticulation is an amputation technique the main indications for which
are primary malignant tumors of the pelvis. However, in some cases this
procedure is indicated for metastatic tumors, infection or trauma. One of
the challenges after an external hemipelvectomy for tumors infiltrating the
gluteal muscles is to choose the right flap to repair the deformity created.
Objectives: To review medical records for clinical case descriptions
and to review the literature for anterior myocutaneous flap hemipelvectomy
Methods: We reviewed the medical records and literature.
S205
Results: We report a case of a 47-year-old female with a large ulcerative and infected lesion (30 x 26 cm) in the right gluteal region; it had
originated years previously in an area of chronic ulceration that was being
treated as a local infection. Biopsy confirmed the diagnosis of epidermoid
carcinoma. The other case is a 73-year-old female who had had pelvic pain
for about a year. Pelvic magnetic resonance showed a large tumor involving
the sacral plexus and coxofemoral joint. An open biopsy confirmed the
diagnosis of chondrosarcoma. Both patients were submitted to an anterior
myocutaneus flap hemipelvectomy, and they were discharged on the 4th
and 7th postoperative days respectively
Conclusions: An anterior myocutaneous flap based on femoral vessels
is a safe option for repairing deformities after hemipelvectomies for tumors
from the pelvic gluteal region and proximal posterior region of the thigh,
and even for intrapelvic tumors since there was no compromise of the
femoral vessels.
029311
A surgical procedure in a patient with acral lentiginous melanoma: a
case report
Pompermaier, C.1, Winkelmann, C.P.1, Chiaradia, C.P.1, Pr, R.B.1, dos
1
clapw@terra.com.br, crisllipreussler@gmail.com, rochelepra@gmail.com,
Introduction: Acral lentiginous melanoma (ALM) is the least common
variant of radial growth phase melanomas. It arises most commonly on
palmar, plantar, subungual, and mucosal surfaces.
Objectives: To report a surgical procedure accomplished in a patient
with ALM.
Methods: Patient VF, a 48-year-old male Caucasian, recognized a
pigmented ulcerated blackened lesion in the right subungual region after a
non-traumatic loss of the nail in 2014. The medical aide suggested trauma
or fungal damage. In 2015, the appearance of a right inguinal lymphadenopathy associated with the growth was observed. The PET-CT showed
hypermetabolic lymphadenopathy in the right external iliac chain, the
largest being 1.4 cm. The patient underwent amputation of the hallux and
inguinal lymph-node biopsy. Pathology indicated the dignosis of ALM
Clark IV, Breslow 8.0 mm, with metastatic lymph-node disease. Iliac and
retroperitoneal lymphadenectomy was carried out.
Results: Cutaneous malignant melanoma is the most lethal form of
skin cancer. Of its histological subtypes, ALM is the least common, and
is more prevalent in dark-skinned individuals. The incidence increases
with age and is associated with poorer survival rates, which may be due to
delay in diagnosis. Wide local excision is the treatment of choice. Regional
lymphadenectomy is indicated for lymph nodes that measure 14 cm.
Intraoperative lymphatic mapping and sentinel-node biopsy are effective
techniques for identifying suspicious nodes.
Conclusions: Early detection is the bottom line for the patient who has
ALM to have a better prognosis. In this case, the differential diagnosis was
late, indicating a more advanced disease. Resection of the first site is indicated to prevent possible metastasis. Thus, the physician should investigate
whether the patient has other similar skin lesions and perform other tests
that might indicate a possible neoplasia.
S206
029170
Dysplastic melanocytic nevus and melanoma: a case report
Lira, G.A.1, Medeiros, D.B.G.1, Arajo, M.T.1, Barreto, L.K.D.1,
Medeiros, D.B.G.1
1
georgelira@hotmail.com, joaobernardomed@gmail.com,
micheleteixeiraa@gmail.com, laianabarreto@gmail.com,
brunoeng@gmail.com
Introduction: The melanoma is a malignant tumor of melanocytes that
may metastasize via the lymphatic route and hematogenously. In Brazil,
knowledge of melanoma epidemiology is limited due to the absence of
compulsory notification, lack of a central register, and little attention from
the public health managers. However, the INCA has estimated 6130 cases
in the year 2013. In the article in question, the patient, LCC, 73 years old,
presented a skin lesion on the left hallux of necrotizing and bloody aspect,
suggesting malignancy.
Objective: To present a case report regarding a melanoma, and to
assess the surgical techniques and risks involved in the treatment of this
disease.
Methods: This is a case analysis based on literature and recently
published papers, with emphasis on the dermatological and oncological
surgical techniques for melanoma.
Results: Two biopsies were performed; the first result indicated a
dysplastic melanocytic nevus, and the second indicated melanoma. The
patient was successfully submitted to amputation of the left hallux and
left inguinal lymphadenectomy, and evolved without complications. The
patient was discharged on the third postoperative day.
Conclusion: The distinction between the dysplastic nevus and
melanoma can be histologically difficult. Therefore, the treatment must
always be for both. Although it is a less frequent form of skin cancer, the
melanoma has the worse prognosis and the highest mortality rate. However,
when diagnosed at an early stage, the chances of recovery are >90%.
029167
Classic Kaposis sarcoma in immunocompetent patients: a case report
Falco, M.F.1, Vieira, Y.T.H.1
1
Department of General Surgery, Santo Antnio Hospital, Salvador, Brazil
mariofalcao@oi.com.br, yhirakawav@gmail.com
Introduction: Kaposis sarcoma (KS) is an angio-proliferative
malignant neoplasm associated with Herpesvirus 8 infection (HHV8). It
is characterized by pleomorphic lesions with macular or papular aspects
and a color which ranges from violet to brown. It can be classified into
four groups: (1) endemic described in sub-Saharan Africa prior to the
HIV epidemic; (2) iatrogenic related to immunosuppressive drugs; (3)
HIV-induced immunosuppression more common, and (4) the classic form
which is rare and occurs mostly in men from Eastern Europe and the
Mediterranean.
Objectives: To describe two cases of classic Kaposis sarcoma in an
immunocompetent patient.
Methods: Two patients with HIV-negative quick test and serology
developed subcutaneous, violet and well defined lesions on the lower limbs.
The male patient (patient 1) black, 61 years old exhibited multiple
lesions of slow progressive growth around 5 years previously; these were
associated with paresthesia and local burning. The female patient (patient
2) black, 95 years old had a single lesion on the side of her right foot,
which was painless and asymptomatic.
Results: Patient 1 underwent a resection of lesions in two operations
owing to their quantity and placement. Patient 2 underwent excision of the
ABSTRACTS
local lesion with healing by secondary intention. Both showed physiological progress and had no further complications. Patient 1s anatomopathological study was compatible with a spindle-cell neoplasm with a mitotic
index of 5/10 CGA. Patient 2 had a vascular proliferation associated with
epidermal ulceration along with pseudocarcinomatous hyperplasia; immunohistochemistry was positive for vimentin, actin, CD34, CD31, desmin,
HHV-8, S-100 and factor VIII, suggesting Kaposis sarcoma.
Conclusion: Classic Kaposis sarcoma is uncommon, with an estimated prevalence of 0.010.03% of neoplasms. It shows little to no
response to chemotherapy. The surgical treatment of such lesions with free
margins is still the major procedure of choice, with a possibility of association with radiotherapy to either the infiltrated plaques or the vegetative
tumors.
028968
Collision tumor malignant melanoma within squamous-cell
carcinoma: a case report and review of the literature
Couto Netto, S.D.1, Arakaki, M.S.1, Perina, A.L.F.1, Teixeira F.J.R.1,
Ferreira, F.O.1, Utiyama, E.M.1
1
Sarcoma and Melanoma Group, So Paulo Cancer Institute (ICESP), So
Paulo, Brazil
sergiodcnetto@gmail.com, mariarakaki@hotmail.com,
andreperina@gmail.com,fredteixeira@gmail.com,fabioferreira@uol.com.br,
eutiyama@hotmail.com
Introduction: Malignant cutaneous tumors comprising basal-cell
carcinoma, squamous-cell carcinoma and malignant melanoma are
common and well documented, but the association of these neoplasms in
the same tumor, denominated collision tumors, is rare and poorly described.
Objectives: To report the case of a man who had a collision tumor, a
combination of squamous-cell carcinoma and melanoma.
Methods: We describe a case report and review the literature of the
above patient.
Results: A 61-year-old man was admitted with a huge exophytic
bleeding skin tumor at the back of his right foot. Incisional biopsy revealed
squamous-cell carcinoma. Staging work-up showed no evidence of distant
disease, and he underwent an emergency tumor radical resection with
vacuum skin closure because of hemorrhagic shock and infection. The
histopathological examination showed an invasive squamous-cell carcinoma with free surgical margins, and in the center there was a pigmented
fusocellular proliferation. The immunohistochemical profile revealed
strong immunoreactivity for HMB45 and Melan A, revealing a malignant
melanoma (Breslow depth 10.4 mm; Clark IV, ulceration and 3 mitoses/
mm), inferring the diagnosis of a collision tumor. After clinical stability
was achieved and the infection treated, this patient was submitted to widemargin excision, inguinal sentinel-node biopsy and skin reconstruction.
Pathological evaluation revealed melanoma macro-metastasis (S100 positive) in all four lymph nodes evaluated. In the following month primary site
relapse was identified and a transtibial amputation was required. Inguinal
and right iliac-obturatory lymphadenectomy was necessary owing to the
four positive sentinel lymph nodes. The histopathological examination
showed squamous-cell carcinoma, free surgical margins and absence of
affected lymph nodes (0/28). Adjuvant radiotherapy (50 Gy) was performed
because of the compromised nodes. Functional recovery was achieved by
prosthetic devices.
Conclusion: This rare presentation of skin neoplasm showed how
aggressive the combination of two prevalent tumors may be. Advanced
stages confirmed the obscure prognosis and can lead to a poor quality of
life, evolving into huge infected malignant skin tumors.
ABSTRACTS
028378
Dermatofibrosarcoma protuberans (DFSP): experience and analysis
of a clinical series
Furtado, J.P.R.1, Furtado, C.F., Laporte, G.A.1, Barros, E.D.1,
Conterno, J.1, Polo, R.1, Kwiatkonski, R.1, Zoletti, F.C.2, Morais, C.S.2
1
Irmandade da Santa Casa de Misericrdia de Porto Alegre, Servio de
Cirurgia Oncolgica do Hospital Santa Rita, Brazil 2Universidade Federal
de Cincias da Sade de Porto Alegre, Brazil
piofurtado@terra.com.br, laportegustavo@gmail.com
Introduction: Dermatofibrosarcoma protuberans (DFSP) is a malignant tumor of the skin. Because DFSP is infrequent and has varied presentations, it is often underdiagnosed and remains untreated, leading to high
rates of recurrence and, occasionally, high mortality.
Objectives: To evaluate epidemiological data from patients with DFSP
and to analyze predictors of its local recurrence.
Methods: This is a retrospective study presenting a statistical analysis
of 19 patients with DFSP treated at the Hospital Santa Rita, Santa Casa de
Misericordia de Porto Alegre, Brazil, over a period of 10 years.
Results: Among our sample, five patients (26.5%) had recurrences of
DFSP. However, no deaths were recorded. We analyzed the following variables: location, size, stage and surgical margins the latter being statistically significant (P < 0.03).
Conclusions: Although there is as yet no consensus in the literature
about the extent of resection margins in dermatofibrosarcoma protuberans,
margins <1.0 cm are likely inadequate, as suggested for other skin tumors,
including some melanomas.
027443
Dermatofibrosarcoma protuberans groin-penis-scrotum: a case report
Ferretti, C.E.A.1, Ferretti, L.E.A.2
1
Cirurgio Oncolgico, Taubat, Brazil, 2Urologista, Caapava, Brazil
ferretticea@gmail.com, luizferretti@bol.com.br
Introduction: Dermatofibrosarcoma protuberans (DFSP) is a rare
malignant neoplasm characterized by bland spindle cells that extend from
the dermis into the subcutis. Surgical treatment with three-dimensional
resection and negative margins is the method of choice. However, the
finger-like extensions promote incomplete resection, and local recurrence
rates are up to 60%. The rates of regional recurrence and distant metastatic
disease are low.
Objective: To describe the management in patients with DFSP of the
groin-penis-scrotum.
Methods: A 62-year-old man had undergone seven previous surgeries
for resection of a lesion that was initially located in the left groin. There was
an early recurrence. He was referred to the radiotherapy department, which
in the case of DFSP referred him to us to assess the resectability of the case.
Results: The patient was submitted to wide resection with a margin
of 3.0 cm and primary reconstruction with an ipsilateral tensor fascia lata
flap and contralateral gracilis myocutaneous flap. Margins were evaluated
intraoperatively through CCPDMA (complete circumferential peripheral
and deep margin assessment). The clinical outcome was acceptable and the
patient was followed up for 18 months without local recurrence.
Conclusions: DFSP is a cancer that must be treated by professionals
experienced in sarcoma resection and reconstruction; it must be dealt with
properly so that it is not necessary to perform radical resection involving
patient mutilation, as presented in this study.
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029013
Desmoid tumor in the abdominal wall during the postpartum period:
a case report
Barros, A.V.1, Medrado, P.C.1, Oliveira, F.A.P.F.1, Melo, C.L.A.1,
Mota, B.R.1, Cmara, C.B.S.1
1
Brazil
aldobarros@ig.com.br, patriciamedrado@hotmail.com,
fapfo.med@uol.com.br,ciceroludgero@ig.com.br,drbrunormota@bol.com.br,
camarac@hotmail.com
Introduction: Desmoid tumors or aggressive fibromatoses are benign
neoplasms arising mainly from fascial sheaths and musculoaponeurotic
structures. Histologically they are characterized by fibroblastic cells with
elongated nuclei which appear almost normal. They are locally invasive
but do not metastasize; they are known for their propensity for local recurrence, even after complete surgical resection. These rare tumors occur in
patients with familial adenomatous polyposis and in patients with previous
surgical trauma (previous surgery). Although uncommon, desmoids are
found to be associated with women of fertile age, especially during and
after pregnancy.
Objectives: To present an unusual case of desmoid tumor in the
abdominal wall in a young woman postpartum.
Methods: The patient was a 23-year-old female with a history of the
appearance of tumors in the lower abdominal wall 1 month after cesarean
delivery. The two cesarean deliveries: A0 G2 P2. Abdominal CT showed a
large tumor in the abdominal wall below the left topography of the rectus
abdominal muscle with close contact with the left external iliac vessels
and bladder. The patient underwent wide resection of the tumor along with
the left rectus abdominal muscle from the umbilicus to its insertion in the
pubis; the parietal peritoneum was preserved. There was no evidence of
tumor invasion of the bladder and iliac vessels. The abdominal wall was
reconstructed using polypropylene mesh.
discharged from hospital on the 2nd POD. Histopathological and immunohistochemical reports confirmed that the tumor was of the desmoid
fibromatosis type with margins free from neoplasia. The patient is in the
26th month of follow-up without evidence of recurrence.
Conclusions: Desmoid tumors have a higher incidence in women and
are a rare occurrence during pregnancy or the postpartum period. This case
emphasizes the importance of diagnosis and definitive treatment with wide
surgical resection for local control of the disease.
028045
Desmoplastic small-round-cell tumor: a case report
Lopes, E.P.D.1, Pracucho, E.M.1, Campos, R.de A.1, Tomal, K.T.1,
Passeri, C.R.1, Zanatto, R.M.1
1
Hospital Amaral Carvalho, Jahu/SP, Brazil
epdlopes@hotmail.com, epracucho@yahoo.com.br,
ricardoc2@gmail.com, karlatomal@hotmail.com, celsopasseri@uol.com.br,
renato_zanatto@ig.com.br
Introdution: The desmoplastic small-round-cell tumor is a rare and
aggressive neoplasm. The prognosis is poor: the median survival is 17
months and at 5 years is 15%.
Objective: To report a case of desmoplastic small-cell tumor treated at
the Hospital Amaral Carvalho of Jahu, SP, Brazil.
Methods: Review of medical records and a brief literature review.
Results: The patient was a 27-year-old obese male; he reported weight
loss. An abdominal epigastric mass with slow and asymptomatic growth
was found. USG, CT, and MRI of the abdomen showed a heterogeneous
lesion with indefinite limits, central necrosis and liquefaction, measuring
S208
approximately 21.6 x 13.1 cm. He underwent exploratory laparotomy
which revealed an unresectable mass; only biopsies were taken. Its outcome
was undifferentiated malignancy, which immunohistochemistry identified as a desmoplastic small-round-cell tumor. The patient was referred
to the clinical oncology sector for clinical treatment with chemotherapy
(CT). The abdominal MRI lesion showed a partial clinical response, >50%
volume reduction, which was localized in the left upper quadrant; the tumor
was potentially resectable through multivisceral resection. The patient
underwent exploratory laparotomy, and evidence was found of a tumor
in the supramesocolic space, with no apparent origin; the tumor involved
segments II and III of the left hepatic lobe, stomach, transverse colon,
greater omentum and left diaphragmatic peritoneum with carcinomatosis.
Cytoreductive surgery was performed, according to precepts of Sugarbaker,
by tumor resection with centripetal dissection monoblock with left hepatic
segmentectomy, total gastrectomy, partial colectomy, bursectomy, splenectomy, subdiaphragmatic peritonectomy and retroperitoneal lymphadenectomy. The patient remained hospitalized for 60 days. The pathology report
was consistent with complete resection with clear margins and the presence
of metastases in 11 lymph nodes and the subdiaphragmatic peritoneum.
Conclusions: It is essential that from the diagnostic process through
the therapeutic setting, the approach for a patient with desmoplastic smallround-cell tumor should be performed by a multidisciplinary team, and that
monitoring is carried out in a specialized center. The aim is not only to
improve survival rates but also to have a beneficial impact on the patients
quality of life. Moreover, the lack of standardization, staging criteria, and
the small number of patients with the disease make it difficult to establish
evidence for the optimization of treatment.
028624
Does amputation improve the survival rate in soft-tissue sarcomas of
the extremities?
Furtado, J.P.R.1, Laporte, G.A.2, Dragon, L.L.1, Conterno, J.1,
Kwiatkonski, R.V.2, Zoletti, F.2, Correa, L.H.L.2, Molinari, V.3,
Strey, Y.T.M.3
1
Sade de Porto Alegre, Brazil, 3Universidade Federal de Cincias da
Introduction: Soft-tissue sarcomas of the extremities comprise a
heterogeneous group of rare tumors that predominantly arise from the
embryonic mesoderm. Their main treatment is surgical, between wide excision and radical amputation, complemented with radiotherapy and chemotherapy in selected cases.
Objectives: To describe clinical presentation, pathological characteristics and survival rates of patients surgically treated for soft-tissue sarcoma
of the extremities with amputation and no amputation.
2014 including patients surgically managed for soft-tissue sarcoma of the
extremities.
Results: A total of 123 patients were included, from which 70 were
female. Of the total, 34 patients underwent amputation and 89 patients
did not. The first group had more cases of sinovial sarcoma, pleomorphic
sarcoma and neurofibrosarcoma. They also presented larger lesions and
higher grades, with the majority in stage III. Additionally, they were more
likely to undergo chemotherapy than the group without amputation. The
survival rate of the amputation group was 60%, while for the other group it
was 70%; the difference was not statistically significant.
ABSTRACTS
Conclusions: Our service has a high incidence of radical surgeries,
such as amputations. These amputated patients received more adjuvant
treatment, including chemotherapy and radiotherapy. Moreover, their
survival rates were similar to those in patients without amputations.
029103
Evaluation of repeated isolated limb perfusion: safety and results
Falco, A.C.A.1, Bertolli, E.1, Nasser, S.1, Matos, P.E.L.D.C.1,
Molina, A.S.1, Neto, J.P.D.1
1
AC Camargo Cancer Center, So Paulo, SP, Brazil
carolanacleto_falcao@hotmail.com,
ebertolli@hotmail.com, nchsamar@gmail.com, pauloeloi@yahoo.com.br,
drandremolina@gmail.com, joao.duprat@accamargo.org.br
Background: Isolated limb perfusion (ILP) is a therapeutic option for
patients with in-transit metastasis of skin malignancies, as well as unresectable lesions that would lead to limb amputation. It can be also used
or repeated in the salvage setting, especially when tumoral necrosis factor
(TNF) can be used.
Objectives: To evaluate outcomes of patients who underwent repeated
ILP in a single institution.
Methods: We undertook a retrospective analysis of patients who
underwent repeated ILP in AC Camargo Center since the year 2000.
Results: Since July 2000, 106 ILPs have been performed in 99 patients,
of whom seven underwent it twice. There were four male patients (57.14%)
and the mean age at the first procedure was 61.14 years (4277 years).
Mean time for the second procedure was 18.42 months (642 months). Five
patients developed late recurrence (between 9 and 42 months). One patient
had no response after the first ILP and another had tumor progression 8
months after surgery. Toxicity after the first ILP was low; five patients
were classified as Wieberdink II. The average hospitalization was 7.71
days (418 days). After the second procedure, six patients were considered Wieberdink II and one developed phlegmasia cerulean dolens, which
led to limb amputation. Mean hospitalization was 8.14 days (418 days).
Three patients developed systemic disease at between 2.4 and 26.7 months
and died. One patient had a complete response and has been alive without
disease for 72 months. Two patients had partial responses and are under
immunotherapy now. The last patient underwent his last surgery recently
and his response is under evaluation.
Conclusions: In selected patients, ILP can be repeated for limb
salvage. Our data suggest that this procedure is safe and feasible. Global
response is similar, and repeating ILP may be an option for patients without
systemic disease.
029105
Fifteen years of isolated limb perfusion in a single institution
Bertolli, E.1, Falco, A.C.A.1, Nasser, S.1, Couto, P.H.F.S.T.1,
Molina, A.S.1, Neto, J.P.D.1
1
AC Camargo Cancer Center, So Paulo/SP, Brazil
ebertolli@hotmail.com, carolanacleto_falcao@hotmail.com,
nchsamar@gmail.com, pedrotrocoli@yahoo.com.br,
Background: Isolated limb perfusion (ILP) is a therapeutic option for
patients with in-transit metastasis of skin malignancies, as well as unresectable lesions that would lead to limb amputation. In the AC Camargo
Cancer Center, Brazil, this technique has been used for the last 15 years,
as reported below.
Objectives: To evaluate data and outcomes of ILP performed in a
single institution for the last 15 years.
ABSTRACTS
Methods: This was a retrospective analysis of patients who underwent
ILP in the AC Camargo Center since the year 2000.
Results: Since July 2000, 106 ILPs have been performed in 99
patients. There was a slight predominance of female patients (55.75%),
and the mean age was 58.62 years (1884 years). The great majority of
procedures (89.62%) were performed in lower limbs. Regarding primary
disease, there were 89 patients (83.97%) with melanoma, eight (7.54%)
with squamous-cell carcinoma, seven (6.6%) with sarcomas, one with
a desmoid tumor and one with Merkel-cell carcinoma (0.94% each).
Regarding toxicity, 83 patients (78.3%) were classified as Wieberdink I and
II, and nine patients (8.5%) were classified as grades III and IV. Amputation
after ILP was performed in five patients (4.71%). Toxicity was significantly
higher in lower limbs than in upper ones (P = 0.0304). Weve had a 58.5%
global response rate, there being 33 cases of complete response (31.13%)
and 29 partial responses (27.35%). There were 13 patients (12.26%) with
no response. A second ILP was necessary in eight patients. Since 2012, the
use of tumoral necrosis factor (TNF) has been approved in Brazil. We have
used it in addition to Melphalan in nine patients.
Conclusions: ILP is a well established procedure for in-transit metastasis of melanoma and other cutaneous neoplasias. In 15 years, we have
achieved the learning curve for this technique and our results might be
compared with other centers worldwide.
026349
Giant desmoid tumor of the abdominal wall: a case report
Cardoso, M.W.C.1, Nunes, L.F.1, Rezende, J.F.N.1, Oliveira, J.L.1
1
National Cancer Institute Jos Alencar Gomes da Silva (INCA), Rio de
Janeiro, Brazil
michelcalabria@yahoo.com.br, lnunes@inca.gov.br,
dr.jrezende@gmail.com, jadivanleite@hotmail.com
Introduction: The desmoid tumor is a rare neoplasm, with an incidence of 24 cases/1,000,000 inhabitants, representing about 0.1% of
the tumors in the population. It has an indolent growth, but is aggressive
in some cases. It does not metastasize, but is locally invasive. Its most
common site is in the extremities (40%), but also occurs less frequently
in places such as the abdominal wall (2022%). Women are affected three
times more often than men. The treatment of choice is surgical resection
with wide margins, but this is not always feasible because of the anatomical
extent of the tumor. Desmoid tumors present high rates of local recurrence,
being related to certain mutations already being studied; rates may vary
between individuals. Among those affected by the disease, there are some
higher incidence groups: among them, pregnant women and individuals
with Gardner syndrome (polyposis of the colon, an adenomatous syndrome
associated with soft-tissue tumors such as lipomas).
Objectives: To report a case of giant desmoid tumor of the abdominal
wall; pedicled greater omentum and biocompatible mesh were used for
reconstruction.
Results: Patient APS, a 36-year-old female, sought medical assistance
at INCA with a mass on the abdominal wall which had grown progressively
in the previous 4 months. It was a solid mass of relatively fast growth,
high volume, ulcerated and bleeding on physical examination. Biopsy of
the lesion was performed and a desmoid tumor was diagnosed. The patient
underwent antihemorrhagic radiotherapy. Tomography of the abdomen and
chest was performed for locoregional evaluation. The patient was prepared
for surgery requiring blood transfusion. Intraoperatively, the upper limit
was extended twice based on the results of freezing, as well as the lower
limit affecting much of the rectus abdominis muscle. For reconstruction
biocompatible mesh was used in the abdominal wall and a pedicled greater
omentum was made to cover the chest wound area and thoracoabdominal
transition, where it was not possible to complete approximation of the
S209
wound edges. The patient remained in intensive therapy for 2 days, was
discharged in good general condition, and is being followed up as an outpatient in good clinical condition.
Conclusions: There are cases of aggressive desmoid tumor in an atypical location, requiring major resection and reconstruction tactics that are
not always feasible. For this, we anticipate the need for suitable material,
auxiliary teams from different specialties, and especially the common sense
over the extent of resection to maintain the quality of life associated with
overall survival and freedom from disease for the patient.
029302
Giant sarcoma resection in posterior thoracic wall with primary
wound closure using bilateral advance flap: a case report
Haji junior, A.C.1, Santos, M.H.1, Di tomaso, R.A.S.1, Coelho
junior.M.J.P.1, Anjos neto, J.C.A.1, Correa junior, M.A.R.1
1
Manaus, Brazil
caoru.junior@gmail.com, oncomhs@gmail.com,
bekinha_santos@hotmail.com
Introduction: Sarcomas account for less than 1% of all adult solid
malignant cancers and comprise over 50 different histological subtypes
that differ in pathogenesis and outcomes. Malignant peripheral nerve
sheath tumors (MPNST) are highly aggressive soft-tissue sarcomas that
rarely occur sporadically in the general population. These tumors originate
from the nerve sheath rather than from the nerve itself. Complete surgical
resection with or without adjuvant radiotherapy remains the most important
treatment for those patients with primary disease. Soft-tissue sarcomas are
easier to detect and the average size at diagnosis is approximately 10 cm.
Objectives: To describe the case of a giant sarcoma of the back which
underwent surgical resection and wound closure with bilateral advancement flaps.
Methods: An ambulatory patient presented with a large posterior chest
tumor requiring surgical treatment and surgical wound closure in a single
procedure.
Results: The patient was a 25-year-old female patient who presented
with bulge in the posterior thoracic region which had been evolving for
about 15 months; growth was progressive, and it was associated with local
pain. On physical examination, a tumor of 18 cm maximum dimension was
found; the tumor was hardened and extended from about the sixth cervical
vertebra to the fifth thoracic vertebra. The tumor was biopsied and immunohistochemical study detected spindle-cell sarcoma of indefinite histogenesis, and the MPNST was a diagnostic possibility. Subsequently the patient
was subjected to staging and resection with margins. During surgery wound
closure was performed with bilateral advancement flaps.
Conclusion: The majority of sarcomas, even the soft-tissue sarcomas,
arrive for surgical treatment at large sizes. These present challenges both in
surgical resection and in the closure of wounds. Bilateral feed flaps can be
considered as alternatives for closing wounds after resection of the bulky
tumors in patients with good clinical condition and when considering the
proportions of the flaps in advanced conditions.
028846
Hemipelvectomy modified posterior flap: a case report
Campos, R.A.1, Lopes, E.P.D.1, Salvio, A.G.1, Pracucho, E.M.1,
Oliveira, J.C.1, Zanatto, R.M.1
1
ricardorac2@gmail.com,
epdlopes@hotmail.com, gasalvio@hotmail.com, epracucho@yahoo.com.br,
juneacaris@yahoo.com.br, renato_zanatto@ig.com.br
S210
Introduction: External hemipelvectomy is indicated for the treatment
of tumors concomitantly affecting the hemipelvis and the root of the thigh.
With increasing life expectancy, despite the advances of multimodal treatment, hemipelvectomy may be considered more often in elderly patients.
The literature on this subject is sparse.
Objectives: To demonstrate in a case report the treatment of an elderly
patient with modified external hemipelvectomy, highlighting technical
aspects of the operation, morbidity data and follow-up.
Methods: We present an interesting case report.
Results: A female patient aged 70 years had presented with a tumor of
the thigh 3 months previously. Physical examination demonstrated, beneath
the previous surgical scar on the right thigh, there was a tumor 15 x 20 cm
fixed to the pubic bone bulging into the right side wall of the rectum and
vagina. The CT images showed locoregional disease of soft tissue involving
the superomedial portion of the right thigh, groin and part of the rump;
the neurovascular bundle was preserved. Previously, in 2000 and 2006,
the patient had been treated in our hospital with R1 resection followed
by additional chemotherapy and radiotherapy. The incisional biopsy had
been positive for mixofibrosarcoma. A conservative procedure was frustrated, leaving as a therapeutic option the modified hemipelvectomy of the
posterior flap.The surgery went as planned and was uneventful. The patient
progressed well and was discharged on the 8th postoperative day with a
urinary catheter and a suction drain for atonic bladder. Histopathological
analysis revealed a mixofibrosarcoma 12 x 9.5 cm with clear margins,
pT2bN0M0 G3 III TNM 2010. Adjuvant radiotherapy was applied to
the affected area. The patient has been in follow-up for 22 months without
evidence of recurrence.
Conclusion: The hemipelvectomies are aggressive surgical procedures, but despite the restricted indication, especially in elderly patients, it
can be a saving procedure in selected cases, resulting in cure or prolonged
control of locoregional disease.
029135
Histopathological and epidemiological profile of melanoma in patients
assisted by an oncology clinic in the state of Sergipe between 2007 and
2013
Neto, G.L.S.1, Frana, A.V.C.1, Arago, M.T.1, Gurgel, R.Q.1
1
Universidade Tiradentes, Aracaju, Se, Brazil
roberto@oncohematos.com.br
Introduction: The incidence of melanoma has increased in recent
years. It is a very aggressive neoplasm with high lethality, being the leading
cause of death from skin tumors. More studies are necessary, especially in
Brazil, regarding its epidemiology and histopathology.
Objectives: To analyze and describe epidemiological and histopathological data from patients with melanoma assisted by an oncology clinic in
the state of Sergipe between 2007 and 2013.
Methods: This was a retrospective, descriptive and cross-sectional
study of medical records and pathology reports of patients with melanoma
between 2007 and 2013.
Results: The patients were predominantly women, mean age 53.3
years, rural, married, lesions on the trunk and limbs, nodular histological
type/superficial, Clark IV, Breslow @ 5.1 mm, no angiolymphatic and
peritumoral infiltration, 12% regression, 55.5% ulceration, mitotic index
average of 10.33, 25% metastatic rate.
Conclusions: There was an increased frequency of more advanced
tumors, with a high risk of metastasis and consequently poorer prognosis
in these patients.
ABSTRACTS
028840
Importance of an expert surgical oncologist in follow-up monitoring:
a case report of ovary leiomyosarcoma with lung and axillary lymphnode metastases
Vieira, H.C.1, Moreira, R.C.L.1, Salles, P.G.O.1, Carvalho, E.A.1,
Cintra, C.A.1, Meira, M.L.G.1
1
Oncological Surgery, Mario Penna Institute, Belo Horizonte, Brazil
hcvieira@gmail.com, renicecilia@me.com,
pgosalles@gmail.com, ehawilla@yahoo.com.br, cassioacintra@ig.com.br,
mlg.meirap@gmail.com
Introduction: Leiomyosarcoma of the ovary is a rare lesion usually
seen in postmenopausal women.
Objectives: To discuss the importance of clinical examination and
imaging in the detection, diagnosis, treatment planning and follow-up
performed by the oncological surgeon, and the influence on prognosis in
ovary leiomyosarcoma.
Case report: A 42-year-old woman presented with a left adnexal mass
and severe abdominal pain. An exploratory laparotomy was performed in
2007. The pathological analysis showed leiomyosarcoma. After 4 years of
having no evidence of disease (NED), she experienced a local recurrence
and was referred to our group. The tumor was surgically removed with
full adjuvant radiotherapy and chemotherapy. On the follow-up monitoring,
lung node metastases appeared in 2014 and were surgically removed. In
2015 other lung nodes appeared and were also removed. At control phase, a
new axillary mass appeared and was surgically removed.
Results: The patients with high-grade sarcomas presented adverse
clinical evolution and high rates of local and distant recurrences. The prognosis is invariably poor. Most patients expire within 1 year. To increase
survival in this disease multimodal treatment is necessary, including radical
excision or surgical debulking, postoperative radiotherapy to control local
disease and routine chemotherapy after or concomitant with radiotherapy
to avoid distant metastases.
Conclusions: Review of the literature suggests that early and aggressive surgery is of benefit and may improve health-related quality of life
and well-being for all individuals or increase overall survival. In advanced
cases, surgical debulking gives good symptomatic relief. An oncology
surgeon is mandatory for successful management of this disease because
surgery planning, correct follow-up and sometimes re-resections will give
the patients the best chance of cure and quality of life.
028331
Importance of lymphadenectomy in high-risk cutaneous squamouscell carcinoma (cSCC).
Quadros, C.A.1, Andrade, M.N.2, Vieira, L.V.1, Brito, F.A.3,
Peixoto, A.R.L.3, Prisco, E.1
1
Surgical Oncology Team, So Rafael Hospital, Salvador, Brazil, 2Medical
School, Bahia State University, UNEB, Salvador, Brazil, 3Reconstructive
Surgery Team, So Rafael Hospital, Salvador, Brazil
caquadros@gmail.com, manaandrade@hotmail.com,
lucasvelame@hotmail.com, drfranciscoanibal@gmail.com,
delunaplastica@gmail.com, emersonprisco@hotmail.com
Introduction: Cutaneous squamous-cell carcinoma (cSCC) is the
second most common skin cancer and its incidence is increasing due to
ultraviolet exposure. Most cSCCs have a favorable behavior; however,
some of them are aggressive and have an increased risk of recurrence and
metastasis. Patients with cSCC associated with two or more risk factors are
classified as at high risk for metastasis; these include: tumor thickness
4 mm, recurrent cSCC, moderate/poor differentiation, immunodeficiency,
tumor diameter 20 mm, rapid growth rate, irregular borders, dedifferentiation and tumor location on the ear, lip or non-sun-exposed areas. Patients
ABSTRACTS
with cSCC have a 36% chance of metastasis, primarily to the lymph
nodes, and this percentage may rise to 40% in high-risk tumors.
Objectives: To show the importance of lymphadenectomy in high-risk
cSCC.
Methods: This case report describes a high-risk cSCC with right axillary lymph-node recurrence.
Results: A 66-year-old male patient was submitted to a right anterior thoracectomy with resection of the right clavicle, second, third and
fourth right anterior ribs, thoracic wall and pleura to completely remove
a high-risk cSCC. A surgical mesh was used to contain the lung, reconstruction was done with rotation of a contralateral pectoralis major flap.
Lymphadenectomy in the right subclavian and carotid arteries region was
performed for enlarged lymph nodes. Histopathological report indicated
clear surgical margins of a completely resected 9.0 x 5.0 cm well-differentiated squamous-cell carcinoma, invading the full length of the thoracic
wall, ribs, clavicle and pleura, with two metastatic lymph nodes out of 11,
stage: pT4pN1M0. Adjuvant radiotherapy was undertaken without complications. Fifteen months later, the only recurrence site was to right axillary
lymph nodes, requiring lymphadenectomy.
Conclusions: In high-risk cSCC, lymphadenectomy should be
performed in all lymphatic basins that drain the location of the tumor for
proper cancer treatment, because of the increased possibility of lymph-node
metastasis.
029175
Inguinal lymphadenectomy with sartorius muscle fascia wound
covering: a case report
Pompermaier, C.1, Winkelmann, C.P.1, Chiaradia, C.P.1, Pr, R.B.1, dos
1
clapw@terra.com.br, crisllipreussler@gmail.com, rochelepra@gmail.com,
Introduction: Inguinal lymphadenectomy (IL) exposes the femoral
vessels, and these vessels need to be covered; this is achieved through
different techniques which vary according to specific conditions.
Objective: We describe a covering procedure for the femoral vessels,
carried out utilizing the sartorius muscle fascia (SMF), an alternative
aproach.
Methods: PNP is a male patient who sought treatment in 2014 with a
right calcaneus melanoma, confirmed throught excisional biopsy. Cancer
resection ensued, with margin amplification and IL due to clinically detectable adenopathy. To prevent possible vascular complications, in the event
of suture dehiscence or a seroma infection, sartorius muscle transposition
(SMT) is recommended in such cases. Here the position, size and thickness
of the SMF make it an alternative for covering and protecting blood vessels.
In the same way that an SMT is carried out, the muscle fascia is sectioned
in its cranial and lateral limits and rotated medially for fixation along the
inguinal ligament and medial to the vessels.
Results: En-bloc IL carried along radical primary site cancer resection
is associated with considerable morbidity. When the surgical defect generated does not impede the primary closure of the skin and subcutaneous
tissue due to excessive tension as in our patient, covering of femoral
vessels is indicated. Usually, this is achieved with SMT, but in this context,
covering femoral vessels utilizing the SMF could be applied.
Conclusion: SMF covering for the femoral vessels seems to have less
morbidity than the SMT. By avoiding muscular sectioning, the patient can
be mobilized and assisted in deambulation earlier, with less pain and movement restraints, contributing to a shorter hospital stay. The limitations to
this techique are related to the availability and integrity of the sartorius
muscle fascia which cannot be involved in the en-bloc resection, neither
S211
can it be too thin or too small so that, when freed, it is not wide enough
to cover the vessels entirely without being excessively tensioned when
sutured along the inguinal ligament.
029219
Internal hemipelvectomy for large-cell tumor resection
Fernandes, P.H.S.1, Rezende, J.S.1, Kaminice, L.M.1, Chebel, M.J.1,
Reggiani, R.1
1
Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil
drpaulohenrique@netsite.com.br, jessycarezende@yahoo.com.br,
lara_kaminice@hotmail.com, michelchebel@gmail.com,
robertoreggiani_@hotmail.com
Introduction: The bones of the pelvic region are home to less than
5% of all malignant bone tumors, which although infrequent are a separate
chapter in the treatment of bone tumors given their regional anatomical
complexity. If there are conditions for keeping a good oncological resection margin without amputation, preserving surgeries are indicated, being
nominated internal hemipelvectomies.
Objective: To report a case of a giant-cell tumor treated by left internal
hemipelvectomy. We detail the surgical technique used, neoadjuvant treatments, adjuvants and follow-up.
Case report: RRC, an 18-year-old single woman, was admitted to
our service in 2013 with a complaint of left leg pain and a tumor with
progressive growth in the left flank for approximately 8 months. She did
not have any history of local trauma. Computed tomography of the pelvis
showed an expansive mass measuring approximately 25 cm in the region
of the iliac wing, with clear invasion of abdominal wall musculature. The
result of an incisional biopsy was compatible with large-cell bone tumor.
Neoadjuvant treatment was performed with denusumab for 4 weeks before
the surgery, followed by operation (internal hemipelvectomy with resection of most of the abdominal wall). The reconstruction of the abdominal
wall was accomplished using polypropylene mesh, partly protected by the
omentum. The patient progressed with good cicatrization and epithelization of the surgical wound. She is now in the 18th postoperative month; she
remains in ambulatory attendance and is still using denusumab as adjuvant
treatment.
Discussion and Conclusion: The internal hemipelvectomy for treatment of some pelvic tumors should be considered whenever possible so as
to preserve the lower limb of the patient; it positively influences morbidity,
mortality and quality of life. We report here a successful case using denusumab as an adjuvant treatment and regular polypropylene mesh in the
reconstruction of the abdominal wall.
028854
Internal hemipelvectomy with total pelvic exenteration and
reconstruction with wet colostomy for pelvic chondrosarcoma: a
report of two cases
Sousa, T.A.1, Pedrosa, P.H.A.1, Neves, A.R.S.1, Filho, D.F.F.1,
Zanvettor,P.H.1
1
Department of Pelvic Surgery, Aristides Maltez Hospital, Salvador-Bahia,
Brazil;
tiagofamed@yahoo.com.br, phenriquepedrosa@gmail.com,
adsonneves@ufba.br, dfalcao@gmail.com, phzanvettor@terra.com.br
Introduction: Extensive malignant tumors originating from bone
and cartilage in the pelvis are real therapeutic challenges. Data are lacking
regarding the utility of en-bloc exenterative resections with portions of the
bony pelvis.
S212
Objectives: To describe two cases of compound internal hemipelvectomy and pelvic exenteration that were oncologically successful, and to
review the recent literature.
Methods: Two patients with pelvic chondrosarcoma were admitted
to the Department of Pelvic Surgery of Aristides Maltez Hospital, Brazil,
between July 2011 and April 2012. They were submitted to internal hemipelvectomy with total pelvic exenteration, without the use of orthopedic
implants and with combined urinary and fecal reconstruction. We carried
out a review of the literature using the key words compound and internal
hemipelvectomy, total pelvic exenteration and chondrosarcoma.
Results: Both patients tolerated the procedure well, developing minor
complications and being discharged around the 20th to 30th postoperative
days. During the follow-up (36 and 27 months, respectively), the patients
did not present locoregional recurrence or metastatic disease, and did not
need the aid of orthosis. With the improvement of surgical techniques,
the internal hemipelvectomy has achieved oncological outcomes similar
to those of external hemipelvectomy with reasonable functionality by
preserving the femoral vascularnervous bundle and the sciatic nerve. The
overall 5-year survival of 90% for stage I and 81% for stage II fully justifies the procedure, besides a mortality rate of 5.79% and high morbidity
(mainly flap necrosis and wound infection) of 4462%.
Conclusion: The internal hemipelvectomy with pelvic exenteration
for pelvic chondrosarcoma is a complex procedure, but safe in selected
patients; it is only indicated as a curative option if it is possible to obtain
surgical margins similar to the classical amputation with preservation of
function and a good life expectancy. The good rate of overall survival and
disease-free survival, the improved quality of life, and the good tolerance
to ostomy justify this radical surgical treatment.
029099
Isolated limb perfusion for in-transit metastases of melanoma: a video
report
Camaro, W.R.1, Bertolli, E.1, Molina, A.S.1, Duprat, J.P.1
1
wrcamarco@msn.com, ebertolli@hotmail.com,
Introduction: Isolated limb perfusion (ILP) is the procedure that
allows the administration of high doses of chemotherapy exclusively in the
limb with an extracorporeal circulation. The results are a minimal systemic
toxicity and a better outcome for in-transit melanoma or other malignancies
restricted to the limb.
Objectives: To report the technique of ILP applied in our institution
in an edited video.
Methods: A patient with in-transit metastases of melanoma restricted
to the right lower limb was selected for ILP with melphalan. We performed
ILP with the following steps: the volume of the limb was indirectly calculated by measuring the limb diameter every 5 cm, which led to the adequate
melphalan dose for the patient; a tourniquet was placed at the root of the
thigh; two thermometers were placed inside the muscles to control the
temperature; the femoral vessels were dissected in the femoral triangle
distally to the tourniquet; vascular catheters were inserted in the vessels
after clamping them proximally; they were connected to an extracorporeal
circulation; the artificial circulation was established after insufflating the
tourniquet, and the drug was injected in the system after hyperthermia
of 38C was achieved. ILP was performed for 1 hour; then all the system
content was drained and the circulation washed with saline solution; the
catheters were withdrawn and the vascular incisions were closed; the tourniquet and the clamps were cut off and then the physiological circulation
was reestablished.
Results: The patient had minimal surgery-related complications and
drug-related systemic toxicity with enhanced locoregional control.
ABSTRACTS
Conclusions: Hyperthermic ILP combined with melphalan is an
accepted treatment for obtaining locoregional control in advanced
melanoma of the extremities and other malignant neoplasias restricted to
the limb.
028845
Karakousis incision for treatment of a recurrent abdominal and
pelvic liposarcoma: a case report.
Campos, R.A.1, Carvalho, A.M.1, Oliveira, J.C.1, Pracucho, E.M.1,
Tomal, K.T.1, Zanatto, R.M.1
1
ricardorac2@gmail.com,
andremcar@gmail.com,juneacaris@yahoo.com.br,epracucho@yahoo.com.br,
karlatomal@hotmail.com, renato_zanatto@ig.com.br
Introduction: Abdominal pelvic tumors are difficult surgical challenges because of the complex anatomy and limited access. Inappropriate
access can hinder the resection or correction of an inadvertent vascular
injury during the procedure. Karakousis described an incision which allows
exposure of the tumors in such a way that they can undergo lateral fixation
for dissection, ensuring control of the iliac vessels. This procedure should
be familiar to any surgeon who is qualified to treat tumors in this region,
as conventional abdominal incisions lead to inadequate exposure and poor
access.
Objectives: To demonstrate the importance of abdominoinguinal incision in the treatment of abdominal and pelvic tumors.
Results: A 48-year-old patient presenting a recurrent liposarcoma of
the left thigh root, extending to the iliac fossa and retroperitoneum, had
previously been submitted to surgery; surgery was followed by incomplete
chemotherapy and radiotherapy due to the patients non-compliance. The
patient was submitted to marginal resection and vascular clipping by an
abdominoinguinal incision that allowed wide access to the region with good
exposure and safety, enabling control of the proximal and distal iliac and
femoral vessels. The piece was removed en bloc, with the entire capsule
and a large defect in the abdominal wall. Reconstruction was possible with
the use of polypropylene mesh and rotational fasciocutaneous flap of the
rectus abdominis. The patient was discharged on the 10th postoperative
day. Pathology of the resected specimen revealed a myxoid liposarcoma
with the same characteristics as the primary tumor: neoplasm and subcutaneous tissue infiltration with free surgical margins, pT2bN0M0 (IIB).
Adjuvant chemotherapy and radiotherapy were offered to the patient, but
were refused. The patient was followed up for 2 years after surgery with no
evidence of local recurrence, but after this period the patient failed to attend
the follow-up appointments.
Conclusion: The Karakousis incision through the median abdominal
line connected to a longitudinal inguinal incision is safe and effective in
treating iliac inguinal lesions that extend to the retroperitoneum.
028927
Laparoscopic iliac lymph-node mass resection for melanoma
Cruz, R.P.1
1
Hospital Nossa Senhora da Conceio, Porto Alegre, RS, Brazil
rpcruz2004@gmail.com
Introduction: Laparoscopic iliac node dissection may be a valuable
management option because it allows benefits such as decreased operative morbidity owing to decreased surgical trauma, less violation of the
abdominal muscles or the inguinal ligament, reduced postoperative pain,
and increased patient satisfaction with the cosmetic result. It also provides
ABSTRACTS
an improved view of the operative area, dissection zone, and surrounding
structures.
Objectives: To show that an iliac lymph-node mass can be safety
resected by laparoscopy.
Methods: A 71-year-old male patient presented with an iliac lymphnode mass at abdominal CT. He had a history of right inguinal lymphadenectomy 18 months previously because of melanoma metastases; the
primary site was unknown. The Cloquet lymph node was negative for
melanoma at that time. Abdominal CT showed a right iliac lymph-node
mass measuring 5.5 cm maximum dimension. Laparoscopic resection was
performed; a 10-mm trocar was placed at the umbilicus, and two 5-mm
trocars at the suprapubic and the right flank. Blunt dissection at the adventitia of the vessels was performed and the mass was dissected. It was
possible to identify all structures, allowing resection with little bleeding.
An inguinotomy was performed for extraction of the surgical specimen.
The patient was discharged the next morning, without any complaint.
Results: A successful tumor excision without surgical complication
was performed. The surgery allowed a complete evaluation of the abdominal cavity for implants and a rapid postoperative recovery of the patient.
Conclusions: Laparoscopic lymph-node mass lymphadenectomy can
decrease operative morbidity due to decreased surgical trauma, less violation of the abdominal muscles or the inguinal ligament, reduced postoperative pain, and increased patient satisfaction with the cosmetic appearance.
A steep learning curve is not necessary for conducting the procedure safely.
029124
Laparoscopic resection of an intraabdominal schwannoma
Igreja Jnior, H.J.S.1, Carvalho, B.S.V.1, Batista, V.L.1, Coelho, J.G.1,
Soares, A.L.O.1, Azevedo, V.V.Z.1
1
Sociedade de Beneficncia Portuguesa de Campos, Brazil
haroldoigreja@hotmail.com, brunosvcarvalho@hotmail.com,
Vilson_Leite@msn.com, jugoncalvescoelho@hotmail.com,
aninhalosoares@gmail.com, vitorvza@vza@hotmail.com
Introduction: Schwannomas are typically solid-cystic tumors that
arise from Schwann-cell proliferation in the nerve root sheaths. It occurs
most commonly in women between the ages of 20 and 50 years. There are
no reports in the literature about incidence of schwannoma in the genitofemoral nerve.
Objectives: To report a rare case of genitofemoral nerve schwannoma
submitted to laparoscopic resection.
Method: This is a descriptive study based on the analysis of medical
records and the patients clinical records associated with a literature review.
Results: The patient was a women, 64 years old, who presented lower
abdominal pain which had been treated with irradiation to the right groin
for 1 year; she had an abdominal mass in the right lower quadrant, with pain
on palpation. The clinical work-up continued with a CT scan and a pelvic
MRN, and a heterogenous mass was found at the lower right quadrant. The
patient was submitted to preoperative workup prior to surgical resection. In
surgery, the patient was in supine position, under general anesthesia. A first
a 12-mm trocar was placed cephalic to the umbilicus, using Hassons technique; a second 10-mm trocar was placed at the left iliac fosse, and the last
one, a 5mm trocar, was placed at the hypogastrium. After the removal of
operative adhesions, the cecum and the apendix were freed from the mass,
and its origin was found to be the genitofemoral nerve. The genitofemoral
nerve and the tumor were resected en bloc, and the specimen was retrieved
through the umbilical trocar incision. Pathology reviewed the mass as being
a schwannoma. The patient was discharged within 24 hours after surgery
and remains disease-free 18 months later.
Conclusions: Surgical treatment is recommended, especially when
pain or neurological defects are present. Usually surgery is possible without
permanent damage to the nerve, but this depends on the location and size.
S213
Satisfactory treatment depends on good surgical margins during surgical
resection, and this can be achieved with laparoscopic surgery. Recurrences
after total excision are rare.
029153
Late metastasis of cutaneous melanoma: a case report
Lustosa, A.G.1, Filho, K.J.C.2, Bezerra, C.F.2, Gis, M.C.2,
Medeiros, K.M.O.T.2, Corra, R.S.2, Pires, T.C.3, Lira, G.A.2, Souza, W.B.1
1
Natal, Brazil
Introduction: Melanoma affects mainly white adults and represents
4% of malignant neoplasms of the body; it is the most serious skin cancer
because of the high probability of metastasis.
Objectives: To demonstrate - through a case report of a patient clinical aspects, diagnosis and treatment of late metastasis of cutaneous
melanoma.
Methods: Patient MAO 49 years old, female, married, from Natal,
RN presented with a pigmented lesion in her left breast which had been
there for 12 years. In 2003, after excisional biopsy of the lesion, a superficial spreading melanoma (vertical growth phase, Clark III and Breslow
0.88 mm, free margins) was found. Computed tomography (CT) of the
abdomen (05/06/2013) showed an ovalar tissue formation with irregular
contours, solid, measuring 1.5 cm, located with contrast enhancement in
the splenorenal recess; it was of indeterminate aspect, and so we could not
be sure that it was not a secondary lesion. A later PET-CT (07/31/2013)
showed that the nodule in the splenorenal recess had increased in size since
the previous study (1.5 cm); currently it measures 2.0 x 1.6 cm. Chest CT
(01/16/2014) showed a partly calcified nodule (8 mm) in the lower lobe
of the right lung and a calcified nodule in the periphery of the left lung.
CT of the total abdomen (01/16/2014) showed an oval image on the right,
suspected of being an ovarian cyst. Breast USG (01/24/2014) showed
lump in the left breast, BIRADS 3 (1.0 x 0.7 cm). CT of the total abdomen
(04/27/2015) showed a solid nodule in the left adrenal, 3 cm in its largest
dimension, which may represent a secondary lesion, and a small lesion (0.5
cm) on segment VI of the liver. Chest CT (04/27/2015) showed a calcified
pulmonary nodule in the lower segment of the left lower lobe of the lung,
residual, and calcified micronodules in the left lower lobe.
Results: We chose to follow the lesion because it affects lymph nodes
in the axillary chain, demonstrates axillary emptying by positive sentinel
lymph node, and illustrates adjuvant radiotherapy in the left armpit.
Conclusions: We demonstrated with this case the importance of
regular monitoring in the treatment of malignant melanomas.
028855
Malignant degeneration in Madelungs disease: a case report
Couto Netto, S.D.1, Arakaki, M.S.1, Andrade Lima, T.M.1, Teixeira F.J.R.1,
Akaishi E.H.1, Utiyama, E.M.1
1
Surgical Oncology Group, Division of Surgical Clinic III, Clinics
Hospital, So Paulo University, So Paulo, Brazil
sergiodcnetto@gmail.com, mariarakaki@hotmail.com,
tiberiodeandradelima@yahoo.com.br, fredteixeira@gmail.com,
eduardoakaishi@gmail.com, eutiyama@hotmail.com
Introduction: Madelungs disease (MD) also known as multiple
symmetric lipomatosis or Launois-Bensaude syndrome is a rare disease
of unknown etiology. MD occurs more frequently in males and it is related
to a history of chronic alcoholism. There are around 300 cases reported
S214
in the literature. It is caracterized by a slow-growing non-encapsulated
adipose tissue accumulation, which is symmetric around the neck, upper
part of the arms, pelvis, back and thigh. There are only two cases of liposarcomatous progression documented in the literature.
Objective: To report a rare case of malignant transformation of
Madelungs disease and to revise the literature
Methods: We describe a case report from a patient submitted to surgical
treatment of a recurrent liposarcoma arising from Madelung disease.
Results: A 41-year-old man with a chronic history of alcoholism had
been diagnosed with MD. He had large lipomatous masses located in the
face, neck, pelvis and thigh, in addition to 2 years of gradual progressive
growth of an adipose scrotal mass. An inadequate fragmented resection of
the scrotal lipomatous mass was done and the histopathological examination revealed low-degree liposarcoma. Clinical staging was negative for
metastatic disease. Five years later a local relapse occurred and the patient
was referred to our center. A wide resection involving the scrotum, medial
aspect of right thigh, and pubis was performed and a V-Y skin flap reconstrution was made. Pathological evaluation showed a dedifferentiated
liposarcoma. After 2 years of follow up there is no evidence of disease.
Moreover other esthetic resections were performed in the thigh, face and
neck without any other neoplasms being found.
Conclusion: It is important to relate that, despite its rarity, progressively growing lipomatous masses might represent malignant transformation in Madelungs disease.
028219
Metastasis of basal-cell carcinoma to the lungs: a case report and
review of the literature
Oliveira, J.L.1, Rezende, J.F.N.1, Araujo, M.S.1, Nunes, L.F.1, Fiod, N.J.J.1,
Ribeiro, L.C.1
1
jadivanleite@hotmail.com, dr.jfrezende@gmail.com,
drmarcelosa@gmail.com, lfernandonunes@gmail.com, fiod@globo.com,
lurribeiro@yahoo.com.br
Introduction: Basal-cell carcinoma (BCC) is the most common form
of skin cancer and rarely metastasizes. The prevalence of metastatic basalcell carcinoma (MBCC) varies between 0.0028% and 0.55% of all primary
BCC cases. Over 250 MBCCs have been reported in the literature. Almost
85% of these arise from primary lesions in the head and neck; less frequently
lesions originate on the back and extremities. Epidemiology suggests that
BCC is more common among Caucasians and can develop anywhere on the
body surface, especially on the exposed areas of the head and neck region;
there is a high propensity for local recurrence. Most metastases occur in
men. The BCCs from which they arise are commonly large, facial, locally
invasive and destructive, ulcerated, long-standing, treatment-resistant and
histologically aggressive. Lymphatic and hematogenous spread are equally
prevalent, with lymph nodes, lungs and bone being the most common sites
of metastases.
Objectives: To present a case of a large BCC on the patients right arm
with the radiological and histopathological findings; there were indications
of metastases in the right lung and bone destruction of the right humerus.
Right thoracic interscapular amputation (Berger surgery) and right thoracotomy for pulmonary metastasectomy were performed.
Methods: We present a case report and review of the literature. A
60-year-old male presented with a bulky ulcerated lesion in his right arm.
Imaging showed local bone destruction and pulmonary nodules suggestive
of metastatic disease. He was submitted to surgical treatment.
Results: The case meets all the criteria for an MBCC to the lung. The
primary lesion in our case was significantly large in the upper right limb
with local invasion and bone destruction, and the histological diagnosis was
compatible with MBCC.
ABSTRACTS
Conclusions: Although MBCC is a rare entity, its occurrence should
be borne in mind especially when dealing with a giant, recurrent, or longstanding tumor in the head and neck region.
029148
Metastatic in-situ melanoma
Firmino, N.L.J.1, Miranda, P.H.D.2, Miranda, E.2, Ximenes, L.M.1,
Pordeus, A.L.B.1, Azevedo, L.W.1, Arruda, A.E.1, Ramalho, W.C.1,
Gomes, A.S.A.2
1
2
UNIONCO Surgical and Clinical Oncology Institute, Recife, Brazil
nflj_@hotmail.com, mirandaphd@hotmail.com,
emiranda.onco@gmail.com, lucasmartinsximenes@gmail.com,
luisa.pordeus@gmail.com,laiswa.med@gmail.com,amandaiehuda@hotmail.com,
drwcramalho@gmail.com, alexandre.unionco@gmail.com
Introduction: In 2015 an estimated 112,200 patients will be diagnosed
with malignant melanoma in the United States and five major European
countries. More than 90% will be diagnosed early when the disease is
resectable. However, when discovered late, the prognosis is poor.
Objectives: To describe a case of metastatic melanoma from in-situ
pathology.
Methods: The patient was male, 32 years old, born and raised in
Recipe; he presented with a dark lesion on his back. It appeared as a dusty
lesion 3.5 cm x 1.8 cm x 1.0 cm, with a, brownish lesion measuring 1.0 cm
x 0.5 cm in the center, with irregular borders. The patient was referred to
the oncology surgery service.
Results: The first surgery in July 2014 revealed a malignant in-situ
lentigo with free margins. In January 2015 he felt a palpable, painless
nodule in the left axillary region. In February 2015, he underwent a core
biopsy that revealed an undifferentiated malignancy, sparsely sampled,
with necrosis, probably metastatic in origin. The immunohistochemical
panel was compatible with infiltrative malignant melanoma in fibroadipose
tissue. PET/CT showed lymphadenopathy with glycolytic hypermetabolism in the left axillary chain measuring 5.2 cm x 3.1 cm (SUV maximum
of 11.72), with enlarged lymph nodes in the right pulmonary hilum 2.5 cm
x 2.3 cm (SUV maximum of 9). The patient underwent radical left axillary
lymphadenectomy with muscle resection of the pectoral minor muscle in
July 2015.
Conclusion: The patient is in clinical follow-up without evidence of
disease.
029299
Metastatic malignant melanoma of the gallbladder: a case report and
literature review
Fermino, A.L.1, Diniz, F.D.1, Aveiro, W.C.1, Carvalho, C.E.B.2,
Vasquez, V.L.2
1
Surgical Oncology resident of Barretos Cancer Hospital, Barretos, Brazil,
2
Department of melanoma and sarcoma, Cancer Hospital of Barretos,
Barretos, Brazil
andrefermino@yahoo.com.br, daldegan_felipe@hotmail.com,
castorxxxv@yahoo.com.br
Introduction: Metastatic melanoma is a very aggressive tumor that
can spread to virtually all body organs. Gastrointestinal involvement is a
common occurrence in patients with metastatic melanoma. However, the
involvement of the gallbladder is rare, with prevalence rates between 4 and
20% of the gastrointestinal occurrences, and this causes complications or
symptoms.
Objective: To report a case of malignant melanoma metastasis to gallbladder that simulated symptoms of acute cholecystitis, to give details of
ABSTRACTS
macroscopic observation and pathology, as well as to briefly review the
subject.
Methods: We present the case of a woman of 65 who presented with a
blackened spot in the left supraclavicular region. The lesion was resected.
Histopathology revealed a nodular malignant melanoma (Breslow 1.7 mm,
Clark IV) with ulceration. Chest CT imaging and USG of the abdomen were
unchanged. Expansion margin and sentinel lymph node in the left armpit
were excised. Pathology of the specimen piece (5.0 x 3.0 cm) showed scarring with no lymph-node metastasis, with staging IIA-T2bN0M0. After 3
months follow-up the patient presented again with abdominal pain in the
right hypochondrium, epigastric discomfort and some episodes of vomiting
(usually postprandial). CT of the chest and abdomen showed a solid 2.0-cm
nodule of polypoid aspect in the gallbladder body. Laparoscopic cholecystectomy was performed, and the macroscopic polyp appeared blackened
and approximately 2.5 cm. Pathology demonstrated a metastatic cutaneous
melanoma. The patient is in the 5th postoperative month and shows no
further pathological changes.
Conclusion: We report this case to emphasize the need to always think
of the possibility of involvement of the gallbladder in patients with melanoma, and to highlight the need for research into poorly defined lesions in
the bile duct in patients with a history of melanoma. The clinical presentation, diagnosis, histopathology, prognosis and treatment of metastatic gallbladder melanoma are also discussed and reviewed.
028849
Metastatic melanoma of breast: a case report
Filho, R.L.M.1, Morais, R.A.1, Campos, R.A.1, Caldeira, J.R.F.1,
1
raulfilho_26@hotmail.com, rafaelamoraisgo@hotmail.com,
ricardorac2@gmail.com, jrfcaldeira@gmail.com, jaulermasto@uol.com.br,
Introduction: Breast metastases are rare (0.52% of all breast malignancies). In addition to contralateral breast cancer, lymphoma, melanoma,
rhabdomyosarcoma, and cancers of the lungs and ovaries can metastasize
to the breast. The treatment may be surgical or medical. Breast metastatic
melanoma has a poor prognosis, with a median survival of 10 months.
Objectives: To show a rare case of metastatic melanoma in the differential diagnosis of breast tumor and to update the literature.
Results: A 52-year-old woman had had a skin lesion on her back
from birth; the lesion had bled 2 months ago. The patient was attended
by the Skin and Soft Tissues Service of the Amaral Carvalho Oncologic
Hospital. On dermatological examination, a blackened lump was found
in the scapular region measuring 8 x 3 cm without palpable lymphadenopathy. Excision with sentinel lymph-node biopsy (SLB) was indicated.
The pathology report revealed malignant melanoma. The SLB showed
two right axillary lymph-node metastases. Axillary lymphadenectomy was
carried out. There were no metastases in the other lymph nodes dissected
(13). Adjuvant therapy was performed with interferon. Eleven months
after the first surgery a lump in the left breast was observed; it was mobile,
well-defined, 5 x 3 cm, and fast-growing. Mammography was requested,
classified as BI-RADS 4. Metastatic melanoma was confirmed after core
biopsy, and radical mastectomy with left axillary lymphadenectomy was
performed. Core biopsy confirmed the diagnosis and showed metastases in
three of the 31 lymph nodes removed. There was no need for immunohistochemistry. The patient underwent chemotherapy and interferon adjuvant
therapy. Five months after mastectomy she had multiple metastases (in
contralateral breast and lung) and died in 4 months.
Conclusions: Metastatic melanoma of breast, although rare, is
differential diagnosis in patients with breast lump and history of primary
S215
melanoma. It is important your research differentiating between the
primary tumor and metastatic breast disease.
028847
Metastatic melanoma of stomach and small bowel: a case report
Carvalho, A.M.1, Campos, R.A.1, Filho, R.L.M.1, Zanatto, R.M.1,
Pracucho, E.M.1, Tomal, K.T.1
1
andremcar@gmail.com,
ricardorac2@gmail.com,raulfilho_26@hotmail.com,renato_zanatto@ig.com.br,
epracucho@yahoo.com.br, karlatomal@hotmail.com
Introduction: The gastrointestinal tract is a relatively rare place for
metastatic melanoma. It is generally treated with surgical procedures which
can improve the symptoms and increase long-term survival.
Objectives: To show a rare metastatic melanoma of the stomach and
small bowel and to describe our approach to treatment.
Methods: We decided to expound a rare case report.
Results: A white woman, 46 years old, started treatment for a
dark lesion on her right shoulder previously diagnosed as an ulcerated
melanoma; the lesion was 1.1mm thick according to Breslows criteria and
Clarks level IIIIIA stage (TNM 2010). Excision of the margin extension
and the sentinel lymph node was performed. The patient was followed at
Amaral Carvalho Oncologic Hospital for 5 years when the symptoms of
anemia, weight loss and bleeding appeared. The endoscopy showed a black
ulcerated lesion in the upper stomach, and a metastatic melanoma was
confirmed by immunohistochemistry. The patient underwent total gastrectomy and received palliative chemotherapy; she had an excellent evolution.
After 3 years, the patient started bleeding again, with abdominal pain and
intestinal obstruction. The abdominal tomography detected intussusception
images in the small bowel, and an enterectomy with primary anastomosis
was performed. She remained without symptoms until she started bleeding
again 2 years ago, when the tomography showed lots of bowel lesions and
the PET-CT showed hypermetabolic areas in the left abdomen (SUV: 17.8)
and right colon (SUV: 11.2) suggesting metastatic disease. Palliative clinical treatment was initiated and the patient is still alive.
Conclusions: Surgical management is certainly the main treatment for
metastatic melanoma of the gastrointestinal tract, giving relief of symptoms
with low morbidity and mortality. As showed with this case report, we can
increase the long-term survival and give the patient a better quality of life.
028201
Morbidity/mortality and survial of hepatic metastases of soft-tissue
sarcoma: the Brazilian National Cancer Center experience
Santos, C.E.R.*1, Guedon, G.1, Rezende, J.1, Meton, F.1, Monteiro, M.1,
Albagli, R.1, Gonalves, R.1, Castro, L.1
1
INCA, Rio de Janeiro/RJ, Brazil
carloseduardo@cirurgiaonline.com.br
Objective: The objective of this study was to evaluate the outcome of
surgical treatment of patients with liver metastasis of soft-tissue sarcomas,
with emphasis on the identification of prognostic factors and survival.
Methods: A retrospective analysis of 25 patients undergoing liver
resection for metastatic soft-tissue sarcomas in the National Institute of
Cancer in Rio de Janeiro, between 1996 and 2014.
Results: The most prominent primary tumor site was the retroperitoneum. Histopathological findings were compatible with leiomyosarcoma
in 21 cases (84%). Leiomyosarcoma patients showed a 31-month survival
rate, whereas patients with other histologies showed a rate of 37 months.
Concerning the degree of differentiation, the tumor was considered G3
in 12 cases (48%), G2 in 11 cases (44%) and G1 in two cases (8%). The
S216
median time between surgery and surgery of the primary tumor was 19
months (0292 months), with an average of 39 months and seven cases
(28%) of synchronic metastasis (six cases were resected simultaneously
and one in less than 6 months). The use of adjuvant therapies did not result
in an increase in the survival rate. There was a decrease in survival with
an increase in the number of resected hepatic segments. Survival amongst
patients with synchronic metastasis reached 21 months, versus 36 months
on metachronic metastasis. Median survival on completely resected patients
(R0) was 42 months, whilst R1 and R2 surgeries resulted in survivals of 49
and 11 months, respectively. Eight patients underwent blood transfusions,
with an average of 1162.5 mL (6001800 mL), and they had a worse prognosis (P = 0.001). Nine patients had some type of postoperative complication, and there were no deaths up within 30 days of the procedure. Six
patients were reoperated due to recurrence. Those submitted to more than
one hepatic resection showed an average survival of 61 months, versus 26
months on those operated only once. The median overall survival was 26
months, with an average of 32 months (1103 months), with disease-free
survival of 11 months (137 months). For palliative surgeries (R1 and R2),
the median survival rate was 9 months, with a 19 months average.
Conclusion: Hepatic resection for sarcoma metastasis should be
considered in treatment strategies, especially in low-grade sarcomas
and if complete resection (R0) is possible. The presence of metachronic
metastases and multiple hepatic resections allowed for longer survivals.
Synchronicity and blood transfusions shortened survivals. In this series
there was no gain from adjuvant therapies.
028912
Neoadjuvant radiotherapy for retroperitoneal sarcomas: is it worth
irradiating the entire lesion or just the periphery?
Spencer, R.M.S.B.1, Aguiar Jr, S.1, Mello, C.A.L.2, Silva, M.L.G.3,
Oliveira, D.A.M.1, Lopes, A.1
1
So Paulo, Brazil, 2Department of Clinical Oncology, AC Camargo Cancer
Center, So Paulo, So Paulo, Brazil, 3Department of Radiotherapy, AC
Camargo Cancer Center, So Paulo, So Paulo, Brazil
ranyell.spencer@gmail.com, samuel.aguiar.jr@gmail.com,
deciomontenegro@gmail.com
Introduction: Retroperitoneal sarcomas correspond to 1215%
of soft-tissue sarcomas, with 5-year overall survival estimated at 60%.
Surgery is the only potentially curative modality for local disease, but its
proximity to vital structures and viscera make many procedures complex
and challenging. The risk of local recurrence after marginal resections,
which happens in most cases, reaches 5060%. Large lesions are challenging for radiotherapy (RT) because of the need for large doses, which
can damage adjacent organs.
Objective: To demonstrate that the use of maximum-dose RT to the
periphery of the lesion (local or marginal resection) can be done with a
reduction in local recurrence rates.
Methods: In February 2015 AC Camargo Cancer Center started to use
a new treatment protocol for retroperitoneal sarcomas; this involved use of
neoadjuvant RT (IMRT at a dose of 50 Gy to the lesion and margins, and
concentration of hot spots in the areas considered for marginal resection).
Surgery is scheduled for 4 weeks after the end of RT.
Results: The protocol was initiated in February 2015. A patient with
vena cava leiomyosarcoma (T = 12 cm) was submitted to the protocol and
so far has no evidence of disease. There was no intraoperative evidence of
radiation-induced bowel injury.
Conclusion: The realization of neoadjuvant RT can be an auxiliary
method before surgery for patients with large retroperitoneal sarcomas.
The strategy of irradiating the hot spots of marginal resection may decrease
ABSTRACTS
damage to adjacent organs and decrease local recurrence rates. A larger
number of patients should be evaluated.
PEComa of the external iliac artery: a case report

Sousa, A.R.1, Dias, A.N.1, Vaz, L.A.1, Borges, L.C.1, Lopes, E.P.D.2,
Lopes, A.P.R.M.2
1
laizzavaz@hotmail.com, liviacborges@yahoo.com.br,
epdlopes@hotmail.com, rm_anapaula@hotmail.com
Introduction: Malignant perivascular epithelial tumor (PEComa) is
a rare entity composed of different types of perivascular epithelioid cells
with variable immunoreactivity for melanocytic and muscle markers. The
natural history of this tumor is still unpredictable and the treatment is
controversial, especially in advanced cases.
Objectives: To describe an advanced case of soft-tissue PEComa of
the left external iliac artery with lung and pleural metastases associated
with extensive deep-vein thrombosis (DVT) of the left leg, and to give a
brief review of the literature.
Methods: The medical records of the case were analysed. Researches
of books and scientific articles at PubMed, MEDLINE and BIREME were
also used.
Results: AFLN, a 33-year-old male, presented with pain in the left
thigh that had existed for over 2 years; he had developed DVT in the left
lower limb (LLL) which had not been properly investigated. He noticed
a palpable lesion in the left inguinal region 15 months ago, developing a
pain on the left hemithorax associated with mild dyspnea. Physical examination involved lung auscultation with murmur abolished at the base of
the left hemithorax, and found a painful fixed mass on the left inguinal
region, not well defined, associated with swelling and no palpable pulse in
LLL. Chest CT showed pulmonary nodules and pleural effusion on the left.
Total abdominal CT showed a hypodense mass, 7.5 x 5.0 cm, involving
external iliac vessels and femoral artery bifurcation without bone invasion and/or lymph-node invasion. Pelvis and left tight resonance showed
infiltration of the hip joint. Thoracoscopy with biopsies of pleural nodules
was performed. Histopathology was suspicious for PEComa: malignant
mesenchymal tumor metastasis with epithelioid appearance and sometimes
perivascular distribution with fibrous stroma. The immunohistochemistry showed positivity for cytokeratin, HMB-45 and CD-31 and CD-34,
confirming the diagnosis of PEComa.The patient referred for palliative
chemotherapy.
Conclusion: The case reported is important for its rarity and the lack
of studies and appropriate protocols for treatment in this area. Another
important factor is the delayed diagnosis, which was definitely decisive
for the outcome.
029077
Pelvis reconstruction after hemipelvectomy using polyester and
collagen barrier mesh fixed by sutures placed through holes drilled in
the sacrum and remaining contralateral pelvic bones
Quadros, C.A.1, Guedes, A.2, Azevedo, R.M.C.3, Andrade, M.N.3,
Barreto, B.G.2, Prisco, E.3
1
Surgical Oncology Team, So Rafael Hospital, Salvador, Brazil,
2
Orthopedics Team, Santa Izabel Hospital, Salvador, Brazil, 3Medical
School, Bahia State University, Salvador, Brazil
alexguedes2003@yahoo.com.br,
renara.maga@hotmail.com, manaandrade@hotmail.com,
bbarreto@hotmail.com, emersonprisco@hotmail.com
ABSTRACTS
S217
Introduction: Hemipelvectomy is a surgical treatment for pelvic

sarcomas consisting of the removal of part or the whole hemipelvis. Major
neurovascular limb invasion defines whether preservation is possible or
not. It is a complex oncologic procedure. Pelvic reconstruction and stabilization after hemipelvectomies is a problem to be solved. Incisional hernias
occur with an incidence as high as 20%, affecting the bladder, colon and
small intestine. The use of polypropylene mesh has been described to avoid
incisional hernias after hemipelvectomies, but mesh placement is challenging because of the lack of firm tissue for fixation.
Objective: To describe a technique for containment of abdominal
viscera and prevention of incisional hernia after hemipelvectomies, using
mesh fixation via holes drilled in the remaing pelvic bones.
Methods: This case report describes pelvic reconstruction after a
type 4 internal hemipelvectomy using the technique of mesh fixation with
sutures placed through holes drilled in the sacrum and contralateral pelvic
bones. The mesh was the Covidien, Parietex Composite, offering a
resorbable collagen barrier on one side to limit visceral attachments and a
polyester knit structure on the other.
Results: A 24 year-old female patient with a 30-cm chondrosarcoma
invading the right ilium and pubic bones, psoas and gluteus muscles and the
anterior abdominal wall was submitted to type 4 internal hemipelvectomy
with limb preservation. Pelvic reconstruction was possible with the use of a
mesh that permits contact with abdominal viscera, retaining internal organs
in the peritoneal cavity after the resection. The mesh was fixed with sutures
placed medially in the rectus abdominis aponeurosis, dorsally in dorsal
muscles aponeurosis and through drill holes made posteriorly in the sacrum
and anteriorly in the contralateral pubic and ischium bones. There was no
postoperative morbidity.
Conclusion: The strategy of drilling holes in the remaining pelvic
bones for mesh fixation is a safe way of providing abdominal viscera
containment after hemipelvectomies and avoiding postoperative hernias.
029223
Primary malignant melanoma of the bladder: a case report and
review of the literature
Pinheiro, E.R.1, Chebel, M.J., Pitta
Junior, C.A., Ribeiro, M.M.Q., Bacchi, C.E.
1
Clnica medicina oncolgica, Limeira, SP, Brazil
028703
Pericardial synovial sarcoma: a case report and literature review
Saboia, L.V.1, Delabio, L.C.1, Fukushima, J.I.1, Boareto, A.M.1, BiondoSimoes, R.1, Mari, D.C.D.1
1
Sul, Brazil
028913
Rare presentation of melanoma with unknown primary site
Cruz, R.P.1, Rosa, M.R.D.1, de Pellegrin, B.B.B.1, Rodini, G.P.1,
Damiani, P.A.1
1
Department of Oncogynecology, Hospital Nossa Senhora da Conceio,
Porto Alegre, RS, Brazil
rachel_simoes@yahoo.com.br, clinirad@clinirad.com.br
Introduction: Primary cardiac tumors are rare. The purpose of this

report is to describe a case of synovial sarcoma of the pericardium with
good response to treatment and outcome
Case report: A woman presented with pain in the left shoulder with a
year of evolution, which has progressed to chest pain, dyspnea, edema and
pericardial effusion. Tests revealed pericardium damage. The patient underwent surgery with partial resection of a pericardial tumor. The pathological
examination, confirmed by immunohistochemistry, revealed a pericardial
synovial sarcoma. In this condition neoadjuvant chemoradiotherapy was
indicated. The patient was submitted to subsequent surgery with complete
resection, and then the treatment was completed with adjuvant chemoradiotherapy. The patient has remained asymptomatic in follow-up.
Conclusion: Primary cardiac tumors are rare. Data from a series
of 22 autopsies revealed a prevalence of 0.02%. Pericardial synovial
sarcomas are extremely rare. According to Yoshino et al. there have been
20 cases reported in the English literature. It is a very aggressive neoplasm.
Complete surgical resection is rarely achieved and is the main factor for
patient survival. In a case report complete resection was achieved only in
22.7% of patients. Survival is about 25 months.
Introduction: Only 2.5% of cutaneous melanomas metastasize to the

genital tract, the ovaries being the most commonly affected site. Only 10%
of melanomas with genital involvement reach the uterus; when they do, the
myometrium is affected more frequently than the endometrium.
Objectives: To report a rare initial presentation of melanoma with
metastasis to the endometrium.
Methods: The information has been obtained through review of
medical records, image exams performed, and review of the literature.
Results: A 46-year-old female was referred to our hospital after an
emergency hysterectomy for irregular vaginal bleeding of great intensity. Pathology showed a little differentiated malignant neoplasm in the
endometrium with myometrial invasion. Immunohistochemical analysis
revealed that the tumor cells expressed S100 (anti-human S100), HMB45
(HMB45 clone), Melan A (A103 clone) but not cytokeratin (AE1 and AE3
clones), compatible with metastatic melanoma. CT scans of the abdomen
and chest revealed metastases to the lung, liver, small intestine, mesentery,
left adrenal, and left inguinal lymph nodes. Fine-needle aspiration of the
left inguinal lymph nodes was compatible with metastases. Chemotherapy
with vemurafenibe was started. Follow-up CT control scans of brain, chest
and abdomen evidenced local progression in the left inguinal lymph node
and new metastatic implants in the right supraclavicular lymph nodes.
The patient underwent palliative left inguinal and right supraclavicular
eduardorpinheiro@gmail.com, michelchebelGmail.com
Introduction: Primary melanomas of the bladder are extremely rare.
We discribe a single case with a good prognosis during the actual follow up.
Objectives: To present a case of a 65-year-old woman with primary
melanoma of the bladder, and to perform a literature review to identify
reported cases of this disease.
Methods: A 65 year-old woman was undergoing investigation of
sporadic hematuria; a deep transurethral resection was performed, and a
pathological diagnosis of melanoma of the bladder was made. There was no
history of previous or regressed cutaneous malignant melanoma. Clinical
studies and radiological examinations were negative for other primary sites
of melanoma. There is no evidence of a tumor in 2 years of follow-up.
Results: Less than 30 cases of the disease have been reported. Rather
than being a primary lesion, malignant melanomas of the bladder are more
commonly metastatic lesions. The histopathological appearance mostly
does not differ from that of melanoma at other body sites. It is often
difficult to discriminate whether a bladder melanoma is primary or metastatic. Therefore, a careful review of histological features and the necessary performance of immunohistochemical staining procedures for S-100
protein and HMB-45 are very important in achieving a correct diagnosis.
Conclusions: Malignant melanoma in the bladder is very rarely seen
and has a poor prognosis. A careful review of histological features and
performance of necessary immunohistochemical staining procedures for
S-100 and HMB-45 are very important in achieving a correct diagnosis.
S218
lymphadenectomies about 1 year and 18 months, respectively, after the
initial presentation. Dermatological, gynecological, upper aerodigestive,
and anorectal evaluations were unremarkable. After 2 years of vemurafenibe, the patient presented with dizziness and fainting; brain CT showed
an expansive right parietotemporal intra-axial lesion. The patient died
without the primary site being discovered.
Conclusion: With melanomas of unknown sites, the lack of early
and specific signs contribute to late diagnosis and poor prognosis. This
case underscores that malignant melanoma can metastasize to rare sites,
including endometrium.
028627
Resection of an inferior vena cava sarcoma and venous reconstruction
with an autologous peritoneal tube
Pilleti, K.1, Magalhes, M.A.2, Dotto, M.S.3, Balzan, S.M.P.3
1
Faculade de Medicina, Universidade de Santa Cruz do Sul, Santa Cruz
do Sul, Brazil, 2Centro de Oncologia Inegrado, Hospital Ana Nery, Santa
Cruz do Sul, Brazil, 3Centro de Oncologia Inegrado, Hospital Ana Nery/
Faculdade de Medicina, Universidade de Santa Cruz do Sul, Santa Cruz
do Sul, Brazil
Introduction: Primary sarcoma of inferior vena cava (IVC) is a
rare neoplasm originating from the smooth muscle of the venous wall.
Complete resection results in improved survival. Venous reconstruction
can be performed with primary repair or an autologous venous patch for
smaller defects, usually with synthetic prostheses after major resections.
The use of an autologous peritoneal patch is described for venous reconstruction in many situations. However, venous reconstruction with the use
of an intravenous peritoneal tube is rarely used, despite its advantages over
synthetic implants.
Objective: To report the case of a primary leiomyosarcoma of the IVC
submitted to complete resection and venous reconstruction with an autologous peritoneal tube.
Methods: Review of records and a case report.
Results: An expansive mass involving the infrarenal segment of the
IVC was identified in a 68-year-old woman while a non-specific abdominal pain was being investigated. Ultrasound and CT angiography showed
a 7-cm extension lesion into the IVC, suggesting a primary tumor of the
vena cava. Complete resection of the affected segment of IVC and venous
reconstruction with an autologous fascial peritoneal tube was performed.
Histopathological and immunohistochemical analysis confirmed a lowgrade primary leiomyosarcoma of the IVC and expression of Ki-67 in
20% of the cells. Rivaroxaban anticoagulation was performed for 6 months
followed by antiplatelet therapy. Doppler ultrasound and CT scan 1 year
after resection showed adequate blood flow through the vein graft and no
evidence of tumor recurrence.
Conclusions: Venous reconstruction with an autologous peritoneal
tube graft is a low-cost technique, easy to perform, which avoids the disadvantages of synthetic prostheses. It is useful in the treatment of primary
sarcoma IVC that requires complete vascular reconstruction.
028408
Robot-assisted and video endoscopic inguinal lymphadenectomy for
melanoma and other malignancies
Molina, A.S.1, Moura, T.S.O.F.1, Bertolli, E.1, Duprat Neto, J.P.1,
Camaro, W.R.1, Oliva, E.1, Guimaraes, G.C.1, Favaretto, R.1
1
drandremolina@gmail.com,
thiagomour@yahoo.com.br,ebertolli@hotmail.com,joaopuprat@gmail.com,
ABSTRACTS
wrcamarco@msn.com,thiagomour@yahoo.com.br,guimaraesgc@gmail.com,
ricfavaretto@gmail.com
Background: It is known that radical lymphadenectomy can offer
a durable disease-free survival in stage III melanoma patients, but some
early and late complications are related to the procedure. Among the radical
lymphadenectomies for melanoma treatment, the radical groin dissection
(RGD) carries more postoperative morbidity. Patients undergoing RGD
may present 4060% morbidity with postoperative wound infection and
skin-flap necrosis, and may sometimes have larger dehiscence, leading to
a long healing process. The video endoscopic inguinal lymphadenectomy
(VEIL) and robot-assisted VEIL are less invasive procedures than the traditional technique.
Methods: This was a retrospective analysis of 11 stage III melanoma
patients and one patient with clear-cell carcinoma with an occult primary
site; they underwent video endoscopic inguinal lymphadenectomy in a
single institution. The surgeries were performed by two surgeons qualified for video and robot-assisted surgeries. Patients with no information on
follow-up were excluded from lymphedema analysis because lymphedema
is not possible to define in early postoperative stages. The stastistical analysis was made with Fisher exact test and regression.
Results: The mean follow-up after groin dissection was 13.8 months.
Nine patients underwent sentinel-node biopsy (SNB) prior to VEIL and
two had clinical groin disease diagnosed by fine-needle aspiration. Among
patients who underwent SNB, five had one sentinel node retrieved, two had
two and two had three. The median number of lymph nodes dissected in
VEIL was 14. If we consider the total number of lymph nodes, the median
was 12 nodes. The median length of drain was 20 days. Regarding postoperative complications, four patients had infection and two had dehiscence. Only three patients had symptoms and signs of lymphedema. Only
one patient had both dehiscence and infection. Robot-assisted surgery was
performed in two patients. There was no correlation between dehiscence,
infection and number of lymph nodes dissected and lymphedema.
Conclusions: Robot-assisted surgery and VEIL are related to lower
rates of postoperative complications. Although in this analysis both infection and dehiscence rates were high, they were lower than in the open
technique reported in literature. The number of lymph nodes retrieved was
higher than the number proposed by quality standards recommendation for
inguinal lymphadenectomy. Robot-assisted surgery and VEIL seem to be
safe for the treatment of melanoma inguinal metastasis, but a learning curve
is necessary to reduce morbidity.
028955
Solitary fibrous tumor of the pelvis: a case report
Fontes, A.A.1, Valena, L.B.1, Dias, J.J.S.1, Blohem, I.V.1,
Amaral, M.B.E.V.1, Boente, P.1
1
Centro de Hematologia e Oncologia da Bahia (CEHON), Brazil
angelofamed@hotmail.com,
loanavalenca@yahoo.com,jadeilton06@yahoo.com.br,igor.oncologia@gmail.com,
marciavillemor@hotmail.com, pboente@terra.com.br
Introduction: Solitary fibrous tumor (SFT) is an uncommon fibroblastic neoplasm, usually benign, with slow growth and a favorable prognosis, although 1015% are malignant. SFT can be detected in several
different anatomical sites.
Objectives: To report a case of SFT located in the pelvis and to review
the main aspects of the pathology and treatment.
Results: A 71-year-old woman presented with progressive pain in the
leg and left hip since 3 years earlier. Abdominal computed tomography (CT)
in February 2014 showed a large extraperitoneal mass in the left ischial
rectal fossa. The mass was well defined, solid and heterogeneous with
calcification areas and no invasion of adjacent organs. Work-up showed
ABSTRACTS
no other lesion. The patient underwent a CT-guided percutaneous biopsy
which suggested SFT. Wide surgical excision of the tumor was performed.
Grossly, the lesion measured 12 x 7. 5x 7.0 cm. The pathological report
revealed positive margins (bone invasion), pleomorphism, no necrosis and
10 mitotic figures per high-power field, confirming the diagnosis of malignant SFT. Local recurrence was observed 2 months after surgery with a 11
x 7.5 x 8.3 cm mass. The patient has been treated with temozolamide and
bevacizumab since December 2014 and her disease is stable.
Discussion: SFT is a rare mesenchymal neoplasm. The diagnosis is
based on histological features and positive staining for CD34, CD99 and
bcl-2 on immunohistochemistry (IHC). The IHC for the NAB2STAT6
fusion gene is considered specific to SFT. The factors associated with
malignant tumors are: size >10 cm, infiltrative margins, low expression of
CD34 and high expression of IGF2, hypercellularity, nuclear atypia, more
than 4 mitotic figures per 10 high-power fields. Complete surgical resection
is the only curative treatment. Anthracyclines, ifosfamide, dacarbazine,
temozolamide plus bevacizumab have shown antitumor activity in retrospective series.
Conclusions: We report a case of a rare malignant tumor; based
on the literature review, we have treated it with surgical excision and
chemotherapy.
028931
Squamous-cell carcinoma of the gluteal region: a case report
Guth, G.Z.1, Atade, L.O.1, Loureno, L.A.1, Ribeiro, L.R.1, Richwin, N.J.1,
Junior, L.C.V.1
1
Urgecy Surgery Department, Irmandade Santa Casa de Moresicrdia de
gguth@uol.com.br, lillianataide@hotmail.com, lara.lourenco@yahoo.com,
ribeirorlucas@live.com,nicolasrichwin@hotmail.com,junaoxd@hotmail.com
Introduction: Squamous-cell carcinoma is the second most common
skin cancer, accounting for about 20% of non-melanoma skin cancers. It
usually occurs in areas exposed to the sun and is related to chronic sun
damage, which means damage accumulation by ultraviolet radiation on the
skin throughout life.
Objective: To present a case for the rarity of the disease by its location.
Methods: We studied the case of a 52-year-old male from Limeira,
So Paulo, who was referred with only a buttocks lesion of approximately
1 years evolution; it had an ulcerated appearance with a reddish color associated with rough areas and was keratotic (yellowish/whitish crusts, hard
and rough).
Results: The patient submitted to the removal of the lesion with partial
withdrawal of the gluteus maximus muscle and placement in Z-plasty. The
patient developed partial necrosis of the flap which was redone a second
time; the patient evolved without further complications.
Conclusion: Squamous-cell carcinomas have a very aggressive
behavior with a complicated course. In their more severe forms, they may
become invasive and develop metastases, but the chances vary depending
on the size, depth and location of the lesion, among other parameters.
029118
Subscapular synovial sarcoma: a case report
Medeiros, M.F.1, Jacob, G.G.1, Leite, F.A.V.1, Nogueira, J.F.L.1
1
Department of general surgery, Hospital Universitrio Cincias Mdicas,
Belo Horizonte, Brazil
marinafontesm@gmail.com, gjacob@cirurgia.med.br,
fernandovleite@hotmail.com, jflimanogueira@gmail.com
Introduction: Synovial sarcomas (SSs) are rare tumors comprising
approximately 510% of soft-tissue sarcomas. They often affect the
S219
extremities (8095% of cases), particularly in the popliteal fossa among
teenagers and young adults (1540 years). Despite the name, the lesion
does not often appear in the intra-articular location, but usually occurs near
the joints.
Objectives: To report an unusual case of a 32-year-old male patient
with a subscapular synovial sarcoma.
Case report: A 32-year-old male patient presented with a back pain
and increasing volume of the right scapular region after a traumatic injury.
Four years after the traumatic episode he was submitted to a thoracic
magnetic resonance imaging (MRI) that revealed a subscapular 83, 16 cm
mass which was shown by biopsy and immunohistochemical studies to
be synovial sarcoma. The computed tomography (CT) and MRI did not
show any metastasis. The patient was submitted to radiotherapy before a
scapulectomy and nearby muscle resection. The immediate postoperative
period was without complications and the patient began follow-up as an
outpatient.
Conclusions: SS has been reported to be particularly likely to metastasize. Many factors modify patient outcome, such as tumor size, anatomical
localization and histological grade. In this case, the unusual localization
and the tumor size increase the chances of recurrence; that is why patient
review with location MRI and a chest CT is recommended to obtain early
diagnosis if there is a tumor recurrence.
028394
Surgical management of head and neck tissue sarcomas at Santa Rita
Hospital
Furtado, J.P.R.1, Laporte, G.A.1, Dragon, L.L.1, Barros, E.D.1, Zoletti, F.1,
Kwiatkonski, R.V.1, Correa, L.H.L.1, Oliveira, H.B.R.2, Molinari, V.K.2
1
Cincias da Sade de Porto Alegre, Brazil
Introduction: Soft-tissue sarcomas of the head and neck are a heterogeneous and rare group of tumors. They arise predominantly from embryonic mesoderm. Their main treatment is surgical, complemented with
radiotherapy and chemotherapy in selected cases.
Objectives: To describe clinical and pathological characteristics of
patients undergoing surgical intervention due head-and-neck soft-tissue
sarcoma.
2014, including patients submitted to surgical treatment for head-and-neck
soft-tissue sarcoma.
Results: The series included seven patients, of whom three were
female. Average age was 54.57 years. Our service performed seven
surgeries for primary lesions. The most common histopathological type
was dermatofibrosarcoma (three cases), followed by liposarcoma (one
case), malignant fibrous histiocytoma (one case) and neurofibrosarcoma
(one case). Regarding staging, we found three patients in stage I, another
three patients in stage II and one patient in stage IV.
Conclusions: Head-and-neck soft-tissue sarcomas are rare compared
to other sites. In the initial stages, the most common histopathological type
is dermatofibrosarcoma.
028607
Surgical management of liposarcoma at Santa Rita Hospital
Furtado, J.R.P.1, Laporte, G.A.2, Barros, E.D.1, Dragon, L.L.1,
Schnor, O.H.2, Conterno, J.2, Polo, R.2, Molinari, V.3, Strey, Y.T.M.3
1
S220
Introduction: Liposarcoma is a type of soft-tissue sarcoma. This
pathology has over 50 histological subtypes. Its main treatment is surgical
resection with negative margins, complemented with radiotherapy and
chemotherapy in selected cases.
Objectives: To describe clinical features, pathological characteristics
and survival outcomes of patients undergoing surgical intervention for
liposarcoma.
2014 including patients submitted to surgical treatment for liposarcoma.
Results: A total of 44 patients were included, among whom 24 were
female. Average age was 61.73 years. Our service performed 36 surgeries
for primary lesions, 30 procedures for recurring lesions and 17 for metastatic lesions. The most frequent location was the limbs (72.8%), followed
by the trunk (9.1%) and retroperitoneum (15.9%). We performed 13 radical
surgeries, with nine amputations, two re-amputations and two hemipelvectomies. Regarding staging and survival, we found five cases in stage I, nine
cases in stage II, 23 cases in stage III and one case in stage IV; 5-year
survivals were 100%, 90%, 50% and 100%, respectively.
Conclusions: Our epidemiological and survival results are similar to
those of other studies in the literature. This series mainly involved cases in
advanced stages, portraying Brazils public system reality.
028609
Surgical management of lower-limb soft-tissue sarcomas at Santa Rita
Hospital
Furtado, J.R.P.1, Laporte, G.A.2, Dragon, L.L.1, Kwiatkonski, R.V.2,
Zoletti, F.2, Leonardi, L.A.2, Correa, L.H.L.2, Oliveira, H.B.R.3,
Molinari, V.K.3
1
Introduction: Lower-limb soft-tissue sarcomas are a heterogeneous
group of rare tumors that arise predominantly from the embryonic mesoderm. The main treatment of this pathology is surgical, complemented with
radiotherapy and chemotherapy in selected cases.
Objectives: To describe clinical and pathological characteristics,
as well as survival rates of patients undergoing surgical intervention for
lower-limb soft-tissue sarcoma
2014 including patients surgically managed for lower-limb soft-tissue
sarcoma.
Results: A total of 86 patients were included, of whom 52 were female.
Average age was 49.36 years. Our service performed 70 surgeries for
primary lesions, 56 procedures for recurring lesions, and 50 for metastatic
lesions. Among these, we performed 31 radical surgeries, with ten primary
amputations, ten amputations for recurrent disease, six re-amputations and
five hemipelvectomies for recurring lesions. The most common histopathological type was malignant fibrous histiocytoma (26.7%), followed by
liposarcoma (19.8%) and synovial sarcoma (15.1%). Regarding staging
and survival rates, we found 22 cases in stage I (25.6%), 20 cases in stage
ABSTRACTS
II (23.3%), 34 cases in stage III (39.5%) and 10 in stage IV (11.6%); 6-year
survival rates were 95%, 70%, 40% and 0%, respectively.
Conclusions: Our epidemiological and survival results for lowerlimb soft-tissue sarcomas are similar to those described in the literature.
The overall survival in this series was influenced by the high incidence of
advanced tumors (stage III and IV), a typical epidemiological characteristic
of our country.
028610
Surgical management of malignant fibrous histiocytoma at Santa Rita
Hospital
Furtado, J.R.P.1, Laporte, G.A.2, Dragon, L.L.1, Schnor, O.H.1,
Conterno, J.2, Polo, R.2, Zoletti, F.2, Oliveira, H.B.R.3, Strey, Y.T.M.3
1
Introduction: Malignant fibrous histiocytoma is a type of soft-tissue
sarcoma. According the WHO guidelines, this diagnosis should be considered only in lesions composed of tumor cells without evidence of a specific
differentiation line. In other words, its diagnosis is made by exclusion of
other pathologies. Its main treatment is surgical, complemented with radiotherapy and chemotherapy in selected cases.
Objectives: We aim to describe clinical and pathological characteristics, as well as survival rates, of patients undergoing surgical intervention
for malignant fibrous histiocytoma.
2014 including patients surgically managed for malignant fibrous
histiocytoma.
Average age was 61.73 years. Our service performed 36 surgeries for
primary lesions, 30 procedures for recurring lesions and 17 for metastatic
lesions. The most frequent location was the limbs (72.8%), followed by
the trunk (9.1%) and retroperitoneum (15.9%). We performed 13 radical
surgeries, with nine amputations, two re-amputations and two hemipelvectomies. Regarding staging and survival, we found five cases in stage I, nine
cases in stage II, 23 cases in stage III and one case in stage IV; 5-year
survival rates were 100%, 90%, 50% and 100%, respectively.
those of other studies in the literature. This series mainly included cases in
advanced stages, portraying Brazils public system reality.
028613
Surgical management of retroperitoneal soft-tissue sarcomas at Santa
Rita Hospital
Furtado, J.P.R.1, Laporte, G.A.2, Barros, E.D.1, Dragon, L.L.1,
Kwiatkonski, R.V.2, Leonardi, L.A.2, Correa, L.H.L.2, Molinari, V.3,
Strey, Y.T.M.3
1
ABSTRACTS
Introduction: Retroperitoneal sarcomas are a heterogeneous group of
rare tumors. They predominantly arise from the embryonic mesoderm. The
main treatment is surgical, complemented with radiotherapy and chemotherapy in selected cases.
Objectives: We aim to describe clinical and pathological characteristics, as well as survival rates of patients undergoing surgical intervention
for retroperitoneal soft-tissue sarcoma
Methods: This is an historic cohort study from May 2000 to December
2014 including patients surgically managed for retroperitoneal soft-tissue
sarcoma.
Results: A total of 32 patients were included, of whom 15 were
for primary lesions, 12 procedures for recurring lesions and four interventions for metastatic lesions. The most common histopathological type was
liposarcoma (40.6%), followed by malignant fibrous histiocytoma (21.9%)
and leiomiosarcoma (21.9%). Regarding staging and survival, we found
12 cases in stage I (37.5%), one case in stage II (3.1%), 15 cases in stage
III (46.9%) and four in stage IV (12.5%); 5-year survival rates were 90%,
90%, 70% and 0%, respectively.
Conclusions: Our epidemiological and survival results for retroperitoneal soft-tissue sarcomas are similar to those previously described in
literature. The overall survival of patients in this series was influenced by
the high incidence of advanced tumors (stages III and IV), a typical epidemiological characteristic of our country.
028614
Surgical management of soft-tissue sarcomas in women at Santa Rita
Hospital
Furtado, C., Schorn, O.H.2, Polo, R.2, de Morais, C.O.3, Molinari, V.K.3
1
Introduction: Soft-tissue sarcomas are a rare and heterogeneous group
of tumors. They arise predominantly from the embryonic mesoderm. Their
main treatment is surgical, complemented with radiotherapy and chemotherapy in selected cases. Especially in women, this pathology can have an
important psychological impact.
Objectives: To describe the clinical presentation, pathological characteristics and survival rates of female patients undergoing surgical intervention for soft-tissue sarcoma.
2014 including female patients surgically managed for soft-tissue sarcoma.
Results: A total of 131 female patients were included. The average age
was 51.36 years. Our service performed 105 surgeries for primary lesions,
45 procedures for recurring lesions and 32 for metastatic lesions. The most
common location was the limbs (53.4%), followed by the trunk (32.8%) and
retroperitoneum (11.5%). Among these, we performed 28 radical surgeries,
with 19 amputations, three re-amputations and six hemipelvectomies. The
most frequent histopathological type was malignant fibrous histiocytoma
(18.3%), followed by leiomiosarcoma (15.3%) and liposarcoma (12.2%).
Regarding staging and survival, we found 32 cases in stage I, 35 cases in
stage II, 45 cases in stage III and 19 in stage IV; 5-year survivals were 90%,
80%, 55% and 50%, respectively.
those previously described in the literature. The overall survival of this
series was influenced by the high incidence of advanced tumours (stages
S221
III and IV). Nevertheless, we had good prognosis by using complementary
treatment with radiotherapy and chemotherapy.
028602
Surgical management of soft-tissue sarcomas at Santa Rita Hospital
Furtado, J.R.P.1, Laporte, G.A.1, Barros, E.D.2, Dragon, L.L.2,
Furtado, C., Schorn, O.H.1, Leonardi, L.A.1, Oliveira, H.B.R.3,
Strey, Y.T.M.3
1
Misericrdia de Porto Alegre, Brazil, 3Universidade Federal de Cincias
da Sade de Porto Alegre, Brazil
Introduction: Soft-tissue sarcomas are a rare and heterogeneous group
of tumors. They arise predominantly from the embryonic mesoderm. Their
main treatment is surgical, complemented with radiotherapy and chemotherapy in selected cases.
Objectives: To describe the clinical presentation, pathological characteristics and survival rates of patients undergoing surgical intervention for
soft-tissue sarcoma.
2014 including patients surgically managed for soft-tissue sarcoma.
for primary lesions, 129 procedures for recurring lesions and 99 interventions for metastatic lesions. Among these, we performed 57 radical
surgeries, with 40 amputations, seven re-amputations and ten hemipelvectomies. The most common location was the limbs (67.7%), followed by the
trunk (15.7%) and retroperitoneum (13.6%). The most frequent histopathological type was malignant fibrous histiocytoma (18.7%), followed by
liposarcoma (18.3%) and leiomiosarcoma (11.1%). Regarding staging and
survival, we found 70 cases in stage I, 55 cases in stage II, 83 cases in stage
III and 27 in stage IV; 5-year survivals were 90%, 70%, 55% and 30%,
respectively.
those previously described in the literature. The overall survival of this
series was influenced by the high incidence of advanced tumours (stages
III and IV).
028616
Surgical management of soft-tissue sarcomas of the extremities at
Santa Rita Hospital
Furtado, J.P.R.1, Laporte, G.A.2, Barros, E.D.1, Dragon, L.L.1, Polo, R.2,
Kwiatkonski, R.V.2, Zoletti, F.2, Oliveira, H.B.R.3, Strey, Y.T.M.3
1
Introduction: Soft-tissue sarcomas of the extremities are a rare and
heterogeneous group of tumors, arising predominantly from the embryonic
mesoderm. Their main treatment is surgical, between wide excision and
radical amputation. Additionally, surgery can be complemented with radiotherapy and chemotherapy in selected cases.
S222
Objectives: To describe the clinical presentation, pathological characteristics and survival rates of patients undergoing surgical intervention for
soft-tissue sarcoma of the extremities.
extremities.
for primary lesions, 80 procedures for recurring lesions and 60 for metastatic lesions. In this series 69.9% of lesions were located in the lower
limbs and 30.1% in the upper limbs. We performed 46 radical surgeries,
with 34 amputations, seven re-amputations and five hemipelvectomies for
recurring lesions. The most common histopathological type was malignant
fibrous histiocytoma (26%), followed by liposarcoma (17.1%) and synovial
sarcoma (13%). Regarding staging and survival, we found 31 cases in stage
I (25.2%), 34 cases in stage II (27.6%), 48 cases in stage III (39%) and
ten in stage IV (8.1%); 5-year survivals were 95%, 80%, 50% and 10%,
respectively.
Conclusions: Our epidemiological and survival results for soft-tissue
sarcomas of the extremities are similar to those previously described in the
literature. The overall survival of this series was influenced by the high
incidence of advanced tumors (stages III and IV), a typical epidemiological
characteristic of our country.
028620
Surgical management of trunk soft-tissue sarcomas at Santa Rita
Hospital
Furtado, C., Leonardi, L.A.2, Correa, L.H.L.2, Molinari, V.3, Strey, Y.T.M.3
1
Introduction: Trunk soft-tissue sarcomas are a rare and heterogeneous
group of tumors. They arise predominantly from the embryonic mesoderm.
The main treatment for this pathology is surgery, complemented with radiotherapy and chemotherapy in selected cases.
Objectives: We aim to describe clinical presentation, pathological
characteristics and survival rates of patients undergoing surgical intervention for trunk soft-tissue sarcoma.
trunk.
The average age was 52.51 years. Our service performed 59 surgeries
for primary lesions, 37 procedures for recurrent lesions and 45 for metastatic lesions. We performed five hemipelvectomies for recurring lesions.
The most frequent histopathological type was leiomiosacorma (13.7%),
followed by dermatofibrosarcoma (12.3%), liposarcoma (11%) and carcinosarcoma (9.6%). Regarding staging and survival, we found 24 cases in
stage I (32.9%), 17 cases in stage II (23.3%), 20 cases in stage III (27. 4%)
and 12 in stage IV (16.4%); 5-year survivals were 75%, 65%, 50% and
10%, respectively.
Conclusions: Our epidemiological and survival results for trunk softtissue sarcomas are similar to those previously described in the literature.
The overall survival of this series was influenced by the high incidence of
advanced tumors (stages III and IV), a typical epidemiological characteristic of our country.
ABSTRACTS
028621
Surgical management of upper-limb soft-tissue sarcomas at Santa
Rita Hospital
Furtado, C., Schorn, O.H.2, Leonardi, L.A.2, Oliveira, H.B.R.3,
Molinari, V.K.3
1
Introduction: Tissue sarcomas of the upper limbs are a rare and heterogeneous group of tumors that predominantly arise from the embryonic
mesoderm. Their main treatment is surgical, complemented with radiotherapy and chemotherapy in selected cases.
Objectives: To describe the clinical and pathological characteristics
of patients undergoing surgical intervention for upper-limb soft-tissue
sarcoma.
2014 including patients surgically managed for upper-limb soft-tissue
sarcoma.
The average age was 48.24 years. Our service performed 27 surgeries for
primary lesions, 24 procedures for recurring lesions and ten for metastatic
lesions. We performed 15 radical surgeries, with ten primary amputations, four amputations for recurrent disease, and one re-amputations for
recurrent lesions. The most frequent histopathological type was malignant
fibrous histiocytoma (24.3%), followed by dermatofibrosarcoma (10.8%),
liposarcoma (10.8%) and epithelioid sarcoma (10.8%). Regarding staging,
we found 22 cases in stage I (24.3%), 20 cases in stage II (37.8%), 34 cases
in stage III (37.8%) and 0 in stage IV (0%).
Conclusions: Our epidemiological and survival results for the upper
limb soft-tissue sarcomas are similar to those previously reported in the
literature. This series has a high incidence of radical surgeries due the large
number of advanced tumors with involvement of the neuromuscular bundle
at the time of the surgery.
028267
Synchronous cutaneous melanoma: a case report
Silva, L.C.1, Silva, M.C.1, Nunes, L.F.1
1
National Institute of Cancer, Rio de Janerio, Brazil
liliti.silva@hotmail.com
Introduction: The definition of multiple synchronous melanomas
applies when the second primary melanoma is diagnosed within 13
months of the occurrence of the first malignancy.
Objectives: To present a case in which two synchronous primary
melanomas became clinically evident at the same time in a woman whose
family history of melanoma is positive.
Methods: Descriptive method, case report.
Results: The case was a 33-year-old Brazilian woman with a two
primary melanomas, one on her left foot and other on her back; she
presented last year with an extended growth and bleeding.
Conclusions: In this case, the two lesions were located in different
anatomical areas and became clinically evident at the same time. The
literature reports body site concordance in the location of synchronous
melanomas, and that the definition of multiple synchronous melanomas
applies when the second primary melanoma is diagnosed within 13
months of the first.
ABSTRACTS
029110
Synovial sarcoma of left thigh: a case report
Barros, A.V.1, Medrado, P.C.1, Oliveira, F.A.P.F.1, Melo, C.L.A.1,
Melo, R.S.1, Cmara, C.B.S.1
1
Brazil
aldobarros@ig.com.br, patriciamedrado@hotmail.com,
fapfo.med@uol.com.br, ciceroludgero@ig.com.br, roberiomelo@uol.com.br,
camarac@hotmail.com
Introduction: The synovial sarcoma is a rare tumor and represents
around 510% of all soft-tissue sarcomas. These tumors originate from the
multipotential mesenchymal cells; incidence is higher in the young, with an
average age ranging of 1535 years. A slight predominance of males has
been observed. Synovial sarcomas are more common on the extremities,
although they can occur in any part of the body with no relation to synovial
membranes. They typically appear as a painful mass with slow growth next
to a large joint, especially in the region of knee. Histologically there may be
two types: monophasic and biphasic. The risk of developing distant metastases is higher in patients with tumor size >5 cm.
Objective: Present a case of lower limb sarcoma underwent radical
treatment with limb preservation.
Methods: The patient was a 28-years-old male who had had a tumor
in his left thigh for 6 months; the tumor showed progressive growth. He
underwent incisional biopsy which gave a diagnosis of lipoma. MRI
showed a massive heterogeneous lesion (11 x 8.2 x 5.9 cm) with areas of
cystic/necrotic degeneration located in the medial aspect of the middle third
and proximal thigh, between the adductor longus, magnum and sartorius,
in close contact with the superficial femoral vascular bundle, suggestive
of a primary neoplasm of sarcomatous lineage. Staging tests revealed no
metastatic disease. The patient underwent wide resection of the tumor with
vascular preservation; limb amputation was not necessary.
Results: The patient had a good postoperative course and was
discharged from hospital on the 4th POD. Immunohistochemistry on the
surgical specimen showed a biphasic synovial sarcoma with necrosis, 9
mitoses/10 CGA. The patient underwent adjuvant treatment with chemotherapy and radiation without complications. He has been attending as an
outpatient for 10 months with no evidence of recurrence.
Conclusions: In soft-tissue sarcomas, whenever possible radical
surgery with preservation of the limb should be indicated, allowing no loss
in quality of life without compromising the oncological outcome.
028915
Treatment of desmoid tumors first non-surgical approach: initial
experience of an institution
1
Introduction: Desmoid tumors are benign monoclonal myofibroblastic tumors that are slow growing, coming from and infiltrating the
muscleaponeurotic tissues. The treatment of these tumors has been mostly
surgical, but recently it has been considered that surgery should not be
performed without a better understanding of the behavior of the individual
lesions, with a strategy of surveillance or first-line drugs.
Objective: To maintain local control rates, favorable outcomes being
stable disease or regression, even without the need for surgery.
S223
Method: In February 2015 our institution started a new treatment
protocol for desmoid tumors, applying a non-surgical approach with only
observation or with oral medications, depending on the location of the
tumors and symptoms. The follow-up of patients is given monthly, each 3
months or 6 months until the third year.
Results: In total, nine patients were admitted to our institution. Two
of them had already been operated, but with compromised margins. The
average tumor size was 5.9 cm largest dimension, with four cases of location in the shoulder girdle. Six patients are being treated with tamoxifen
and/or NSAIDs and have a partial response; the remainder have stable
disease.
Conclusion: In view of the literature, this proposal aims to spare
patients from unnecessary mutilating surgery, without adding risk to them.
Longer follow-up and higher numbers of cases are necessary to confirm
this.
028911
Treatment protocol of high-grade soft-tissue sarcomas of extremities
(STSE) with neoadjuvant chemotherapy and hypofractionated
radiotherapy: initial experience of an institution
1
Introduction: The main treatment for high-grade STSE is multimodal,
including surgery, radiotherapy and chemotherapy. In 2014 our institution
finalized a treatment cycle with a total of 48 cases treated exclusively
with neoadjuvant chemotherapy followed by surgery; patients with highgrade tumors located in the limbs and not amenable to adequate resection
underwent adjuvant radiotherapy. With a median follow-up of 40 months,
the overall survival (OS) was 78.1%. Patients with surgical specimens
containing 10% of viable cells after neoadjuvant chemotherapy had better
OS and distant disease-free rates. However, of 36 patients treated with curative intent, only nine achieved this result. In order to increase the tumor
necrosis rate in patients with STSE not amenable to adequate resection,
correlating with survival, we propose a treatment regimen that involves,
in addition to neoadjuvant chemotherapy, the association of concomitant
hypofractionated radiotherapy (HRT).
Objective: To compare the disease-free survival rates of this cohort
with those of patients treated exclusively with neoadjuvant chemotherapy.
Methods: This is a prospective phase II study, not controlled, started
in February 2015. The end of recruitment is planned for December 2018.
Patients with high-grade STSE not amenable to adequate resection will be
included. The treatment plan will be: three cycles of preoperative chemotherapy (each 21 days), in conjunction with HRT (concomitant with the
C2). Surgery will be performed 46 weeks after the C3. Three more cycles
of chemotherapy will be given for patients with 30% viable cells in
surgical specimens.
Results: We have a total of for patients enrolled so far; two have been
operated. Both cases had <30% viable cells in surgical specimens and
are now receiving chemotherapy. There were no complications related to
chemotherapy or HRT.
Conclusion: Given the preliminary results, the proposed treatment did
not present unacceptable complications that might require discontinuation
of treatment. Longer follow-up and higher numbers of cases are required.
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029157
Uveal melanoma: a case report
Lustosa, A.G.1, Filho, K.J.C.2, Bezerra, C.F.2, Gis, M.C.2,
Oliveira, I.B.M.D.2, Medeiros, K.M.O.T.2, Pires, T.C.3, Corra, R.S.2,
Lira, G.A.1
1
Natal, Brazil
Introduction: The ocular melanomas correspond to 5% of all
melanomas, and 85% of them have their origin in the uveal tract.
Objectives: To demonstrate through a patient case report of uveal
melanoma its clinical aspects, diagnosis and treatment.
Methods: Patient AGC, a 70-year-old female from Natal, Brazil,
presented 4 months ago with the appearance of an eye injury, accompanied by xerophthalmia and itching. Physical examination showed a hyperchromic lesion, fibroelastic, mobile, painless, non-adherent to the deep
planes, located on the left eyelid, with dimensions of 2 x 2 x 2 cm. There
were no palpable lymph nodes in the submandibular, cervical and infraclavicular chains. Anatomicopathology (08/16/13) showed a melanoma in
the vertical growth phase, with a low mitotic index and the presence of
peritumoral and intratumoral inflammatory infiltrate. Computed tomography (CT) of the chest (09/19/2013) showed pulmonary micronodules
scattered bilaterally, and the right subclavian artery of aberrant origin.
Skull CT (09/19/2013) showed a small left frontal cerebral granuloma.
CT of the abdomen (09/19/2013) showed a cyst in the left kidney. Chest
CT 2 months later (11/26/2013) showed persistence of the micronodules,
sequelae granulomas, and diffuse enlargement of the thyroid. Orbital CT
(06/06/2014) showed the presence of amorphous tissue partially filled at
the orbital surgical margins, associated with reactional hyperostosis of
the orbital walls; this tissue was of non-specific aspect, and is probably
reactional, but we cannot exclude activity on injury. Orbital magnetic resonance (08/04/2014) did not show obvious disease. On 03/27/2015, fineneedle aspiration was performed on the left parotid, revealing epithelial
cells without activity and a cervical nodule with metastatic melanoma. A
further chest CT (03/16/2015) still showed micronodules.
Results: The patient was submitted to exeresis of the left orbit, left
parathyroidectomy, with sacrifice of the facial nerve and neck dissection
II, III and IV to the left; she was then referred for radiotherapy. She was
discharged and was to return at 21 days to follow-up.
Conclusions: The main determinant factor in the choice of treatment
is the size of the tumor lesion.
028902
Primary malignant melanoma of the vagina
Firmino, N.L.J.1, Miranda, P.H.D.2, Miranda, E.2, Arruda, A.E.3,
Ramalho, W.C.1, Ximenes, L.M.1, Pordeus, A.L.B.1, Azevedo, L.W.1,
Gomes, A.S.A.2
1
2
3
nflj_@hotmail.com, mirandaphd@hotmail.com,
emiranda.onco@gmail.com, amandaiehuda@hotmail.com,
drwcramalho@gmail.com, lucasmartinsximenes@gmail.com,
luisa.pordeus@gmail.com,laiswa.med@gmail.com,alexandre.unionco@gmail.com
Introduction: Primary malignant melanoma of the vagina is a rare
and aggressive tumor that most commonly affects postmenopausal women.
Most cases are diagnosed at an advanced stage, and the prognosis is very
poor as nearly 80% of vaginal melanomas will recur. Late diagnosis and the
ABSTRACTS
existence of a rich vascular and lymphatic network in the vaginal mucosa
can contribute to early tumor spread and the development of metastases.
The 5-year survival rate for vaginal malignant melanoma ranges from 0%
to 25%.
Objectives: To describe a clinical case of a vaginal melanoma.
Methods: A 73-year-old patient with a vaginal tumor underwent a local
resection of a lesion on the anterior third of the vagina. Histopathological
findings were ulcerated malignant melanoma of the vaginal mucosa, with
Breslow thickness of 4.5 mm. Lateral and deep surgical margins were not
clear. Head and pelvic MRIs, chest x-ray, PET-CT and CT of the abdomen
didnt reveal any signs of lymphadenopathy or metastases. During physical
examination, lesions were identified on both inner surfaces of the labia
major.
Results: The patient underwent a partial vaginectomy. Histopathological
findings showed a melanoma on the posterior margin of the urethral orifice,
with Breslow thickness of 9 mm, invading the lamina propria, and with
vascular invasion. Deep surgical margin was focally positive, and other
margins were clear. Immunotherapy was recommended with high doses of
interferon, followed by pelvic radiotherapy and brachytherapy.
Conclusion: There is no standard treatment protocol for vaginal
primary malignant melanoma. Conservative wide local excision, radical
surgery, radiotherapy, immunotherapy and chemotherapy are therapeutic
options. However, surgery remains the primary treatment of choice.
Immunotherapy with interferon offers survival benefits in patients at high
risk for recurrence. In previous studies, melanoma ulceration was associated with a worse prognosis, but it has also been identified as a predictive
marker for response to adjuvant interferon therapy.
029136
Video endoscopic inguinal lymphadenectomy for metastatic
melanoma: a video report
Camaro, W.R.1, Molina, A.S.1, Bertolli, E.1, Duprat, J.P.1
1
wrcamarco@msn.com, drandremolina@gmail.com,
ebertolli@hotmail.com, joao.duprat@accamargo.org.br
Introduction: Inguinal lymphadenectomy is the standard treatment
for inguinal lymph-node metastases of melanoma, but the morbidity rate
associated with the conventional technique is near to 50%. Video endoscopic inguinal lymphadenectomy (VEIL) is an alternative minimally invasive technique.
Objectives: To report a case and show the video of VEIL performed in
a patient with inguinal metastatic melanoma
Methods: A 65-year-old patient was submitted to excision of a lesion
on her right thigh. The pathology report revealed a melanoma Breslow
1.65 mm. Sentinel-node biopsy was performed in the groin and was positive for metastatic melanoma. We performed VEIL in the following steps:
the patient was placed supine on a split-leg table; the boundaries of the
femoral triangle were drawn on the skin with a surgical pen; one 12-mm
balloon trocar was placed distal to the apex of the triangle after incising
the skin and sharply dissecting down through the Scarpa fascia, and two
other 5-mm trocars were placed on each side; the dissections were carried
under the Scarpa fascia with a bipolar vessel-sealing device; the node
packet was sectioned laterally above the sartorius and medially above the
long adductor; on the apex, the saphenous vein was sealed and cut; the
femoral vessels were identified and dissected from inferior to superior until
the saphenofemoral junction was identified, dissected and transected with
a stapler; the packet was separated from the inguinal ligament and became
free in the cavity; the scar of the previous node biopsy was excised and the
node packet was extracted; the wound was sutured and a drain was placed.
ABSTRACTS
Results: The patient had no wound complication in the postoperative
period. Thirteen lymph nodes were retrieved and one additional lymph
node was positive for malignancy.
Conclusion: Video endoscopic inguinal lymphadenectomy is a minimally invasive technique that minimizes wound complications while
achieving comparable oncological control, preserving oncological radicality of surgery.
S225
S226
Neoplasms of the head and neck and chest

029263
Forty-three thyroidectomy cases with prior cytology classified by the
Bethesda system
Moreira Junior, D.N.1, Queiroz, A.C.1, Moreira, L.C.1, Santos, F.P.1,
Maia, W.S.1, Barreto, R.O.1
1
LAPPAQ-Pathology Laboratory of Santa Casa, Itabuna, Brazil
dariomoreira@yahoo.com.br,
acheto10@hotmail.com,lilian_lcm@hotmail.com,francine.biofarm@gmail.com,
wesllenmaia@hotmail.com, rafael_barreto@hotmail.com
Introduction: The presence of a thyroid nodule doesnt necessarily
imply the presence of cancer. A well done fine-needle aspiration and a
cytopathological report written in clear language are essential to decrease
the number of unnecessary surgeries in patients with benign nodules or to
enable an adequate triage in patients with malignancy.
Objectives: To study 43 thyroidectomy cases performed throughout
the last 5 years in our service, with cytohistological correlation by the
Bethesda system.
Methods: All the thyroidectomy cases with prior cytology were gathered, including cases of partial and total thyroidectomy, correlating them
with the Bethesda classification, and cytology reports with the histopathological diagnosis. Pathocontrol software was used, and all the cytology and
histology sheets were put side by side to be revised and to considered from
a critical position.
Results: From 43 cases of thyroidectomy, 20 presented a histological diagnosis of nodular goiter, 17 were papillary carcinomas, two were
follicular carcinomas, one was medullary carcinoma, two were follicular
adenomas and one was chronic lymphocytic thyroiditis (Hashimoto). As
for the correlated cytologies, two were classified as Bethesda VI, 13 as
Bethesda V, nine as Bethesda IV, six as Bethesda III and 13 as Bethesda
II. 100% of Bethesda VI and 61% of Bethesda V were malignant; 44%
of Bethesda IV were diagnosed as follicular lesions on histology, wherein
two were follicular adenomas and two follicular carcinomas. Of Bethesda
III lesions, 50% were found to be benign and the remainder were papillary
carcinoma; 84% of Bethesda II were found to be nodular goiter.
Conclusions: Thyroid cancer is the most common neoplasia in the
head and neck region. For a precise diagnosis and adequate treatment a
versatile multi-professional team with easy and clear communication are
necessary. In our case-by-case study 38% of the cases classified as Bethesda
V were nodular goiter on histology, and 33% of Bethesda IV were papillary
carcinomas. In constrast, only two out of 13 Bethesda II cases were falsenegatives (15%).
029246
Advanced osteosarcoma of the mandible: a case report
Genaro, A.1, Ribeiro, D.G.1, Netto, W.J.M.2, Finotti, A.S.2, Filho, M.A.F.1,
Horie, M.K.S.2
1
Prudente, Brazil
andregennaro@hotmail.com,
diogogr83@gmail.com, willymacedo@gmail.com, amandasf92@gmail.com,
franco.80@hotmail.com, matheus_horie@hotmail.com
Introduction: Osteosarcoma (OS) of the mandible is rare. Although
osteosarcoma represents approximately 20% of sarcomas, only 5% occur in
the jaw. OS of long bones is most common in children and adolescents, and
the most common sites of metastasis are the lungs, occurring in 3040%
of cases. OS of the jaw, on the other hand, affects adults at around the 3rd
and 4th decades, and metastases are rare, with local recurrence being the
ABSTRACTS
main cause of death. The 5-year survival rates for primary OS of the jaw
vary from 30 to 40%, rising to over 80% when early radical resection is
performed.
Objective: To describe a case of advanced OS of the jaw with an
excellent surgical outcome, from January 9 to June 13, 2015.
Methods: This was a medical record survey, case report description,
and discussion based on books and online database review.
Results: A 47-year-old female patient sought our services on January
9, 2015 due to a rapidly growing nodular lesion in the right jaw (30 days)
with sessile implementation and an ulcerated surface. The anatomopathology on February 10 revealed an osteosarcoma in the right mandible
with chondroblastic areas of differentiation. A face MRI performed on
February 27 showed a lesion measuring 6.4 x 5 x 4.3 cm. A chest CT scan
showed no deviations. The patient was submitted to three cycles of neoadjuvant chemotherapy and underwent a right hemimandibulectomy, a level
Ia and Ib lymphadenectomy, and a pectoralis major muscle flap on June 13,
with no surgical complications and an excellent outcome.
Conclusion: OS of the jaw is rare; early diagnosis and adequate
resection are essential for survival. Where adequate resection is possible,
surgery alone is appropriate, while adjuvant therapy should be considered
in cases with inadequate margins. In general, OS of the jaw shows positive
outcomes, and despite the complex resection involved surgery may result in
a significant increase in quality of life, self-image, and possibility for cure.
028306
Anaplastic thyroid carcinoma: a case report
Melo, I.S.1, Freitas, H.C.1, Fonteles, A.F.1, Bezerra, D.A.1, Pereira, T.C.U.1,
Oliveira, T.O.1
1
acd.isadoramelo@gmail.com, hermanycf@hotmail.com,
amandafonteles81@gmail.com, diegobezerra.onco@gmail.com,
tiagomedicina@gmail.com, thaisoliveirasilva27@gmail.com
Introduction: Anaplastic thyroid carcinomas (ACTs) are thyroid
follicular epithelial undifferentiated tumors. They represent the most
advanced stage in the dedifferentiation of papillary or follicular carcinoma.
The importance of ACT lies in its rarity and aggressiveness in relation
to other thyroid cancers, making it difficult to perform more conclusive
studies.
Objective: To report an ACT with atypical characteristics, confirmed
by biopsy and cervical computed tomography (CCT), and its evolution.
Methods: A 33-year-old female, previously healthy, began a progressive dysphagia 7 months ago, progressing to weight loss of 6 kg. During
upper digestive endoscopy (UDE), it was impossible to progress beyond
the cricopharyngeal muscle; lesions were not displayed. The esophagogram
showed reduced flow in the cervicalthoracic transition, with a slight diameter reduction. CCT was initially unchanged. Three UDEs were performed
without endoscope progression, with dilatation of the stenotic area with
a balloon, aiming to introduce a nasogastric tube to ensure nutritional
support. In evolution, bronchoscopy showed inflammation of the larynx
and trachea. Cervical ultrasonography showed hypoechogenicity of the
thyroid right lobe. New CCT showed tracheal deviation due to a heterogeneous mass.
Results: We opted for the realization of cervicotomy. A whitish and
stony mass was revealed, relating to the trachea and esophagus. Extension
to deep planes was impossible to determine. A sample was collected for
biopsy, and the pathology results showed undifferentiated adenocarcinoma
of the thyroid. A slide review and immunohistochemistry were requested,
and these confirmed the diagnosis of ATC. The TNM classification
considers all anaplastic carcinomas as T4. It was classified as T4b (tumor
beyond the thyroid capsule), considered unresectable.
ABSTRACTS
Conclusion: ATC comprises 12% of primary thyroid tumors. It
primarily affects females. About 50% of patients have a history of goiter or
well-differentiated thyroid carcinoma. A large percentage of these patients
have a 320-cm cervical mass of rapid growth, painful, hard and fixed to
the deep planes. The tumor quickly adheres and invades adjacent structures
such as the trachea, esophagus and sternocleidomastoid muscle.
029271
Basosquamous carcinoma ulcerated with open fracture of the right
collarbone with thoracoplasty reconstruction: a case report
Winkelmann, C.P.1, Chiaradia, C.P.1, Kurtz, G.S.T.2, Pr, R.B.3, dos
1
Universidade de Caxias do Sul, Brazil, 2Universidade de Passo Fundo,
Brazil, 3Hospital Geral de Caxial do Sul, Brazil
clapw@terra.com.br,crisllipreussler@gmail.com,guilhermestkurtz@gmail.com,
Introduction: Basosquamous carcinoma (BSC) is a rare neoplasia
which has histopathological features of squamous-cell carcinoma (SCC)
and basal-cell carcinoma (BC) connected by a transition area.
Objective: To report a case of thoracoplasty with reconstruction using
a pedicle flap of pectoralis major muscle in a patient diagnosed with an
ulcerated BSC with open fracture of the right collarbone.
Methods: Patient JRDS, a 59-year-old male Caucasian, began with an
infiltrative lesion in the infracollarbone region in 2012. The histopathology
showed BC. He attended 33 sessions of radiotherapy. In 2014, he had an
exposed fracture of the proximal third of the right collarbone with an ulcerated lesion of fibrin with a purulent background and infiltrating the periosteum. A thoracoplasty with reconstruction was performed using a pedicle
flap to create an island of skin, resecting the pectoralis major muscle at
its medial insert, preserving the pedicle that lies in the cranial and lateral
position. The histopathology showed an ulcerated SCC invading the bone.
Results: The BSC is aggressive with a high potential for local recurrence and metastasis. It has been suggested that it arises from the BC,
undergoing a process of degeneration. The treatment is complete surgical
resection. The myocutaneous pedicle pectoralis major muscle is used for
reconstruction based on muscle body rotation about its vascular pedicle
to preserve the blood supply and prevent suture tension. The mobility and
availability of autologous tissue should be considered. Preconditions may
alter normal tissue conditions and limit the choice of the graft, as with the
radiotherapy.
Conclusions: The hypothesis is that the BSC emerged from the degeneration of a previous BC, as the initial diagnosis in 2012. BSC was suggested
only in 2014, after local destruction. Regarding surgical reconstruction,
flap position could have been better delineated in order to promote a better
esthetic result. However, this design was proposed because of the lack of
flap mobility, affected by previous radiotherapy. The patient reported the
absence of local pain and improved movements, implying an optimistic
view of the procedure.
028839
Carotid paraganglioma: a case report
Vasconcelos, J.L.M.1, Amaral, M.B.M.2, Gonalves, P.A.L.H.2,
Filho, F.S.N.H.2, Andrade, C.S.2, Junior, W.E.M.2, Brando, B.C.2,
Bezerra, D.A.1, Dourado, G.P.2
1
Department of Oncology, Holy Mercy House of Sobral, Sobral, Brazil,
2
Federal University of Ceara, Sobral, Brazil
janssen.loiola@hotmail.com, marinabma@yahoo.com.br,
paulinhahass@gmail.com, savio.nogueira0@gmail.com,
carolinesandrade12@gamil.com, waldethjunior@hotmail.com,
S227
brunocavalcantebrandao88@hotmail.com, diegobezerra.onco@gmail.com,
guilhermep.dourado@gmail.com
Introduction: The paraganglioma is a rare form of neoplasm which
in most cases is benign. It is classified as a neuroendocrine tumor which
originates from autonomous extra-adrenal paraganglia; it consists of cells
derived from samples of neural embryonic crest and has, on the whole,
not been functioning. Its incidence is generally sporadic, occurring in individuals of 2575 years old, with no indication of gender predilection. Its
most common location is the carotid body.
Objectives: To report a case of a carotid paraganglioma in a 44-yearold female patient.
Methods: The information was collected from review of the patients
chart, a photographic record of the diagnostic methods to which the patient
was submitted, and a literature review.
Results: The 44-year-old female patient, currently residing in a
hospital in Cear, presented on 03/24/13 complaining of a neck bulge for
a period of 6 months; she denied any increase in volume and local pain
during this period. CT scans of the neck were requested, revealing a heterogeneous solid nodule in the right carotid space, a possible indication of
paraganglioma, and some enlarged lymph nodes in the area; lymph nodes in
the jugular carotid, posterior cervical and submandibular regions appeared
normal in both number and size. At surgery, the patient presented with a
pulsatile vascular lesion of approximately 2 cm that was in close contact
with the right external carotid; the cervical lymph nodes had increased to
level 2, on the right. We performed a cervical carotid resection of the tumor
as well as lymphadenectomy.
Conclusion: The paraganglioma is a rare tumor, mostly benign, and
affects mainly the carotid body region. Usually, the patient is asymptomatic, complaining only of swelling of the affected area. The diagnosis
is confirmed by imaging studies, particularly ultrasound, angiography and
computed tomography. The cause of this tumor remains unknown; nevertheless there are acknowledged risk factors associated with heredity and
chronic hypoxia. This case presented a satisfying outcome after successful
surgical treatment.
028859
Evaluation of patients with laryngeal cancer treated in a general
hospital
Azeredo, R.B.1, Silva, R.L.1, Priante, A.V.M.1, Nunes, C.L.S.1,
Cardoso, C.A.1
1
Taubat University, Brazil
re.azeredo19@gmail.com,rafaelkretschmer10@gmail.com,priante@uol.com.br,
caio@saocamilovale.org.br, caugustocardoso01@gmail.com
Introduction: Cancer of the larynx represents around 25% of the
tumors in the upper aerodigestive tract. Exposure to tobacco and alcohol
has been strongly implicated in the carcinogenesis. In Brazil, around 7640
new cases and 3889 deaths were estimated in 2014.
Objectives: To evaluate sociodemographic and clinical characteristics
of laryngeal cancer patients submitted to treatment in a general hospital.
Methods: This was a retrospective analysis of the medical records
of 48 patients previously untreated with a diagnosis of laryngeal cancer
between January 2008 and December 2011.
Results: Most of the patients were male (38; 86.4%). Patient age
ranged from 42 to 82 years (median 64 years). Smoking habit (95.5%)
and alcohol consumption (68.2%) were admitted by most of the patients.
Dysphonia was found in 35 patients (79.5%). The tumor location was glottis
in 23 (52.3%), supraglottis in 12 (27.3%), transglottis in eight (18.2%)
and subglottis in one (2.3%). All tumors were squamous-cell carcinomas.
Eighteen cases (40.9%) were classified as clinical stage (CE) IV and five
cases (11.4%) as CEI. Surgical treatment was performed in 12 patients
(27.3%) and conservative treatment (radiotherapy associated or not with
S228
chemotherapy) in 32 cases (72.7%). During the follow-up period, ranging
from <1 to 86 months (median 13.5 months), 18 patients (40.9%) had registered recurrences (11 locoregional), but in only three cases was salvage
surgery performed. In the last status record, ten patients (22.7%) were alive
without disease, eight (18.2%) were dead from cancer, one (2.3%) was
alive with recurrence, one (2.3%) was dead from another reason, but 24
cases (54.5%) were lost to follow-up.
Conclusions: Most of the cases occurred in the elderly, in men, and
in smokers and alcoholics; the tumors were mostly located in the glottis
larynx, classified as CEIV, and treated with radiotherapy. Although nine
cases died from laryngeal cancer, in this series more than half of the cases
were lost to follow-up.
028469
Sarcomatoid carcinoma of the eyelid: a case report
Silva,T.O.1, Melo, I.S.1, Fonteles, A.F.1, Bezerra,D.A.1,
Magalhes,L.C.C.S.1, Freitas,H.C.1
1
thaisoliveirasilva27@gmail.com, acd.isadoramelo@gmail.com,
amandafonteles81@gmail.com, deigobezerra.onco@gmail.com,
leilacarla@bol.com.br, hermanycf@hotmail.com
Introduction: This is a morphological variant of head-and-neck
squamous-cell carcinoma, composed of epithelial and mesenchymal malignant components intimately mixed. According to research published by
the Cancer Institute of So Paulo, the sarcomatoid carcinoma with other
cancers make up only 4.4% of head-and-neck oncology consultations held
at the institution, demonstrating its low incidence.
Objective: To report a case of sarcomatoid carcinoma and its evolution.
Methods: A 60-year-old male, previously healthy, began a visual
deficit and enlargement of the left orbital volume 8 months before care
in the oncology center. On that occasion, he was subjected to resection
of the lesion by an ophthalmologist with remission of symptoms. After 7
months he returned for medical consultation with complaints of eye irritation associated with the sensation of a foreign body. Staging tests were
performed (ocular ultrasonography and cranial tomography) and showed
the presence of a homogeneous mass in the lateral portion of the left eyeball
measuring 3.4 x 3 cm without bone erosion and in intimate contact with the
lateral rectus muscle. Incisional biopsy showed undifferentiated malignant
neoplasia, and immunohistochemistry diagnosed sarcomatoid carcinoma.
Results: After performing preoperative tests and staging, patient was
submitted to exenteration of the orbit and reconstruction with skin grafts.
He progressed well, and was referred for adjuvant radiotherapy. He is
currently being followed as an outpatient and shows no local and systemic
signs of recurrence.
Conclusion: Owing to the small amount of scientific evidence, the
source of these mixed malignant tumors is not known exactly. It is thought
that epithelial and mesenchymal components differentiate from a single
totipotent stem cell. There is also the multiclonal hypothesis. The treatment
for this type of tumor is surgical with margins of 1 cm. There is no evidence
for benefit from adjuvant chemotherapy or radiotherapy.
028980
Giant-cell fibroma: a case report
Pereira, T.S.S.1, Mierzwa, T.C.1, Wandeur, V.2, Peters, L.C.2,
Silva, M.T.B.1, Nagai, H.M.3
1
Brazil, 2Medicine Course, College Assis Gurgacz, Cascavel, Brazil,
ABSTRACTS
3
Department of Head and Neck Surgery, UOPECCAN Hospital, Cascavel,
Brazil
talita.siemann@hotmail.com, ti1601@hotmail.com,
marianatbs89@gmail.com
Introduction: Giant-cell fibroma is rare non-neoplastic lesion of the
oral mucosa. The vast majority of the lesions are <1 cm in diameter. They
are more commonly seen in the mandibular gingiva in females. The giantcell fibroma is a localized reactive proliferation of fibrous tissue, much like
the irritation fibroma. It is painless and often has lobules or nodules on its
surface. The most characteristic histological feature is the presence of large
spindle-shaped and stellate mononuclear cells and multinucleated cells.
Objectives: To present a case of a large giant-cell fibroma which was
diagnosed after excisional biopsy.
Methods: A review of the literature and medical records.
Results: A 66-year-old male patient was referred to our institution
complaining of extrusion of an oral lesion after coughing. His medical
history was non-contributory. There was no history of trauma or pain. On
oral examination, a pedunculated mass was seen on the glottic larynx. It
was a firm, irregular, mobile, soft-tissue nodule measuring 12 cm long by 4
cm across. The mass did not bleed on touch. The rest of the oral mucosa was
normal. Tomography revealed a lobed expansive mass externalized by the
oral cavity, regular in contour, with precise limits apparently originating in
the right aryepiglottic fold, with a mass effect in the hypopharynx, reducing
their light. Based on its clinical presentation, the differential diagnosis was
papilloma and sarcoma. Incision biopsy and a tracheostomy were done.
The excised specimen was sent for routine histopathological examination.
Based on the microscopic findings, the lesion was diagnosed as a giant-cell
fibroma. In a second operation the whole lesion was removed by surgical
access via the suprahyoid.
Conclusions: Although it is a rare entity, usually <1 cm in size, and
most commonly located in the gingiva, it should be suspected even when
the lesion is large and located in other sites of the oral cavity.
028629
Information on mens health care with tracheostomy in head-andneck neoplasms: implications for nursing
Freitas, A.A.S.1, Coelho, M.J.2
1
Divisao de Enfermagem Cirurgia Oncologia Hospital de Cncer I,
Instituto Nacional de Cncer Jose Alencar Gomes da Silva, Rio de Janeiro,
Brazil, 2Departmento de Enfermagem Medico Cirrgico DEMC-EEAN,
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
souzaaafreitas@yahoo.com.br, zezecoelho@yahoo.com.br
Introduction: The National Policy for Integral Attention to Mens
Health seeks to promote health care in the male population. Information is
a civil right; it constitutes the means by which the individual obtains knowledge of health care and disease, because the practice of health information
can help in identifying the main healthcare needs of men.
Objective: To describe the information (about care) which men need
to be given when they undergo tracheostomy, and the implications for the
nursing staff who look after them.
Methods: This was a descriptive study, with a qualitative approach,
in which 24 men with head-and-neck tumors underwent tracheostomy. The
study was developed at the National Cancer Institute: Cancer Hospital I,
Rio de Janeiro, Brazil. Collection of data was carried out by individual,
semi-structured interviews. The data were interpreted by thematic analysis.
The study was carried out in accordance with the ethical guidelines of
Resolution CNS466/2012. CEP-INCA RJ n 14/11.
Results: After a tracheostomy, the patient will need various types
of information regarding care. Two categories of information, regarding
care, emerged from the thematic analysis. Category 1: advice to cough
ABSTRACTS
carefully via the tracheostomy. A cough can result from the activity of the
defense mechanism of the respiratory system following a tracheostomy;
deep breathing helps to reduce the deposition of those secretions which the
cough helps to expel. Category 2: advice on humidification; the patient is
advised that the nebulizer should be directed to the tracheostomy as no
effect is produced if it is placed in front of the patients face.
Conclusion: Following tracheostomy for head-and-neck cancer, the
information that guides the nurses care should be understood by the patient
who should be encouraged to participate in the care. The nurse should
ensure that the patient understands the specific type of care applicable to
his tracheostomy.
029198
Intramandibular mucoepidermoid carcinoma: a case report
Freitas, A.C.1, Junior, R.J.2, Ferrari, C.1, Graebin, L.1, Paim, G.P.1,
Tiago, L.1 H.B.L.1, Silva, N.Z.1, Miranda, I.H.1, Gomes, L.N.2
1
Federal University of Pelotas, Pelotas, Brazil, 2Institute of Oncology,
Hospital Santa Casa de Misericordia, Pelotas, Brazil
andersoncasalidefreitas@gmail.com,
rauljjr36@hotmail.com, cristianoferrari90@hotmail.com,
liege.graebinmm@gmail.com, giovana_paim@hotmail.com,
luuiza_bt@hotmail.com,nataliazanini@outlook.com,isabelhmiranda@gmail.com,
lng@terra.com.br
Introduction: The intramandibular mucoepidermoid carcinoma is a
rare neoplasm, with about 200 case reports in the literature. Its pathogenesis is not clearly defined, and can have different origins: (1) imprisonment
of retromolar mucous glands in the jaw, (2) epithelium of the maxillary
sinus, (3) iatrogenic imprisonment of minor salivary glands, (4) dental
lamina remnants, (5) fabric remnants of salivary glands in the jaw, and (6)
neoplastic transformation of mucus-secreting cells in the epithelial lining
of odontogenic cysts. These lesions primarily affect the molarpremolar
region and the angle of the mandibular canal.
Objectives: To report a case of a patient with intramandibular mucoepidermoid carcinoma.
Methods: Disease information used in this study was obtained through
chart review, photographic documentation of diagnostic methods, followup surgery and photographic records of the removal of the lesion to which
the patient was submitted and, finally, a review of the literature.
Results: A 54-year-old male patient had a lesion detected in the right
posterior jaw region along the dental equipment during a dental procedure,
followed by removal and biopsy. Histopathological report revealed malignant neoplasm of the salivary gland, which was diagnosed as mucoepidermoid carcinoma; we cannot discard the hypothesis of the primary lesion
as intraosseous. The patient underwent right mandibulectomy associated
with neck dissection. The pathological report identified the submandibular
salivary gland displaying a discrete focus of chronic inflammatory infiltration, hyperplastic right cervical lymph nodes, intramandibular mucoepidermoid carcinoma with bone infiltration, free surgical margins, and bone
and pharyngeal margins free of cancer. The treatment continued with
radiotherapy, since this is the treatment of choice for mucoepidermoid
carcinomas.
Conclusions: This is a rare malignant neoplasm which can be asymptomatic, being diagnosed incidentally by radiographs. Several theories have
attempted to determine its pathogenesis. Staging is determined by the ratio
of mucosecretor components to squamous components. With proper treatment, survival and prognosis are favorable.
S229
029268
Intraosseous mucoepidermoid carcinomas of the mandible in a
teenager: a surgical approach
Teshirogi, E.Y.2
1
Introduction: Intraosseus mucoepidermoid carcinomas are uncommon
tumours, comprising 23% of all mucoepidermoid carcinomas reported.
They are histologically low-grade cancers, usually affecting the mandible
as uni- or multi-locular radiographic lesions.
Objectives: To present a case of primary intraosseous squamous-cell
carcinoma of the mandible in a teenager.
Results: A 16-year-old male patient had expansion of buccal and
lingual cortices of the anterior region of the mandible, covered by ulcerated mucosa, of 4 months evolution. An incisional biopsy was performed,
and the histopathological findings confirmed low-grade mucoepidermoid
carcinoma. The patient was treated with a mandibulectomy, including a
segment of the gingival arcade followed by supraomohyoid neck dissection. A mandibular titanium plate was used in the reconstruction. There was
no evidence of local recurrence, or of regional or distant metastasis. The
patient was alive and without disease after a follow-up interval of 3 years.
Conclusion: Intraosseous mucoepidermoid carcinomas of the
mandible are usually low-grade tumours, and effective surgical treatment
involving wide local excision or en-bloc resection gives patients a favourable prognosis after long-term follow-up.
028867
Laryngectomy in oncology: what are the epidemiological differences
between partial and total?
Nascimento, L.S.1, Gama, G.B.2
1
Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil,
2
Faculty of Medicine, Salvador University, Bahia, Brazil
lu.cas.s_nascimento@hotmail.com, gbgama21@gmail.com
Introduction: Brazil is one of the countries with the highest incidence
of laryngeal cancer in the world, and laryngectomy total or partial is one
of the methods of treatment.
Objectives: To examine the major epidemiological differences
between partial and total laryngectomy in oncology.
Methods: This was an epidemiological study of 8794 AIHs related to
oncological laryngectomy, with 4229 partial and 4565 total. The collection of data and variables (total value, permanence, mortality) covered the
period January 2008 to December 2014, was obtained from the DATASUS
system, and is presented in graphics and spreadsheets after statistical calculations in SPSS 22.
Results: It was observed that partial laryngectomy in oncology represents 48%, while total laryngectomy comprises 52%. Yet it was observed
that over the study period, these surgeries varied annually. An average
value was found of R $ 1,905.10 for partial laryngectomy in oncology and
an average value of R $ 4,105.42 for total laryngectomy in oncology. As
for hospital stay, there was an average of 3.6 days for partial oncological
laryngectomy against 10.2 for total oncological laryngectomy. There was
a mortality rate of 0.47 for laryngectomy in oncology from 2.58 for total
laryngectomy in oncology. When we analyzed the number of deaths, we
found a total of 20 (14%) for partial oncological laryngectomy and 118
(86%) for total oncological laryngectomy.
S230
Conclusions: We observed statistically significant differences between
partial and complete laryngectomies. While the number of partial oncological laryngectomy has increased in recent years, while the total oncological laryngectomy has decreased. It was concluded that total oncological
laryngectomy has higher cost, longer average hospital stay, and a higher
mortality rate.
028579
Lip cancer: a review of patients treated in a general referral hospital
Figueiredo, N.C.L.1, Nunes, B.E.P.1, Priante, A.V.M.1, Cardoso, C.A.1,
Nunes, C.L.S.1
1
Taubat University, Brazil
natalialimafigueiredo@gmail.com,
biamed44@hotmail.com,priante@uol.com.br,caugustocardoso01@gmail.com,
caio@saocamilovale.org.br
Introduction: Lip cancer (LC) occurs mostly in white-skinned men in
their sixth decade. The main risk factors are smoking and long-term exposure to sunlight. LC has particular significance in Brazil because of its tropical weather and agriculture-based economy, where workers are constantly
exposed to the sun.
Objectives: To evaluate sociodemographic and clinical characteristics
of LC patients submitted to surgical treatment in a tertiary general hospital.
Methods: We carried out a retrospective analysis of medical records of
69 previously untreated patients with LC diagnosed between January 2008
and December 2013.
Results: Most of the patients were males (47; 68.1%). Patient age
ranged from 22 to 95 years (median 63 years). The vast majority (95.7%)
had white skin. Occupational exposure to sunlight was observed in 17
cases (24.6%); 43 patients (62.3%) had a smoking habit ranging from
10 to 70 years (median 45 years). The lower lip was involved in 60 cases
(87.0%). Histologically, squamous-cell carcinoma was the most prevalent
type (82.6%). Tumors classified as T1 represented 48 cases (69.6%), only
two cases (2.9%) were T4. No lymph-node metastases were identified.
The surgical techniques mostly performed were V-shaped resection in 24
cases (34.8%), W-plasty in 19 (27.5%) and vermilionectomy in seven cases
(10.1%). The median follow-up was 17 months, ranging from <1 to 75
months. Four patients (5.8%) evolved with recurrences (two local and two
nodal) and they were submitted to local resection and cervical dissection
with radiotherapy, respectively. Among patients with recurrence, in the last
status record, two were alive without disease evidence, one died due to
cardiovascular disease, and one was lost to follow-up.
Conclusions: Most of the LC cases occurred in the elderly and in men
with white skin; squamous-cell carcinoma, located in the lower lip, was
diagnosed in the early disease stage. In this cohort, due to early diagnosis,
a good prognosis was noted in many of the patients.
029178
Lower lip tumour and reconstruction
Paula, W.T.1, Defelippe, M.A.2, Reis, T.R.2, Lima, C.R.C.2,
Carvalho, V.D.P.2 Barbosa, R.R.C.2
1
Instituto Oncolgico, Hospital Nove de Julho, Liga de Clnica Cirurgica,
Universidade Presidente Antnio Carlos, Juiz de Fora, Brazil, 2Liga de
Clnica Cirurgica, Universidade Presidente Antnio Carlos, Juiz de Fora,
Brazil
ninadefelippe@gmail.com
Introduction: Most labial neoplasias are non-melanoma skin
tumours, and occur more frequently on the lower lip. Identified risk
factors for non-melanoma labial cancer are smoking, exposure to sunlight,
ABSTRACTS
skin type, alcohol consumption, HPV and chronic immunosuppression.
Squamous-cell carcinoma is the most common kind on the lower lip.
Objectives: To present a case report on a patient with a lower lip
tumour subject to reconstruction.
Methods: We researched indexed databases (Scielo, CAPES, Bireme)
and medical records related to the cases received in 2012 at Hospital 9 de
Julho, in Juiz de Fora, Minas Gerais, Brazil.
Case report: The patient was male, 75 years old, Caucasian, hypertensive, and dyslipidemic; a lesion was noticed on the inside of the lower lip,
which was subject to a biopsy in February 2012. A squamous-cell carcinoma was confirmed, with small to moderate differentiation, ulceration and
invasion down to the muscle layer. Resection of the lesion was performed
on December 2012; histopathologically, the irregular skin and labial
mucosa fragment (1.7 x 1.5 cm) had a grey and smooth surface, sporting
a depressed white-yellowish lesion with raised borders, measuring 1.8 cm
tangential to the left border. It was concluded that the lesion was consistent
with plasma-cell mucositis (plasma-cell granuloma). Curative treatment for
these tumours includes radiotherapy or surgery.
Results: In the case of large tumours, it may be necessary to perform
labial reconstruction using grafts or flaps. Reconstruction of the lower lip
was successful in this case, both maintaining an acceptable appearance and
preserving its function, as well as the oral sphincters.
Conclusion: From a systematic analysis of the available medical
records, the patient in question had removed a malignant tumour, and
underwent a subsequent labial reconstruction procedure with the use of
grafts. After the aforementioned procedure, the patient obtained social
acceptance for the reconstruction, and continued his treatment.
029207
McGregor flap in the repair of an extensive oncological defect of the
face: an analysis of six cases
Souza, C.D.1, Sunahara, E.R.M.1, DallInha, V.N.2, Horta Filho, V.2, Meira
Neto, C.C.2, Capuzzo, R.C.3
1
Department of Reconstrutive Surgery - Barretos Cancer Hospital, So
Paulo, Brazil, 2Department of Surgery Oncology - Barretos Cancer
Hospital, So Paulo, Brazil, 3Department of Surgery Oncology - Head and
Neck - Barretos Cancer Hospital, So Paulo, Brazil
drcleytondias@gmail.com,erika.sunahara@gmail.com,oncovnd@gmail.com,
vitorhortafilho@yahoo.com.br, claudemironeto@yahoo.com.br,
renatocapuzzo@gmail.com
Introduction: Treatment of head and neck cancer often requires extensive resections and large flaps for reconstruction. The temporo-frontal flap,
or McGregor flap, described in 1963, is based on the superficial temporal
vessels.
Objectives: To report six cases and to promote the McGregor myocutaneous flap technique.
Methods: We reviewed retrospectively six patients who underwent
extensive tumor resection of the head and neck between 2010 and 2015
in the Barretos Cancer Hospital. The data included age, gender, skin type,
diagnosis and clinical stage, adjuvant therapies, hospital stay, morbidity of
the donor site, the default size, feasibility of a flap, complications, associated procedures, length of stay, subsequent surgeries, current state, and
functional and esthetic results.
Results: The average age of the patients was 84.66 years, 83.33% being
men. The predominant phototypes II and III were each 50%. Squamouscell carcinoma occurred in 100% of the cases. The clinical stages were
II (four cases, 66.66%), II and IV (one case each). One case underwent
neck dissection. All cases underwent adjuvant radiotherapy. The front area
was repaired with a donor skin graft in all cases. The average length of
hospital stay was 1.6 days. The biggest defect was 9.3 x 6.7 x 4.6 cm, and
the smalles was 4.7 x 4.3 x 1.4 cm, prevalent along the pre-auricular region.
ABSTRACTS
The feasibility of a flap was achieved in all cases. Among the complications, there were four relapses (66.66%), of which two were submitted to
salvage surgery and palliative chemotherapy, and one with ectropion. Five
patients are alive (83.33%), four without active disease, one with disease,
and one died in the immediate postoperative period. The functional result
was satisfactory in all cases and without esthetic complaint.
Conclusions: In our initial experience, the operation proved easy to
perform, and is indicated in patients who cannot tolerate free flaps.
028663
Minimally invasive thoracic surgery in the treatment of typical lung
carcinoid: the first pleuropneumonectomy by single port in Brazil
Arajo, C.A.A.1, Carvalho, G.S.L.2, Pinheiro, L.D.P.3
1
Department of Integrated Medicine, Federal University of Rio Grande
do Norte, Natal, Brazil, 2Health Sciences Center, Federal University of
Rio Grande do Norte, Natal, Brazil, 3Faculty of Health Sciences, State
University of Rio Grande do Norte, Mossor, Brazil
cabetoufrn@gmail.com, gabrielsalesmed@gmail.com,
lucadipace.med@gmail.com
Introduction: Notably, pleuropneumonectomy is one of the surgeries
that has the highest rates of morbimortality among surgical lung resections.
Among the main causes for this poor prognosis are bleeding and cardiopulmonary complications, mainly because of lung function loss and its
consequent impact on cardiac function. Statistical data show that complications are registered in 60% of pleuropneumonectomies performed, and
the overall mortality rate is 8.6% of patients who undergo the procedure. Another important complicating factor is the surgical trauma itself
conferred by posterolateral thoracotomy, since this type of surgical
approach is currently conceptualized as a disease because of the consequences on patient physiology during the perioperative period. That said,
minimally invasive thoracic surgery has demonstrated an important role in
reducing surgical morbimortality of pleuropneumonectomy, especially in
patients with lung cancer whose tumor staging and location advocate such
a procedure.
Objectives: To present and demonstrate, by video, the first case of
a pleuropneumonectomy held in Brazil for minimally invasive thoracic
surgery by a single port, to attempt to make it more embracing in the treatment of lung cancer and pleural mesotheliomas, and to directly improve the
prognosis of patients with resectable tumors.
Methods: We made a video recording of the surgical procedure, as
well as presenting a clinical case report and patient follow-up after surgery
until hospital discharge.
Results: Pleuropneumonectomy by single port for the treatment of
typical lung carcinoid presented, in addition to the normal intraoperative
benefits, a great impact on the early and late postoperative periods, namely
a significantly smaller surgical wound, less than 24 hours stay in the ICU,
and hospital discharge after 72 hours.
Conclusions: The success of the procedure points to pleuropneumonectomy by single port as an excellent alternative to thoracic surgery,
especially tumor resections. Moreover, studies show the feasibility and
use of this technique as a first-line strategy for elective thoracic surgeries,
revealing great future prospects for the surgical treatment of chest tumors.
029313
Myocutaneous pectoral muscle ally of the surgeon who works with
head-and-neck surgery defects: analysis of three cases
Souza, C.D.1, Sunahara, E.R.M.1, Meira Neto, C.C.2, DallInha, V.N.2,
Horta Filho, V.2, Santos, C.R.3
1Department of Reconstrutive Surgery - Barretos Cancer Hospital, So
Paulo, Brazil, 2Department of Reconstructive Surgery - Barretos Cancer
S231
Hospital, So Paulo, Brazil, 3Department of Surgery Oncology - Head and
Neck - Barretos Cancer Hospital, So Paulo, Brazil
drcleytondias@gmail.com,
erika.sunahara@gmail.com, claudemironeto@yahoo.com.br,
oncovnd@gmail.com, vitorhortafilho@yahoo.com.br, carlonella@gmail.com
Introduction: Flaps are important tools in the armamentarium of the
surgeon dealing with major defects during surgery for cancer of the head
and neck. Their versatility, tissue supply, and wide arc of rotation seduce
plastic surgeons, head-and-neck surgeons, and oncological surgeons by
their ease of construction. First described in 1947 by Pickrell et al for chest
wall reconstruction after radical mastectomies, and then by McGraw et al
in 1977 who used a myocutaneous flap of the island type; in 1979 Ariyan
performed the first reconstruction in head-and-neck surgery. The flaps
blood supply is given by the thoracoacromial artery.
Objective: To report a series of three cases that illustrate routine operations, the incidence of complications, and results.
Method: This was a retrospective analysis of three patients operated in
the Cancer Hospital of Barretos, in which this technique was used. The data
collected included age, sex, skin type, diagnosis and clinical stage, adjuvant
therapies, morbidity of the donor site, flap feasibility, complications, length
of stay, current status, and functional and esthetic results.
Results: Patients were on average 80 years old, with a predominance
of females (66.66%); the prevalent skin type was type III (66.66%), the
highest incidence of diagnosis was squamous-cell carcinoma of the head
and neck. Clinical statuses were, respectively, II, III and IV. All cases
underwent adjuvant radiotherapy. The morbidity of the donor site was
minimized by repair opportunity. The flap had good viability in all patients.
There was one case of recurrence (33.33%). The average length of hospital
stay was 4 days. The functional and esthetic results were satisfactory. The
recurrent case was referred for palliative care.
Conclusion: Complications were similar to those observed in the literature. The flap proved to be a great ally to the surgeon, being reliable and
easy to perform.
029260
Plantar medial flap in cancer defect repair of the calcaneus: analysis
of three cases
Souza, C.D.1, Sunahara, E.R.M.1, Meira Neto, C.C.2, DallInha, V.N.2,
Horta Filho, V.2, Carvalho, C.E.B.3
1
Department of Reconstrutive Surgery, Barretos Cancer Hospital, So
Paulo, Brazil, 2Department of Reconstructive Surgery, Barretos Cancer
Hospital, So Paulo, Brazil, 3Department of Surgery Oncology, Melanoma
and Soft Tissue Group, Barretos Cancer Hospital, So Paulo, Brazil
drcleytondias@gmail.com,
erika.sunahara@gmail.com, claudemironeto@yahoo.com.br,
oncovnd@gmail.com,vitorhortafilho@yahoo.com.br,carloshcb79@gmail.com
Introduction: Oncological defects in the topography of the calcaneus
has characteristics distinct from those of other regions, being associated
with the pressure area taking the body weight, walking, and foot contact
with footwear. In general, it is an important reconstructive challenge that
means long periods of hospitalization resulting in high costs and functional
consequences in most cases. Reconstruction with a medial plantar flap, first
described by Harrison and Morgan in 1981, is based on the medial plantar
artery and consists of a cutaneousfascial flap.
Objectives: To evaluate the results obtained with the medial plantar
flap in the reconstruction of soft tissue of the heel during oncological
surgery.
Methods: We reviewed retrospectively three patients who underwent
immediate reconstruction of an oncological defect of the calcaneus in 2014
in the Barretos Cancer Hospital. The data collected included age, sex,
S232
skin type, diagnosis and clinical stage, adjuvant therapies, hospital stay,
morbidity of the donor site, the default size, flap feasibility, complications
associated with the procedure, length of hospital stay, subsequent surgeries,
current state, functional and esthetic results.
Results: The patients were on average 67.3 years of age, all women,
whose skin types were I, II, and V. All had a diagnosis of acral lentiginous melanoma and clinical stages were I, IIIb and IV. Only one case was
submitted for ipsilateral inguinal lymphadenectomy. The average length of
hospital stay was 3.6 days. The biggest defect was 16.3 x 7.4 x 4.3 cm
and the smallest defect 7.3 x 5.7 x 1.54 cm. The donor area was treated
respectively with skin grafting, healing with negative-pressure therapy and
other methods. The flap was feasible in 100% of the cases. Complications
included one case of wound infection which developed with wet gangrene
and resulted in limb amputation. All cases are alive and without active
malignancy. The functional outcome was satisfactory in all cases and there
were no esthetic complaints.
Conclusions: The flap is reliable, technically easy, and allows early
hospital discharge.
028359
Pneumonectomy with lymphadenectomy as a factor in improving the
prognosis for rare lung carcinosarcoma: a case report and literature
review
Arajo, C.A.A.1, Carvalho, G.S.L.2, Pinheiro, L.D.P.3
1
Department of Integrated Medicine, Federal University of Rio Grande
do Norte, Natal, Brazil, 2Health Sciences Center, Federal University of
Rio Grande do Norte, Natal, Brazil, 3Faculty of Health Sciences, State
University of Rio Grande do Norte, Natal, Brazil
cabetoufrn@gmail.com, gabrielsalesmed@gmail.com,
lucadipace.med@gmail.com
Introduction: The carcinosarcomas belong to a heterogeneous group
of non-small-cell lung tumors, being composed of typical carcinoma
tissue with sarcomatous elements (rhabdomyosarcoma in the clinical case
reported). This histological type is considered a rare biphasic primary
lung tumor, representing 0.20.3% of pulmonary neoplasms. In addition,
the literature points to a survival rate at 5 years of just 6% of patients,
demonstrating the aggressiveness and tendency to metastasize of carcinosarcomas; this makes the histological diagnosis itself a negative prognostic
factor. Other relevant factors for low survival include the difficulty of diagnosis (bronchoscopy tends to catch only the epithelial component) and the
absence of a literary consensus about treatment; thus pneumonectomy with
lymphadenectomy is the central pillar for treating this malignancy.
Objectives: To demonstrate and describe, by presenting a clinical case
and a literature review, that pneumonectomy with lymphadenectomy may
be a key procedure in improving the prognosis of patients with carcinosarcoma without lymphatic spread, or with a rather vague histopathological
diagnosis (such as malignancy of anaplastic cells), and to attempt to add
new perspectives to the knowledge of these approaches.
Methods: Reporting and monitoring the diagnosis, surgery and postoperative evolution to date over 3 years of clinical cases. We also review
the literature on the topic.
Results: The patient who underwent pneumonectomy with
lymphadenectomy without adjuvant chemotherapy is evolving steadily,
without signs of local recurrence or distant metastasis 40 months after
surgery. He also shows excellent Karnofsky performance status (90%) and
high expectation of reaching 5-year survival (i.e. healing).
Conclusions: The case report demonstrates the importance of pneumonectomy with lymphadenectomy in patients with confirmed carcinosarcoma or biopsy with an inconclusive result. This in addition to illustrating
and adding to the sparse literature raises the surgical procedure to the
status of an optimizer in respect of prognosis of the rare and aggressive
ABSTRACTS
carcinosarcoma, since the treatment of the patient was successful without
the need for adjuvant chemotherapy or radiotherapy.
028519
Salvage laryngectomy: a case report
Reis, T.R.1, Paula, W.T.1, Lima, C.R.C.1, Defelippe, M.A.1,
Furquim, M.A.T.A.1, Ribeiro, I.C.P.1
1
Universidade Presidente Antonio Carlos, Juiz de Fora, Brazil
tha.spf@gmail.com,
wtassipaula@gmail.com,carlalima1909@gmail.com,ninadefelippe@gmail.com,
tata_furquim1@hotmail.com, isabela-cristina14@hotmail.com
Introduction: Salvage laryngectomy is a procedure that carries greater
risks than primary laryngectomies, due to tissue alterations induced by radiotherapy that may hinder further surgical procedures. Survival rates with
radiochemotherapy are similar to those of primary surgeries in the treatment of laryngeal cancer. Salvage laryngectomy is recommended for cases
where there is a noted absence of distance metastases and the locoregional
disease can be resected.
Objectives: To analyse salvage laryngectomy as an alternative for the
treatment of recurring laryngeal tumours, with a case report.
Methods: We undertook a thorough review of both related literature
and medical records collected from Hospital 9 de Julho in Juiz de Fora,
Minas Gerais, Brazil.
Results: The patient was a 60-year-old male with a history of tobacco
use, and no further comorbidities; he presented with hoarseness and
dysphagia for approximately 6 months. A neck CT scan revealed alterations in his vocal cords and right-side paraglottic space. A further biopsy
performed via laryngoscopy confirmed the presence of a moderately
differenciated epidermoid laryngeal carcinoma. The patient was sent for
radiochemotherapy, and 5 months later he returned with complaints of
hoarseness, dry coughing and cervical pain which radiated towards the ear.
A new neck CT scan was performed, revealing, in relation to the previous
scan, progression, size increase, asymmetry and obliteration of right-side
fatty paraglottic tissue, reduction of the laryngeal inlet at this level, and
the absence of lymph-node enlargement. A new biopsy was performed,
revealing the presence of scaly mucous membrane hyperplasia with atypical cells in the basal layer. A salvage laryngectomy was performed and
there were no postoperative complications. Following his recovery the
patient was forwarded to speech therapy assistance so as to attempt to learn
oesophageal vocalization and swallowing coordination.
Conclusion: Due to the alterations caused by radiochemotherapy and
the patients debilitation, this procedure carries greater risks and presents
higher chances of complications than primary laryngectomy.
028959
Sarcomatoid carcinoma of the eyeball
Delfino, J.N.F.1, Bustamante, E.F.1, Alves, D.G.1, Ramos, M.A.N.1,
Leite, R.S.1, Rondelo, G.D.1
1
Hospital de cncer de Mato Grosso, Cuiab, Mato Grosso, Brazil
dr.joaquimdelfino@hotmail.com, forbus2012@gmail.com,
gobbi.dani@gmail.com, manoelcba@uol.com.br, rogerioleite@me.com,
gustavo.gdp@hotmail.com
Introduction: Sarcomatoid carcinoma is defined by the World Health
Organization as a biphasic tumor consisting of malignant elements of
epithelial and mesenchymal origin. The cancer is most commonly found
in the renal pelvis, lung and colon, but its occurrence in the eyeball is
extremely rare.
Case report: A 72-year-old male presented with a 1-year history
of itching and conjunctival hyperemia and swelling of the eyeball with
ABSTRACTS
progressive visual impairment; he presented to an ophthalmologist and was
referred to the head-and-neck surgery clinic. The patients had a history of
hypertension and diabetes with insulin; he had been an ex-smoker for 60
years and was a former alcoholic, using preferably distilled spirits daily for
50 years. During the physical examination hyperemia and increased volume
conjunctival bottom left tarsal which prevented the eye from opening was
found, together with important periorbital hyperemia and no palpable
lymph nodes. A biopsy of the conjunctiva was performed under local
anesthesia; magnetic resonance imaging of the orbit revealed an extensive
tumor (measuring 3.5 x 3.0 x 3.5 cm) with involvement of the lower portion
of the left eyeball and of adjacent muscles of the lens and surrounding soft
tissues. An orbital exenteration was performed on 06/05/2013. Pathology
showed a mesenchymal neoplasm with a pattern of epithelioid malignant
spindle cells invading periorbital and lateral muscle and adipose tissue;
deep margins were compromised and immunohistochemistry was positive
for vimentin. The patient underwent adjuvant treatment with 25 sessions of
radiotherapy ending on 09.02.2013. He has been followed up in outpatients
on a quarterly basis without tumor recurrences and/or metastases. The
surgical specimen was sent for review in the pathology laboratory at the AC
Camargo Hospital due to rarity of the case. Immunohistochemistry showed
a pattern of spindle-cell malignancy with a carcinoma-in-situ component
and strong positivity for cytokeratin AE1/AE3.
Conclusion: Sarcomatoid carcinoma of the eyeball is an extremely
rare tumour. After treatment with surgery and radiotherapy the patient is
showing good progress.
029244
Surgical approach in the cure of sporadic medullary thyroid
carcinoma: a case report
Teixeira, R.L.1, Lima, L.W.R.1, Ruvio, V.B.1, Jnior, J.S.2,
Fonseca, C.C.F.3, Caldas, R.A.T.4
1
Graduanda em Medicina na Universidade Federal do Amap, Macap,
Amap, Brazil, 2Mdico Residente em Cirurgia Geral pela Universidade
Federal do Amap (UNIFAP), Macap, Amap, Brazil, 3Mdico
especialista em Cirurgia de Cabea e Pescoo e Cancerologia Cirrgica
pelo Hospital Arajo Jorge -Goinia-GO, Brazil, 4Graduando em
Medicina na Faculdade de Cincias Mdicas da Paraba, Joo PessoaParaiba, Brazil
railalinhares@hotmail.com,
lana_wrl@hotmail.com, vitor_benevides@hotmail.com,
drjoaosjr@hotmail.com,cleicharles@hotmail.com,caldas_rafael@hotmail.com
Introduction: The thyroid carcinoma is the most frequent tumor of the
endocrine system, and the medullary thyroid carcinoma (MTC) is responsible for 310% of the cases. The MTC affects the C cells, has strong
autosomal dominant inheritance, and is related to the multiple endocrine
neoplasia syndrome (type 2). It can be familial or sporadic. The only treatment with healing potential is surgery.
Methods: This studys data were obtained with the patients consent
through chart review, interview, photographic records and literature review.
Case report: Patient AKBA, female, 33 years old, from Afu, PA, came
from the Cardiology Clinic to the Surgical Oncology Service with head and
neck symptoms: voice changes, difficulties in swallowing, and sporadic
dyspnea associated with bulging of the left cervical region. Cervical ultrasound was performed with Doppler, showing a left-sided uninodular goiter
with central vascularization (CHAMMAS IV). Fine-needle aspiration
biopsy resulted in a cytological finding classified as BETHESDA IV. On
01/22/2014, total thyroidectomy was performed due to the intrasurgical
finding with biopsy and malignancy freezing on the left lobe. The anatomopathological exam showed poorly differentiated carcinoma; the etiological investigation by immunohistochemistry showed medullary thyroid
carcinoma. On 04/08/2014 the patient was reoperated with neck dissection
S233
(level 6). There was a good response to the surgical treatment. It is known
that the most frequent clinical presentation for sporadic MTC is the solid
uninodular goiter, which is similar to other tumors that affect the gland.
Establishing the frequency of solid uninodular goiter among MTC cases
has diagnostic and therapeutic implications, because the surgical approach
for MTC differs from that for other thyroid tumors.
Conclusion: Like most cancers, the early detection of MTC results in a
better prognosis. However, tracking the dosage of calcitonin which reduces
the chances of curing the disease is not yet a reality in Brazil.
029183
Surgical management of patients with pleural tumors based on
clinical and radiological diagnosis
Andrade, R.L.1, Bonomi, D.O.2, Carvalho, E.A.2, Pinho, A.J.M.2,
Santos, F.G.C.D.1, Carvalho, C.C.1
1
2
Thoracic surgery, Mario Penna Institute, Belo Horizonte, MG, Brazil
raffaelandrade@hotmail.com, danielbonomi@hotmail.com,
erlon_avila@hotmail.com, astujr@hotmail.com, nandabhmed@hotmail.com,
camila_ccavalcante@hotmail.com
Introduction: Solitary fibrous tumors of the pleura are rare neoplasms
that usually manifest as exophytic masses causing compression of adjacent
structures.
Objectives: To present diagnostic and therapeutic procedures in four
patients with clinical and CT diagnosis of pleural tumours, and to present
aspects of surgical technique and postoperative evolution of such patients.
Methods: In total, four cases of patients with pleural tumors were
studied. In all cases the surgical procedure was performed on the basis of
radiological diagnosis only. Case 1 was a male patient with pain in the
left hemithorax and a large mass in the left thoracoabdominal transition;
he underwent a posterolateral thoracotomy and resection of the lesion and
lung segment of the left lower lobe adhered to it. Case 02 was a female
patient admitted in respiratory failure due to large mass in the right hemithorax, promoting mediastinal shift to the contralateral side and lowering
the diaphragm. She underwent right posterolateral thoracotomy and resection of the lesion that had minimal contact with the lower lobe of the
right lung. Case 03 was a woman with atypical chest pain; she underwent
resection by VATS and thoracotomy for lesion excision. This patient had
recurrence of the disease after 2 years and was reoperated, this time by
thoracotomy and resection. Case 04 was a woman with a clinical diagnosis
of a pulmonary mass in the left upper lobe; thoracoscopy showed a lesion
encompassed by the lung parenchyma, and she therefore underwent pulmonary lobectomy by VATS.
Results: All patients had pathological anatomical diagnoses and
immunohistochemical analysis of solitary fibrous tumors of the pleura. No
biopsy was performed on any of the patients before the surgery. Imaging
tests alone were enough to indicate surgery. Only one patient had a recurrence of disease which required a new resection by thoracotomy.
Conclusions: The solitary pleural tumor can be diagnosed by clinical
history and careful evaluation of imaging. When evaluated by specialists,
the diagnosis can be made and treatment can be carried out without biopsy
before surgery.
028497
Surgical treatment of a giant lipoma in the parotid gland
Cruz, R.P.1, Pinheiro, B.H.2, dos Santos, M.A.2
1
Hospital Nossa Senhora da Conceio, Porto Alegre, RS, Brazil,
2
Hospital Universitrio, Canoas, RS, Brazil
S234
Introduction: Parotid tumors are uncommon and are normally
benign. The most common tumor is the pleomorphic adenoma. Intraparotid
lipomas are rare, and few studies have been performed on them. Their incidence among parotid tumors ranges from 0.6% to 4.4%, with most series
reporting an incidence of 1%. Surgical intervention for these tumors is challenging because of the proximity of the facial nerve, and thus knowledge of
the anatomy and meticulous surgical technique are essential.
Objectives: To describe a successful resection of a huge parotid
lipoma.
Methods: A 66-year-old male patient presented with a huge right
cervical mass, with a 10-year history of swelling. He denied local pain,
nerve palsy or other symptoms. Physical examination revealed large lesion
of soft consistency in the parotid gland topography. We did not perform
any imaging exam. He was submitted to surgical exploration. A mass from
the tail of parotid lateral lobe was enucleated. The surgery finished with
complete mass extirpation without any nerve injury. Histopathological
analysis showed a lump of fatty, ovoid, encapsulated and elastic tissue,
weighing 216 g and measuring 14.5 x 7.4 x 4.1 cm, compatible with the
diagnosis of a huge parotid lipoma.
Results: We describe a successful tumor excision without any surgical
complications. The patient had no postoperative complication. After 4
years he remains without any complaint or recurrence.
Conclusions: The surgical decision is made on the basis of increased
swelling with functional and esthetic discomfort. Surgical management of
the tumor is dependent on the location, right recurrence, and the possibility
of liposarcoma. Enucleation and superficial or total parotidectomies may
be performed. To our knowledge, this is the largest parotid lipoma reported
and the third giant parotid lipoma to be described.
028872
Sweat-gland carcinoma: a case report
Melo, I.S.1, Oliveira, T.S.1, Fonteles, A.F.1, Bezerra, D.A.1, Freitas, H.C.1,
Magalhes, L.C.C.S.1
1
acd.isadoramelo@gmail.com, thaisoliveirasilva27@gmail.com,
amandafonteles81@gmail.com, diegobezerra.onco@gmail.com,
hermanycf@hotmail.com, leilacarla@bol.com.br
Introduction: The sweat-gland carcinoma affects both sexes at the
same rate, predominating in individuals between 50 and 80 years of age.
It requires differential diagnosis from skin adenocarcinoma and basal-cell
carcinoma. This cancer can present itself in eccrine and apocrine ways.
The clinical appearance of these tumors is similar. Currently, some of these
neoplasms require special techniques such as electron microscopy, immunoperoxidases and monoclonal antibodies to reveal their precise nature.
Objective: To report a case of a patient with a preauricular left sweat
gland carcinoma in the city of Sobral, Cear, Brazil.
Methodology: A 66-year-old male noticed a nodule in the pre-auricular region 2 years ago that has progressed over time. He denies comorbidities. He sought medical assistance after the first surgical procedure
was performed, when there was deterioration progressing to ulceration and
swelling of the lesion. Tomography showed an extensive neoplastic area
measuring 9.0 x 6.6 cm involving the left masseter muscle, subcutaneous
tissue and skin. Axial slices with heterogeneous enhancement after the use
of intravenous contrast also showed commitment of the left parotid gland.
There was lymphadenomegaly on levels 1 to 7 with the largest lymph node
1.4 cm. Face biopsy showed the lesion to be compatible with sweat-gland
carcinoma.
Results: An enlarged parotidectomy was performed, followed by flap
rotation. The pathological examination revealed carcinoma of sweat glands
and carotid gland, with free surgical margins.
ABSTRACTS
Conclusion: Carcinoma of sweat glands is rare and can grow slowly
for several years, before unexpectedly beginning to grow rapidly. It often
metastasizes, especially to regional lymph nodes. The best treatment is
wide surgical excision of the lesion, freezing of the margins, and chemotherapy and radiotherapy for patients who have suffered metastasis.
028834
Tactical aspects in surgical resection of tumors with superior vena
cava invasion
Andrade, R.L.1, Bonomi, D.O.2, Carvalho, E.A.2, Pinho, A.J.M.2,
Santos, F.G.C.D.1, Carvalho, C.C.1
1
2
Thoracic surgery, Mario Penna Institute, Belo Horizonte, MG, Brazil
raffaelandrade@hotmail.com, danielbonomi@hotmail.com,
erlon_avila@hotmail.com, astujr@hotmail.com, nandabhmed@hotmail.com,
camila_ccavalcante@hotmail.com
Introduction: The surgical approach for tumors invading the superior
vena cava (SVC) is a challenge to the surgical team. The etiology is varied,
and includes lung cancer, lymphomas, and metastatic neoplasias.
Objectives: To present tactical aspects used in three cases of patients
with tumors infiltrating the SVC who underwent surgical resection en bloc
with venous reconstruction.
Methods: Case 1 was a 77-year-old woman with lung cancer stage
cT4N0M0. Case 2 was a woman who at 26 years of age had undergone
resection of a schwanoma at the posterior mediastinum, and 6 years later
developed SVC syndrome. Case 3 was a 57-year-old man who underwent
nephrectomy for renal clear-cell carcinoma; he progressed with a mass in
the anterior mediastinum with SVC infiltration.
Results: Case 1 underwent posterolateral thoracotomy and right upper
lobectomy. Azygos vein ligature was performed. Innominate veins (IVs)
and pericardial intra cava were repaired. The lesion was resected and the
vein reconstructed with a bovine pericardium patch (BP). Case 2 underwent
sternotomy with extension to right anterior thoracotomy. Left and right IV
were dissected and ligated. Pericardial intracava and azygos were repaired.
Resection of the lesion and reconstruction with a BP tube between SVC
and left IV was performed. Case 3 underwent sternotomy and right anterior
thoracotomy. Tumor was released with UltraCision Harmonic and left IV
ligation with a stapler. Lesion resection en bloc and vein reconstruction
with BP was followed by application of biological glue in the suture and
mediastinal line. The average time of SVC clamping was 24 minutes. All
patients were maintained on prophylactic anticoagulation postoperatively.
All remain clinically well so far. The mean hospital stay was 14 days.
Conclusion: The complex resections of tumors with SVC invasion should be regarded as major operations; however, there are no noted
complications that prevent this type of approach. Postoperative anticoagulation is controversial in the literature. The bovine pericardium has been
increasingly employed in this type of intervention. The energy utilization,
stapling and biological glue seem to make the procedure less complex and
faster.
029287
Thyroglossal duct cyst papillary carcinoma: a case report
Genaro, A.1, Horie, M.K.S.2, Pereira, A.O.2, Netto, W.J.M.2,
Filho, M.A.F.1, Pereira, L.P.2
1
Prudente, Brazil
andregennaro@hotmail.com, matheus_horie@hotmail.com,
franco.80@hotmail.com, larissa_ppereira@yahoo.com.br
ABSTRACTS
Introduction: Thyroglossal duct cysts (TGDCs) result from a failure
to obliterate the embryogenic duct produced during thyroid migration
toward the its final position and secretion from the epithelium to the lumen.
TGDC carcinomas are rare (1% of all cases), occur predominantly among
women, and 91% are papillary carcinomas. There is no consensus about the
etiology. It may originate from thyroid ectopic tissue present in over 62% of
cases, or may be an occult papillary thyroid carcinoma metastasis.
Objectives: To present a papillary carcinoma case in TGDC.
Methods: This was a retrospective survey, with a description and
discussion of a case report and a literature review of books and database.
Results: A 35-year-old female patient presented to the surgery department of Presidente Prudente Regional Hospital due to a growing cervical
mass of approximately 2.5 cm at the midline, painless, with a firm consistency, little mobility and no signs of inflammation; there was no cervical
lymphadenopathy, and no alterations were found on thyroid palpation. A
neck ultrasound confirmed TGDC with microcalcifications inside. The
patient was submitted to resection of the lesion in May 2015. The anatomopathology revealed a TGDC, 2.5 x 1.7 x 1.1 cm, with a grainy surface,
grayish, and with the presence of a papillary thyroid carcinoma. The patient
is currently undergoing outpatient follow-up. A new neck ultrasound was
performed, with no alterations. She awaits total thyroidectomy.
Conclusions: Preoperative diagnosis of TGDC carcinoma is difficult
due to lack of clinical signs indicative of malignancy, as in our case; malignancy was confirmed from analysis of the surgical specimen. Despite the
excellent prognosis, because <2% of cases have distant metastases, it was
decided in the reported case to perfom a radical thyroidectomy, as recommended by various authors; this is advisable also because of the fact that
up to 33% of thyroids are affected at diagnosis, and to confirm whether the
carcinoma is a TGDC primary or an occult thyroid papillary carcinoma
meastasis.
S235
S236
NUMACO (abstracts in the areas of Psychology,

Nursing, Nutrition, Speech Therapy, Physiotherapy and
Social Works)
028277
Benefits of setting up a protocol for the use of central venous catheter
peripheral insertion (PICC), model mono-lumen PowerPICC, guided
by ultrasound, as a venous access option in cancer infusional therapy
Silva, N.A.1, Souza, F.J.1, Arajo, J.R.C.1, Matarezzi, E.S.S.T.1,
Silva, S.A.S.2, Almeida, B.2
1
Unimed Jundia, Brazil, 2Politec Sade, Brazil
nnsilva@unimedjundiai.com.br, fjsouza@unimedjundiai.com.br,
jraraujo@unimedjundiai.com.br, esmatarezzi@unimedjundiai.com.br,
samir.silva@politecsaude.com.br, bianca.almeida@politecsaude.com.br
Introduction: In a private clinical oncological department, chemotherapy is administrated as intravenous therapy for the treatment of
cancer. From there, an institutional protocol was developed for the use of
a central venous catheter peripheral insertion (PICC), model mono-lumen
PowerPICC, during this therapy. The PICC is a catheter that has lower
financial costs, and also offers less risk to the patient compared to other
central venous catheters. There are several indications for the use of the
PICC, including treatments with vesicant therapies. The venous network
can be difficult to access for the administration of antibiotics and blood.
However, the contraindications are a lower proportion relative indications;
anatomical changes; skin infection near the insertion site; and the presence
of thrombosis or phlebitis. In the clinic the implantation occurs intravenously guided by ultrasound and is carried out by qualified nurses responsible for infusion therapy. The criteria adopted in the institutions protocol
were: patients with edema in the upper limbs, difficulty in obtaining peripheral venous access, and vesicant therapy within less than a year of chemotherapy treatment.
Objective: To demonstrate the benefits of the protocol for the use of
mono-lumen PowerPICC guided by ultrasound, as an option for venous
access in infusion therapy for cancer.
Methods: This is a report about experience with and benefits of the
PICC in a private oncology clinic. The data collection was made from
January 2013 to May 2015, and we included data on the inclusion criteria,
length of stay, withdrawal reason, and the number of procedures performed
for collection for laboratory tests.
Results: We implanted a total of 58 PICC. Reasons for selection were:
vesicant chemotherapy, 41 (70.6%), and difficulties with peripheral venous
access, 17 (29.4%). Length of hospital stay averaged 121 days. Withdrawal
reasons were: end of intravenous therapy, 30 (73.1%); death, 9 (21.9%);
infection, 1 (2.4%); and thrombosis, 1 (2.4%). Number of blood samples
taken was 257.
Conclusions: This study revealed that the mono-lumen PowerPICC,
guided by ultrasound, was a reliable and safe option in infusion therapy
with vesicant chemotherapy, and contributed to the quality of life of patients
who had difficult peripheral venous access. The PICC provided adequate
assistance and resulted in reduced physical and psychological suffering,
because it decreases the number of venous punctures in cancer treatment.
028756
Benefits of using the peripheral insertion central catheter (PICC) in
oncological patients
Agostinho, C.S.1, Luz, M.L.S.1, Oliveira, K.S.1, Souza, T.1
1
Department of Oncology, Hospital San Rafael, Salvador, Bahia, Brazil
cristiane.agostinho@hsr.com.br, michele.luz@hsr.com.br,
kelestrela.kelly@gmail.com, thataisouza@gmail.com
ABSTRACTS
Introduction: Peripheral insertion central catheter (PICC) is a venous
device used in oncology for the delivery of chemotherapy; it has many
benefits to cancer patients, providing security and comfort when it is indicated, and ease of handling and maintenance performed by medical doctors
and nurses.
Objectives: This work aims to define the importance of PICC in oncological therapies and its benefits for the patient, as well as highlighting the
importance of the communication between medical and nursing staff for the
best use and maintenance of this device.
Methods: This study was performed with a literature review, using
available databases in virtual libraries, with data collection on features and
benefits of the use of PICC and its contributions to cancer patients.
Results: PICC is an innovative technology, providing an easy-tohandle catheter with a widespread use for venous therapies; benefits
include lower cost, lower risk of contamination, and reduction of potential
complications such as pneumothorax and hemothorax. The use of PICC
may also present complications such as phlebitis, bloodstream infection
and embolism that can cause damage and unnecessary hospitalizations.
The most effective way of avoiding these complications is related to proper
catheter maintenance by the nursing team, mostly with proper aseptic catheter handling and dressings. For the best results in the use of PICC, the
medical team who defines its placement and the nursing team that provides
its installation and maintenance need to be in accordance.
Conclusions: The use of PICC has many benefits in cancer therapy,
with advantages and disadvantages, making necessary a patient assessment
by the medical and nursing team for its indication and maintenance. An
effective understanding between these professionals is essential for optimal
indication of this catheter. Further studies are necessary to address this
issue and promote the use of this venous device
028835
Clinical profile of oncological patients submitted to negative-pressure
therapy at AC Camargo Cancer Center
Matsubara, M.G.S.1, Conti, E.C.1
1
maria.matsubara@accamargo.org.br, erica.conti@accamargo.org.br
Introduction: Therapy applying the use of negative pressure is a new
concept in the literature for improving wound healing.
Objective: To identify the clinical profile of cancer patients using
negative-pressure therapy.
Methods: This was a descriptive retrospective cohort study from 2012
to 2013. Data were obtained from the pharmacy department of the institution about patients who used the equipment necessary for negative-pressure
therapy. Revision of the electronic records was made.
Results: Thirty-nine patients were evaluated, 61.4% of whom were
women; mean age was 59 years; 30.72% of the patients were diagnosed
with rectal adenocarcinoma, and they used negative-pressure therapy for
21 days after the presence of the wound (69%) and at dehiscence. They also
used other treatments such as radiotherapy and chemotherapy.
Conclusions: The clinical profile of oncological patients using negative-pressure therapy is correlated with the diagnosis of rectal cancer. These
patients underwent neoadjuvant chemotherapy and subsequently rectosigmoidectomy or laparotomy; they had wound dehiscence in the abdominal
region, which was the site at which negative-pressure therapy was used.
ABSTRACTS
028452
Clinical profile of patients in the oncology emergency room and
factors associated with the diagnosis of sepsis
Matsubara, M.G.S.1, Villela-Castro, D.L.1
1
maria.matsubara@accamargo.org.br, diana.villela@accamargo.org.br
In 2014, 21,888 patients attended the Oncology Emergency Room
(OER). On the Manchester rating scale (Manchester Triage Group), there
was on average 0.2% red, 6.7% orange, 15.0% yellow, 62.7% green, 8.1%
blue and 7.3% white. Of these, 606 (2.8%) had confirmed sepsis, including
329 (54.3%) with sepsis, 172 (28.4%) with severe sepsis, 105 (17.3%)
with septic shock, and 106 (17.5%) died. Of the 106 deaths, 41 (38.7%)
were receiving palliative care exclusively. The patients who died had an
average age of 62 years (2493 years); 54.7% had metastasis, tumors of the
lung (17.0%) and breast (13.2%) being the most prevalent. According to
the flowchart, the most prevalent status was unwell adult (14%), follow
by abdominal pain (11.4%) and shortness of breath (11.2%). In AC
Camargo Cancer Center we have a protocol for early diagnosis of sepsis,
and the symptoms and signs are: hypothermia, hyperthermia, hypotension,
low oxygen saturation, bradycardia, tachycardia, bradypnea, alteration
of consciousness and chills; hypothermia and tachycardia were the most
prevalent symptoms.
028435
Antineoplastic classification by colors: reporting a tool experience to
prevent extravasation
Souza, F.J.1, Silva, N.A.1, Arajo, J.R.C.1, Fher, R.1, Matarezzi, E.S.S.T.1,
Santos, M.I.M.1
1
Unimed Jundia, Brazil
jraraujo@unimedjundiai.com.br
Introduction: Chemotherapy is one of the main therapeutic modalities
for cancer treatment, administered by nurses specially trained because of
the complexity of action of some drugs. Among the complications, extravasation stands as an oncological emergency, because of the risk of functional
and esthetic damage to the patient. The chemotherapeutic agents can be
divided into (1) vesicant drugs that cause late changes such as edema, local
pain and induration, ulceration, blistering, tissue necrosis and functional
damage; (2) irritant drugs that lead to an inflammatory condition without
tissue damage; and (3) non-vesicants which have no immediate or late local
reactions after extravasation.
Objective: To demonstrate that the use of the classification of chemotherapy, by green, yellow and red colors in chemotherapy bags and
medical prescriptions optimizes the action of the nurses before and after
extravasation.
Methods: This is an experience report from a private oncology clinic.
The following model was used in January 2014 to May 2015: adhesive
circles of three different colors green for non-vesicant drugs, yellow for
irritating drugs and red for vesicant drugs were used. The pharmacist
during preparation stuck these to bags of medications to be infused into
the patient during outpatient treatment; their prescriptions were underlined
and placed where they would be visible to the nursing staff, and the nurses
had pens in the same colors to highlight the chemotherapeutic treatment
involved. With the identification of colors, the action of nurses faced with
an extravasation is more responsive and appropriate, because of the rapid
and simple visualization of the type of chemotherapy being infused.
Results: The incidence of vesicant drug extravasation from January
2014 to May 2015 was recorded. Using the color system, the reaction of
the nursing team was immediate. The patient, using a peripheral venous
line, said during infusion that the site was burning; there was an immediate
pause in medication, the type of drug was identified, and interventions were
S237
initiated as per institutional protocol. There were no late complications of
this event.
Conclusions: This is a simple, low-cost method which helps the
nursing staff with drug identification prior to infusion, so there is increased
attention in the choice of venous access and conduct during an extravasation. It highlights the importance of adopting preventive measures during
chemotherapy, aiming to prevent complications resulting from this oncological emergency.
028971
Cut-offs for lymphedema by comparing limb volume of manual
perimetry and optoelectronic volumetry in volunteers
Campanholi, L.1, Duprat Neto, J.P.1, Fregnani, J.H.T.G.1,
Baiocchi, J.M.T.1, Baiocchi, G.1
1
larissalcm@yahoo.com.br, joao.duprat@accamargo.org.br,
mdfregnani@terra.com.br, jaquemunaretto@gmail.com,
glbaiocchi@yahoo.com.br
Introduction: Measurement techniques for limb volume are currently
evolving, and a determination of normal values for each method is required.
Objective: To propose a cut-off for lymphedema, comparing data
from a healthy population by assessing upper and lower limb volume using
manual perimetry and optoelectronic volumetry (perometer).
Methods: This was an observational cross-sectional study with
prospective data collection, obtained by measuringthe volume of limbs.
Fifty healthy adults participated in this study. Individuals with a history of
severe trauma or lymphonodectomy were excluded. Subjects were evaluated by manual perimetry and optoelectronic volumetry.
Results: Using manual perimetry, a difference of 169.5 mL (7.8%)
between upper limbs (dominant to non-dominant) was considered normal.
Using optoelectronic volumetry, the difference between upper limbs was
normal up to 179.6 mL (7.5%). The difference between lower limbs was
normal up to 312 mL (6.3%) in manual perimetry, while in optoelectronic
volumetry normal values were up to 403.8 mL (7%). A significant difference (P < 0.001) between upper limbs and right lower limb was observed
between methods.
Conclusions: Value differences were considered normal at 150 mL or
7% in upper limbs and 300 mL or 6% in the lower limbs. Lymphedema of
the upper limb can be diagnosed by values >200 mL or >10% difference
between the ipsilateral and contralateral limb and for lower limbs >420
mL or >7%.
028973
Evaluation through optoelectronic volumetry for arm lymphedema in
patients who have undergone lymphadenectomy or sentinel-lymphnode biopsy for breast cancer
Kopittke, L.1, Baiocchi, J.M.T.1, Rodrigues, T.R.1, Friedrich, C.F.1,
Campanholi, L.L.2, Bevilacqua, J.L.B.1, Baiocchi, G.1
1
AC Camargo Cancer Center, So Paulo, Brazil, 2CESCAGE, Brazil
lu-k@uol.com.br, jaquemunaretto@gmail.com,
telmarr@yahoo.com.br,celenafriedrich@yahoo.com.br,larissalcm@yahoo.com.br,
jose.bevilacqua@accamargo.org.br, glbaiocchi@yahoo.com.br
Introduction: Lymphedema is a common morbidity after breast
surgery.
Objectives: To study the advantages and disadvantages of using optoelectronic volumetry (OPEV) for evaluation of upper limbs in patients
undergoing surgical treatment of breast cancer with lymphadenectomy.
Methods: We conducted a prospective longitudinal study by evaluating patients over 6 months postoperatively through the perometer
S238
Pero-System, Wuppertal, Germany. The arm was positioned vertically to
the perometer infrared light. A measure of the cross-sectional area of the
arm was taken every 5 mm from the armpit to the hand. Three measurements were made, and the final value was the mean of them. Between
August 2013 and October 2014 we evaluated 44 patients who underwent
selective lymphadenectomy (sentinel-lymph-node biopsy, SLB) or radical
lymphadenectomy (axillary dissection, RL).
Results: The time interval between surgery and mid assessment of
lymphedema was 35.3 months (6170). The median difference in volume
between the limbs of the patients was 88.15 mL; 4.75% (101220 mL;
0.441.5%) with a mean of 129.5 mL. Median BMI was 25.3 (19.743.9)
and the median age was 58 years (3876). Each evaluation took about 35
minutes including installation of the appliance. Limbs with irregular shapes
could be analyzed accurately. In this study no patient was excluded due to
technical difficulties of assessment or limb size. OPEV therefore presents a
method of good accuracy and with relevant advantages over other methods
of assessing the volume of limbs in the literature. OPEV shows excellent
reproducibility between and within methods, which means that the patient
does not need to be evaluated by the same professional during their monitoring or therapy, being excellent for daily, weekly or monthly measurements in the evaluation of treatment or disease progression. Among the
disadvantages are the high cost of the perometer and patients with orthopedic impairments who cannot keep their arm in the ideal position on the
machine.
Conclusions: The perometer is easy to operate, fast, convenient, and
can be used regardless of the condition of the skin and the patients limb
format. In this study the perometer proved to be a very useful and effective
tool to measure volumes of limbs.
028895
Evaluation through optoelectronic volumetry as a method of diagnosis
of lymphedema in limbs in patients who have had lymphadenectomy
and radical treatment of cutaneous melanoma
Campanholi, L.1, Duprat Neto, J.P.1, Fregnani, J.H.T.G.1,
Baiocchi, J.M.T.1, Baiocchi, G.1
1
larissalcm@yahoo.com.br, joao.duprat@accamargo.org.br,
mdfregnani@terra.com.br, jaquemunaretto@gmail.com,
Introduction: Optoelectronic volumetry (OPVO) is an unpublished
method in Brazil, used in the diagnosis of lymphedema in limbs.
Objectives: To evaluate a method for the diagnosis of lymphedema in
limbs, unprecedented in this country, in patients with radical lymphadenectomies as a treatment for cutaneous melanoma, to analyze reproducibility
between OPVO and manual perimetry (MP), and to evaluate the prevalence
of lymphedema with these methods using different cut-off points.
Methods: We studied 97 patients who underwent axillary lymphadenectomy (46 cases, 47.4%) inguinal (2626.8%) or ilio-inguinal (2525.8%)
in the period between 1990 and 2012. We excluded patients with amputation of a limb or bilateral dissection. The measurement of limb volume
was done by MP applied in the formula of the truncated cone and OPVO
(perometer). The difference between the volumes of the MP and OPVO was
checked by the Wilcoxon test. The kappa coefficient was used to assess the
agreement between the methods.
Results: The proposed cut-off points for upper limbs are a difference
between members >7%, >10%, >150 mL, >200 mL and 3 circumferences of more than 2 cm difference between the ipsilateral and contralateral side, and for lower limbs >6%, >7%, >300 mL, >420 mL and 3
circumferences. The prevalence of upper-limb lymphedema by OPVO
ranged from 15.2% to 34.8% and by MP 2.2% to 32.6%, while for lower
limbs the range was 66.7% to 80.4% by OPVO and 49.0% to 76.5% by
ABSTRACTS
MP. At a cut-off >10% for upper limbs, the prevalence was similar in both
OPVO and MP, but for other cut-offs there were differences. The agreement
between the methods was satisfactory and statistically significant (axillary
lymphadenectomy: 0.663, P < 0.001; inguinal: 0.549, P = 0.003, and ilioinguinal: 0.884, P < 0.001).
Conclusion: Both methods showed good reproducibility among themselves, but the perometer provides more precise measurements, is practical
and fast, with instantaneous volume compatible with the MP. The OPVO
had higher prevalence rates of lymphedema when compared to the MP, and
the lower the cut-off, the higher the prevalence of lymphedema.
029239
Factors affecting food intake in cancer patients
Freitas, E.C.1, Miranda, A.S.2, Santana, R.F.3, Cardoso, L.M.L.4
1
Nutritionist, Institute of Nephrology of Brumado and General Hospital
of Vitria da Conquista - Home Care Fesf/SUS/SESAB, Vitria da
Conquista, Bahia, Brazil, 2Department of Nutrition, Faculty of Technology
and Sciences and Northeast Independent College, Vitria da Conquista,
Bahia, Brazil, 3Department of Nutrition, Federal Institute of Norte de
Minas and Faculty of Technology and Sciences, Vitria da Conquista,
Bahia, Brazil, 4Nutritionist, Vitria da Conquista, Bahia, Brazil
erllannya@hotmail.com, adrinut@gmail.com, rena_nutri@yahoo.com.br
Introduction: Cancer patients have increased demands resulting from
the disease itself and its main forms of treatment: radiotherapy or chemotherapy (separate or combined) and/or surgery. The patient undergoing
cancer treatment is more vulnerable to complications from the treatment
that lead to a reduction in their food intake, aggravating their health condition and adding to the damage to the body caused by the disease.
Objectives: To evaluate the factors that affect food intake in patients
with cancer.
Methods: This project was held at Casa de Acolhimento ao Paciente
Oncolgico in Southwest Bahia, Brazil. It was approved by the Research
Ethics Committee (CEP/UESB), N 131/2011. The events affecting
food intake in 20 patients were evaluated using the Subjective Global
Assessment Form (anorexia, nausea, sore mouth, taste changes, difficulty
in chewing, vomiting, dry mouth, olfactory changes, early satiety, dependence for having food, odynophagia, and others). The results were analyzed
using descriptive statistics, chi-square test by Pearson for association,
significance value P < 0.05.
Results: The most relevant types of cancer presented by the evaluated
patients were neck and prostate cancesr, 26.1% each, followed by uterine
and head cancers. The major oncological complications were difficulty in
chewing, reaching 56.5%, followed by nausea (39.1%), anorexia (34.8%),
odynophagia (30.4%), dry mouth (26.1%), and vomiting (21.7%). When
evaluating the association of these factors with the prevailing nutritional
status of the investigation, anorexia and sore throat contributed significantly to weight loss (P = 0.01 and P = 0.03, respectively), the loss possibly
being caused by reduced food intake.
Conclusions: The identification and monitoring of clinical complications resulting from therapies in cancer patients should be undertaken in
order to minimize their implications for the patients body. Professional
training in interventionist actions at all stages of the treatment is necessary,
so that food intake and nutritional status are preserved.
ABSTRACTS
028087
Factors associated with quality of sleep in oncology patients in the
chemotherapy treatment period: an integrative literature review
Salvador, A.1, Costa, A.L.S.1
1
School of Nursing of the University of So Paulo, So Paulo, Brazil
amanda.salvador@usp.br, anascosta@usp.br
Introduction: Cancer is defined as a multifactorial disease that occurs
from disorderly and uncontrolled cell growth. Classical chemotherapy is
one of the treatment modalities for cancer; it involves the managed administration of toxic chemicals that cause changes in the physiological and
biochemical structures of the human body. Secondary to the side effects
caused by chemotherapy treatment are changes in sleep patterns that occur
in 3050% of oncological patients; this causes decreased quality of life,
difficulty in treatment acceptance and treatment success for cancer.
Objectives: To determine the factors associated with sleep quality in
cancer patients undergoing chemotherapy.
Method: This was an integrative literature review with research in
PUBMED, CINAHL and LILACS databases using the PICO strategy with
the descriptors chemotherapy, antineoplastic agents, sleep and sleep
disorders, in Portuguese, English and Spanish. Inclusion criteria were: (1)
full text available; (2) studies published between 2006 and 2012; (3) studies
published in English, Portuguese or Spanish. Studies were excluded if: (1)
they referred to the family and/or caregiver; (2) they involved laboratory
animals; (3) they referred to the pediatric population; and (4) they did not
use specific tools for the evaluation of sleep patterns.
Result: The initial set of data included 552 references. After application of the inclusion and exclusion criteria, 13 studies were included in the
final sample. Analysis of the studies identified bio-psycho-physiological
factors associated with sleep disorders in oncological patients undergoing
chemotherapy, such as fatigue, depression, pain, hot flashes, nocturia,
dyspnea, coughing, snoring, feeling cold, anxiety, and change in levels of
interleukin-1 and interleukin-6.
Conclusion: The results obtained have provided a theoretical basis
for the development and structuring of interventions applicable to clinical
practice; these cover the management of the factors that are related to sleep
disorders in oncological patients.
029214
Food consumption in cancer patients
Freitas, E.C.1, Santana, R.F.2, Miranda, A.S.3, Cardoso, L.M.L.4
1
State University of Southwest Bahia (UESB), 2Department of Nutrition,
Federal Institute of Norte de Minas and Faculty of Technology and
Sciences, Vitria da Conquista, Bahia, Brazil, 3Department of Nutrition,
Faculty of Technology and Sciences and Northeast Independent College,
Vitria da Conquista, Bahia, Brazil, 4Nutritionist, Vitria da Conquista,
Bahia, Brazil
erllannya@hotmail.com, adrinut@gmail.com
Introduction: The assessment of food intake is a valuable tool for
identifying patients at nutritional risk and, thus, for establishing the best
dietotherapeutic treatment; some diseases, like cancer, have a negative
effect on food consumption.
Objectives: To assess the food intake of patients assisted by the Casa
de Acolhimento ao Paciente Oncolgico in the Southwest of Bahia, Brazil.
Methodology: This is a descriptive, quantitative and cross-sectional
study, conducted in 2011, after being approved by the Research Ethics
Committee (CEP/UESB) 131/211. The participants in this study were 23
patients who were in surgical treatment, chemotherapy and/or radiotherapy
and who agreed to participate by signing the Informed Consent Form.
Therefore, the 24-h Recall feed was applied, and, through this, the energy
values and macro- and micronutrients (vitamins A and C, and minerals
S239
calcium, iron, selenium and zinc) were quantified using the DIETPRO software, version 5i. The data are presented as means and standard deviation.
Results: We identified prevalent low-calorie diets (100%): hypoglycemic (100%), low protein (43.5%) and low fat (91.3%). Mean total energy
value was 966.87 348.39 kcal, ranging from 295.82 to 1731.51 kcal. The
quantification of food intake showed that an inadequate number of calories
and macronutrients were being consumed, and that 73.9% were even below
the basic energy needs. As for the micronutrients, 82.6% had an inadequate
intake of vitamins, and 84.85% had inadequate mineral intake. This result
can be explained by the low consumption of fruits and vegetables in the
participants studied.
Conclusion: Better monitoring, in order to develop strategies to
improve food intake by patients, must be emphasized, since the installation of malnutrition may affect survival by increasing the complications
of applied therapy and, in some cases, decrease expectation and quality of
that survival.
028864
Implantable infusion port fracture and embolization to the right
ventricle: a case report
Firmino, N.L.J.1, Gomes, A.S.A.2, Miranda, E.2, Nascimento, A.C.S.3,
Jesus, C.G.3, Costa, F.C.R.1, Lins, P.I.A.B.3, Arajo, I.V.3, Almeida, M.M.1
1
2
3
emiranda.onco@gmail.com, aidacarla.acsn@gmail.com,
caroline.graciliano@hotmail.com, fernandacecile@hotmail.com,
pedroablins@gmail.com, irlavalenca_20@hotmail.com, marcella.
markman13@gmail.com
Introduction: Central venous access is useful for clinical practice,
including diagnostic and therapeutic purposes, and especially for infusion
of chemotherapy. Its use has increased in an extraordinary way, and today
it is a safe procedure, with possible complications that should not be disregarded as they can be fatal. The main complications due to venous catheters
are thrombosis and catheter infection. Mechanical complications are rare:
among them is the embolization of catheter fragments which affects about
1% of patients. Despite the low incidence, embolization is responsible
for a high mortality through its evolution to thromboembolism, bacterial
endocarditis, sepsis, myocardial injury and cardiac arrhythmias. Thus, the
removal of these foreign bodies is always recommended.
Objectives: To describe a clinical case of Port-a-Cath catheter fracture
and embolization to the right ventricle.
Methods: A 52-year-old patient on neoadjuvant chemotherapy for
breast cancer underwent Portacath insertion via the right subclavian vein.
Subsequently the line disconnected from the port, and embolized to the
right ventricle. The patient had soreness at the catheter site and no venal
reflux.
Results: A pigtail catheter was used to pull the central portion of the
line; however, it was not possible to ensnare it.
Conclusion: Fracture of central venous catheters is a rare but serious
complication of their use. Embolized fragments are associated with a
number of complications, including pulmonary embolism, sepsis, arrhythmias, and cardiac perforation. Although our attempt at late extraction
was unsuccessful at first, there are reports in the literature of successful
percutaneous extraction of catheter fragments as long as 12 years after
embolization.
S240
029139
Implementation of a multidisciplinary outpatient care program in a
referral gynecologic oncology department
Rocha, P.1, Nunes, J.S.1, Affonso Jr, R.1, Reis, R.1, Simioni, E.B.1,
Tsunoda, A.T.1
1
patygineco31@gmail.com,
jsnunes@yahoo.com.br,renatolusa@yahoo.com.br,dr.ricardoreis@hotmail.com,
elisasimioni83@gmail.com, atsunoda@gmail.com
Introduction: An appropriate approach to cancer treatment involves
various specialties that require effective communication. Few studies
address effective ways of implementing multidisciplinarity communication
in gynecological cancer care.
Objectives: To describe the impact of the implementation of outpatient
multidisciplinary care in a referral gynecological oncology department.
Methods: All consecutive cases were reviewed, discussed, and decided
in a multidisciplinary meeting the week before the patients appointment. It
was possible to determine the treatment plan, including the specialties and
aspects to be addressed (preferably on a single day) in the same outpatient
facility. Involved specialties are: surgical gyneoncology, radiooncology,
medical oncology, radiology and pathology. The project included structural
aspects of the clinic, scheduling improvements, care flow, and analysis of
indicators. Data was collected weekly in a REDCap (Research Electronic
Data Capture) file, by the leading nurse in the department. Statistic analysis was descriptive.
Results: Between 07/2013 and 05/2015, 724 cases were discussed
in our multidisciplinary meetings. Patients attending the postdiscussion
consultation were evaluated by radiooncology in 61% (n = 446), clinical
oncology in 54.1% (n = 392), and surgery in 34.25% (n = 248). Among
these, 53.7% (n = 389) were evaluated by a single specialty, 42.5% (n =
308) by two specialties, and 3.7% (n = 27) by three specialties on the same
day. Patients missing the evaluation were excluded (n = 13, 1.79%), and 9%
could not attend all the necessary consultations on the same day. There was
a mean of 38.4 days (1289) from the date of admittance and the start of the
proposed treatment; and 11.4 days (149) from the date of the multidisciplinary consultation and the start of treatment.
Conclusions: With this project, it was possible to organize the flow
of patients on demand, optimizing the time for treatment within the therapeutic plan decided in multidisciplinary meetings. Most patients could be
evaluated in the specialty/specialties related to the treatment plan in a single
day, in one single outpatient clinic.
029120
Intraoperative complications of robotic prostatectomy surgery
Tadini, T.L.1, Abilio, N.S.1, Alves, R.L.G.1, Trevisani, M.S.1,
Castro, D.L.V.1, Angelo, C.S.1
1
A.C. Camargo Cancer Center, So Paulo, Brazil
nicole.abilio@accamargo.org.br
Introduction: Robotic surgery has been developed since the 1980s to
overcome the limitations of laparoscopy. The benefits to patients include
less postoperative pain, smaller incisions, shortened hospital stay and
recovery, and a quicker return to the activities of daily living. In May 2013
robotic surgery was started at a cancer hospital in So Paulo, opting first for
urology procedures such as prostatectomy.
Objectives: To identify the incidence of intraoperative complications
of robotic surgery and to correlate them with the clinical and epidemiological variables of the affected patients.
Methods: This was a quantitative retrospective study performed with
all patients undergoing robotic surgery at a cancer hospital in So Paulo in
the period between May 2013 and May/2015 to answer the main question:
ABSTRACTS
What is the incidence of complications during robotic surgery, and what is
their correlation with the patients clinical and surgical conditions?.
Results: Of the 515 surgeries performed, 377 were prostatectomies
(73.2%), 41 nephrectomies (7.9%), 38 rectosigmoidectomies (7.3%), 19
hysterectomies (3.7%) and 40 other modalities. In prostatectomies, 16
skin lesions were identified as well as 344 other complications, including,
respectively: six bruises, four skin tears, two decubit ulcers (DU) grade
1, one DU grade 2, one lesion of the upper lip, one lesion of left cervical
region, one reactive hyperemia, 212 bloody urine, 57 pain complaints, 21
hypotension, 11 hyperglycemia, ten bleeding, six complaints of nausea,
four tachycardia, three indwelling catheter obstructions, three subcutaneous emphysema, two surgical reapprochements, two decreased diuresis,
two bulges in right flank, one bronchospasm, one episode of agitation, one
bradycardia, one decreased level of consciousness, one hypoglycemia, one
hypothermia, one loss needle, one cervical edema, one tooth extracted, one
hypertension and one possible fistula.
Conclusions: The results obtained are in the statistical analysis phase.
028243
Lymphocytic leukemia and the treatment of febrile neutropenia
Pinto, S.S.1, Bergamasco, H.C.2, Barbosa, G.C.3
1
Hospital Geral Roberto Santos, Salvador, Brazil, 2Instituto Israelita Albert
Einstein de Ensino e Pesquisa, So Paulo, Brazil, 3Odebrecht, Salvador,
Brazil
symonysantos@bol.com.br
Introduction: According to the Brazilian Cancer Institute, acute
lymphocytic leukemia (ALL) is the most common type of cancer during
childhood. ALL constitutes 7580% of all acute leukemia cases in children and 20% of all cases in adults. Life expectancy of leukemia cases,
especially ALL, has been advancing alongside improved treatments,
including intensive chemotherapy. Febrile neutropenia (FN), a consequence of chemotherapy, is a frequent complication, and may be deadly.
For that, it is fundamental for the nurse to instruct his/her team to provide
humanitarian care.
Objective: To describe nursing assistance for children with ALL who
have developed FN, according to evidence in the scientific literature since
2005.
Methods: We carried out a review of databases LILACS, DEDALUS
and SCIELO using the descriptors neoplasia, neutropenia, fever and
children. A convenient sample was obtained after inclusion criteria were
applied, and ten articles were selected for content analysis.
Results: During the treatment of ALL, complications may occur if
the neutrophil count is low; the immune system is affected and the patient
becomes more vulnerable to infections. Any elevated temperature deserves
attention, since untreated FN may be fatal. Development of adequate
measures for prevention and control in immunologically compromised
children is of great relevance, mainly in neutropenia cases, since in these
patients infections are the main causes of death. Nurses perform many
functions on a daily basis, from the initial contact to diagnosis, as well as
the childs disturbance, which allows nurses to have a wide vision of all the
patients needs.
Conclusions: Research shows that febrile neutropenia, an oncological
emergency, is usually treated in hospitals where broad-spectrum antibiotics
are used empirically; treatment demands a multidisciplinary and specialized team. Children affected by FN may evolve with sepsis and then are at
imminent risk of death. Patients need frequent care with specialized nursing
when chemotherapeutics are being administered, and side effects such as
vomiting, dehydration, infections, convulsions or fever need to be dealt
with. Pinpointing the origin of the infection is mandatory.
ABSTRACTS
029200
Nursing interventions used in the early detection of skin cancer: an
integrative review of the literature
Paula, L.L.R.J.1, Ferreira, V.2
1
A.C. Camargo Cancer Center, So Paulo, Brazil, 2Universidade de
Araraquara, Brazil
livialoami@gmail.com, ferreiravi@hotmail.com
Introduction: Skin cancer is the most frequent type of cancer in
Brazil. Nursing professionals have a fundamental role in prevention and
control activities, providing assistance to cancer patients in the diagnostic
evaluation, treatment, rehabilitation and care for family members. They are
also involved in developing educational activities, integrating actions with
other professionals, identifying occupational risk factors, and offering practical assistance to cancer patients and their families.Objective: To evaluate
the evidence available in the literature on interventions by nurses in early
detection of skin cancer.
Methods: This was an integrative literature review, which sought
articles in the databases LILACS, PUBMED, SCIELO, CINHAL and
COCHRANE through the keywords skin cancer and nursing in the last 10
years.
Results: We found 587 articles, of which 19 met the inclusion criteria.
Of these, only two were Brazilian and published in a national journal.
Among the interventions we observed campaigns, clinical examination
by health experts in mobile primary care units for early detection, genetic
counselling, and health education for self-examination, including children and adolescents. Also we noted studies that reported the importance
of adequate training of health professionals in the early detection of skin
lesions.
Conclusions: Although skin cancer is the most frequent cancer in
Brazil, studies of interventions performed by nurses in early detection are
still scarce; however, there has been an intensification of such studies since
2010. Despite the climate of Brazil, skin cancer prevention habits are still
little used by Brazilians. More detailed studies are needed to investigate
the early detection routine of nurses as well as their level of knowledge on
the subject.
028285
Nursing perspectives in the creation of a database on molecular tests
Salvador, A.1, Silva, M.C.1, Frana, A.A.2, Achatz, M.I.W.2
1
Department of Nursing, AC Camargo Cancer Center, So Paulo, Brazil,
2
Department of Oncogenetics, AC Camargo Cancer Center, So Paulo,
Brazil
amanda.salvador@accamargo.org.br, mayara.silva@accamargo.org.br,
amanda.nobrega@accamargo.org.br, miachatz@gmail.com
Introduction: Currently, it is estimated that about 510% of all
cancers are linked to an inherited predisposition. Oncogenetics is the discipline responsible for identifying individuals with hereditary cancer through
analysis of germline mutations directly associated with the syndromes of
predisposition to cancer. Oncogeneticists provide: (1) genetic counseling
which aims to provide information on personal and family risk; (2) genetic
testing; (3) diagnosis; (4) screening; and (5) advice on prevention. In oncogenetics, educational and research activities are attributed to the nurse who
builds the database. Databases provide the information for studies that aim
to better understand familial cancer groupings, inherited syndromes, and
other relevant clinical and epidemiological information.
Objectives: To describe the importance of structuring a database on
patients who have undergone genetic testing for syndromes of hereditary
predispositions to cancer.
Method: This was a retrospective and descriptive study with quantitative analysis. Data were collected between the periods of May 2004 and
S241
June 2015 from genetic testing reports stored in the oncogenetics department of an oncological referral hospital in So Paulo, Brazil. Data were
divided into 17 variables and introduced into an electronic spreadsheet,
using the software Excel 2010.
Result: The creation of the database gave us the number of patients
who underwent genetic testing, as well as allowing us to expand the statistical analyses of these data. In total, 746 patients were registered, of which:
(1) 84.7% (n = 632) were female; (2) average age was 45 years; (3) 20.7%
(n = 155) showed pathogenic mutations; (4) the prevalence of mutated
genes were BRCA1 32.9% (n = 51), TP53 25.2% (n = 39), BRCA2 21.3%
(n = 33) and CDKN2A 8.4% (n = 13).
Conclusion: The implementation of an organized and well-structured
database has provided access to updated data, making them available for
research/study, in addition to expanding the possibilities for statistical analysis of data and generating several important results in clinical practice.
029209
Nutritional profile of a patient with esophageal cancer: a case report
Freitas, E.C.1, Silva, A.C.M.1, Ferraz, A.S.2, Souza, C.L.S.3, Costa, C.M.2,
Duque,A.C.M.1
1
State University of Southwest Bahia (UESB), 2Department of Medicine,
State University of Southwest Bahia (UESB), 3Department of Physiology,
Federal University of Bahia (UFBA);
erllannya@hotmail.com, carolmorais_@hotmail.com,
clara_mduque@yahoo.com.br
Introduction: Esophageal cancer is a highly aggressive neoplasm,
considered the sixth leading cause of death from cancer worldwide.
Relevant to the increase in morbidity and mortality is the development of
proteinenergy malnutrition.
Objective: To evaluate the nutritional profile of the patient CDS:
male, 70 years old, a former smoker and drinker, with a tumor in the distal
esophagus.
Methods: This was a retrospective case study. The patient presented
with dysphagia and reported difficulty in consuming solid foods which
progressively worsened from January 2013. The patient was admitted to
a public hospital at Bahia, Brazil, in September 2013 with dysphagia and
odynophagia. He underwent upper digestive endoscopy, and a tumor in the
distal esophagus was diagnosed. To evaluate the nutritional profile both
subjective and objective methods were used.
Results: Physical examination showed depletion of fat and muscle
reserves in all areas; hypochromia of the eye mucosa (+++/IV) and
anasarca. The subjective global assessment (SGA) indicated a weight loss
of 28.8% of the usual weight, 76 kg over the last 6 months, which is considered severe malnutrition. The arm circumference (AC) was appropriate
to the 50th percentile for the age, 71.6%, which characterizes moderate
malnutrition. The height measured was 1.66 m and the weight measured
was 64.1 kg, allowing for 10 kg of anasarca; the dry weight was considered
54.1 kg with a BMI = 19.60 kg/m2, indicating leanness. Considering all
these nutritional parameters the patient was diagnosed with severe malnutrition. Biochemical tests showed abnormalities (hemoglobin: 11.9 g/dL;
hematocrit: 37.2%; RDW: 19.8%; albumin 3.0 g/L) indicating a likely
anemia of chronic disease, normocytic, normochromic, with anicistose
albumin indicating malnutrition.
Conclusion: This study highlights the importance of evaluating the
nutritional profile of the patient in order to promote actions to attenuate the
possible nutritional risks and to improve recovery.
S242
029217
Nutritional status for cancer patients
Freitas, E.C.1, Santana, R.F.2, Miranda, A.S.3, Cardoso, L.M.L.4
1
State University of Southwest Bahia (UESB), Brazil, 2Department of
Nutrition, Federal Institute of Norte de Minas and Faculty of Technology
and Sciences, Vitria da Conquista, Bahia, Brazil, 3Department of
Nutrition, Faculty of Technology and Sciences and Northeast Independent
College, Vitria da Conquista, Bahia, Brazil, 4Nutritionist, Vitria da
Conquista, Bahia, Brazil
erllannya@hotmail.com, adrinut@gmail.com
Introduction: The nutritional status of cancer patients is directly
related to food consumption, which may interfere with the treatment and
recovery of the affected patient.
Objectives: To assess the nutritional status of patients under cancer
treatment assisted by the Casa de Acolhimento ao Paciente Oncolgico in
the Southwest of Bahia, Brazil.
Methodology: This is a descriptive, quantitative, transverse and
field-based research project. The work was conducted in 2011 after being
approved by the Research Ethics Committee (CEP/UESB) with the consolidated report number 131/211. The research participants comprised 23
patients in surgical treatment chemotherapy and/or radiotherapy who
agreed to participate by signing the Consent Form. The following instruments were used: anthropometric measurements through the body mass
index, skin folds (bicipital, triceps, subscapular and suprailiac), calculation of the arm muscle circumference, and suitability. The results were
expressed as relative frequency, mean and standard deviation.
Results: The participants were mostly men (65.2%) with a mean age
of 58.13 16.01 years. BMI was determined for specific groups (adults and
elderly); 21.7% of adults were classified as thin and 21.75% of the elderly
with low weight, a total of 43.45% of thinness. Other BMI classifications
in adults were 13% of normal weight and 21.7% preobese. But, among
the elderly, normal weight percentage was 21.7556.45% of eutrophic
nutritional status and preobese. In the adequacy of arm muscle circumference, the percentage equivalent of malnutrition totaled 56.5%. The nails
skintriceps presented prevalence of malnutrition in varying degrees which
resulted in 86.9%.
Conclusion: A higher BMI, eutrophy and overweight are positive
factors, since the course of the disease tends to cause malnutrition among
patients in cancer treatment, as shown in the study. However, early assessment of nutritional status is important, as this could prevent major health
problems in these patients.
029218
Nutritional status in a public hospital unit in the southwest of Bahia
Freitas, E.C.1, Miranda, A.S.2, Santana, R.F., Dias, B.M.R.4, Moraes, P.C.5
1
Nutritionist, Institute of Nephrology of Brumado and General Hospital
of Vitria da Conquista - Home Care Fesf/SUS/SESAB, Vitria da
Conquista, Bahia, Brazil, 2Department of Nutrition, Faculty of Technology
and Sciences and Northeast Independent College, Vitria da Conquista,
Bahia, Brazil, 3Department of Nutrition, Federal Institute of Norte de
Minas and Faculty of Technology and Sciences, Vitria da Conquista,
Bahia, Brazil, 4Department of Nutrition, Faculty of Technology and
Sciences, Vitria da Conquista, Bahia, Brazil, 5Nutritionist, Vitria da
Conquista, Bahia, Brazil
erllannya@hotmail.com, adrinut@gmail.com, rena_nutri@yahoo.com.br,
pamel_ac@hotmail.com
Introduction: Nutritional counseling is considered an important
practice for the quality of care provided to hospitalized patients, since a
compromised nutritional status in patients is very common. Thus the adoption of actions related to food and nutrition at different levels of complexity
ABSTRACTS
and intervention is essential, taking into account individual characteristics
of the patients and the type of illness.
Objectives: To evaluate the nutritional status of hospitalized patients
at a public hospital in the southwest of Bahia, Brazil.
Methods: The nutritional status was assessed by using anthropometric (weight, height, arm circumference, arm muscle circumference,
calf, abdominal circumference, triceps skinfold), the subjective global
assessment, and biochemical tests (hematocrit, hemoglobin, white blood
cells, albumin and lymphocyte count). The results were analyzed using
descriptive statistics. The research was approved by the Research Ethics
Committee CEP/UESB No 151/2011.
Results: Twenty patients were evaluated, aged between 54.45 21.
Of these, 45% were elderly people and 50% were men. In relation to body
mass index, 15% and 5% of men and women, respectively, presented thinness or some degree of malnutrition. According to the results of nutritional
status on the subjective global assessment, 50% of the patients investigated
showed up some malnourishment or were at nutritional risk. In anthropometric measures, muscular arm circumference, brachial circumference and
abdominal circumference, and a prevalence of eutrophy was found except
for the triceps skinfold which was characterized as malnutrition. Regarding
the laboratory tests, the hematocrit and hemoglobin showed normal values
and changed 35%, respectively, indicating the presence of anemia; 30%
of the respondents did not present the results of biochemical tests in the
medical records.
Conclusions: The prevalence of malnourished patients is still considered a very frequent problem in hospitals. Thus, the daily monitoring of
patients nutritional status is fundamental in the treatment of all hospitalized patients, guiding dietetics for continuous monitoring of their health
condition.
029228
Nutritional therapy in partial glossectomy: a case report
Duque, A.C.M.1, Freitas, E.C.2, Miranda, A.S.3, Santana, R.F.4,
Oliveira, J.J.5
1
Speech Therapist, General Hospital of Vitria da Conquest, Home
CareFESF/SUS/SESAB, Vitria da Conquista, Bahia, Brazil, 2Nutritionist,
Institute of Nephrology of Brumado and General Hospital of Vitria da
Conquista, Home Care Fesf/SUS/SESAB, Vitria da Conquista, Bahia,
Brazil, 3Department of Nutrition, Faculty of Technology and Sciences
and Northeast Independent College, Vitria da Conquista, Bahia, Brazil,
4
Department of Nutrition, Federal Institute of Norte de Minas and
Faculty of Technology and Sciences, Vitria da Conquista, Bahia, Brazil,
5
Nutritionist, Vitria da Conquista, Bahia, Brazil
clara_mduque@yahoo.com.br, erllannya@hotmail.com,
adrinut@gmail.com, rena_nutri@hotmail.com, holler_vc@hotmail.com
Introduction: Oral cancer has the highest rate among tumors when
compared to head cancer and neck cancer. It affects mostly men, with estimates of 14,170 cases/year.
Objectives: To demonstrate the importance of professional team work
from nutrition and speech therapy in a case study. DD, a 68-year-old male
patient, underwent surgical procedures at the left of the cervical region due
to the presence of a tongue tumor.
Methodology: The patient discovered a cancer by observing a small
lump on his tongue. On June 6th 2013 he underwent surgery in which the
sternothyroid muscle, the unilateral submandibular gland, the hyoid bone
and two thirds of the tongue were removed. DD required tracheostomy
and gastrostomy because of aspiration of his saliva and food. He had been
attended by a speech therapist and a nutritionist for 1 year and 4 months,
and was checked once a week at that time.
Results: DD was diagnosed with severe mechanical oropharyngeal
dysphagia and malnutrition. Both nutritive and non-nutritive therapies were
ABSTRACTS
used in voice rehabilitation. In the non-nutritional therapy, the exercises
that acted in the oral motor control, tone and posture on the adjacent structures of the resected tongue were emphasized. In the nutritional therapy, the
headback posture maneuver was used to assist the ejection of food into
the pharynx, as was the use of frozen foods which contribute to proprioception and gustatory stimulation. While the maneuvers were carried out to
facilitate mouth usage, the patient was fed a high-protein and high-calorie
handmade diet via gastrostomy. Within 3 months he no longer aspirated
his saliva and ate food of a semi-liquid consistency. The tracheostomy was
removed within 5 months, and the gastrostomy within 11 months.
Conclusion: Even at full chewing deficit because of the difficulty of
lateralization and retropulsion of the food, speech therapy care was relevant
to modify and readjust these stomatognathic functions; furthermore nutrition enabled a better quality of life for the subject, and made possible withdrawal of the gastrostomy with the improved development of oral function.
The patient is currently feeding orally and is eutrophic.
028943
Pain and quality of life in patients with cancer
Calistro, F.C.F.1, Barrichello, E.2, Neves, L.F.M.1, Dias, L.A.1, Real, J.1
1
Santa Casa de Misericrdia de Belo Horizonte, Brazil, 2Universidade
Federal do Tringulo Mineiro, Brazil
fccalistro@gmail.com
Introduction: Pain is present in most patients with cancer, affecting
survival and quality of life.
Objectives: To characterize a sample of cancer patients interviewed
and to identify the risk factors of pain in respect of quality of life.
Methods: Data were collected from 42 patients undergoing cancer
treatment in the Association Against Cancer of Central Brazil. Three
questionnaires were used: a sociodemographic and clinical questionnaire
developed by the authors, the European Organization for Research and
Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C 30),
and the European Organization for Research and Treatment of Cancer
Quality of Life Questionnaire.
Results: Of the patients evaluated, 73.8% were male, 50% had metastasis; 42.85% underwent surgery, 92.85% chemotherapy, and 73% radiotherapy. Pearson correlations between EORTC general health and the
domains were all significant (except for constipation), with P < 0.05, the
correlation with pain begins at P < 0.000. Fatigue, pain, dyspnea, insomnia,
diarrhea, and financial difficulties scored >60% in the EORTC-QLQ-C30
questionnaire, which indicates a compromised quality of life. The McGill
questionnaire answers were: 14% of patients had no pain complaints, 50%
of patients reported the evaluative descriptor, 19% affective, 10% sensory,
and 7% miscellaneus.
Conclusions: The study allowed an adequate assessment of pain and
quality of life. The authors view is that an effective program to control pain
in cancer patients should not be limited to pain relief with analgesia but
should include factors such as understanding the mechanism of pain and
minimizing treatment side effects.
028978
Physiotherapeutic performance after the Tikhoff-Linberg procedure:
a case report
Campanholi, L.1, Baiocchi, J.M.T.2, Baiocchi, G.2
1
CESCAGE, Brazil, 2AC Camargo Cancer Center, So Paulo, Brazil
larissalcm@yahoo.com.br, jaquemunaretto@gmail.com,
S243
Introduction: The TikhoffLinberg procedure was originally
described more than 80 years ago as a limb-sparing surgical option for
malignancies involving the shoulder girdle.
Objective: To report physical therapy in a patient who underwent
TikhoffLinberg surgery, with the object of improving member functionality, range of motion gain (ADM), joint and muscle strength, and to
show the evolution of the affected limb functionality through the proposed
therapy.
Methods: We report the case of a female patient, a 41-year-old housewife, who underwent modified TikhoffLinberg surgery for the treatment
of a soft-tissue sarcoma in the right arm. The proximal third of the humerus,
the glenoid cavity, the deltoid muscle and portions of the rhomboid, biceps
and triceps were removed. Flexion and elbow extension showed improvement. Abduction could not be performed due to the absence of the deltoid.
Treatment was initiated at the 6th week after the surgery eight sessions in
total, twice weekly with exercises designed to gain strength and improve
ADM using active-assisted mobilization and active, proprioceptive
neuromuscular facilitation, resistance training with Thera-band and a load
ranging from 0.5 to 1 kg, according to evolution.
Results: In the first treatment, the patient reported that she could not
wipe up, dress or cook; she kept up the second and third visits. In the fourth
treatment, she showed progress in household activities with the aid of a
sling and had no more pain. On the fifth visit she reported that she had
swept the house, dressed herself and fastened her bra. On the sixth treatment she was able to cut her nails by herself, on the seventh visit she could
wash the dishes, and on the eighth she could wring cloths. This demonstrates that extensive physiotherapy can considerably improve the consequences of the TikhoffLinberg procedure.
Conclusion: There was an improvement in daily activities and
decreased pain. The independence achieved was the main goal, seeking
to improve the patients ability to carry out normal activities through a
targeted treatment, not only for the consequences of the surgery, but also
what can be achieved after it.
028472
Preoperative pain and associated factors in cancer patients
Oliveira, N.K.P.1, Mota, D.D.C.F.1, Pereira, L.V.1, Souza, L.A.1,
Salvetti, M.G.1
1
Nursing College, Federal University of Gois, Goinia, Brazil
nayketley@hotmail.com
Introduction: Surgery is one of the most effective treatments for
cancer control and cure. The preoperative period corresponds to the first
phase of the surgical process, and the control of pain should be aimed for
early since it can interfere with the surgical patients safety and the postoperative recovery.
Objectives: To estimate the prevalence of pain in patients in the preoperative period of surgical oncology and to identify its associated factors.
Methods: We carried out a cross-sectional study, conducted from
March 2014 to January 2015, in two hospitals in the city of Goinia, Brazil.
The sample consisted of 117 adult patients in the preoperative period of
elective, conventional, oncological surgery (mean age: 51.2 14.9 years;
76.9% were women; 65.8% lived with a partner, 58.1% had self-reported
brown skin color; 11.1% were smokers, and 16.2% received neoadjuvant
treatment). Patients were interviewed between 36 and 2 hours before
surgery, using a pain numeric scale and measures of stress, fatigue, anxiety,
depression, sleep, cognitive function and performance status. Chi-square
test, Student T-test and U MannWhitney were performed.
Results: The prevalence of preoperative pain was 57.3%, and 16.2%
reported mild pain, 23.9% had moderate pain, and 17.1% severe pain
(mean pain score = 3.0; 95%CI = 2.43.6). Moderate/severe pain was asso-
S244
ciated with skin color, neoadjuvant treatment, cognitive function, sleep
disturbance and performance status.
Conclusions: Pain was common in the preoperative period and many
patients had moderate to severe pain. Preoperative assessment should
include pain evaluation, as well as assessment of emotional state, functionality, use of neoadjuvant cancer treatments and cognitive function, in order
to implement interventions that can facilitate recovery and minimize the
difficulties in the postoperative phase.
029166
Informing the professional nurse about the role of nutrition in the
prevention and non-drug treatment of cancer
Santos, L.S.C1
1
Universidade Estadual de Londrina, Brazil
lucascamargounivers@gmail.com
Introduction: Cancer is defined as genetic alterations favoring uncontrolled and disorderly multiplication of mitotic cells, and is correlated with
endogenous, environmental and hormonal factors.
Objective: To improve the knowledge of nursing professionals about
the importance of nutrition in the prevention and non-drug treatment of
cancer, motivating the interest of these professionals regarding the cancer
patients.
Methods: For the selection of articles used the databases Scielo,
Lilacs, Medline, Ministry of Health, and the sample consisted of 20 articles.
Results: The prevalence of cancer has increased significantly in the
last century; it has been suggested that globalization may have played a
role in this increase. Cancer is ranked second among the causes of death in
Brazil. It has been reported that diet alone can prevent some types of cancer.
Conclusions: Analysis of the studies indicates that cancer is related
not only to the patients genetic make-up; there are several other factors, the
most important of which is tobacco. Diet is also of great importance in the
prevention and treatment of cancer, and the nurse, as a health worker and
educator, has a fundamental role in guiding patients towards an appropriate
diet, which may in itself contribute to the prevention or even slow the
progression of cancer.
029293
Protein supply in parenteral nutrition in surgical cancer patients
Silva, I.C.1, Costa, G.L.O.B.1, Moura, R.L.1, Ferreira, P.A.1,
Freire, M.D.M.1, Freire, A.N.M.1
1
Servio de Nutrio Enteral e Parenteral, Hospital Santa Izabel, Santa
Casa de Misericrdia da Bahia, Salvador, Brazil
ianacsilva@yahoo.com.br, giovannabonina@yahoo.com.br,
rosanemoura4@hotmail.com, pryscillaferreira@yahoo.com.br,
marcosdmfreire@yahoo.com.br, andreney.freire@gmail.com
Background: Changes in nutritional status often occurs in cancer
patients. The adequate supply of protein is needed because of the intense
stress and surgical approaches that promote protein degradation. The catabolism results in wear and fatigue of protein synthesis, which may negatively influence treatment and worsen the patients prognosis.
Purpose: To identify the protein supply in parenteral nutrition of
patients undergoing cancer surgery.
Methods: This was a longitudinal and retrospective study with data
collected from all adult patients undergoing cancer surgery who used
parenteral nutrition therapy (NPT) accompanied by enteral and parenteral
nutrition service (SENEP) at the Santa Izabel Hospital between January
2014 and May 2015. In addition to the personal identification and clinical
data, the quantities of proteins provided by the NPT were collected. Data
were tabulated using SPSS 17.0.
ABSTRACTS
Results: Of the 160 patients who were followed, 50.6% were male,
and the mean age was 59.8 18.5 years. The average period of use of
parenteral nutrition was 14.9 17.9 days. The sample consisted of 80%
of patients undergoing cancer surgery of the digestive system, followed
by 9.4% of the genitourinary system and 10.6% for other surgeries. The
diagnosis of malnutrition was evident in 84.4% of cases. It was observed
that 60.6% evolved to discharge; 36.3% died, and 3.1% remain hospitalized
with NPT. The protein intake administered to these patients had an average
of 90.1 16.6 g. The average weight of the patients was 60.2 12.6 kg.
Thus, there was an average protein intake of 1.5 g/kg/day.
Conclusion: The protein intake administered by NPT for cancer
surgery patients agrees with the recommendations and appears to have
influenced the successful outcome for most patients in the hospital.
029285
Ratio of non-protein calories to nitrogen in the prescription of
surgical cancer patients on parenteral nutrition therapy
Costa, G.L.O.B.1, Silva, I.C.1, Moura, R.L.1, Ferreira, P.A.1,
Freire, M.D.M.1, Freire, A.N.M.1
1
giovannabonina@yahoo.com.br, ianacsilva@yahoo.com.br,
rosanemoura4@hotmail.com, pryscillaferreira@yahoo.com.br,
marcosdmfreire@yahoo.com.br, andreney.freire@gmail.com
Backgroung: Cancer is associated with multisystemic changes and
alterations in macronutrient metabolism, generating increased energy
expenditure and depletion of the protein reserves. The negative protein
balance can cause immunosuppression, poor healing, muscle weakness,
reduced patient survival and increased length of hospital stay, as well as
higher financial costs. For a positive nitrogen balance and tissue synthesis,
the ratio of non-protein calories to grams of nitrogen should be appropriate.
Purpose: To evaluate the relationship of non-protein calories per
gram of nitrogen in parenteral nutrition in patients undergoing oncological
surgery.
Methods: This was a longitudinal and retrospective study with data
collected from all adult patients undergoing cancer surgery who used
parenteral nutrition therapy (NPT) for enteral and parenteral nutrition
service (SENEP) at Santa Izabel Hospital between January 2014 and May
2015. Personal identification and clinical data were analyzed and nonprotein and protein calories provided by the NPT were calculated. The
amount of protein was divided by the amount of nitrogen: 6.25 g protein
containing 1 g of nitrogen. The resulting value was the divider of total
calories derived from non-protein sources. Data were tabulated using SPSS
13.0.
Results: Of the 160 patients followed, 50.6% were men with a mean
age of 59.8 18.5 years. The average period of use of parenteral nutrition
was 14.9 17.9 days; 80% underwent surgery of the digestive tract, 9.4%
of the genitourinary system and 10.6% of others. Malnutrition was diagnosed in 84.4%. It was observed that 60.6% were discharged from hospital;
36.3% died, and 3.1% remain hospitalized using NPT. The ratio of nonprotein calories and grams of nitrogen was 102:1.
Conclusion: The ratio of non-protein calories per gram of nitrogen
reached with the NPT in patients is consistent with the recommendations
for patients in situations of severe stress.
ABSTRACTS
029070
Risk factors and preventive measures for skin cancer in farm workers
Paula, L.L.R.J.1, Silva, A.P., Brando, J.C.2
1
A.C. Camargo Cancer Center, So Paulo, Brazil, 2ASMEC, Brazil
livialoami@gmail.com, ana_crf@yahoo.com.br,
jucilene_enf@hotmail.com
Introduction: Skin cancer is the most common type of cancer
in Brazil and is most often related to work. Rural workers can often be
exposed to risk factors, and preventive measures are essential in controlling
this disease.
Objective: To identify and analyze the risk factors and preventive
measures for skin cancer performed by rural workers.
Methods: We interviewed 300 workers who had worked in the field
for at least 1 year; they were over 18 years old, and of both sexes. Data
analysis was carried out by distributing simple frequency measures of
centrality and dispersion.
Results: Most participants were men, with intense exposure to sun and
chemicals. They were shown to have many risk factors for disease, but
took few preventive actions against skin cancer; 6.6% of respondents had
recent skin assessment by health professionals, and only one participant
had skin examined by a nurse. More than half do not know about skin
self-examination.
Conclusions: Most rural workers have risk factors for skin cancer, but
do not make use of preventive measures and not have adequate monitoring
by health professionals, despite the high incidence of this disease. Nursing
has a fundamental role in preventive actions and control of skin cancer,
providing assistance to cancer patients in the diagnostic evaluation, treatment, rehabilitation and care to family members. Nurses can also develop
educational activities, integrated actions with other professionals, identify
occupational risk factors and provide practical assistance to cancer patients
and their families. Group guidance and nursing consultations may be
among the actions needed to capture this population.
028908
Stomach and colorectal cancer: influence of social and cultural
aspects in the search for health aid
Dalla Valle, T.1, Poveda, V.B.1
1
School of Nursing, University of So Paulo, So Paulo, Brazil
thatadallavalle@hotmail.com, vbpoveda@usp.br
Introduction: Colorectal and stomach cancers are distinguished by
their frequency, and although risk factors, prevention and diagnosis are well
established, many patients in Brazil are diagnosed at an advanced stage of
the disease, a situation that worsens the prognosis.
Objectives: To analyze the process of searching for medical care by
patients with stomach or colorectal cancer, identifying: the time between
the first symptoms and the start of treatment; biopsychosocial aspects
that affect the search for health aid, and the commitment generated by the
disease.
Methods: This was a quantitative, descriptiveexploratory study,
which included adult patients diagnosed with stomach or colorectal cancer,
undergoing elective surgery in a hospital specialized in oncology. The data
were collected by an instrument which contained social and demographic
aspects and aspects related to the diagnosis, treatment and changes in the
life style.
Results: Of the 101 patients, most were men (53.5%), with an average
age of 61.7 years (SD = 12.94 years), with diagnoses of cancer of the
rectum (55.4%) and of the stomach (29.7%); from these patients only
18.8% had undergone preventive screening, even though 61.4% of them
had a family history of cancer. Of the respondents, 93.6% noticed the symptoms themselves, as compared with 34.7% of cases with other diseases. The
S245
most frequent changes after diagnosis occurred in feeding (68.9%), work
(43.2%) and family dynamics (46.5%). Financial changes were reported by
41.6%, including the drop in income (69%) and work absence (45.2%). The
children (29.7%) and partners (20.8%) were the most significant people in
the process. Most (66.3%) sought medical attention within 30 days after the
onset of symptoms. The average time delay between the onset of symptoms
and the start of treatment was 15.16 months.
Conclusions: Lack of knowledge about the key signs and symptoms of
the disease leads to delay in the start of treatment. Thus, it is believed that
health education, strengthened by family participation, combined with an
efficient health system, are the best ways to minimize delays in diagnosis
and treatment of cancers.
028230
The RIME intervention as a resource for the well-being of patients in
the intermediate postoperative period with intestinal ostomy
Ribeiro, R.O.B.1, Elias, A.C.A.2, Schimidt, T.C.G.3, Cedotti, W.4,
Silva, M.J.P.3
1
Instituto do Cncer do Estado de So Paulo, Brazil, 2Faculdade de
Medicina da Universidade de So Paulo, Brazil, 3Escola de Enfermagem
da Universidade de So Paulo, Brazil, 4Hospital das Clinicas da Faculdade
de Medicina da USP, Brazil
roberta.oliveirpsi@yahoo.com.br, anacatarinaelias@uol.com.br,
teresa.schimidt@gmail.com, cedotti@gmail.com, juliaps@usp.br
Introduction: Patients facing colorectal cancer might have two
possible losses: life, or the mutilation of part of the body. In many cases,
they can be submitted to colostomy or ileostomy. The use of a colostomy
bag provides psychological distress, and changes their body image.This can
reflect negatively on self-esteem, sexuality, and hence personal identity.
Often it can lead to social isolation, because of feelings of worthlessness,
inability, discredit and shame for feeling different. It is noted that cancer
patients can experience total pain, meaning that the disease besides
bringing physical suffering also brings social, psychological, financial
and spiritual suffering. One of the possible ways to integrate the psychological and spiritual dimensions is through the application of RIME intervention (relaxation, mental images and spirituality). The intervention is
based on the biopsychosocial and spiritual model that has as its objective
to reframe the symbolic pain of death. The purpose of RIME is to cause the
well-being of the patient by stimulating the patient to contact their inner
resources, and it results in positive changes.
Objectives: The study was conducted in order to evaluate and discuss
the effectiveness of the therapeutic intervention relaxation, mental images
and spirituality (RIME), considering the well-being of a group of patients
in the intermediate postoperative period with intestinal ostomy.
Methods: In this quantitative and qualitative, exploratory and prospective field, a total of 21 patients participated, all of whom completed the
Visual Analogue Scale (VAS) for well-being before and after RIME.
Results: The mean VAS values were 3.33 and 1.38 respectively. From
the question of how they felt emotionally before the surgery and after
the RIME intervention, the following contextual units emerged: feeling,
emotion, sensation, and expectation of action, which generated four distinct
categories representING the transformation related to psychological
well-being.
Conclusions: It was concluded that the RIME was the only variable
that was statistically significant, leading to the affirmation that it contributes to improving the emotional well-being of the ostomy patients.
S246
028209
The sociodemographic and clinical profiles of patients with prostate
cancer in radiotherapy treatment
Quijada, P.D.S.1, de Oliveira, D.S.2, Santos, B.M.O.1
1
Universidade de Franca, Brazil, 2Hospital do Cncer de Franca, Brazil
patriciaquijadatizzo@gmail.com
Introduction: In Brazil, INCA estimates the occurrence of approximately 576,000 new cases of cancer in the years 2014 and 2015; the estimate for prostate cancer is about 68,800 cases, which corresponds to a
risk estimated at 70.42 new cases for each 100,000 men. Excluding nonmelanoma skin tumors, prostate cancer is the most common cancer among
men all over the country.
Objective: To determine the clinical and sociodemographic profile
of patients with prostate cancer undergoing radiotherapy treatment in the
countryside of the state of So Paulo, Brazil.
Methodology: This is a descriptive study, accomplished during March,
2015. The population comprised 31 patients in treatment during this period,
and the given data were obtained through consultation of their records. The
research is part of the thesis project approved by the CEP under the law
816.082.
Results: From the 31 records checked, it seemed that most patients
were between the ages of 71 and 85 years (51%), white skinned (69%),
married (78%), with low levels of education (71%), or retired (81%). The
highest number of diagnoses (71%) occurred during the year 2014, treatment beginning in 2015; 47% were diagnosed with the histological degree
Gleason 6 (3+3), and 52% showed a genetic background of cancer.
Conclusion: By the sociodemographic and clinical characteristics of
the patients, it is possible to highlight the necessity and importance of the
commitment and training of all health professionals to offer a humanitarian
reception, planned actions and orientations about the disease and its consequences. Diverse educational strategies may be used which may improve
the knowledge of the patients about the therapeutic procedures, minimizing
doubts and difficulties, sharing with the patient and their family anxieties in
relation to the process of the radiotherapy treatment, and collaborating for
the improvement in quality of life with the people involved.
029298
Use of an inline filter for surgical cancer patients on parenteral
nutrition therapy
Ferreira, P.A.1, Costa, G.L.O.B.1, Freire, M.D.M.1, Almeida, M.M.V.1,
Feitosa, C.S.1, Freire, A.N.M.1
1
pryscillaferreira@yahoo.com.br, giovannabonina@yahoo.com.br,
marcosdmfreire@yahoo.com.br, manuelavinhas@yahoo.com.br,
carolinesfeitosa@hotmail.com, andreney.freire@gmail.com
Background: The use of an inline filter during the infusion of parenteral
nutrition is a recommendation of the National Health Surveillance Agency.
This device aims to prevent the aggregation of droplets of fat and precipitation of calcium phosphate amorphous and crystalline which could
trigger diffuse microvascular lung embolism.
Objective: To evaluate the occurrence of pulmonary embolism and the
use of an inline filter in surgical oncology patients on parenteral nutrition
therapy (PNT).
Methods: This was a longitudinal study of all adult patients undergoing cancer surgery who used PNT and the enteral and parenteral nutrition service (SENEP) in Santa Izabel Hospital from January 2014 to the
present day. The frequency of the inline filter usage in the NPT and its association with the occurrence of pulmonary embolism were evaluated. Data
ABSTRACTS
were tabulated in SPSS 17.0 and were presented as absolute and relative
frequency or average standard deviation.
Results: The present study included 160 patients. Of these, 81 (50.6%)
were male, with a mean age of 59.8 18.5 years. The sample consisted of
128 patients (80%) undergoing surgery for cancer of the digestive system,
followed by 15 (9.4%) of the genitourinary system and 19 (10.6%) of other
cancers. Of the total study sample, 91 (56.9%) used an inline filter. The
average period of PNT in patients using a filter was 15.8 16.2 days, while
in the unfiltered group it was was 13.7 19.9 days. There were no cases of
pulmonary embolism in either group.
Conclusion: These results, taking into consideration the costbenefit,
suggest that the use of an inline filter is recommended for procedure safety
in high-risk patients or in services that do not have specialized staff.
ABSTRACTS
Urologic cancer
029002
Adrenal pheochromocytoma: left adrenalectomy with renal vein
thrombectomy and suture allowing full renal preservation
Prisco, E.1, Quadros, C.A.1, Silva, R.G.M.1, Vieira, L.V.1, Prisco
Filho, L.G.R.2
1
So Rafael Hospital, Salvador BA, Brazil, 2Medical School of University
of Caratinga MG, Brazil
ramirogmsm@gmail.com, lucasvelame@hotmail.com,
luizprfilho@hotmail.com
Introduction: Pheochromocytoma is a rare disease caused by a tumor
that produces aldosterone. Incidence is 0.10.3% of cancer cases; it is more
commonly found in females aged between the third and fifth decades. Some
of these tumors have malign features, invading vessels or having distant
metastasis. Surgery is the gold standard treatment, and its radicalness determines the patients prognosis.
Objectives: To report a left adrenal pheochromocytoma case with
renal vein invasion, successfully treated by radical adrenalectomy followed
by renal vain thrombectomy and renal preservation.
Results: A female patient, 33-years-old, started clinical symptoms
with trembling, headache and episodes of fainting. In October 2011 she
was brought to the hospital as an emergency, presenting with a brain stroke
due to severe arterial hypertension. Urgent craniotomy was performed and
a brain hematoma was drained; this was followed by intensive care hospitalization. An investigation was performed and abdominal tomography
evidenced a 6-cm circular tumor in the left adrenal gland, with renal venal
occlusion by a thrombus 4 cm in length. High levels of serum catecholamines and urinary metanephrins suggested pheochromocytoma. After
clinical improvement, the patient received hospital discharge 1 month later
with motor sequellae in the right limbs. After blocking with an alpha-adrenergic drug, radical surgery was performed in January 2012, with full left
adrenalectomy plus local lymphadenectomy, renal vain thrombectomy and
suture, with full renal preservation. The patient stayed in the cardiac intensive unit for 3 days, being discharged from hospital on the 4th postoperative
day. Histopathological evaluation identified a pheochromocytoma with free
surgical margins and no lymph-node metastases. She has had 3.5 years of
follow-up with almost complete motor recovery and without evidence of
oncological disease.
Conclusion: Clinical and surgical management requires a specialized
and skilled multidisciplinary team, as it often requires specific and individualized treatments with a high level of complexity, as shown in this case
report. These factors may be related to a favorable early and late prognosis
for the patient.
028842
Cutaneous metastasis of renal clear-cell carcinoma: a case report
Aichinger, L.A.1, Kool, R.1, Mauro, F.H.O.1, Preti, V.1
1
lillyaichinger@gmail.com, ronald.kool@yahoo.com.br,
fernandomauro@gmail.com, vbpreti@yahoo.com.br
Introduction: Kidney cancer is the third most common malignancy of
the genitourinary tract and comprises 23% of malignant tumors. Renalcell carcinoma accounts for 85% of renal cancers in adults. The kidney
adenocarcinoma has had a higher incidence in the last 50 years, with a
higher incidence in the age group 6070 years; incidence in relation to
gender is 1.5 men for 1 woman. The clear-cell carcinoma is the most
common type, accounting for 7080% of renal-cell cancers. Most cases
S247
are sporadic, but familial forms have also been described as Von Hippel
Lindau syndrome, where 35% of patients develop renal clear-cell carcinoma. Patients with renal-cell carcinoma develop metastases in 30% of
cases, and when they occur they mainly affect the lungs, liver, bones, brain,
and adrenal glands. The cutaneous metastatic renal tumors are usually
caused by emboli secondary to a hematogenous tumor infiltrating the
renal vein. Approximately 80% of the cases present after the diagnosis of
primary renal cancer. Skin metastases of renal-cell carcinoma are very rare.
Objectives: To report a patient with cutaneous metastasis of renal
clear-cell carcinoma, and thus to contribute to the recognition of the disease
and the possibility of early diagnosis in such cases.
Methods: It is a clinical case description made by chart review of a
patient treated for renal-cell cancer with cutaneous metastasis.
Results: A woman aged 37 presented with multiple bilateral renal
solid nodules with slow evolution. She was diagnosed with renal clear-cell
carcinoma. She evolved with progression of hemangiomatous lesions on
the scalp which were completely resected and diagnosed as metastases of
renal cancer.
Conclusions: This is a case report of a patient with a rare disease and
a poor prognosis; she had a survival of 1 year after diagnosis of metastatic
cutaneous lesions. Through this report other professionals can diagnose
such lesions and thus provide adequate treatment in order to increase the
quality of life of these patients.
029215
Epdemiological review and clinical of patients with neoplasia
sumitted to prostatectomy in Salvador, BA, between 2008 and 2014
Strappa, G.B.S.1, Freitas, V.F.2, Jesus, M.S.3, Matos, R.M.2, Amaral, J.B.4
1
Nursing student, Federal University of Bahia, Salvador, Brazil, 2Medical
giorgiabruna-2006@hotmail.com, vdefritas@gmail.com,
Introduction: According to the Instituto Nacional do Cncer (INCA),
2014, the risk of prostate cancer is estimated at 70,42 new cases per 100,000
men; this is one of the highest incidences in the country, apart from men
in the northeast region (47.46/100,000). Age is the only well established
risk factor.
Objectives: To describe the clinical profile of patients with neoplasia
submitted to prostatectomy in Salvador, Brazil, between 2008 and 2014.
Methods: We used data from the Sistema de Informao sobre
Hospitalizao (SIH/SUS) about patients with neoplasia who were
submitted to prostatectomy between 2008 and 2014, from DATASUS.
Cases were standardized by age, sex, race-color, death during the surgery,
cross infection, and duration of hospital stay from 2008 to 2014 in Salvador,
BA, Brazil.
Results: We noted an increase in the percentage of prostatectomies
in patients with neoplasia between 2011 and 2014, with 13 (3.8%) and
129 (38.1%) cases, respectively, from the total number of prostatectomies performed. However, during previous years there was a decrease in
performance of this procedure between 2008 (n = 46; 13.6%) and 2011
(n = 13; 3.8%). The age range of the patients was mostly >60 years old
(n = 339; 83.9%), in particular 6074 years (n = 246; 60.9%). In the race/
color category 50.7% (n = 205) were brown. Cross infection as a result of
surgery did not occur, and there were eight deaths (2%). The longest period
of postoperative hospitalization was 2 days (n = 126; 31.2%).
Conclusion: Awareness in the major population of prostate cancer,
leading to early diagnosis, may account for the increased number of
prostatectomies. Senior citizens were the most affected, confirming the
S248
relationship between age and this neoplasia. The high frequency in brown
people is supposedly related to other risk factors, such as ethnicity and
genetic factors. The absence of infections, the reduced number of deaths
and fewer days of hospitalization are presumably correlated with the
upgrading of surgical techniques in recent decades.
028917
Internal hemipelvectomy for treatment of a testicular nonseminomatous germ-cell tumor with solitary metastasis to the left iliac
bone: a case report
Oliveira, D.A.M.1, Spencer, R.M.S.B.1, Guimares, G.C.1,
Santana, T.B.M.1, Stevanato Filho, P.R.1, Lopes, A.1
1
So Paulo, Brazil
deciomontenegro@gmail.com, ranyell.spencer@gmail.com
Introduction: Although chemotherapy is the standard care for metastatic germ-cell cancer patients, surgery for localized relapse could be
proposed. Furthermore, extended surgery has been established as an effective method for other tumor treatment and could be used for metastatic
germ-cell tumors in selected cases. This is the first case reported in the literature of a case of testicular cancer with a solitary bone metastasis treated
with extended surgery.
Objective: To show the possibility of indicating this type of surgery
in selected cases.
Methods: We report here a 36-year-old man with a testicular nonseminomatous germ-cell tumor with a solitary metastasis to the left iliac
bone. He was treated with chemotherapy followed by internal hemipelvectomy. In view of the lack of therapeutic options for this case, and the
absence of metastasis, extended curative surgery for the non-seminomatous
germ-cell tumor was performed, with en-bloc resection of the left iliac bone
(type I + II internal hemipelvectomy).
Results: After 36 months of follow-up, the patient is asymptomatic,
with no signs of local recurrence or metastasis.
Conclusions: In selected cases, testicular non-seminomatous germcell tumor with iliac bone metastasis can be treated in association with
chemotherapy by extended and aggressive surgery, including bone resection, to improve survival.
029312
Laparo-endoscopic single-site (LESS) surgery for the treatment of
renal cysts: a new gold standard ?
de Melo, M.S.B.1, de Souza, S.R.V.2, de Oliveira, T.B.C.1
1
Centro Universitrio Christus, Fortaleza, Ceara, Brazil, 2Instituto Dr Jos
Frota, Fortaleza, Ceara, Brazil
manuelasbmelo@gmail.com, sandrorvs1210@gmail.com,
thaisbrandaoo@hotmail.com
Introduction: The decortication of a laparoscopic renal cyst was
described in 1992 by Hulbert. The main advantages were the reduction in
recurrences as compared to aspiration, and decreased mortality compared
to open surgery. The LESS surgery is a new surgical technique which aims
to reduce the number of incisions.
Objectives: To present our experience with LESS for the treatment
of simple renal cysts.The main advantages of this procedure would be less
postoperative pain, faster recovery and better cosmetic results.
Methods: Three patients with symptomatic renal cysts were evaluated
retrospectively from March to June 2011; they underwent decortication by
LESS. Among the symptoms, two patients reported pain, and one patient
reported a mass. The patient was placed in lateral decubitus 45. A semilunate periumbilical incision was made, through the pneumoperitoneum,
ABSTRACTS
and three trocanters (one 10 mm and two 5 mm) were inserted through the
same incision. Conventional laparoscopy was carried out, and decortication
was performed with electrocautery. Specimens were taken out through the
same incision. All patients were operated by the same surgical team.
Results: The average age of the patients was 57 years. The diameter
of the cysts ranged from 8.3 to 17 cm, and the average operative time was
63 min; there was no conversion to open surgery. The average of hospital
stay was 2 days. The pathological study showed no sign of malignancy in
the patients.
Conclusion: The LESS surgery is the latest innovation in the armamentarium of laparoscopic surgery. The difficulty that arises from tweezers
triangulation usage is the main challenge of this procedure. New technologies emerge to minimize these problems, but the cost precludes its widespread use in our routine. The cosmetic benefits allied with the undeniable
benefits of minimally invasive surgery have increased interest in and helped
to enhance the use of LESS techniques. Such techniques assure the advantages of laparoscopy and a better cosmetic outcome. The low complication
rate and the possibility of performing the procedure without any special
instruments allow the adoption of this technique by those who are already
experienced with laparoscopy.
028466
Minimally invasive partial nephrectomy versus renal cryoablation for
small renal masses
Juncal, S.R.1, Ordon, M.1, Lusch, A.1, Lessa, K.P.2, Okhunov, Z.1,
Andreoni, C.3, Landman, J.1
1
University of California, Irvine, Orange, United State, 2State University
of Bahia, Salvador, Bahia, Brazil, 3Federal University of So Paulo, So
Paulo, Brazil
krysnapireslessa@gmail.com
Introduction: Minimally invasive partial nephrectomy (MIPN) is the
gold standard treatment for small renal masses (SMRs). Renal cryoablation
(RC) is a promising treatment for patients with SMRs.
Objectives: To compare perioperative, functional, and oncological
outcomes of MIPN and RC in the treatment of patients with SRMs.
Methods: We retrospectively reviewed the medical records of 264
patients who underwent a minimally invasive nephron-sparing approach
as a primary treatment for renal mass between January 2003 and March
2013. Tumors were divided into two groups according to the procedure
performed: kidney cryoablation (percutaneous and laparoscopic) and minimally invasive partial nephrectomy (laparoscopic and robotic).
Results: We identified 271 SRMs among 264 patients (RC, n = 123;
MIPN, n = 148). Patients undergoing MIPN were younger (60.6 years
versus 65.8 years; P < 0.0001). The average size of the renal mass was
higher in the MIPN group (3.0 versus 2.4, P < 0.0001). The incidence of
perioperative complications was less likely for RC (14.6% versus 23.6%,
P = 0.062). RC was associated with a shorter operative time and anesthetic
(P < 0.001 and P < 0.0001, respectively), less estimated blood loss (P <
0.0001), and shorter hospital stay (P < 0.0001). Patients undergoing RC had
a higher treatment failure rate (8.9% versus 2.0%, P = 0.01). Recurrencefree survival in 3, 5 and 10 years was 94.9%, 86.3% and 86.3% for RC; and
97.4%, 97.4% and 91.3% for MIPN respectively (P = 0.123). Disease-free
survival in 10 years was 95.5% for RC and 98.5% for MINP (P = 0.930).
The MIPN group had a lower estimated glomerular filtration rate at postoperative day 1 compared to the RC group (P = 0.019).
Conclusions: Patients undergoing RC have a lower incidence of perioperative complications and better preservation of renal function in the
immediate postoperative period. Although MIPN had a lower local recurrence rate, there was an equivalent treatment effect when patients initially
treated by RC were salvaged.
ABSTRACTS
029322
Pelvic lymph-node dissection in radical prostatectomy: a study of
4197 cases
Froede, A.G.1, Menezes, L.M.1, Moreira, R.C.L.1, Portela, A.R.1,
Vieira,H.C.1, Salles, P.G.O.1
1
Instituto Mrio Penna, Belo Horizonte, Brazil
astaruth@hotmail.com, leticia.mmenezes@gmail.com,
renicecilia@me.com, andrerossettiportela@gmail.com,
pgosalles@gmail.com, hcvieira@gmail.com
Introduction: Pelvic lymph node dissection (PLND) represents the
most accurate and reliable staging procedure for the detection of lymphnode invasion (LNI) in prostate cancer (PCa), since standard imaging
procedures have limited ability to predict LNI. Which candidates to select
for this procedure, and the optimal extent of PLND, are still points of
discussion, especially considering that not all patients are at the same risk of
harboring PCa nodal metastases; a meticulous PLND is a time-consuming
and challenging procedure which requires skilled surgeons, and the impact
of PLND on PCa outcome is not indisputably established.
Objectives: To present the data related to a large series of radical prostatectomy-associated PLNDs.
Methods: The data of 4197 radical prostatectomy (RP) procedures performed at 12 different hospitals, from May 2008 to May 2015,
were studied retrospectively. The number of cases in which PLND was
performed, the number of lymph nodes dissected and their association
with patients age, Gleason biopsys score and PSA before surgery were
analyzed.
Results: The patients mean age was 63.5 years (3984 years); mean
PSA was 9.49 ng/mL (0.8293.00 ng/mL). PLND was not performed in
382 patients. PLND, when performed (3815 patients, 91%), was always
bilateral, and described as pelvic, obturator, iliac, or was not specified; only in 73 cases was PLND referred to as extended. Number of LNs
dissected ranged from 1 to 27 (2.95 2.71). In 313 cases of PLND, no LNs
were identified, in spite of the use of LN-revealing solution. Metastases
were found in <1% of the cases; in these patients mean PSA was 35.55 ng/
mL (3.97157.0 ng/mL), and Gleason biopsys scores ranged from 6 to 9.
Conclusions: The results of this study indicate that, in the great
majority of cases, there is a lack of standardization and agreement regarding
RP-associated PLND, and that PLND is usually performed in disagreement
with international guidelines.
029091
Renal carcinoma of clear cells: report of a giant cystic kidney injury
Lustosa, A.G.1, Lira, G.A.2, Gis, M.C.2, Santos, L.V.S.2, Silva, R.P.2,
Pires, T.C.3, Oliveira, I.B.M.D.2, Filho, K.J.C.2, Corra, R.S.2
1
Natal, Brazil
Introduction: Renal-cell carcinomas represent about 3% of all visceral
cancers. They occur most frequently in the elderly, usually in the 6th or 7th
decades, and have a preponderance in men. The clear-cell carcinoma is the
most common subtype, accounting for 7080% of renal-cell cancers.
Objectives: To present a case of renal carcinoma of clear cells, with a
volume of approximately 5448.1 cm3, situated on the top of the left kidney
an unusual presentation.
Methods: The patient was a 30-year-old female, diabetic, from
Mossor, RN, Brazil. Her initial diagnosis was of pregnancy; she had
abdominal and costovertebral pain on moderate effort. Laboratory tests
showed: normocytic and normochromic red series; leukogram with
S249
leukocytosis with a predominance of targeted, discrete thrombocytopenia;
C-reactive protein 169.90 mg/L; 3 FSH mIU/mL; CA-125 3.3 U/dL; CA
19-9 5 IU/mL; urea 17 mg/dL; creatinine 0.60 mg/dL; alkaline phosphatase
132.6 U/L; liver function test was normal despite the tumor being attached
to the liver. CT of the abdomen and pelvis was performed before the patient
was subjected to partial nephrectomy for removal of a left renal cyst. At
surgery, specimens were removed for biopsy, and histopathology identified
carcinoma of clear cells grade II Fuhrman. During the procedure it was
necessary to resect the liver edge that was attached to the tumor.
Results: This presentation differs from those in the literature epidemiologically, in cyst size, sex, age, and predisposing factors, since the patient
did not have any.
Conclusions: This is a rare case, worthy of scientific and academic
debate, with the purpose of showing an atypical manifestation of renal
carcinoma of clear cells: giant abdominal tumors. The description of exceptional cases is significant for clinical consideration of possible tumor etiologies, variants, perioperative management and prognosis.
028467
Retrospective comparison of percutaneous renal cryoablation versus
laparoscopic cryoablation for renal tumors
Juncal, S.R.1, Ordon, M.1, Okhunov, Z.1, Lusch, A.1, Lessa, K.P.2,
Andreoni, C.3, Landman, J.1
1
University of California, Irvine, Orange, United State, 2State University
of Bahia, Salvador, Bahia, Brazil, 3Federal University of So Paulo, So
Paulo, Brazil
Introduction: Renal cryoablation has attracted great interest with the
increase in detection of small renal tumors (SRTs).
Objectives: To compare oncological efficacy and complication rates
of percutaneous renal cryoablation (PRC) versus laparoscopic renal cryoablation (LRC) in the treatment of SRT.
Methods: We carried out a retrospective review of our experiences
with PRC and LRC between 2003 and 2013. We analyzed demographic
data, tumor characteristics, oncology and perioperative data, and outcomes
of renal function.
Results: Renal cryoablation was performed in 120 patients with 123
renal tumors. Of these, 83 were treated with PRC and 40 were treated with
LRC. Both groups were similar in age, gender, body mass index, ethnicity,
ASA score, and Charlson comorbidity index adjusted for age. There was
no difference in mean tumor size (2.4 cm for PRC versus 2.7 cm for LRC;
P = 0.193). Multifocal and perihilar tumors were statistically associated
with LRC (P < 0.001 and P = 0.009, respectively). Anterior and posterior
tumor corresponded to 77.9% and 13% of the PRC and 37.5% and 50%
of the LRC (P < 0.0001) respectively. Mean operative time (minutes) was
lower for CRP (130.0 versus 170.0; P = 0.002). PRC showed shorter mean
hospital stay (2.0 days versus 3.0 days; P < 0.0001). There was no difference between residual disease and recurrence in both groups (P = 0.211
and P = 0.486, respectively). Recurrence-free survival in 3, 5 and 7 years
was 94.4%, 89.3% and 79.4% for PRC, and 96.0%, 96.0% and 96.0% for
LRC (P = 0.208). Disease-free survival was 92.3% for CRP and 100% for
LRC (P = 0.358).
Conclusions: Percutaneous renal cryoablation and laparoscopic renal
cryoablation both provide adequate and equivalent oncological efficacy.
Although complications in the PRC group were lower, tumors in the LCR
group had greater complexity.
S250
029321
Robot-assisted laparoscopic radical prostatectomy: transperitoneal
versus extraperitoneal which is the best approach?
Juncal, S.1, Juncal, M.2, Arajo J.C.1, Carvalho G.P.1, Hisano, M.3,
Anuar, M.3
1
Universidade Federal da Bahia, Salvador, Brazil, 2Escola Bahiana de
Medicina e Sade Pblica, Salvador, Brazil, 3Hospital Srio Libans, So
Paulo, Brazil
zeheck@hotmail.com
Introduction: Robot assisted laparoscopic radical prostatectomy
(RALRP) is a treatment option for patients with localized prostate cancer.
RALRP is less invasive than open surgery. Furthermore, it offers threedimensional visualization of the surgical field, resources for decrement
of trembling during the procedure, and more precise handling of delicate
vessels and nerves. The minimally invasive technique can be performed by
transperitoneal (TP) or extraperitoneal (EP) approach.
Objective: To perform a review comparing the transperitoneal and
extraperitoneal approaches, regarding their oncological and functional
results within the RALRP.
Methods: We selected case series studies, published between 2000 and
2012 in the English language. The search for the articles was conducted
within the Pubmed database using the following key terms: [prostatectomy or robotic prostatectomy] and [prostate or prostate cancer]
and [transperitoneal or extraperitoneal].
Results: There were no significant differences in perioperative and
postoperative short-tem complications between the two approaches.
The use of the TP approach seems to be easier during the learning curve
compared with the EP approach.
Conclusions: So far the oncological and functional results of the two
approaches have been similar. Although RALRP is gaining popularity,
most procedures are performed with the transperitoneal approach. Both
techniques are feasible and remain available for teaching purposes. The
access option must be based on patient characteristics as well as surgeon
preference.
028844
The effectiveness of medial inguinal lymphadenectomy in penile
neoplasm
Campos, R.A.1, Hayashi, M.C.1, Costa, G.A.P.1, Neto, A.C.1,
Schaal, C.H.1, Costa, R.P.1
1
ricardorac2@gmail.com, marcelch35@yahoo.com.br,
gcostajau@hotmail.com,neto.cavani@uol.com.br,carloshschaal@gmail.com,
renatopradocosta@gmail.com
Introduction: Penile neoplasm is an aggressive disease that occurs
most frequently in the glans; its dissemination occurs predominantly by the
lymphatic route, and the main prognostic factor is lymph-node involvement.
Objective: To evaluate the effectiveness and following the medial
inguinal lymphadenectomy (medial saphenous vein) in patients with cancer
of the penis.
Methods: This was a retrospective study of 169 men with penile
neoplasm between 1985 and 2014 in the Hospital Amaral Carvalho-Jau-SP,
Brazil. Medical records were reviewed and analyzed; factors included age,
histological type, tumor grade, inguinal lymph nodes degree on physical
examination, histopathological findings of lymphadenectomy, complications and follow-up time.
Results: There were 169 cases with penile cancer who underwent
amputation and evaluation of their inguinal lymphatic chains. Of these,
35 were excluded, eight were lost to follow-up, three had advanced
staging, four with histology not CEC, and 20 had verrucous tumors. So
ABSTRACTS
134 patients were included in the study; 109 (81.34%) underwent superficial medial inguinal lymphadenectomy and the remaining 25 underwent
radical lymphadenectomy directly by palpable adenopathy in the presentation of the disease. Of the 109 patients, 16 had positive lymph nodes on
histopathological analysis and had superficial radical lymphadenectomy.
The remaining 93 patients were followed up. Of these, eight (8.6%) had
inguinal recurrence between 6 and 12 months of follow-up. Three were lost
to follow-up and returned with inoperable masses, and the other five underwent radical bilateral inguinal lymphadenectomy (only two with a histological analysis of one lymph node). These patients had an average age of
52.37 years (25-85 years), and a mean survival time of 39.87 months (range
6120 months). The main complications included 16 cases of lymphoceles
(nine with drainage) and six cases of edema of the lower limbs.
Conclusion: Medial inguinal lymphadenectomy is effective, safe, has
low rates of complication and is easy to implement. Cure rates are high with
radical rescue surgery provided that the patients are followed up properly.
029201
Ureteral metastasis of prostate cancer: a case report
Pereira, T.S.S.1, Mierzwa, T.C.1, Gonalves, L.2, Brigo, M.J.K.3
1
Brazil, 2Medicine Course, University of Western of Parana, Cascavel,
Brazil, 3Department of Urology, UOPECCAN Hospital, Cascavel, Brazil
talita.siemann@hotmail.com, ti1601@hotmail.com,
malcombrigo@yahoo.com.br
Introduction: Carcinoma metastatic to the ureter is rare. The sites
of primary tumors that later involve the ureter are, in order of frequency:
breast, colon/rectum, cervix, prostate, bladder, retroperitoneal lymphoma,
and others. Symptoms referable to the genitourinary tract are lacking in
most patients. Abeloff and Lenhard demonstrated that <50% of patients
with metastatic tumors were symptomatic,and Cohen and associates found
85% of such patients to be asymptomatic, with tumors discovered only at
autopsy.
Objectives: To present a case of metastasis in the ureter from primary
adenocarcinoma of the prostate.
Methods: This was a review of the literature and medical records.
Results: An 81-year-old male patient was referred to our institution
in March 2013 with prostate cancer. The PSA level was initially at 5.8 mg/
dL. The subsequent prostate biopsy showed acinar adenocarcinoma of the
prostate gland (Gleason score 7 = 4 + 3) on both lobes. The patient was
submitted to radiation therapy with a total dose of 78 Gy. Six months after
completion of radiotherapy, the patient returned with a CT scan identifying
a mass lesion in the distal ureter. The magnetic resonance imaging demonstrated an expansive mass 1.6 cm of the urethral meatus, hydronephrosis of
the left kidney and bilateral iliac lymph nodes suggestive of malignancy.
An open radical nephroureterectomy was done. Histology and immunohistochemical analysis revealed a metastasis of the ureter from a prostate
adenocarcinoma.
Conclusions: In the first half of the last century, these ureteral metastases have only been been found incidentally during autopsy. Currently,
with the wide availability of radiographic examination, the rate of incidental findings has greatly increased. This may lead to an increase in the
number of living cases with a diagnosis of ureteral metastases.
ABSTRACTS
029294
Wilms tumor in a horseshoe kidney: therapeutic strategy
Teshirogi, E.Y.2
1
Introduction: The incidence of horseshoe kidney is about 1 in 400
cases. The presence of Wilms tumor with a horseshoe kidney is unusual,
and the occurrence is estimated at 0.40.9% of all Wilms tumors. The
context represents a difficult diagnostic and therapeutic challenge.
Objectives: We present a case report of a young boy, 1 year-old, with
Wilms tumor in a horseshoe kidney.
Results: We report the case of a 1-year-old boy who presented with a
stage I tumor. The clinical examination showed an abdominal mass which
S251
had been growing for 5 months. CT scan showed a horseshoe kidney and
tumor growth in the isthmus which was distorting the ureters and renal
vessels. Neoadjuvant chemotherapy with actinomycin, vincristine and
doxorubicin was performed with a significant therapeutic response. The
tumor was resected using a sealant and a hemostatic device; a bloodless
surgical approach was performed, preserving the renal function. After adjuvant chemotherapy, the patient was alive and without disease after a followup interval of 3 years. The ultrasound image showed normal renal function.
Conclusions: The diagnosis of horseshoe kidney has often been
observed on preoperative imaging. Accurate preoperative diagnosis is
important in planning the operative approach, and may help to decrease
complications related to transection of the urinary collecting system.
Although 37% of patients with Wilms tumor arising in a horseshoe kidney
were judged inoperable at initial exploration, all were amenable to resection after chemotherapy. This case illustrates the role of preoperative
chemotherapy and intraoperative use of a sealant and hemostatic device
for preserving renal function, and aims to highlight multimodal treatment.
S252
ABSTRACTS
Author index
Abade, B., S95 (29225)
Abilio, N.S., S240 (29120)
Abreu, L.V.S.S.S., S104 (28944), S116 (28938)
Accordi, C.C., S110 (28248), S120 (28454),
S123 (28455), S124 (28249), S144 (28250),
S154 (28252)
Achatz, M.I.W., S241 (28285)
Affonso Jr, R., S240 (29139)
Agostinho, C.S., S236 (28756)
Aguiar Jr, S., S141 (28910), S144 (29108), S145 (29116),
S147 (29082), S151 (28916), S216 (28912),
S223 (28911), S223 (28915)
Aguiar Jr., S., S142 (28999), S153 (28983)
Aguiar-Junior, S., S139 (28833), S203 (28958)
Aichinger, L.A., S144 (28848), S165 (28537),
S178 (29119), S247 (28842)
Akaishi, E.H., S173 (28979), S204 (29086), S213 (28855)
Albagli, R., S101 (28922), S102 (28933), S104 (28944),
S105 (28937), S105 (28949), S106 (28942),
S114 (28953), S115 (28940), S116 (28938),
S148 (28320), S215 (28201)
Albagli, R.O., S108 (28387), S116 (28385), S130 (29192),
S149 (28389)
Alberton, D., S179 (28985)
Albuquerque, A.F., S103 (28304), S104 (28299),
S107 (28300)
Albuquerque, D.M.G., S94 (29084), S98 (28857)
Albuquerque, T.C.L., S200 (28371), S201 (28373)
Albuquerque, T.L.C., S199 (28534)
Alencar, B.F.P., S196 (28875)
Almeida, B., S236 (28277)
Almeida, D.A.C., S104 (28303), S107 (28300)
Almeida, G.F.G., S180 (28957)
Almeida, J.C., S180 (28957)
Almeida, J.M.C., S91 (29286)
Almeida, M.M., S175 (28862), S202 (28372),
S239 (28864), S99 (29164)
Almeida, M.M.V., S246 (29298)
Alvarenga, A.C.V., S167 (29180)
Alves, D.G., S232 (28959)
Alves, M.P.M., S163 (28429)
Alves, R.L.G., S240 (29120)
Alves, R.M.S, S123 (29205)
Alves, R.M.S., S128 (29296), S142 (29290),
S152 (29301), S176 (29233), S194 (29269)
Amaral, J.B., S156 (29212), S162 (29202), S247 (29215),
S97 (29221)
Amaral, M.B.E.V., S218 (28955)
Amaral, M.B.M., S139 (28843), S227 (28839)
Amorim, C.V.V., S189 (28885), S191 (28887)
Andrade Lima, T.M., S204 (29086), S213 (28855)
Andrade, A.B., S134 (28370)
Andrade, A.E.M.C., S165 (28537)
Andrade, C.E.M.C., S160 (28974), S167 (28965),
S183 (28967), S183 (29057), S184 (28952),
S186 (29189), S190 (29177), S191 (29143),
S192 (29291), S195 (29144), S195 (29149),
S197 (28831)
Andrade, C.S., S139 (28843), S227 (28839)
Andrade, L.M.Q.S., S101 (28512)
Andrade, M.N., S129 (28329), S138 (28170),
S210 (28331), S216 (29077)
Andrade, R.G., S184 (29229)
Andrade, R.L., S102 (28631), S233 (29183),
S234 (28834)
Andrade, W.P., S168 (28964), S92 (28907), S94 (29323),
S97 (28906)
Andrade-Neto, M.R., S99 (29085)
Andreoni, C., S248 (28466), S249 (28467)
Angelo, C.S., S240 (29120)
Anghinoni, M., S121 (29004), S133 (28986),
S187 (28962), S189 (28963)
Anginski, M.A., S161 (29076)
Anjos neto, J.C.A., S209 (29302)
Anjos, R.O., S192 (29141)

Anuar, M., S250 (29321)
Apodaca, F.R., S101 (29231), S111 (28951), S121 (29213)
Aquino, D.R.R.A., S159 (29184)
Aquino, R.G.F., S92 (29315), S94 (29320)
Arago, M.T., S210 (29135)
Arago, P.S., S178 (29150), S179 (29300), S193 (29181)
Arakaki, M.S., S173 (28979), S206 (28968),
S213 (28855)
Arajo, C.A.A., S231 (28663), S232 (28359)
Arajo, I.V., S175 (28862), S239 (28864)
Arajo, J.C., S250 (29321)
Arajo, J.R.C., S236 (28277), S237 (28435)
Araujo, M.S., S214 (28219)
Arajo, M.T., S155 (29176), S166 (29163), S197 (29199),
S206 (29170)
Araujo, R., S141 (28348), S141 (28349), S149 (28347),
S150 (28345)
Arajo, R.F.F., S180 (28957)
Araujo, R.L.C., S120 (28507)
Araujo, R.O.C., S110 (28323), S116 (28385),
S144 (28388), S148 (28320), S152 (28393),
S182 (29152)
Arajo, R.O.C., S115 (28342)
Araujo, S.E.A., S143 (28935)
Aras, A.L.B.G., S164 (28565)
Arruda, A.E., S214 (29148), S224 (28902)
Asfora, F.S.P., S177 (28880)
Assis, E.A.C.P., S160 (28954)
Assumpo, J.I., S111 (28623)
Atade, L.O., S121 (28925), S136 (29095), S219 (28931)
Aveiro, W.C., S214 (29299)
Aveline, P.E., S146 (29161)
Azeredo, R.B., S227 (28859)
Azevedo, B.R.B., S121 (29004), S133 (28986),
S187 (28962)
Azevedo, C.F., S90 (29247)
Azevedo, L.W., S199 (28905), S214 (29148),
S224 (28902)
Azevedo, M.M., S103 (28442), S127 (28422),
S169 (29154)
Azevedo, R.M.C., S216 (29077)
Azevedo, V.V.Z., S213 (29124)
Bacchi, C.E., S217 (29223)
Bacha, O.M., S180 (29270), S181 (29241)
Badiglian-Filho, L., S181 (28982), S184 (28883),
S186 (28882), S189 (28885), S200 (29049)
Baiocchi Neto, G., S92 (28907)
Baiocchi, G., S181 (28982), S184 (28883), S186 (28882),
S189 (28885), S191 (28884), S191 (28887),
S237 (28971), S237 (28973), S238 (28895),
S243 (28978), S97 (28906)
Baiocchi, J.M.T., S237 (28971), S237 (28973),
S238 (28895), S243 (28978)
Baldino, L., S177 (29319)
Balzan, S.M.P., S127 (28626), S157 (28551),
S218 (28627)
Barbosa, C.A., S130 (29192), S182 (29152)
Barbosa, F.R.A.O., S106 (28309), S132 (28399),
S92 (28314)
Barbosa, G.B., S175 (28443), S182 (28496),
S187 (29253), S196 (29308)
Barbosa, G.C., S240 (28243)
Barbosa, M.G., S187 (29253)
Barbosa, R.R.C., S230 (29178)
Baretta, R., S200 (28892)
Barreto, B.G., S216 (29077)
Barreto, C.L., S200 (28371)
Barreto, L.K.D., S155 (29176), S166 (29163),
S197 (29199), S206 (29170)
Barreto, P., S114 (29273), S116 (29292)
Barreto, P.H.F., S107 (29131)
Barreto, R.O., S170 (28970), S226 (29263)
Barrichello, E., S243 (28943)

Barros, A.V., S122 (28876), S131 (28923), S131 (29104),
S173 (28930), S173 (29100), S195 (29111),
S207 (29013), S223 (29110)
Barros, E.D., S164 (28391), S207 (28378), S219 (28394),
S219 (28607), S220 (28613), S221 (28602),
S221 (28614), S221 (28616), S222 (28620),
S222 (28621), S96 (28384)
Barros, K.S., S94 (29320)
Bastos, J.L.A., S122 (29115), S131 (29193)
Batista, R.M.S.S., S153 (28983)
Batista, T.P., S200 (29049), S99 (29085)
Batista, V.L., S145 (29185), S159 (29117), S213 (29124)
Begnami, M.D., S147 (29082)
Begnami, M.D.F.S., S109 (29179), S142 (28999),
S153 (28983)
Bereza, B., S185 (28088)
Bereza, B.R., S186 (29160)
Bergamasco, H.C., S240 (28243)
Bernardino, L.G., S102 (28631)
Bertocco, L.A.S., S112 (28421), S150 (28423)
Bertolli, E., S208 (29103), S208 (29105), S212 (29099),
S218 (28408), S224 (29136)
Bertolucci, P., S105 (29279)
Bertrand, S.A.B., S89 (29255), S90 (29222), S90 (29280)
Bertulucci, P.A., S107 (29028), S108 (29123),
S110 (28871), S115 (29112), S123 (28804),
S133 (29186)
Bertuol, J.V.L., S150 (29262)
Bevilacqua, J.L., S93 (29235)
Bevilacqua, J.L.B., S237 (28973), S91 (29101),
S91 (29107)
Bezerra, C.F., S187 (29204), S213 (29153), S224 (29157)
Bezerra, D.A., S139 (28843), S226 (28306),
S227 (28839), S228 (28469), S234 (28872)
Bezerra, J.L.M., S89 (29318)
Bezerra, T.S., S141 (28910), S144 (29108), S145 (29116),
S151 (28916)
Biondo-Simoes, R., S146 (29161), S163 (28716),
S217 (28703)
Bisneto, J.B.M., S155 (29176), S166 (29163),
S197 (29199)
Bitencourt, A.G.V., S92 (28907)
Bizzo, S.M.D., S189 (28233)
Blohem, I.V., S218 (28955)
Boareto, A.M., S146 (29161), S163 (28716),
S217 (28703)
Boarini, L.R., S138 (29191)
Bocanegra, R.E.D., S205 (29325)
Boente, P., S177 (28880), S218 (28955)
Bomfim, G.A.Z., S168 (28964), S97 (28906)
Bonomi, D.O., S233 (29183), S234 (28834)
Borba, C., S152 (28881)
Bordinhao, R.W., S200 (28892)
Borges, L.C., S103 (28442), S127 (28422), S169 (29154),
S216 (28912)
Borges, W.R., S127 (29203)
Bortoletto, B.L., S159 (29184), S164 (29195),
S167 (29180)
Bortoletto, F.L., S164 (29195)
Bortolini, M.P., S144 (28250)
Botaro, V., S95 (29225)
Brandalize, G.G., S172 (28326), S183 (28343)
Brando, A.B.M., S154 (28920)
Brando, B.C., S139 (28843), S227 (28839)
Brando, D.C.B.S., S179 (28856)
Brando, J.C., S245 (29070)
Brandes, J.L., S145 (29185)
Brazes, F.A.S., S160 (28574)
Breda, J.A., S144 (28250)
Brigo, M.J.K., S250 (29201)
Brito, F.A., S210 (28331)
Brito, F.P.B., S124 (28294), S197 (27455), S201 (28293)
Brito, R.H., S102 (29224), S109 (29179), S119 (29194)
ABSTRACTS
Bugarin, A., S110 (28323)
Burgardt, D., S107 (29028), S110 (28871), S115 (29112),
S123 (28804), S133 (29186)
Bustamante, E.F., S232 (28959)
Bustamante-Lopez, L.A., S137 (28900), S139 (28901),
S140 (28903), S140 (29080), S142 (28928),
S143 (28935), S145 (28946), S146 (28899),
S147 (28893), S147 (28898), S148 (28897),
S170 (28896)
Cabero, F.V., S118 (29211)
Cabral, J.G.V., S180 (28957)
Cabrera Filho, L.H., S164 (29195)
Cagnacci, R.N., S93 (29235)
Caldas, R.A.T., S233 (29244)
Caldeira, J.R.F., S215 (28849), S95 (28850), S95 (28851)
Calistro, F.C.F., S243 (28943)
Callegaro, D., S196 (29308)
Calsavara, V.F., S203 (28958)
Camacho, A.T.C.U., S96 (29109)
Cmara, C.B.S., S207 (29013), S223 (29110)
Camaro, W.R., S181 (28982), S212 (29099),
S218 (28408), S224 (29136), S91 (29101)
Campanholi, L., S237 (28971), S238 (28895),
S243 (28978)
Campanholi, L.L., S237 (28973)
Campbell, L.M., S175 (29281), S190 (29305)
Campelo, B.C., S196 (28875)
Campos, E.C., S187 (28962), S189 (28963)
Campos, E.C.R., S121 (29004), S133 (28986)
Campos, F.G., S147 (28893), S147 (28898)
Campos, R. de A., S207 (28045)
Campos, R.A., S165 (29197), S209 (28846),
S212 (28845), S215 (28847), S215 (28849),
S250 (28844), S95 (28850)
Cancian, L.T., S149 (28389)
Canedo, L.F., S120 (28960), S132 (28506)
Canguss, H.C., S129 (28329), S201 (28332)
Canguss, R.C., S89 (29255), S90 (29280)
Cantin, B., S142 (28999)
Cantisani, G., S154 (28920)
Capuzzo, R.C., S230 (29207)
Cardona, L., S118 (29121)
Cardoso, C.A., S227 (28859), S230 (28579)
Cardoso, L.M.L., S238 (29239), S239 (29214),
S242 (29217)
Cardoso, M.W.C., S161 (29076), S209 (26349)
Carneiro, V.C.G., S200 (29049)
Carvalho, A., S152 (28881)
Carvalho, A.C., S110 (28248)
Carvalho, A.L., S177 (28880)
Carvalho, A.M., S165 (29197), S212 (28845),
S215 (28847), S95 (28850), S95 (28851)
Carvalho, B.S.V., S145 (29185), S159 (29117),
S213 (29124)
Carvalho, C.C., S102 (28631), S233 (29183), S234 (28834)
Carvalho, C.E.B., S214 (29299), S231 (29260)
Carvalho, D.R., S103 (28304), S104 (28299)
Carvalho, E.A., S210 (28840), S233 (29183), S234 (28834)
Carvalho, G.P., S250 (29321)
Carvalho, G.S.L., S231 (28663), S232 (28359)
Carvalho, G.S.S., S130 (29192)
Carvalho, G.T., S205 (29259), S229 (29268),
S251 (29294), S96 (29274)
Carvalho, L.A., S151 (28865), S155 (28863),
S201 (28373)
Carvalho, L.H., S95 (29225)
Carvalho, M.G., S100 (28483)
Carvalho, V.D.P., S230 (29178)
Carvalho, W.S.F., S122 (29115), S131 (29193)
Castro, B., S190 (29275)
Castro, D.L.V., S240 (29120)
Castro, L., S118 (29121), S215 (28201)
Castro, L.S., S101 (28922), S102 (28933), S104 (28944),
S105 (28937), S105 (28949), S106 (28942),
S114 (28953), S115 (28940), S116 (28938),
S136 (29156), S149 (28904)
S253
Castro, M., S121 (29004), S133 (28986), S187 (28962)
Cavalcanti, T.C.S., S188 (28266)
Caxeiro, G.L., S101 (29231), S111 (28951)
Cecconello, I., S137 (28900), S139 (28901),
S140 (29080), S146 (28899), S147 (28893),
S147 (28898), S148 (28897), S170 (28896)
Cedotti, W., S245 (28230)
Cereser Junior, C.H., S202 (29092)
Cereser, C.H., S111 (28623)
Cerski, T., S154 (28920)
Cesar, D., S141 (28348), S141 (28349), S148 (28320),
S149 (28347), S150 (28345)
Cettolin, Q.C., S168 (28860)
Chebel, M.J., S211 (29219), S217 (29223)
Chiaradia, C.P., S151 (29155), S162 (29206),
S205 (29311), S211 (29175), S227 (29271)
Chulam, T.C., S139 (28833)
Cintra, C.A., S100 (28483), S102 (28631), S156 (28487),
S166 (28841), S194 (29208), S210 (28840)
Cintra, G.F., S167 (28965), S183 (29057), S184 (28952),
S186 (29189), S190 (29177), S191 (29143),
S192 (29291), S195 (29149), S197 (28831)
Claus, C.M.P., S129 (28329)
Coelho junior, M.J.P., S209 (29302)
Coelho, J.G., S145 (29185), S159 (29117), S213 (29124)
Coelho, M.J., S228 (28629)
Coelho, P.F.R., S178 (29150), S179 (29300),
S193 (29181)
Coimbra, F.J.F., S100 (29072), S109 (28926),
S109 (29074), S109 (29140), S109 (29179),
S113 (29307), S116 (28929), S124 (28936),
S125 (28932), S125 (28934), S126 (28693),
S128 (29142), S129 (29138), S129 (29145),
S134 (28509)
Coimbra, F.J.H., S102 (29224), S119 (29194)
Colturato, M., S205 (29259), S229 (29268),
S251 (29294), S96 (29274)
Conterno, J., S106 (28379), S126 (28381), S128 (28382),
S132 (28392), S164 (28391), S171 (28380),
S177 (28376), S207 (28378), S208 (28624),
S219 (28607), S220 (28610), S96 (28384)
Conti, E.C., S236 (28835)
Cordeiro, E.Z., S200 (28892)
Cordero, F.L., S196 (28434)
Correa Junior, M.A.R., S108 (29303), S209 (29302)
Correa, J.H.S., S101 (28922), S102 (28933),
S104 (28944), S105 (28937), S105 (28949),
S106 (28942), S114 (28953), S115 (28940),
S116 (28938)
Corra, J.H.S., S149 (28904)
Correa, L.H.L., S126 (28381), S132 (28392),
S164 (28391), S171 (28380), S208 (28624),
S219 (28394), S220 (28609), S220 (28613),
S222 (28620), S96 (28384)
Corra, R.S., S136 (29087), S136 (29088), S171 (28984),
S178 (29089), S187 (29204), S190 (29093),
S192 (29090), S213 (29153), S224 (29157),
S249 (29091)
Correia, C.S., S178 (29150), S179 (29300), S193 (29181)
Costa Jr, W.L., S100 (29072), S102 (29224),
S109 (29074), S109 (29140), S128 (29142),
S129 (29138), S129 (29145), S134 (28509)
Costa Jr., W.L., S109 (29179), S119 (29194)
Costa, A.C., S147 (29082)
Costa, A.L.S., S239 (28087)
Costa, C.M., S127 (29203), S241 (29209)
Costa, F.C.R., S175 (28862), S239 (28864), S99 (29164)
Costa, F.DA., S97 (28906)
Costa, F.P.P., S134 (28370)
Costa, G.A.P., S250 (28844)
Costa, G.L.O.B., S244 (29285), S244 (29293),
S246 (29298)
Costa, J.A.S., S118 (29211)
Costa, K.F.L, S163 (28429)
Costa, K.F.L., S158 (28533), S168 (28532)
Costa, R.P., S250 (28844)
Costa, T.R.P., S113 (29245), S157 (29242), S176 (29254)
Costa, V.S.M., S103 (28304), S107 (28300), S143 (28879)

Costa, W.L.J., S126 (28693)
Cotti, G.C., S140 (29080)
Couto Netto, S.D., S134 (28370), S173 (28979),
S204 (29086), S206 (28968), S213 (28855)
Couto, P.H.F.S.T., S208 (29105)
Couto, U.V.O., S195 (29144), S195 (29149)
Crozzera, A.C.P., S97 (28083)
Crusoe, N.S.D.R., S90 (29247)
Cruso, N.S.D.R., S90 (29280), S91 (29286)
Cruz, I.D.M., S124 (29125)
Cruz, M.R.C., S168 (28964)
Cruz, R.P., S177 (29174), S212 (28927), S217 (28913),
S233 (28497)
Cunha, L.F.T., S105 (28949), S115 (28940)
Curi, C., S91 (29101), S91 (29107)
Cury Filho, A.M., S100 (29072), S109 (28926),
S109 (29074), S109 (29140), S116 (28929),
S119 (29194), S124 (28936), S125 (28932),
S125 (28934), S128 (29142), S129 (29138),
S129 (29145), S134 (28509)
Cury, A.M., S113 (29307)
Cury-Filho, A.M., S129 (28329)
DOrto, U.C., S112 (28295), S126 (28419)
da Costa Junior, W., S113 (29307)
da Costa, A.A.B.A., S189 (28885), S191 (28887)
da Costa, T.R.P., S157 (29257)
Da Costa, W.L., S109 (28926), S116 (28929),
S125 (28932)
da Rosa, M.D., S177 (29174)
Da Silva, M.V.M.V., S115 (28342)
Dagostin, C.C., S146 (29161)
DallInha, V.N., S107 (29028), S108 (29123),
S110 (28871), S115 (29112), S123 (28804),
S133 (29186), S230 (29207), S231 (29260),
S231 (29313)
Dalla Valle, T., S245 (28908)
Dallagnol, J.C., S138 (29129)
Damiani, P.A., S177 (29174), S217 (28913)
Danieluk, M.F.C., S101 (28512)
Dantas, D., S114 (28953)
Dantas, D.C., S115 (28940)
Dario, R.P.D., S126 (28419)
De Arajo, M.S., S161 (29076)
De Brito, R.H., S109 (28926), S116 (28929),
S125 (28932)
de Brot, L., S184 (28883)
de Farias, I.C., S113 (29307), S124 (28936), S125 (28934)
De Godoy, A.L., S124 (28936), S125 (28934)
De Jesus, J.P., S148 (28320)
de Melo, M.S.B., S100 (29295), S248 (29312)
de Morais, C.O., S106 (28379), S111 (28623),
S126 (28381), S128 (28382), S132 (28392),
S177 (28376), S221 (28614)
de Morais, L.L.G., S119 (29081)
de Oliveira, D.S., S246 (28209)
de Oliveira, F.H.M., S144 (28848)
de Oliveira, R.A.R., S191 (28884)
de Oliveira, T.B.C., S100 (29295), S248 (29312)
de Paula, P.H.M., S154 (28921), S156 (28487)
De Paula, W.T., S162 (29134)
de Pellegrin, B.B.B., S217 (28913)
de Souza, S.R.V., S100 (29295), S248 (29312)
Debon, L.M., S105 (29171), S120 (28696)
Defelippe, M.A., S230 (29178), S232 (28519)
Del Pozo, F.A., S158 (29306), S159 (29309)
Delabio, L.C., S163 (28716), S217 (28703)
Delfino, J.N.F., S232 (28959)
Delunardo, L.G.C., S193 (29261)
Di Tomaso, R.A.S., S204 (29317), S209 (29302)
Di Tommaso, R.A.S., S108 (29303), S177 (29319)
Dias, A.N., S127 (28422), S216 (28912)
Dias, B.M.R., S242 (29218)
Dias, E.N., S103 (28442), S194 (28414)
Dias, I.S., S205 (29259), S229 (29268), S251 (29294),
S96 (29274)
S254
Dias, J.C.S., S204 (28247)
Dias, J.J.S., S218 (28955)
Dias, J.M., S156 (29251)
Dias, J.P., S101 (28512)
Dias, L.A., S243 (28943)
Diniz, A.F., S151 (28865), S199 (28905)
Diniz, A.L., S100 (29072), S109 (28926), S109 (29074),
S109 (29140), S125 (28932), S126 (28693),
S128 (29142), S129 (29138), S129 (29145),
S134 (28509)
Diniz, F.D., S183 (28967), S214 (29299)
Diogo, L.C., S154 (28920)
Diz, F.L., S205 (29259), S229 (29268), S251 (29294),
S96 (29274)
do Espirito Santo, G.F., S119 (29081)
do Prado, F.R.S., S154 (28921)
Doi, M., S97 (28906)
Donini, C.M.F., S180 (29188)
dos Reis, R., S187 (29253)
dos Santos, B.F., S138 (29191)
dos Santos, F.M., S122 (29230), S151 (29155),
S162 (29206), S166 (29078), S205 (29311),
S211 (29175), S227 (29271)
dos Santos, M.A., S233 (28497)
Dotto, M.S., S127 (28626), S157 (28551), S218 (28627)
Dourado, D.M., S159 (29184)
Dourado, G.P., S139 (28843), S227 (28839)
Dragon, L.L., S208 (28624), S219 (28394), S219 (28607),
S220 (28609), S220 (28610), S220 (28613),
S221 (28602), S221 (28614), S221 (28616),
S222 (28620), S222 (28621)
Duarte, J.L., S124 (28294)
Duprat Neto, J.P., S218 (28408), S237 (28971),
S238 (28895)
Duprat, J.P., S212 (29099), S224 (29136)
Duque, A.C.M., S152 (28881), S241 (29209),
S242 (29228)
Eccard, G.O., S114 (28593)
Elias, A.C.A., S245 (28230)
Epstein, M.G., S112 (28295), S112 (28417),
S112 (28421), S126 (28419), S150 (28423)
Esteves, F.V.C.S., S93 (28858), S94 (29084), S98 (28857)
Falcao Filho, D.F., S187 (29253)
Falco, A.C.A., S208 (29103), S208 (29105), S91 (29107)
Falco, C.A.F., S130 (29102), S96 (29109)
Falco, M.F., S119 (28877), S143 (28879), S155 (29168),
S168 (28860), S206 (29167)
Faloppa, C.C., S181 (28982), S184 (28883),
S186 (28882), S189 (28885), S191 (28884),
S191 (28887)
Faria, E.P., S134 (28370)
Farias, I.C., S100 (29072), S109 (29074), S109 (29140),
S126 (28693), S128 (29142), S129 (29138),
S129 (29145), S134 (28509)
Fava, B.E.C., S101 (29231), S111 (28951), S121 (29213)
Fava, G., S105 (29279)
Favaretto, R., S218 (28408)
Feil, D.C., S110 (28248)
Feitosa, C.S., S246 (29298)
Feitosa, L.M.C., S92 (29315)
Felicio, S., S132 (28399)
Felicio, S.J.O., S106 (28309), S92 (28314)
Fermino, A.L., S214 (29299), S97 (28083), S99 (27305)
Fernandes, P.H.S., S211 (29219)
Ferracini, I.C.F, S122 (29115)
Ferracini, I.C.F., S131 (29193)
Ferrari, C., S130 (29276), S229 (29198)
Ferraz, A.S., S241 (29209)
Ferreira, A.A.S., S180 (29188)
Ferreira, A.G.L., S115 (28342), S136 (29156)
Ferreira, F.C.S., S114 (28593), S164 (28565),
S171 (28566), S172 (28570), S182 (29152)
Ferreira, F.O., S142 (28999), S144 (29108), S145 (29116),
S147 (29082), S153 (28983), S203 (28958),
S204 (29086), S206 (28968)
Ferreira, M.T.M., S178 (29119)
ABSTRACTS
Ferreira, P.A., S107 (29131), S244 (29285), S244 (29293),
S246 (29298)
Ferreira, R.P., S189 (28963)
Ferreira, V., S241 (29200)
Ferreira, V.A.C., S186 (29160)
Ferreira, V.H.S., S165 (29289)
Ferretti, C.E.A., S207 (27443)
Ferretti, L.E.A., S207 (27443)
Ferro Neto, O.C., S122 (28876), S131 (28923),
S131 (29104), S173 (28930)
Ferzeli, C.F., S159 (29184), S167 (29180)
Fher, R., S237 (28435)
Figueiredo, N.C.L., S230 (28579)
Filho, A.X.F., S175 (29281)
Filho, D.F., S181 (29216), S192 (29141)
Filho, D.F.F., S182 (28535), S185 (29127), S188 (28868),
S211 (28854)
Filho, F.S.N.H., S139 (28843), S227 (28839)
Filho, K.J.C., S136 (29088), S178 (29089), S187 (29204),
S192 (29090), S213 (29153), S224 (29157),
S249 (29091)
Filho, L.C.O., S93 (29310)
Filho, M.A.F., S161 (29282), S226 (29246), S234 (29287)
Filho, R.L.M., S215 (28847), S215 (28849), S95 (28851)
Fin, F.R., S121 (29004), S133 (28986), S187 (28962),
S189 (28963)
Finotti, A.S., S226 (29246)
Fiod, N.J.J., S214 (28219)
Firmino, N.L.J., S151 (28865), S155 (28863),
S175 (28862), S199 (28905), S214 (29148),
S224 (28902), S239 (28864), S99 (29164)
Fleck Junior, A.M., S154 (28920)
Foiato, T.F., S185 (28088), S186 (29160)
Fonseca, C.C.F., S128 (29296), S233 (29244)
Fontana, R., S122 (29230), S151 (29155), S162 (29206),
S166 (29078), S205 (29311), S211 (29175),
S227 (29271)
Fonteles, A.F., S161 (28956), S226 (28306),
S228 (28469), S234 (28872)
Fontes, A.A., S177 (28880), S218 (28955)
Formiga, F.B., S138 (29191)
Formiga, G.J.S., S138 (29191)
Foster, M., S101 (28922), S105 (28937)
Fraianella, L., S93 (29235)
Frana, A.A., S241 (28285)
Frana, A.V.C., S210 (29135)
Frana, R.R., S104 (28299), S107 (28300)
Frana, V.T., S127 (28626), S157 (28551), S218 (28627)
Francischetto, T., S205 (29325)
Franco, A.C., S137 (28981), S180 (29188)
Franco, A.C.G., S163 (29297)
Franco, B.V., S165 (29289)
Franco, C.P., S102 (29224), S109 (29179), S119 (29194)
Fregnani, J.H.T.G., S237 (28971), S238 (28895)
Freire, A.N.M., S107 (29131), S114 (29273),
S116 (29292), S158 (29306), S159 (29309),
S244 (29285), S244 (29293), S246 (29298)
Freire, M.D.M., S114 (29273), S116 (29292),
S158 (29306), S159 (29309), S244 (29285),
S244 (29293), S246 (29298)
Freitas, A.A.S., S228 (28629)
Freitas, A.C., S130 (29276), S229 (29198)
Freitas, E.C., S127 (29203), S152 (28881), S238 (29239),
S239 (29214), S241 (29209), S242 (29217),
S242 (29218), S242 (29228)
Freitas, H.C., S161 (28956), S226 (28306), S228 (28469),
S234 (28872)
Freitas, V.F., S122 (29115), S131 (29193), S156 (29212),
S162 (29202), S247 (29215), S97 (29221)
Freitas, Y.M.M., S197 (27455)
Friedrich, C.F., S237 (28973)
Froede, A.G., S249 (29322)
Frutuoso, A.V.S., S137 (28981), S180 (29188)
Fuga, G.R., S127 (28626), S157 (28551), S218 (28627)
Fukazawa, E.M., S186 (28882)
Fukushima, J.I., S163 (28716), S217 (28703)
Furlan, F.Z., S105 (29171), S120 (28696)
Furquim, M.A.T.A., S232 (28519)

Furtado, C., S221 (28602), S221 (28614), S222 (28620),
S222 (28621)
Furtado, C.F., S207 (28378)
Furtado, G.P., S89 (29318), S92 (29315), S93 (29310),
S94 (29320)
Furtado, J.P.R., S132 (28392), S164 (28391),
S207 (28378), S208 (28624), S219 (28394),
S220 (28613), S221 (28614), S221 (28616),
S222 (28620), S222 (28621), S96 (28384)
Furtado, J.R.P., S106 (28379), S219 (28607),
S220 (28609), S220 (28610), S221 (28602)
Furtado, L.B., S93 (28858), S98 (28857)
Gabriel, T.C., S97 (28083)
Galvo, A.M., S180 (28957)
Galvo, M.P., S114 (29273), S116 (29292)
Gama, G.B., S229 (28867)
Garcia, C.M.M., S182 (28496)
Genaro, A., S161 (29282), S165 (29289), S226 (29246),
S234 (29287)
Ghirello-Pires, C., S152 (28881)
Giordani, D., S111 (28623)
Giordani, D.S.N., S202 (29092)
Giordani, L., S119 (29081)
Giorgetta, L.S., S136 (29156), S196 (28433),
S196 (28434)
Godoy, A.L., S100 (29072), S109 (29074), S109 (29140),
S113 (29307), S126 (28693), S128 (29142),
S129 (29138), S129 (29145), S134 (28509)
Gis, M.C., S136 (29087), S136 (29088), S171 (28984),
S178 (29089), S190 (29093), S192 (29090),
S213 (29153), S224 (29157), S249 (29091)
Gomes, A.S.A., S151 (28865), S155 (28863),
S175 (28862), S199 (28905), S214 (29148),
S224 (28902), S239 (28864), S99 (29164)
Gomes, D.B., S178 (29150), S179 (29300), S193 (29181)
Gomes, F.G., S119 (29081)
Gomes, G.E.S., S151 (28865), S199 (28905),
S201 (28373)
Gomes, I.C., S158 (28533), S163 (28429)
Gomes, L.N., S130 (29276), S229 (29198)
Gomes, M.T.V., S182 (28496), S196 (29308)
Gonalves, L., S250 (29201)
Gonalves, M.C., S161 (29282)
Gonalves, P.A.L.H., S139 (28843), S227 (28839)
Gonalves, R., S215 (28201)
Gnen, M., S120 (28507)
Gottlieb, D., S179 (28985)
Graebin, L., S130 (29276), S229 (29198)
Grangeiro, G.O., S90 (29247)
Grillo, B.C., S193 (29261)
Guedes, A., S216 (29077)
Guedon, G., S215 (28201)
Guerra, S.C., S168 (28860)
Guerreiro, J.A., S165 (28537), S183 (28343),
S185 (28088)
Guimaraes, G.C., S191 (28884), S218 (28408)
Guimares, G.C., S248 (28917)
Guimares, R.B., S94 (29084), S98 (28857)
Guimares, R.S., S114 (28593), S172 (28570)
Guitmann, G., S190 (29275)
Gurgel, M.V.S.A., S186 (29189)
Gurgel, R.Q., S210 (29135)
Guth, G.Z., S121 (28925), S136 (29095), S219 (28931)
Haji Junior, A.C., S108 (29303), S177 (29319),
S209 (29302)
Haji junior, A.C.H., S204 (29317)
Hamdar, F.B., S146 (29060)
Hayashi, M.C., S250 (28844)
Hayashi, R.M., S188 (28266)
Henrique, M.D., S130 (29102), S96 (29109)
Herman, P., S120 (28507)
Hillmann, E., S180 (29270), S181 (29241)
Hirofumi, Y., S91 (29107)
Hisano, M., S250 (29321)
ABSTRACTS
Holanda, A.M., S113 (29245), S157 (29242),
S157 (29257), S176 (29254)
Homobomo, K.F., S128 (29296)
Horie, M.K.S., S161 (29282), S226 (29246),
S234 (29287)
Horta Filho, V., S230 (29207), S231 (29260),
S231 (29313)
Hortegal, L.B., S196 (28875)
Huguenin, J.F.L., S149 (28904)
Hygino, M.C., S104 (28944), S116 (28938)
Igreja Jnior, H.J., S145 (29185)
Igreja Jnior, H.J.S., S159 (29117), S213 (29124)
Iyeyasu, H., S91 (29101), S97 (28906)
Jablonski, R., S130 (29276)
Jacob, G.G., S172 (29106), S219 (29118)
Jesus, C.G., S175 (28862), S239 (28864)
Jesus, J.P., S149 (28389), S152 (28393)
Jesus, M., S118 (29121)
Jesus, M.S., S156 (29212), S162 (29202), S247 (29215),
S97 (29221)
Jesus, P., S141 (28348), S141 (28349), S149 (28347),
S150 (28345)
Johnson, L.F.P., S114 (29273), S116 (29292),
S158 (29306), S159 (29309), S184 (29229),
S205 (29325)
Johnson, L.P.J., S163 (29297)
Joioso, A., S215 (28849), S95 (28850), S95 (28851)
Jonhson, L.F.P., S107 (29131)
Juncal, M., S250 (29321)
Juncal, S., S250 (29321)
Juncal, S.R., S248 (28466), S249 (28467)
Jnior, E.C.N.N., S185 (29240)
Jnior, F.E.L.P., S136 (29087), S136 (29088),
S190 (29093)
Jnior, J.S., S123 (29205), S233 (29244)
Junior, L.C.V., S219 (28931)
Jnior, M.G.C., S160 (28574)
Junior, N.F.L., S200 (28371)
Junior, R.J., S229 (29198)
Junior, W.E.M., S139 (28843), S227 (28839)
Kalil, A.N., S106 (28379), S126 (28381), S128 (28382),
S132 (28392), S171 (28380)
Kaminice, L.M., S211 (29219)
Karimai, J., S200 (28371)
Kawaguti, F.S., S137 (28900)
Kesley, R., S101 (28922), S102 (28933), S104 (28944),
S105 (28937), S105 (28949), S106 (28942),
S114 (28953), S115 (28940), S116 (28938)
Kondo, W., S158 (28395), S165 (28537), S188 (28266)
Kool, R., S138 (29129), S144 (28848), S158 (28395),
S178 (29119), S183 (28343), S186 (29160),
S188 (28868), S247 (28842)
Kopittke, L., S237 (28973)
Kowloski, B., S190 (29275)
Krummenauer, M.L.S., S157 (28551)
Kruschewsky, M.M., S90 (29222)
Kumagai, L.Y., S181 (28982), S184 (28883),
S186 (28882), S191 (28884), S191 (28887)
Kupper, B.E.C., S139 (28833)
Kurtz, G.S.T., S122 (29230), S151 (29155), S166 (29078),
S227 (29271)
Kuster, M.G.B., S175 (28443), S182 (28496),
S188 (28868), S196 (29308)
Kwiatkonski, R., S207 (28378)
Kwiatkonski, R.V., S132 (28392), S164 (28391),
S171 (28380), S177 (28376), S208 (28624),
S219 (28394), S220 (28609), S220 (28613),
S221 (28616)
Kwiatkownski, R.V., S126 (28381)
Lacerda, C.F., S105 (29279), S107 (29028), S108 (29123),
S110 (28871), S115 (29112), S123 (28804),
S133 (29186)
Lajus, J.A., S149 (28904)
S255
Landeiro, L.C.G., S90 (29222), S90 (29280), S91 (29286)
Landeiro, L.G.C., S89 (29255)
Landman, J., S248 (28466), S249 (28467)
Laporte, G.A., S106 (28379), S111 (28623),
S126 (28381), S128 (28382), S132 (28392),
S164 (28391), S171 (28380), S177 (28376),
S207 (28378), S208 (28624), S219 (28394),
S219 (28607), S220 (28609), S220 (28610),
S220 (28613), S221 (28602), S221 (28614),
S221 (28616), S222 (28620), S222 (28621),
S96 (28384)
Lauar, R.A.O., S154 (28921)
Leal, C.S., S127 (29203)
Leo, C.S., S200 (29049)
Leo, F.G.A., S124 (28294)
Leite, A.B.C., S193 (29261)
Leite, A.R., S158 (28533)
Leite, F.A.V., S172 (29106), S219 (29118)
Leite, H.G.A., S193 (29261)
Leite, R.S., S232 (28959)
Lemos, N., S187 (29253), S196 (29308)
Lemos, N.B.M., S175 (28443), S182 (28496)
Leonardi, L.A., S106 (28379), S111 (28623),
S128 (28382), S164 (28391), S220 (28609),
S220 (28613), S221 (28602), S222 (28620),
S222 (28621), S96 (28384)
Lessa, K.P., S248 (28466), S249 (28467)
Lima, A.P., S160 (28954)
Lima, C.A.C., S99 (29085)
Lima, C.R.C., S230 (29178), S232 (28519)
Lima, E.N.P., S92 (28907)
Lima, J.P., S168 (28532)
Lima, L.M., S93 (29310)
Lima, L.R.C., S118 (29211), S125 (29210), S133 (29227),
S135 (29258), S156 (29251), S170 (29234),
S170 (29234)
Lima, L.W.R., S123 (29205), S176 (29233),
S194 (29269), S233 (29244)
Lima, M.B.A., S155 (28863), S199 (28905),
S202 (28372)
Lima, P.S.C.M., S156 (28487)
Lima, R.K.B., S93 (28858), S94 (29084)
Linhares, E., S141 (28348), S141 (28349), S148 (28320),
S149 (28347), S150 (28345)
Linhares, J.C., S143 (28352), S158 (28395),
S178 (29119), S183 (28343), S185 (28088)
Lins, P.I.A.B., S175 (28862), S202 (28372), S239 (28864)
Lira, G.A., S113 (29245), S136 (29087), S136 (29088),
S155 (29176), S157 (29242), S157 (29257),
S166 (29163), S171 (28984), S176 (29254),
S178 (29089), S190 (29093), S192 (29090),
S197 (29199), S206 (29170), S213 (29153),
S224 (29157), S249 (29091)
Litwinczuk, A.F.A., S188 (28868)
Litwinzuk, A.F.A., S182 (28496)
Lombardi, W., S95 (29225)
Lopes, A., S139 (28833), S141 (28910), S142 (28999),
S144 (29108), S145 (29116), S147 (29082),
S151 (28916), S153 (28983), S166 (28841),
S203 (28958), S205 (29325), S216 (28912),
S223 (28911), S223 (28915), S248 (28917)
Lopes, A.P.R.M., S216 (28912)
Lopes, A.R.C., S158 (29306), S159 (29309)
Lopes, A.S., S201 (28293)
Lopes, A.V.Q., S180 (28957)
Lopes, E.P.D., S103 (28442), S127 (28422),
S194 (28414), S207 (28045), S209 (28846),
S216 (28912)
Lopes, H.N., S103 (28302), S104 (28303)
Lopes, P.V.A., S194 (29208), S199 (28226)
Loula, M.D., S132 (28399)
Loula, M.D.S., S106 (28309), S92 (28314)
Loureiro, M.P., S187 (28962), S189 (28963)
Loureno, L.A., S121 (28925), S136 (29095),
S219 (28931)
Lucena, L., S112 (28417)
Ludwig, V.B., S143 (28352)
Lusch, A., S248 (28466), S249 (28467)

Lustosa, A.G., S136 (29087), S136 (29088),
S171 (28984), S178 (29089), S187 (29204),
S190 (29093), S192 (29090), S213 (29153),
S224 (29157), S249 (29091)
Lustosa, E., S190 (29275), S196 (28433)
Luz, A.P.S., S106 (28942), S114 (28953)
Luz, M.A., S143 (28352), S158 (28395), S185 (28088)
Luz, M.L.S., S236 (28756)
Luzzatto, R., S179 (28985)
Maccapani, G., S112 (28295), S150 (28423)
Macedo, A.L.V., S112 (28295), S112 (28417),
S112 (28421), S126 (28419), S150 (28423)
Machado, C.A.C., S89 (29255), S90 (29247),
S90 (29280), S91 (29286)
Machado, D.C.S., S156 (29251)
Machado, L.M., S161 (29076)
Machado, M.C.M., S90 (29247)
Magalhes, L.C.C.S., S228 (28469), S234 (28872)
Magalhes, M.A., S127 (28626), S218 (28627)
Magno, A.W.G., S113 (29245), S157 (29242),
S157 (29257), S176 (29254)
Maia, B.K.F., S180 (28957)
Maia, D.S., S124 (29125)
Maia, G.H.M.R., S124 (29125)
Maia, W.S., S170 (28970), S226 (29263)
Malheiros, J.A., S204 (28247)
Maltoni, L.A., S110 (28323)
Mangueira Jnior, P.E.A., S169 (29154)
Mantoan, H., S181 (28982), S184 (28883), S186 (28882),
S189 (28885), S191 (28884), S191 (28887)
Marcondes, W., S112 (28421)
Mari, D.C.D., S163 (28716), S217 (28703)
Marinho, A.R.S., S163 (28429)
Marinho-Fermino, N.C., S99 (27305)
Maroun, J.J., S114 (28593), S171 (28566), S172 (28570)
Marques, C.F., S139 (28901), S140 (28903),
S145 (28946), S146 (28899), S148 (28897),
S170 (28896)
Marques, C.F.M., S142 (28928)
Marques, M.C., S100 (29072), S109 (29074),
S109 (29140), S116 (28929), S124 (28936),
S125 (28934), S128 (29142), S129 (29138),
S129 (29145), S134 (28509)
Marques, N., S109 (29179)
Marques, R.M., S175 (28443), S182 (28496),
S187 (29253), S188 (28868), S196 (29308)
Marquez, G.J., S125 (29210), S133 (29227),
S135 (29258), S170 (29234)
Marqui, B.A.L., S165 (29289)
Marroni, C.A., S154 (28920)
Martins, J.F.F., S136 (29095)
Martins, M.R., S99 (29085)
Martins-Filho, E.D., S99 (29085)
Matarezzi, E.S.S.T., S236 (28277), S237 (28435)
Matos, D., S142 (29290)
Matos, J.R., S90 (29222)
Matos, P.E.L.D.C., S208 (29103)
Matos, R.M., S122 (29115), S156 (29212), S162 (29202),
S247 (29215), S97 (29221)
Matsubara, M.G.S., S236 (28835), S237 (28452)
Mattana, J.L., S143 (28352), S172 (28326)
Mauro, F.H.O., S138 (29129), S247 (28842)
Mazzarino-Bassols, K.P., S188 (28909)
Mazzini, L., S118 (29121)
Medeiros Filho, W.V., S180 (29188)
Medeiros, D.B.G., S155 (29176), S166 (29163),
S197 (29199), S206 (29170), S206 (29170)
Medeiros, F.Q., S177 (29319)
Medeiros, K.M.O.T., S171 (28984), S187 (29204),
S213 (29153), S224 (29157)
Medeiros, M.F., S172 (29106), S219 (29118)
Medina, R.T., S164 (28565), S171 (28566)
Medrado, P.C., S131 (29104), S173 (29100),
S207 (29013), S223 (29110)
Meine, M.H.M., S154 (28920)
S256
Meinhardt Junior, J.G., S202 (29092)
Meira Neto, C.C., S107 (29028), S108 (29123),
S110 (28871), S123 (28804), S133 (29186),
S230 (29207), S231 (29260), S231 (29313)
Meira, M.L.G., S210 (28840)
Mello, C.A.L., S216 (28912), S223 (28911), S223 (28915)
Mello, E.L.R., S149 (28389), S152 (28393)
Melo, C.L.A., S122 (28876), S131 (28923), S131 (29104),
S173 (28930), S173 (29100), S195 (29111),
S207 (29013), S223 (29110)
Melo, I.S., S161 (28956), S226 (28306), S228 (28469),
S234 (28872)
Melo, M.C., S160 (28574)
Melo, P.T.N., S168 (28860)
Melo, R.S., S131 (28923), S223 (29110)
Mendes, C.R.S., S152 (28393)
Mendona, G.B.S., S159 (29117)
Mendona, S.B., S159 (29117)
Meneses, J.I., S103 (28302), S103 (28304), S104 (28303)
Menezes, J.N., S101 (29231), S111 (28951), S121 (29213)
Menezes, L.M., S249 (29322)
Mesquita, A.B.G., S179 (28856)
Meton, F., S215 (28201)
Michalick, I.D., S204 (28247)
Mierzwa, T.C., S150 (29262), S228 (28980),
S250 (29201)
Minari, C.L., S178 (29119), S183 (28343)
Miranda, A.C.G., S202 (28372)
Miranda, A.S., S238 (29239), S239 (29214),
S242 (29217), S242 (29218), S242 (29228)
Miranda, E., S151 (28865), S155 (28863), S175 (28862),
S199 (28905), S214 (29148), S224 (28902),
S239 (28864), S99 (29164)
Miranda, I.H., S130 (29276), S229 (29198)
Miranda, P.H.D., S214 (29148), S224 (28902), S99 (29164)
Miranda, T.N.A.E., S118 (29326), S134 (29327)
Miranda, T.T., S118 (29211)
Miyata, S., S166 (28841), S204 (28247)
Molina, A.S., S208 (29103), S208 (29105), S212 (29099),
S218 (28408), S224 (29136)
Molinari, V., S208 (28624), S219 (28607), S220 (28613),
S222 (28620)
Molinari, V.K., S219 (28394), S220 (28609),
S221 (28614), S222 (28621)
Mondragon, J.P.M., S148 (28320)
Monteiro, M., S215 (28201)
Moraes, F.P., S108 (29123), S111 (29314), S113 (29304),
S115 (29112)
Moraes, M.D., S107 (29131)
Moraes, P.C., S242 (29218)
Morais Jnior, M.A., S124 (28294), S197 (27455),
S201 (28293)
Morais, C.S., S207 (28378)
Morais, R.A., S215 (28849), S95 (28850), S95 (28851)
Moreira Junior, D.N., S170 (28970), S226 (29263)
Moreira, L.C., S170 (28970), S226 (29263)
Moreira, M., S184 (29229)
Moreira, R.C.L., S100 (28483), S102 (28631),
S156 (28487), S160 (28574), S166 (28841),
S194 (29208), S199 (28226), S210 (28840),
S249 (29322)
Moreira, R.P., S95 (29225)
Mota, B.R., S122 (28876), S173 (28930), S207 (29013)
Mota, D.D.C.F., S243 (28472)
Motta, L.A.C.R., S175 (29281), S190 (29305)
Moura, K.C.F., S196 (28875)
Moura, L.N.M., S93 (28858), S98 (28857)
Moura, R.F., S103 (28302), S103 (28304), S104 (28303)
Moura, R.L., S244 (29285), S244 (29293)
Moura, T.S.O.F., S218 (28408)
Mrue F., , S118 (29211)
Munhoz, R.R., S204 (29086)
Myata, S., S100 (28483)
Nagai, H.M., S228 (28980)
Nahas, C.S., S137 (28900), S139 (28901), S140 (28903),
S140 (29080), S143 (28935), S145 (28946),
ABSTRACTS
S146 (28899), S147 (28893), S147 (28898),
S148 (28897), S170 (28896)
Nahas, S.C., S137 (28900), S139 (28901), S140 (28903),
S140 (29080), S142 (28928), S143 (28935),
S145 (28946), S146 (28899), S147 (28893),
S147 (28898), S148 (28897), S170 (28896)
Nakagawa, W.T., S139 (28833), S142 (28999),
S153 (28983), S203 (28958)
Nascimento, A.C.S., S175 (28862), S201 (28373),
S239 (28864)
Nascimento, H.L.S., S190 (29093)
Nascimento, L.S., S167 (28237), S229 (28867)
Nascimento, M.F.C.L., S93 (28858)
Nascimento, M.F.L.C., S94 (29084)
Nascimento, T.G., S160 (28974), S167 (28965)
Nascimento-Rocha, J.M., S178 (29150), S179 (29300),
S193 (29181)
Nasser, S., S208 (29103), S208 (29105)
Nazima, M.T.S.T., S176 (29233)
Neto, A.C., S250 (28844)
Neto, C.C.M., S111 (29314), S113 (29304)
Neto, G.L.S., S210 (29135)
Neto, J.P.D., S208 (29103), S208 (29105)
Neto, M.L.S., S125 (29210), S170 (29234)
Netto, W.J.M., S161 (29282), S165 (29289),
S226 (29246), S234 (29287)
Neves, A., S205 (29325)
Neves, A.R., S185 (29127)
Neves, A.R.S., S181 (29216), S182 (28535), S211 (28854)
Neves, L.F.M., S243 (28943)
Nicolau, S.M., S187 (29253), S188 (28868)
Nishinari, K., S97 (28906)
Nobre, V.K.A., S197 (27455)
Noda, M.C., S193 (29261)
Nogueira, J.F.L., S172 (29106), S219 (29118)
Nogueira, M.P.M., S193 (29261)
Nonnenmacher, B., S177 (28376)
Nunes, B.E.P., S230 (28579)
Nunes, C.L.S., S227 (28859), S230 (28579)
Nunes, J.S., S240 (29139)
Nunes, L.F., S161 (29076), S209 (26349), S214 (28219),
S222 (28267)
Okazaki, S., S112 (28417)
Okhunov, Z., S248 (28466), S249 (28467)
Oliva, E., S218 (28408)
Oliva, I.M.A.A., S163 (29297)
Oliva, I.M.A.A.O., S184 (29229)
Oliveira Jr, E.P., S205 (29259), S229 (29268),
S251 (29294), S96 (29274)
Oliveira Jnior, I.R.A., S178 (29150), S179 (29300),
S193 (29181)
Oliveira, A.L. de S., S92 (29315)
Oliveira, A.L.S., S94 (29320)
Oliveira, A.M.T.S., S158 (28533), S163 (28429),
S168 (28532)
Oliveira, A.T.T., S105 (29279), S107 (29028),
S108 (29123), S110 (28871), S115 (29112),
S123 (28804), S133 (29186)
Oliveira, B.M.K., S94 (29320)
Oliveira, D.A., S155 (28863), S180 (28957),
S199 (28905), S201 (28373)
Oliveira, D.A.M., S141 (28910), S151 (28916),
S216 (28912), S223 (28911), S223 (28915),
S248 (28917)
Oliveira, D.N.A., S200 (29049)
Oliveira, F.A.P.F., S122 (28876), S131 (28923),
S131 (29104), S173 (28930), S173 (29100),
S195 (29111), S207 (29013), S223 (29110)
Oliveira, G.S.C., S163 (28429), S168 (28532)
Oliveira, H.B.R., S219 (28394), S220 (28609),
S220 (28610), S221 (28602), S221 (28616),
S222 (28621)
Oliveira, H.J., S130 (29102)
Oliveira, I.B.M.D., S136 (29087), S136 (29088),
S171 (28984), S178 (29089), S224 (29157),
S249 (29091)
Oliveira, I.R., S125 (29210), S133 (29227), S135 (29258),

S170 (29234)
Oliveira, J.C., S165 (29197), S209 (28846), S212 (28845)
Oliveira, J.J., S242 (29228)
Oliveira, J.L., S108 (28387), S108 (28387), S209 (26349),
S214 (28219)
Oliveira, J.X., S121 (28925), S136 (29095)
Oliveira, K.S., S236 (28756)
Oliveira, L.O., S130 (29192)
Oliveira, M.C., S163 (29297), S184 (29229)
Oliveira, M.L.S., S185 (29240)
Oliveira, N.K.P., S243 (28472)
Oliveira, P.C., S168 (28532)
Oliveira, P.D., S138 (29191)
Oliveira, P.J.C., S130 (29102)
Oliveira, T.O., S226 (28306)
Oliveira, T.S., S234 (28872)
Oliveira, W.R., S161 (28956)
Oliveira-Junior, R.N.R., S128 (29296)
Ordon, M., S248 (28466), S249 (28467)
Orletti, L., S118 (29121)
Osrio, C.A.B.T., S92 (28907)
Padovese, C.C., S112 (28295), S112 (28417),
S112 (28421), S126 (28419), S150 (28423)
Pdua, J.B., S188 (28868)
Paim, G.G., S130 (29276)
Paim, G.P., S229 (29198)
Paixo, M.P.S., S91 (29286)
Palmeira, L.O., S181 (29216)
Paloschi, J.R.A., S215 (28849), S95 (28850), S95 (28851)
Passeri, C.R., S207 (28045)
Paula, L.L.R.J., S241 (29200), S245 (29070)
Paula, P.H.M., S100 (28483)
Paula, T.M., S190 (29177)
Paula, W.T., S230 (29178), S232 (28519)
Paulo, G.G., S136 (29156)
Pedrosa, K.S.C., S168 (28532)
Pedrosa, M.O., S103 (28302), S107 (28300)
Pedrosa, P.H.A., S211 (28854)
Peixoto, A.R.L., S210 (28331)
Peixoto, E., S106 (28309), S132 (28399), S92 (28314)
Peixoto, R.M., S101 (28922), S102 (28933)
Pena, A.C.B., S102 (28933), S105 (28949)
Perdomo, R.A., S97 (28083)
Pereira, A.A., S125 (29210), S133 (29227), S135 (29258),
S170 (29234)
Pereira, A.H.L.M., S196 (28875)
Pereira, A.O., S234 (29287)
Pereira, C.G.S., S202 (28372)
Pereira, G.C.G., S130 (29102)
Pereira, K.S.M., S158 (28533), S168 (28532)
Pereira, L.A.O.S., S158 (29306)
Pereira, L.P., S161 (29282), S165 (29289), S234 (29287)
Pereira, L.V., S243 (28472)
Pereira, T.C.U., S226 (28306)
Pereira, T.S.S., S150 (29262), S228 (28980),
S250 (29201)
Pereira, V.B.M., S125 (29210), S133 (29227),
S135 (29258), S170 (29234)
Perez, F., S91 (29107)
Perina, A.L.F., S134 (28370), S204 (29086), S206 (28968)
Pessini, S.A., S176 (28878), S179 (28985), S188 (28909),
S202 (29092)
Peters, L.C., S228 (28980)
Petribu, E.F., S93 (29235)
Picanco Junior, O.M., S128 (29296), S152 (29301)
Picanco, T.S.C., S128 (29296), S142 (29290),
S152 (29301)
Picanco-Junior, O.M., S142 (29290)
Picano-Junior, O.M., S123 (29205)
Pignataro, B.S., S97 (28906)
Pilleti, K., S218 (28627)
Pinheiro, A.C., S89 (29318), S92 (29315), S93 (29310)
Pinheiro, B.H., S233 (28497)
Pinheiro, E.R., S217 (29223)
Pinheiro, L.D.P., S231 (28663), S232 (28359)
ABSTRACTS
Pinheiro, L.G.P., S89 (29318), S92 (29315), S93 (29310),
S94 (29320)
Pinheiro, U.A.M.R., S158 (28533), S163 (28429),
S168 (28532)
Pinho, A.J.M., S233 (29183), S234 (28834)
Pinto, C.E., S116 (28385)
Pinto, F.E.L., S171 (28984)
Pinto, R.A., S137 (28900), S139 (28901), S142 (28928),
S143 (28935), S145 (28946), S147 (28893),
S147 (28898)
Pinto, R.M.O., S89 (29255)
Pinto, S.S., S240 (28243)
Pires de Camargo, V., S204 (29086)
Pires, A.L.P., S194 (29269)
Pires, A.R.C., S164 (28565)
Pires, T.C., S136 (29087), S136 (29088), S171 (28984),
S178 (29089), S187 (29204), S190 (29093),
S192 (29090), S213 (29153), S224 (29157),
S249 (29091)
Pitta Junior, C.A., S217 (29223)
Podgaec, S., S196 (29308)
Polo, R., S106 (28379), S126 (28381), S128 (28382),
S164 (28391), S171 (28380), S177 (28376),
S207 (28378), S219 (28607), S220 (28610),
S221 (28614), S221 (28616), S96 (28384)
Pompermaier, C., S122 (29230), S162 (29206),
S166 (29078), S205 (29311), S211 (29175)
Pompeu, B.F., S138 (29191)
Pordeus, A.L.B., S214 (29148), S224 (28902)
Portela, A.R., S249 (29322)
Portela, L.F.S., S89 (29255)
Porto, L.A., S163 (29297), S184 (29229)
Poveda, V.B., S245 (28908)
Pr, R.B., S122 (29230), S151 (29155), S162 (29206),
S166 (29078), S205 (29311), S211 (29175),
S227 (29271)
Pracucho, E.M., S165 (29197), S207 (28045),
S209 (28846), S212 (28845), S215 (28847)
Preti, V., S144 (28848), S247 (28842)
Preti, V.B., S138 (29129)
Priante, A.V.M., S227 (28859), S230 (28579)
Primo, W.Q.S.P., S175 (29281), S190 (29305)
Prisco Filho, L.G.R., S119 (28877), S247 (29002)
Prisco, E., S119 (28877), S143 (28879), S201 (28332),
S210 (28331), S216 (29077), S247 (29002)
Quadros, C.A., S119 (28877), S129 (28329),
S138 (28170), S143 (28879), S201 (28332),
S210 (28331), S216 (29077), S247 (29002)
Queiroz, A.C., S170 (28970), S226 (29263)
Quijada, P.D.S., S246 (28209)
Quinto, F.C., S162 (29134)
Rabello, C., S161 (29076)
Ramalho, R.T., S159 (29184)
Ramalho, W.C., S200 (28371), S201 (28373),
S202 (28372), S214 (29148), S224 (28902),
S99 (29164)
Ramos, M.A.N., S232 (28959)
Ramos, U.O., S185 (29240)
Rausch, M., S154 (28921), S199 (28226)
Real, J., S243 (28943)
Rebolho, J.C., S158 (28395), S172 (28326)
Rech, E.L., S127 (28626), S157 (28551), S218 (28627)
Reggiani, R., S211 (29219)
Reis, J.M.S., S129 (28329), S201 (28332)
Reis, M.P., S110 (28248), S124 (28249), S144 (28250),
S154 (28252)
Reis, R., S160 (28974), S183 (28967), S183 (29057),
S184 (28952), S186 (29189), S190 (29177),
S191 (29143), S192 (29291), S195 (29144),
S195 (29149), S197 (28831), S240 (29139)
Reis, R.J., S177 (28376)
Reis, T.J.C.C., S199 (28534), S200 (28371),
S201 (28373), S202 (28372)
Reis, T.R., S230 (29178), S232 (28519)
Reitan, R., S165 (28537), S185 (28088)
S257
Remonti, T.A.P., S126 (28381), S128 (28382),
S171 (28380)
Remonti, T.P.A., S132 (28392)
Resende, T.C., S187 (29204)
Rezende, J., S215 (28201)
Rezende, J.F.N., S209 (26349), S214 (28219)
Rezende, J.S., S211 (29219)
Ribeiro Jr, U., S140 (29080), S145 (28946),
S146 (28899), S148 (28897), S170 (28896)
Ribeiro, D.G., S226 (29246)
Ribeiro, G.S., S192 (29141)
Ribeiro, H.S., S109 (28926), S125 (28932)
Ribeiro, H.S.C., S100 (29072), S109 (29074),
S109 (29140), S113 (29307), S128 (29142),
S129 (29138), S129 (29145), S134 (28509)
Ribeiro, I.C.P., S232 (28519)
Ribeiro, L.C., S214 (28219)
Ribeiro, L.C.B., S108 (28387), S116 (28385),
S130 (29192), S144 (28388), S149 (28389),
S152 (28393)
Ribeiro, L.R., S121 (28925), S219 (28931)
Ribeiro, M.M.M., S201 (28293)
Ribeiro, M.M.Q., S217 (29223)
Ribeiro, P.M.G., S156 (28487)
Ribeiro, R., S143 (28352), S158 (28395), S172 (28326),
S178 (29119), S183 (28343), S186 (29160),
S188 (28266), S188 (28868)
Ribeiro, R.O.B., S245 (28230)
Ribeiro, T.F., S103 (28302), S103 (28304), S104 (28299),
S104 (28303), S107 (28300)
Ribeiro, V.H.O., S124 (29125)
Ricci, M.A., S177 (29319)
Richwin, N.J., S121 (28925), S136 (29095), S219 (28931)
Rio, J.A., S90 (29280), S91 (29286)
Rocha, F.T.R., S131 (28923), S173 (29100)
Rocha, I.D., S158 (28533)
Rocha, P., S240 (29139)
Rodas, A.K.F., S199 (28534), S200 (28371), S201 (28373)
Rodini, G.P., S177 (29174), S217 (28913)
Rodrigues, A.R., S125 (29210), S133 (29227),
S135 (29258), S170 (29234)
Rodrigues, D.A.T., S104 (28299), S107 (28300)
Rodrigues, J.F., S175 (28443)
Rodrigues, J.V.L., S160 (28954)
Rodrigues, T.H.T., S103 (28302), S104 (28303)
Rodrigues, T.R., S237 (28973)
Rohrs, D., S114 (29273), S116 (29292)
Rohrs, D.F., S107 (29131)
Roman, L.I., S127 (28626), S157 (28551), S218 (28627)
Rombaldi, M.C., S151 (29155), S162 (29206)
Rompinelli, T.K.R., S162 (29134)
Rondelo, G.D., S232 (28959)
Roriz-Silva, R., S99 (27305)
Rosa, A.S.K.K., S127 (28626), S157 (28551),
S218 (28627)
Rosa, M.R.D., S217 (28913)
Rosario, R.R.L., S186 (29160)
Ruvio, V.B., S123 (29205), S176 (29233), S194 (29269),
S233 (29244)
Sabino, F.D., S108 (28387), S110 (28323), S115 (28342),
S116 (28385), S144 (28388), S182 (29152)
Saboia, L.V., S163 (28716), S217 (28703)
Sagrillo, G.D., S189 (28963)
Sakai, P., S140 (28903)
Salles, P.G.O., S102 (28631), S154 (28921),
S156 (28487), S160 (28574), S194 (29208),
S199 (28226), S210 (28840), S249 (29322)
Salvador, A., S239 (28087), S241 (28285)
Salvetti, M.G., S243 (28472)
Salvio, A.G., S209 (28846)
Sanches, M.C.O., S119 (29081)
Sanches, N.S., S124 (29125)
Santana, G.A.A., S124 (28294)
Santana, R.F., S238 (29239), S239 (29214), S242 (29217),
S242 (29218), S242 (29228)
Santana, T.B.M., S248 (28917)
Santo, G.F.E., S137 (28981)

Santos Junior, P.R.M., S108 (29303), S204 (29317)
Santos, A.C.S., S106 (28309), S132 (28399), S92 (28314)
Santos, B.M.O., S246 (28209)
Santos, C.E.R.*, S215 (28201)
Santos, C.H.F., S162 (29134)
Santos, C.M.M., S173 (29100), S195 (29111)
Santos, C.R., S231 (29313)
Santos, F.G.C.D., S233 (29183), S234 (28834)
Santos, F.P., S170 (28970), S226 (29263)
Santos, I.I.A., S158 (28533), S163 (28429), S168 (28532)
Santos, I.P., S90 (29247)
Santos, L.C., S118 (29326), S134 (29327)
Santos, L.S.B., S158 (28533)
Santos, L.S.C, S244 (29166)
Santos, L.V.S., S136 (29087), S136 (29088),
S190 (29093), S192 (29090), S249 (29091)
Santos, M.H., S108 (29303), S177 (29319), S204 (29317),
S209 (29302)
Santos, M.I.M., S237 (28435)
Santos, R.L., S99 (29085)
Sanz, C.J.V., S204 (29317)
Sato, L.M., S182 (28496)
Scapini, G., S173 (28979)
Schaal, C.H., S250 (28844)
Schimidt, T.C.G., S245 (28230)
Schmidt, R.L., S195 (29144)
Schnor, O.H., S164 (28391), S219 (28607), S220 (28610),
S96 (28384)
Schorn, O.H., S221 (28602), S221 (28614), S222 (28621)
Schraibman, V., S112 (28295), S112 (28417),
S112 (28421), S126 (28419), S150 (28423)
Schreiner, C.A., S150 (29262)
Seitenfus, R., S171 (28380)
Sena Jr, A.S., S120 (28960), S132 (28506)
Silva, A.C.M., S127 (29203), S241 (29209)
Silva, A.P., S245 (29070)
Silva, B.T., S105 (29171), S120 (28696)
Silva, C.S., S200 (28892)
Silva, E.S., S204 (29317)
Silva, F.F.C., S116 (28385)
Silva, F.P.A., S91 (29101)
Silva, F.T.V., S124 (28294)
Silva, G.L.R., S151 (28865), S155 (28863), S202 (28372)
Silva, I.C., S159 (29309), S244 (29285), S244 (29293)
Silva, I.F., S197 (27455)
Silva, I.O., S156 (29212)
Silva, I.S., S159 (29184)
Silva, L.A., S90 (29222)
Silva, L.C., S176 (29233), S189 (28233), S194 (29269),
S222 (28267)
Silva, L.M.C., S103 (28442), S169 (29154), S194 (28414)
Silva, M.C., S222 (28267), S241 (28285)
Silva, M.C.A., S201 (28293)
Silva, M.J.P., S245 (28230)
Silva, M.L.G., S216 (28912), S223 (28911), S223 (28915)
Silva, M.T.B., S150 (29262), S228 (28980)
Silva, M.V.M.V., S144 (28388), S149 (28389),
S152 (28393)
Silva, N.A., S236 (28277), S237 (28435)
Silva, N.Z., S130 (29276), S229 (29198)
Silva, P.C.C., S90 (29222)
Silva, P.F.A., S168 (28860)
Silva, R.A.T.A., S122 (28876), S173 (28930),
S195 (29111)
Silva, R.G.M., S201 (28332), S247 (29002)
Silva, R.L., S196 (28875), S227 (28859)
Silva, R.O.P., S179 (28856)
Silva, R.P., S113 (29245), S157 (29242), S157 (29257),
S176 (29254), S178 (29089), S192 (29090),
S249 (29091)
Silva, R.T.F., S118 (29326), S134 (29327)
Silva, S.A.S., S236 (28277)
Silva, S.G., S160 (28574)
Silva, T.O., S161 (28956), S228 (28469)
Silva, T.V., S162 (29134)
Silva, W.P., S163 (28429)
S258
Silva-Neto, M.L., S133 (29227), S135 (29258)
Silveira, A.L., S97 (28083)
Silveira, D.L., S151 (28865), S155 (28863)
Silveira, G.P.G., S176 (28878), S179 (28985),
S188 (28909)
Silveira, L.L., S180 (28957)
Silvestre, J.R., S146 (29161)
Simioni, E.B., S183 (28967), S184 (28952),
S190 (29177), S191 (29143), S192 (29291),
S195 (29149), S240 (29139)
Simonetti, V.V., S102 (29224), S109 (29140),
S116 (28929), S119 (29194), S124 (28936),
S125 (28934)
Simonsen, M., S183 (29057), S197 (28831)
Siosaki, A.T.F., S146 (29060)
Siosaki, M.D., S146 (29060)
Siqueira, Y.T.F., S162 (29134)
Soares, A.L.O., S213 (29124)
Soares, D.F.M., S142 (28928), S143 (28935)
Soares, F.A., S92 (28907)
Soares, M.C., S199 (28905), S200 (28371), S99 (29164)
Soares, P.C., S152 (29301)
Sobrinho, J.F.P., S114 (28593), S171 (28566),
S172 (28570)
Sohn, R.V., S137 (28981), S180 (29188)
Soldati, D., S110 (28323)
Sousa, A.R., S127 (28422), S169 (29154), S194 (28414),
S216 (28912)
Sousa, P.F., S136 (29156), S196 (28433), S196 (28434)
Sousa, T.A., S182 (28535), S185 (29127), S211 (28854)
Souza, C.D., S230 (29207), S231 (29260), S231 (29313)
Souza, C.L.M.S., S163 (29297)
Souza, C.L.S., S241 (29209)
Souza, D.L.S., S106 (28379), S111 (28623),
S126 (28381), S128 (28382), S132 (28392),
S171 (28380), S177 (28376)
Souza, F.J., S236 (28277), S237 (28435)
Souza, F.M.C., S131 (29193)
Souza, H.A.C., S137 (28981)
Souza, H.K.V., S105 (28937), S106 (28942)
Souza, L.A., S243 (28472)
Souza, M.C.M., S185 (29127)
Souza, M.G., S130 (29102)
Souza, M.O., S106 (28309), S132 (28399), S92 (28314)
Souza, T., S236 (28756)
Souza, T.A., S181 (29216)
Souza, T.S., S127 (29203)
Souza, V.J., S159 (29184)
Souza, W.B., S136 (29087), S171 (28984), S178 (29089),
S187 (29204), S190 (29093), S192 (29090),
S213 (29153)
Souza, W.F., S167 (29180)
Spader, M.B., S176 (28878)
Spencer, R.M.S., S144 (29108), S145 (29116)
Spencer, R.M.S.B., S141 (28910), S151 (28916),
S216 (28912), S223 (28911), S223 (28915),
S248 (28917)
Sperotto, M.F.R.M., S167 (29180)
Srouri, M., S142 (28928)
Ssilva, L.M.C., S127 (28422)
Stefani, M.N., S108 (29303)
Stevanato Filho, P., S147 (29082)
Stevanato Filho, P.R., S141 (28910), S144 (29108),
S145 (29116), S151 (28916), S248 (28917)
Strappa, G.B.S., S156 (29212), S162 (29202),
S247 (29215), S97 (29221)
ABSTRACTS
Strey, Y.T.M., S208 (28624), S219 (28607), S220 (28610),
S220 (28613), S221 (28602), S221 (28616),
S222 (28620)
Sugarbaker, P.H., S202 (29092)
Sulbaran, M.N., S140 (28903)
Sunahara, E.R.M., S230 (29207), S231 (29260),
S231 (29313)
Tadini, T.L., S240 (29120)
Takahara, I.A., S101 (29231), S111 (28951)
Takahashi, R.M., S139 (28833), S203 (28958)
Tancredi, R., S200 (29049)
Targa, G.Z., S138 (29129)
Taumaturgo, A.I., S161 (28956)
Tavares, L.P., S122 (29115), S131 (29193)
Tedde, M.L., S166 (28841)
Tefilli, N., S121 (29004), S133 (28986)
Teixeira, A.M.S., S175 (28443), S188 (28868)
Teixeira, F.J.R., S134 (28370), S173 (28979),
S204 (29086), S206 (28968), S213 (28855)
Teixeira, G., S120 (28960), S132 (28506)
Teixeira, J.C.A., S100 (28483)
Teixeira, R.L., S123 (29205), S176 (29233),
S194 (29269), S233 (29244)
Teixeira, W.G., S151 (28865), S155 (28863), S99 (29164)
Teles, M.O., S103 (28304), S104 (28299)
Tenrio, L.E.M., S119 (29081)
Tefilo, A.L.O.Q., S125 (29210), S133 (29227),
S135 (29258), S156 (29251), S170 (29234)
Terra, F.S., S154 (28921)
Teshirogi, E.Y., S205 (29259), S229 (29268),
S251 (29294), S96 (29274)
Texeira, A.F., S152 (28881)
Tiago, L.H.B.L., S130 (29276), S229 (29198)
Tojal, N.O., S131 (29104), S195 (29111)
Tomal, K.T., S165 (29197), S207 (28045), S212 (28845),
S215 (28847)
Toneto, M.G., S105 (29171), S120 (28696)
Torres, M.C., S101 (29231), S111 (28951)
Tosin, R.C., S177 (29174)
Tregnago, A., S91 (29107)
Trevisani, M.S., S240 (29120)
Trippia, C.H., S188 (28266)
Tsumanuma, F.K., S172 (28326)
Tsunoda, A., S187 (29253)
Tsunoda, A.T., S160 (28974), S165 (28537),
S167 (28965), S183 (28967), S183 (29057),
S184 (28952), S186 (29189), S190 (29177),
S191 (29143), S192 (29291), S195 (29144),
S195 (29149), S197 (28831), S240 (29139)
Uliano, E.J.M., S110 (28248), S120 (28454),
S123 (28455), S124 (28249), S144 (28250),
S154 (28252)
Ungethuem, Y.H., S177 (29174)
Urazaki, M.S., S137 (28981)
Utiyama, E.M., S173 (28979), S204 (29086),
S206 (28968), S213 (28855)
Utiyamada, N.L., S160 (28974), S167 (28965)
Valadao, M., S110 (28323), S141 (28348), S141 (28349),
S148 (28320), S149 (28347), S150 (28345)
Valado, M., S182 (29152)
Valena, L.B., S177 (28880), S218 (28955)
Valle, A.S., S167 (29180)
Vasconcellos, A.A., S89 (29318)
Vasconcelos, J.L.M., S139 (28843), S227 (28839)

Vasques, P.H.D., S89 (29318), S93 (29310)
Vasquez, V.L., S214 (29299)
Vaz, L.A., S103 (28442), S169 (29154), S194 (28414),
S216 (28912)
Velasquez, A.R.E., S201 (28332)
Viana, E.F., S124 (29125)
Viana, R.F.R., S194 (29208), S199 (28226)
Viana, T., S118 (29211)
Vieira, F.J., S160 (28954)
Vieira, H.C., S166 (28841), S194 (29208), S199 (28226),
S210 (28840), S249 (29322)
Vieira, I.F., S132 (28506)
Vieira, L.J., S160 (28954)
Vieira, L.V., S201 (28332), S210 (28331), S247 (29002)
Vieira, M., S165 (28537)
Vieira, M.A., S160 (28974), S167 (28965), S182 (28496),
S183 (28967), S183 (29057), S184 (28952),
S186 (29189), S191 (29143), S192 (29291),
S195 (29144), S197 (28831)
Vieira, S.C., S179 (28856), S197 (27455), S201 (28293),
S93 (28858), S94 (29084), S98 (28857)
Vieira, T.R., S118 (29211)
Vieira, Y.T.H., S155 (29168), S206 (29167)
Vieura, I.F., S120 (28960)
Vilar, C.F., S96 (29109)
Vill, L.L., S142 (29290)
Villela-Castro, D.L., S237 (28452)
Vivas, D.V., S93 (29235)
Volpato, G., S146 (29161)
Von Sohsten, A.K.A., S199 (28534)
Wandeur, V., S228 (28980)
Weber, V.G., S127 (28626)
Weinstein, L., S199 (28534), S200 (28371), S201 (28373),
S202 (28372)
Weston, A.C., S111 (28623), S202 (29092)
Westphalen, A.P., S150 (29262)
Winkelmann, C.P., S122 (29230), S166 (29078),
S205 (29311), S211 (29175), S227 (29271)
Wohnrath, D., S113 (29304)
Wohnrath, D.R., S105 (29279), S111 (29314)
Xavier, P.M., S187 (29204)
Ximenes, L.M., S214 (29148), S224 (28902)
Yamashita, T.S., S138 (29129)
Yazbek, G., S97 (28906)
Zanatto, R.M., S165 (29197), S207 (28045),
S209 (28846), S212 (28845), S215 (28847)
Zanin, L.A.G., S126 (28693)
Zanini, L.A.G., S93 (29235)
Zanotelli, M.L., S154 (28920)
Zanotto, M.B., S157 (28551)
Zanvettor, P.H., S181 (29216), S182 (28535),
S185 (29127), S187 (29253), S192 (29141),
S211 (28854)
Zettler, C.G., S188 (28909)
Ziller, C.F., S182 (29152)
Zoletti, F., S106 (28379), S111 (28623), S128 (28382),
S177 (28376), S208 (28624), S219 (28394),
S220 (28609), S220 (28610), S221 (28616),
S96 (28384)
Zoletti, F.C., S207 (28378)
Zomer, M.T., S188 (28266)

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EJSOEuropean Journal of Surgical Oncology

the Journal of Cancer Surgery

Aims and Scope

Virgilio Sacchini, USA

Editorial Advisory Board

Ex Officio - BASO ~ the Association

Ex-Officio - European Society for

Head and Neck Surgery

Editorial Advisory Board

Editorial Advisory Board

Domenico D'Ugo, Italy

Editorial Advisory Board

Tanir M. Allweis, Israel

Editorial Advisory Board

Editorial Advisory Board

Melanoma and Limb Perfusion

Editorial Advisory Board

Valerie Francescutti, USA

Editorial Advisory Board

Editorial Advisory Board

Upper Gastrointestinal Surgery

Editorial Advisory Board

Lorenzo Ferri, Canada

Rebecka L. Meyers, USA

Peritoneal Surface Malignancy

Editorial Advisory Board

Editorial Advisory Board

Editorial Advisory Board

Valery E. Lemmens, Netherlands

Theo de Reijke, Netherlands

Editorial Advisory Board

Editorial Advisory Board

Editorial Advisory Board

Fady B. Geara, Lebanon

Robotic Surgery, Simulation and

Editorial Advisory Board

Elisa Giovannetti, Netherlands

Editorial Advisory Board

Editorial Advisory Board

Maria Foschini, Italy

Editorial Advisory Board

Editorial Advisory Board

Katherine S. Virgo, USA

Epidemiology and Biostatistics

EJSO VOLUME 41 SUPPLEMENT 1 15 OCTOBER 2015

Abstracts of the XII Congress of the Brazilian

Publication information: EJSO (ISSN 0748-7983). For 2015, volume 41

Permission of the Publisher is required for resale or distribution outside the

Printed by Henry Ling, The Dorset Press, Dorchester, UK

EJSO VOLUME 41 SUPPLEMENT 1 15 OCTOBER 2015

Congress Organizing Committee

Best Abstracts Selection Committee

NUMACO/SBEO Multidisciplinary Program

GT5 Logistic Team

Brazilian Society of Surgical Oncology (BSSO)

Abstracts of the XII Congress

Congress of the Latin American Society of Surgical Oncology

THE SURGEON AS A PROGNOSTIC FACTOR IN CANCER TREATMENT

cer Center led by Dr. Murray Brenan, City of

Fig 1: Evolution of BSSO Membership

THE SURGEON AS A PROGNOSTIC FACTOR IN CANCER TREATMENT

ment requires adequate surgical training through residency

THE SURGEON AS A PROGNOSTIC FACTOR IN CANCER TREATMENT