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Objetivo: Reportar la experiencia con las esofagectomías en pacientes con cáncer de esófago, en el Servicio de Cirugía General del Hospital Nacional de Itauguá, periodo 2015-2020. Metodología: Estudio descriptivo, retrospectivo, transversal, donde se revisaron los expedientes clínicos de pacientes con diagnóstico de neoplasia en el esófago sometidos a esofagectomía en el Hospital Nacional de Itauguá, período 2015-2020. Resultados: El estudio incluyó 18 expedientes clínicos. El 78% fueron del sexo masculino, la edad media fue de 62,6 años. El IMC promedio fue de 19. La frecuencia de los síntomas fueron la disfagia en un 86%, pérdida de peso en un 83% y epigastralgia en un 28%. El carcinoma escamoso predominó en un 67% sobre el adenocarcinoma. La ubicación de los tumores se distribuyó con más frecuencia en tercio medio. El 78% de los pacientes fueron sometidos a una esofagectomía total transhiatal por técnica de Orringer y el restante por vía transtorácica por técnica de Mc Keown. Las complicaciones de la anastomosis esofagogástrica correspondieron al 34% y las respiratorias a un 28%. La tasa de mortalidad perioperatoria fue de 17%. Conclusión: La esofagectomía sigue siendo el único tratamiento curativo para el cáncer de esófago a pesar de su alta tasa de morbimortalidad. Es importante el diagnóstico precoz para poder ofrecer un tratamiento curativo. Es infortunado que los pacientes estudiados no tuvieran un seguimiento, de manera que resulta imposible la evaluación objetiva de los resultados a mediano y largo plazo.

Introduction. Surgery remains the mainstay of treatment for most esophagogastric junction (EGJ) tumors. After the surgical resection of EGJ tumors, the anatomy of the esophageal hiatus of the diaphragm is severely altered, increasing the risk of postoperative hiatal hernia (HH). While HH is more often reported after esophagectomy, HH is a rare complication after laparoscopic total gastrectomy and occurs in only approximately 0.5% of patients. Clinical case. A laparoscopic total gastrectomy with D2 lymphadenectomy was performed on a patient with an esophagogastric junction tumor. No intraoperative complications occurred and the patient had an uneventful postoperative course. Two months after the operation, the patient was admitted to the emergency room due to diffuse abdominal and chest pain, vomiting, and hematemesis. The chest and abdominal CT scan showed herniation of several bowel loops into the right hemithorax. Results. Due to hemodynamic instability, an emergent laparotomy was performed and the hiatal hernia was repaired with mesh. The patient recovered well from the operation and was discharged after 10 days. Conclusions. Clinical presentation is often non-specific and warrants a high level of suspicion. Elective surgical repair is recommended for large and/or symptomatic HH. Emergent repair might be needed for complicated HH with incarceration, strangulation, or bowel perforation. Overall, incarcerated HH after laparoscopic total gastrectomy is rare but should be considered in patients with abdominal pain or vomiting during the postoperative course. A prompt diagnosis and treatment are critical to obtain favorable outcomes. [ABSTRACT FROM AUTHOR]

Introduction. The treatment of esophageal cancer has evolved significantly in recent years. New approaches allow preserving the esophagus in early tumors, using endoscopic techniques, and in locally advanced tumors, it is possible to perform minimally invasive resections in combination with an oncological treatment. Surgical innovation is necessary to increase therapeutic efficacy; however, it requires learning curve whose impacts the results obtained. The objective of this work was to show how the learning curve affects the morbidity and mortality associated with the procedure. Methods. A cohort of 128 patients with minimally invasive esophagectomy due to esophageal cancer was included, performed between January 2014 and December 2023. They were grouped into two stages chronologically, creating two groups of 64 patients each. Demographic variables, type of anastomosis performed, complication rate, pathology types, hospital stay and follow-up were analyzed. Results. There was no significant difference between both groups in demographic variables, such as age and sex, histological types, or anastomosis site. Morbidity (Dindo-Clavien types III and IV complications) was 43.7% on the first stage and 23% in the second one, with a significant difference (p=0.02). Conclusions. In our cohort, we showed a statistically significant difference in morbidity between the first and second stages; however, there were no differences in mortality. The findings thus suggest that the learning curve of a procedure has a temporary negative impact on the results. [ABSTRACT FROM AUTHOR]

Introduction. Caustic ingestion is a public health problem worldwide, due to a high burden of morbidity, mortality and costs. Therefore, it is essential to have clear knowledge in the adult population, without extrapolating management data from the pediatric population. Methods. A critical review of the available information was carried out in order to establish important data in the management of caustic esophagitis in the adult population, including an analysis of the type of intake, volume, intention and age, to help identify early complications susceptible to surgical management. Results. Endoscopy has an important role in the first 24-48 hours to establish the severity of the damage according to the Zargar classification, which combined with the imaging classification allows a better prognosis to be achieved. There is no demonstrated benefit from the use of PPI, mitomycin C, nasogastric tube or esophageal prosthesis to prevent strictures. Steroids have a benefit in Zargar ≥ 2B (with airway compromise) and there are promising data with the use of sucralfate at high-doses. In complications derived from stenosis, early dilation with Savary-Guillard is preferred. After 10 years of ingestion, endoscopic follow-up should be performed every 2-3 years to screen for esophageal squamous cell cancer. Conclusion. Caustic esophagitis is a condition with a high morbidity burden, whose prognosis depends on early interventions and multidisciplinary management and follow-up. [ABSTRACT FROM AUTHOR]

Introduction. The ethical aspects and challenges in the care of patients with esophageal pathology include different situations that must be anticipated and known by experts to be resolve in the most appropriate, favorable, and fair manner for the patients and their families. Methods. A review and analysis of the information available in the databases was carried out in order to establish the relevant ethical aspects of esophageal surgery today. Discussion. All surgeons face situations that lead to ethical conflicts in their daily care practice. A capable and suitable surgeon must be not only competent to carry out the art and science of surgery, as traditionally interpreted, but also ethically and morally trustworthy. Conclusion. Ethical principles are of fundamental importance and serve as a guide for the performance of the ethical, humanistic, and competent surgeon, and to strength the dyadic relationship between patient and surgeon. Permanent communication, resolution of possible conflicts, recognition of the patient's vulnerability, and adherence to ethical principles should guide the actions of professionals throughout the surgical care process, putting the well-being and interest of the patient first. [ABSTRACT FROM AUTHOR]

Introduction. Minimally invasive esophagectomy (MIE) has been gaining popularity due to the results obtained in terms of safety, mortality, complications and quality of life, as well as oncologic results comparable to those obtained with open surgery. Methods. Cohort study of patients in whom MIE was performed at Hospital de San José, in Bogotá, D.C., Colombia, between January 2008 and December 2020. Results. Ninety-nine patients were included, 52 men and 47 women, with a mean age of 56 years; 58 had benign diseases and 41 had neoplasms of the esophagus. A McKeown approach was performed in 76 and a laparoscopic transhiatal esophagectomy with cervical anastomosis in 23. The average surgical time was 240 minutes and the average bleeding was 140 ml. Six patients died (6%) and there were 21 complications in 14 patients (14%), with eight esophagogastric anastomosis leaks (8%) and four patients with pneumonia (4%). Conclusions. The results obtained confirm that MIE is a feasible and safe procedure, whose benefits have made the approach of choice for resection and reconstruction of the esophagus. However, it is a complex surgery, with a long learning curve, which must be performed in centers with high volumes and by expert surgeons. Patient selection must be done individually taking into account comorbidities, available resources and expertise of the surgical group. [ABSTRACT FROM AUTHOR]

Introdução: A neoplasia de esôfago é o sétimo câncer mais frequentemente diagnosticado e a sexta principal causa de morte relacionada ao câncer no mundo. No Brasil, ocupa a 13ª posição entre os tipos de câncer mais frequentes. Os sítios mais comuns de disseminação do câncer esofágico são pulmão, fígado e ossos. As metástases do câncer de esôfago para a mama são extremamente raras e pouco documentadas na literatura. Relato de caso: Homem, 45 anos, diagnosticado com adenocarcinoma de esôfago após manifestar dispepsia e epigastralgia. A investigação por endoscopia digestiva alta revelou adenocarcinoma de esôfago, sem metástases a distância. Foi submetido à esofagectomia e quimioterapia adjuvante. Na tomografia por emissão de pósitrons (PET-CT), realizada pós-tratamento, foi detectada recidiva local, iniciando terapia paliativa. Pouco antes, uma nodulação na mama direita foi diagnosticada inicialmente como lesão primária da mama, carcinoma do tipo não especial, triplo-negativo. Contudo, uma revisão da lâmina revelou um adenocarcinoma pouco diferenciado metastático do esôfago, resultando em dois diagnósticos discordantes. Uma terceira análise do material da mama por imuno-histoquímica confirmou a lesão metastática secundária ao esôfago. Durante o tratamento, o paciente apresentou crise convulsiva, com diagnóstico de implante cerebral secundário. Realizou radioterapia em lesão do sistema nervoso central e mastectomia. O PET-CT revelou ausência de sinais de atividade metabólica anormal. Atualmente, encontra-se assintomático com programação terapêutica de imunoterapia de manutenção associada a bloqueio do HER2. Conclusão: Este caso sublinha a raridade da metástase mamária no câncer de esôfago e a importância crucial da imuno-histoquímica para um diagnóstico diferencial preciso e planejamento terapêutico adequado.

Estes cistos de origem congênita, resultam de um desenvolvimento anormal, durante a formação e diferenciação da laringe, pulmões, brônquios e traquéia de um intestino primitivo. Cisto enterógeno é o termo hoje utilizado na literatura, aplicado aos cistos congênitos que se desenvolvem ou ocorrem no trato gastrintestinal, do esôfago ao ânus localizando-se de preferência no intestino delgado e raramente no estômago. Estas formações têm sido assinaladas em todas as faixas etárias, predominando em mulheres.

Fundamento: el cáncer de esófago es una de las neoplasias más agresivas del tubo digestivo, y se asocia a alta morbilidad y mortalidad; similar al cáncer de pulmón, hígado, páncreas y estómago. Su incidencia presenta grandes variaciones geográficas. La supervivencia es individualizada y depende del estadio de la enfermedad.Objetivo: caracterizar los pacientes con diagnóstico de tumores de esófago registrados en la consulta multidisciplinaria de vías digestivas.Métodos: estudio descriptivo longitudinal y de seguimiento prospectivo de una serie de pacientes adultos con diagnóstico de cáncer de esófago registrados en la consulta multidisciplinaria de vías digestivas (N=57), del Hospital Universitario Celestino Hernández Robau, de Villa Clara, en el período enero/2016 a diciembre/2017. Las variables analizadas fueron: edad, sexo, color de piel, factores de riesgo, tipo histológico, localización anatómica del tumor y tiempo del padecimiento.Resultados: existió predominio de pacientes masculinos con diagnóstico de cáncer de esófago (89,5 %); así como de los mayores de 60 años (63,2 %) y color blanco de la piel. Los factores de riesgo más frecuentes fueron el tabaquismo y alcoholismo, con 85,9 % y 66,6 % respectivamente. La variedad histológica más observada fue el carcinoma epidermoide, siendo la principal localización el tercio medio del esófago. En el 71,9 % de los casos transcurrieron más de tres meses desde el inicio de los síntomas hasta el diagnóstico.Conclusión: el diagnóstico de cáncer de esófago no se realiza de manera inmediata a la aparición de los síntomas, lo que limita las opciones terapéuticas y la supervivencia de los pacientes.

Introducción. El diagnóstico adecuado de los tumores de la unión esofagogástrica es esencial para el tratamiento de estos pacientes. La clasificación propuesta por Siewert-Stein define las características propias, factores de riesgo y estrategias quirúrgicas según la localización. El objetivo de este estudio fue describir las características de los pacientes con adenocarcinoma de la unión esofagogástrica tratados en nuestra institución. Métodos. Estudio retrospectivo, descriptivo, de corte longitudinal, que incluyó los pacientes con diagnóstico de adenocarcinoma de la unión esofagogástrica intervenidos quirúrgicamente en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre enero de 2012 y mayo de 2017. Resultados. Se operaron 59 pacientes (84,7 % hombres), con una edad media de 62,5 años. En su orden de frecuencia los tumores fueron tipo II (57,6 %), tipo III (30,7 %) y tipo I (11,9 %). El 74,6 % recibieron neoadyuvancia y se realizó gastrectomía total en el 73 % de los pacientes. La concordancia diagnóstica moderada con índice Kappa fue de 0,56, difiriendo con la endoscópica en 33,9 %. El 10,2 % de los pacientes presentó algún tipo de complicación intraoperatoria. La supervivencia a tres años en los tumores tipo II fue del 89,6 % y del 100 % en aquellos con respuesta patológica completa. Conclusión. Es necesario el uso de diferentes estrategias para un proceso diagnóstico adecuado en los tumores de la unión esofagogástrica. En esta serie, los pacientes Siewert II, aquellos que recibieron neoadyuvancia y los que obtuvieron una respuesta patológica completa, tuvieron una mejor supervivencia a tres años.

Introduction: esophageal cancer is originated in the esophageal mucosa and is expanded towards the muscular layer and the adventitia as it is growing. Depending on the type of cell in which it originates, there is epidermoid carcinoma or squamous cell carcinoma and adenocarcinoma. Objective: to describe the epidemiological, clinical, histological and post-surgical characteristics of patients diagnosed with esophageal cancer operated at the “Arnaldo Milián Castro” Hospital. Methods: a descriptive, prospective longitudinal study was carried out from January 2010 to December 2021. The study population consisted of 71 patients. Results: 58 patients (81.6%) were male and the most frequent ages ranged from 60 to 69 years. Smoking and alcohol consumption were the most frequent risk factors. Two patients had no known risk factors. Infectious (49.3) and surgical (36.6%) complications predominated. Fifty-one patients (71.8%) were discharged alive. Conclusions: male sex and age group 60-69 years predominated, smoking was the most prevalent risk factor and dysphagia was the cardinal symptom. The most affected esophageal segment was the middle third, with histological diagnosis of squamous cell carcinoma. Infectious complications predominated, with a mean hospital stay of 10 to 19 days. Most patients were discharged alive [ABSTRACT FROM AUTHOR]

Metastatic tumors of the heart from esophageal cancer are rare and, consequently, there are few studies on the subject, with poorly defined solutions and an unfavorable prognosis. We present the case of a 49-year-old man, a smoker since childhood, with progressive dysphagia for four years, due to an esophageal tumor. The cardiac involvement was diagnosed during the preoperative echocardiographic examination. The case was discussed collectively, an initial cardiac surgery was discarded and a follow-up by a multidisciplinary team (several specialties) was decided, for subsequent action to be taken depending on the evolution of the patient. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the maximum and mean standardized uptake values, together with the metabolic tumor value and the total lesion glycolysis, at the primary tumor site, as determined by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT), performed before and after neoadjuvant chemoradiotherapy (nCRT), as predictors of residual disease (RD) in patients with esophageal cancer. Materials and Methods: The standardized uptake values and the volumetric parameters (metabolic tumor value and total lesion glycolysis) were determined by 18F-FDG-PET/CT to identify RD in 39 patients before and after nCRT for esophageal carcinoma. We used receiver operating characteristic curves to analyze the diagnostic performance of 18F-FDG-PET/CT parameters in the definition of RD. The standard of reference was histopathological analysis of the surgical specimen. Results: Eighteen patients (46%) presented RD after nCRT. Statistically significant areas under the curve (approximately 0.72) for predicting RD were obtained for all four of the variables evaluated after nCRT. Considering the presence of visually detectable uptake (higher than the background level) at the primary tumor site after nCRT as a positive result, we achieved a sensitivity of 94% and a specificity of 48% for the detection of RD. Conclusion: The use of 18F-FDG-PET/CT can facilitate the detection of RD after nCRT in patients with esophageal cancer. [ABSTRACT FROM AUTHOR]

Background: esophageal cancer is one of the most aggressive neoplasms of the digestive tract, and is associated with high morbidity and mortality; similar to cancer of the lung, liver, pancreas and stomach. Its incidence presents great geographical variations. Survival is individualized and depends on the stage of the disease. Objective: to characterize the patients diagnosed with esophageal tumors registered in the digestive tracts multidisciplinary medical office. Methods: longitudinal descriptive study and prospective follow-up of a series of adult patients diagnosed with esophageal cancer registered in the multidisciplinary consultation of digestive tracts (N=57), of the Celestino Hernández Robau University Hospital, Villa Clara, from January/2016 to December/2017. The analyzed variables: age, sex, skin color, risk factors, histological type, anatomical location of the tumor and time of the disease. Results: there was a predominance of male patients diagnosed with esophageal cancer (89.5%); as well as those over 60 years of age (63.2%) and white skin color. The most frequent risk factors were smoking and alcoholism, with 85.9% and 66.6% respectively. The most observed histological variety was squamous cell carcinoma, the main location being the middle third of the esophagus. In 71.9% of cases, more than three months elapsed from the onset of symptoms to diagnosis. Conclusion: the diagnosis of esophageal cancer is not made immediately after the onset of symptoms, which limits therapeutic options and patient survival. [ABSTRACT FROM AUTHOR]

Introduction: The esophagus cancer is one of the most invasive neoplasms and it means a less survival, because it is generally diagnosed in a late way, mainly in people over 60 years. Objective: To characterize the elderly with esophagus cancer according to clinical epidemiological, endoscopic and histologic variables. Methods: An observational, descriptive, serial cases study, of 58 elderly with esophagus cancer was carried out; they were assisted in the Endoscopic Service of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, during the triennium 2015-2017. Results: In the series there was a prevalence of 70-79 years patients (43.1 %), fundamentally of the male sex (81.0 %), while the most frequent localization of the malignant lesions was the distal third (67.2 %) and the most outstanding symptom, the dysphagia (86.2 %). As for the histologic analysis, the adenocarcinoma was the most representative form (52.0 %). Conclusions: In spite of the surveillance of risk factors associated with the emergence of esophagus cancer in Cuba, it is still detected in advanced stages, reason why it should be emphasized in the application of the clinical method aimed at establishing an earlier diagnosis. [ABSTRACT FROM AUTHOR]

Giant esophageal leiomyomas are rare neoplasms with an imprecise clinical course; most originate from the middle and lower portion of the organ. Imaging and endoscopic tests are used to identify the proper diagnosis and treatment. The purpose of this work, based on a new case, is to share and disseminate a new report of giant esophageal leiomyoma. The patient was admitted for dysphagia. Diagnostic tests included radiography of the esophagus, stomach, and duodenum, upper digestive endoscopy, computed tomography, and MRI. The patient underwent surgery by right thoracotomy, enucleation of a 10x6x5cm tumor was performed, and the integrity of the mucosa was verified. There was no evidence of malignancy in the histopathological study. He was discharged eight days after surgery. Thoracotomy with enucleation of the esophageal tumor is an effective procedure to treat patients with giant leiomyoma.

Introduction: The esophagus cancer is one of the most invasive neoplasms and it means a less survival, because it is generally diagnosed in a late way, mainly in people over 60 years. Objective: To characterize the elderly with esophagus cancer according to clinical epidemiological, endoscopic and histologic variables. Methods: An observational, descriptive, serial cases study, of 58 elderly with esophagus cancer was carried out; they were assisted in the Endoscopic Service of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, during the triennium 2015-2017. Results: In the series there was a prevalence of 70-79 years patients (43.1 %), fundamentally of the male sex (81.0 %), while the most frequent localization of the malignant lesions was the distal third (67.2 %) and the most outstanding symptom, the dysphagia (86.2 %). As for the histologic analysis, the adenocarcinoma was the most representative form (52.0 %). Conclusions: In spite of the surveillance of risk factors associated with the emergence of esophagus cancer in Cuba, it is still detected in advanced stages, reason why it should be emphasized in the application of the clinical method aimed at establishing an earlier diagnosis.

Introdução: O câncer gástrico é a quinta doença maligna mais comum em todo o mundo. Trata-se do tumor maligno mais incidente na Ásia, especialmente na China. O carcinoma esofágico é um dos tipos mais agressivos de tumor maligno. Os tratamentos multimodais, incluindo quimioterapia neoadjuvante e quimiorradioterapia, são utilizados e podem causar fadiga, vômito, diarreia, alterações cutâneas, caquexia e neuropatia periférica, que podem ser efeitos colaterais importantes para muitos pacientes que realizam seus tratamentos. Objetivo: Realizar uma revisão sistemática sobre o manejo e a prevenção de reações adversas da quimioterapia antineoplásica com platinas em pacientes com câncer esofágico e tumor gástrico. Método: Para seleção dos artigos, foi realizada a busca em três bases de dados: MEDLINE/PubMed, Cochrane e Embase, com a estratégia PICO, variando os descritores MeSH/DeCS e operadores booleanos. Resultados: Foram encontrados 455 títulos, dos quais, após utilizar a diretriz PRISMA, restaram 15 artigos para a revisão sistemática, que abordavam o manejo e a prevenção de náusea e vômitos, neuropatia periférica, caquexia, suplementação de magnésio, tratamento de depressão e toxicidade geral. Conclusão: Verificou-se que náuseas, vômitos, neuropatia e hipomagnesemia tiveram maior número de estudos relacionados ao manejo e à prevenção desses sintomas, nos quais identificaram-se algumas sugestões de condutas com maior evidência para essas reações. As demais reações encontradas ainda carecem de mais estudos, principalmente nos casos de cânceres gástrico e esofágico.

Pseudoacalasia se manifesta de forma semelhante à acalasia do esfíncter esofágico inferior (EEI). Corresponde a 2,4 a 4% dos casos que simulam acalasia1 . Estima-se que cerca de 50% dos casos de pseudoacalasia correspondam a malignidade primária do esôfago e da junção gastroesofágica e 18% a malignidades secundárias como doença metastática1,2. Etiologias benignas também estão descritas. No presente trabalho apresentamos um caso de pseudoacalasia com ênfase nos aspectos radiológicos. Revisamos também aspectos clínicos e radiológicos que podem auxiliar no diagnóstico diferencial entre acalasia e pseudoacalasia.

Introdução: pacientes com doença do refluxo gastroesofágico (DRGE) têm de 10 a 15% de chance de desenvolver esôfago de Barrett. Este pode evoluir para displasia e adenocarcinoma esofágico. Objetivo: avaliar fatores relacionados à detecção de displasia em pacientes com esôfago de Barrett longo. Metodologia: estudo retrospectivo com análise de informações de 18 pacientes com diagnóstico de esôfago de Barrett longo, colhidas de bancos de dados dos serviços de Endoscopia e Patologia e prontuários do Hospital Universitário Walter Cantídio (HUWC-UFC), no período de 2010 a 2015. Os pacientes foram divididos em dois grupos para comparação, grupo sem displasia (N=11) e grupo com displasia/adenocarcinoma (N=7). Resultados: do total de 18 pacientes com esôfago de Barrett longo no HUWC, 72% eram do sexo masculino, 47% tinham mais de 50 anos, 64% apresentavam sintomas típicos de DRGE, 23% eram tabagistas, 77% tinha hérnia hiatal, 50% realizaram fundoplicatura. Não houve diferenças estatísticas destas características entre o grupo com e sem displasia. Entretanto, o grupo com displasia teve uma média de 5 endoscopias/paciente, enquanto o grupo sem displasia teve apenas 2 endoscopias/paciente(p

Introduction: Esophagectomy presents a high postoperative morbidity. However, the definitions used are variable. A multinational group (esophagectomy complications consensus group; ECCG) proposed standardized definitions. Aim: To evaluate postoperative complications in esophagectomy according to the definitions proposed by the ECCG. Materials and Method: We conducted a retrospective cohort study, based on a prospective database. Patients undergoing esophagectomy for cancer between 1996 and 2018 at one center were included. The definitions of postoperative complications according to the ECCG were applied. Results: We included 215 patients (64% men, age 67 [31-82] years). Sixty-four percent had some comorbidity. There was a predominance of squamous carcinoma with 68%. The most frequent tumor location was the lower third of the esophagus (48%). An open approach was used in 74% and minimally invasive in 26%. Total postoperative morbidity was 67%. The most frequent complications were respiratory complications, which reached 27%. The leakage of the esophagogastric anastomosis reached 25%, 24% were type II (did not require surgical reoperation). There was a vocal cord paresis in 7%, all were classified as type I (did not require specific therapy). A chylous fistula was presented in 2%, in 1% they were treated with parenteral nutrition (type II) and in 1% a reoperation was performed (type III). Conclusion: Esophagectomy is associated with a high morbidity. The main complications are respiratory and gastrointestinal. The use of consensus definitions allows standardization and grading of complications. [ABSTRACT FROM AUTHOR]

Giant esophageal leiomyomas are rare neoplasms with an imprecise clinical course; most originate from the middle and lower portion of the organ. Imaging and endoscopic tests are used to identify the proper diagnosis and treatment. The purpose of this work, based on a new case, is to share and disseminate a new report of giant esophageal leiomyoma. The patient was admitted for dysphagia. Diagnostic tests included radiography of the esophagus, stomach, and duodenum, upper digestive endoscopy, computed tomography, and MRI. The patient underwent surgery by right thoracotomy, enucleation of a 10x6x5cm tumor was performed, and the integrity of the mucosa was verified. There was no evidence of malignancy in the histopathological study. He was discharged eight days after surgery. Thoracotomy with enucleation of the esophageal tumor is an effective procedure to treat patients with giant leiomyoma. [ABSTRACT FROM AUTHOR]

Objective: To depict the clinical presentation and outcomes of a cohort of critically ill patients with esophageal cancer. Methods: We carried out a multicenter retrospective study that included patients with esophageal cancer admitted to intensive care units with acute illness between September 2009 and December 2017. We collected the demographic and clinical characteristics of all included patients, as well as organ-support measures and hospital outcomes. We performed logistic regression analysis to identify independent factors associated with in-hospital mortality. Results: Of 226 patients included in the study, 131 (58.0%) patients died before hospital discharge. Squamous cell carcinoma was more frequent than adenocarcinoma, and 124 (54.9%) patients had metastatic cancer. The main reasons for admission were sepsis/ septic shock and acute respiratory failure. Mechanical ventilation (OR = 6.18; 95%CI 2.86 - 13.35) and metastatic disease (OR = 7.10; 95%CI 3.35 - 15.05) were independently associated with inhospital mortality. Conclusion: In this cohort of patients with esophageal cancer admitted to intensive care units with acute illness, the in-hospital mortality rate was very high. The requirement for invasive mechanical ventilation and metastatic disease were independent prognostic factors and should be considered in discussions about the short-term outcomes of these patients. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The diagnosis of corrosion cancer should be suspected in patients with corrosive ingestion if after a latent period of negligible symptoms there is development of dysphagia, or poor response to dilatation, or if respiratory symptoms develop in an otherwise stable patient of esophageal stenosis. Narrow Band Imaging detects superficial squamous cell carcinoma more frequently than white-light imaging, and has significantly higher sensitivity and accuracy compared with white-light. OBJECTIVE To determinate the clinical applicability of Narrow Band Imaging versus Lugol´s solution chromendoscopy for detection of early esophageal cancer in patients with caustic/corrosive agent stenosis. METHODS Thirty-eight patients, aged between 28-84 were enrolled and examined by both Narrow Band Imaging and Lugol´s solution chromendoscopy. A 4.9mm diameter endoscope was used facilitating examination of a stenotic area without dilation. Narrow Band Imaging was performed and any lesion detected was marked for later biopsy. Then, Lugol´s solution chromoendoscopy was performed and biopsies were taken at suspicious areas. Patients who had abnormal findings at the routine, Narrow Band Imaging or Lugol´s solution chromoscopy exam had their stenotic ring biopsied. RESULTS We detected nine suspicious lesions with Narrow Band Imaging and 14 with Lugol´s solution chromendoscopy. The sensitivity and specificity of the Narrow Band Imaging was 100% and 80.6%, and with Lugol´s chromoscopy 100% and 66.67%, respectively. Five (13%) suspicious lesions were detected both with Narrow Band Imaging and Lugol’s chromoscopy, two (40%) of these lesions were confirmed carcinoma on histopathological examination. CONCLUSION Narrow Band Imaging is an applicable option to detect and evaluate cancer in patients with caustic /corrosive stenosis compared to the Lugol´s solution chromoscopy.

La esofagectomía abierta o mínimamente invasiva, es un procedimiento técnicamente difícil, que requiere experiencia y habilidad por parte del cirujano, asociado a un cuidado pre- y postoperatorio adecuado. Se ha incrementado su uso y ha ganado aceptación dadas sus amplias ventajas, factibilidad y resultados oncológicos tempranos comparables. Al igual que con otros procedimientos, esta técnica tiene múltiples variaciones que van desde la mezcla de abordajes abiertos y vídeoasistidos, hasta aquellos completamente laparoscópicos, hecho que genera mayor comodidad para los cirujanos al momento de elegir un abordaje, de acuerdo con sus fortalezas y habilidades. El objetivo de este artículo es mostrar algunas de las técnicas utilizadas alrededor del mundo, descritas por los cirujanos que las implementan, así como sus claves y secretos.

Introducción. Suramérica es un área geográfica de incidencia intermedia de cáncer de esófago, con un aumen- to progresivo y diagnóstico temprano poco común. A pesar de que la resección quirúrgica es la piedra angular del tratamiento, todavía la tasa de supervivencia es pobre y la de complicaciones es alta. El objetivo del presente estudio fue describir la frecuencia de complicaciones de la esofagectomía para el trata- miento del cáncer de esófago extirpable en un centro de tratamiento para el cáncer en Bogotá, Colombia. Pacientes y métodos. Se hizo una revisión retrospectiva de una base de datos prospectiva. Se incluyeron 30 pa- cientes sometidos a esofagectomía por cáncer de esófago, 22 por técnica abierta y 8 mediante laparoscopia, en un único centro de tratamiento para el cáncer entre 2012 y 2016. Se documentaron las complicaciones posopera- torias y se comparó su frecuencia, incluyendo las fugas de la anastomosis, entre la anastomosis latero-lateral y la término-lateral, entre la esofagectomía cervical y la intratorácica; entre la sutura mecánica y la manual, y entre la sutura mecánica circular y la lineal. Resultados. Se presentaron complicaciones posoperatorias en 56,7 % de los pacientes y, fugas de la anastomosis, en 30 %. La tasa de mortalidad fue de 6,7 %. Las fugas de la anastomosis fueron más frecuentes en pacientes ma- yores y mujeres (p=0,0116 y p=0,0301, respectivamente). No se presentó diferencia estadísticamente significativa entre las diferentes técnicas anastomóticas. Conclusiones. Los resultados de este estudio demuestran que, a pesar de ser un área de incidencia intermedia de cáncer de esófago, esta sigue siendo una enfermedad poco frecuente con una tasa de complicaciones repre- sentativa. Los resultados sugieren que las fugas anastomóticas se presentan más frecuentemente en pacientes ancianos y mujeres.

Introducción. El cáncer es una de las principales causas de morbilidad y mortalidad en el mundo. Los cánceres del aparato digestivo constituyen una importante carga médica mundial debido a su alta prevalencia, la mor- talidad y la consecuente carga económica. Es importante conocer las características de su presentación clínica en nuestro medio y la experiencia con su manejo, que sirvan como base para analizar tendencias y resultados. Materiales y métodos. Se llevó a cabo un estudio descriptivo, retrospectivo y observacional, con hombres y mujeres de 15 a 50 años de edad con diagnóstico de cáncer del tubo digestivo durante el periodo 2010 a 2015 en el Hospital Universitario San José de Popayán. Fecha de recebido: 16/04/2018 - Fecha aceptación: 20/02/2019 Resultados. De 41 pacientes incluidos, 65,9% (n= 27) fueron hombres. La edad promedio de diagnóstico fue de 41 años, con presentación desde los 26 años. El cáncer fue gástrico en 22% (n=27), colorrectal en 12,2% (n=13) y esofágico en 2,4% (n=1). El estado nutricional se vio comprometido, principalmente, en el carcinoma de esófago. El cáncer gástrico se diagnosticó en estadio IV en 65 % de los casos. La mejor supervivencia se presentó en casos de cáncer de colon sometidos a cirugía. Discusión. El sexo masculino resultó más afectado por cáncer del aparato gastrointestinal; la edad de aparición fue algo mayor que en otros estudios. El cáncer gástrico fue el más prevalente y con peor pronóstico, similar a lo descrito en otros estudios. El estadio avanzado se puede explicar por la consulta tardía y la agresividad intrínseca del tumor.

Objective: To determine whether preoperative anthropometric and computed tomography (CT) measurements of body composition can predict postoperative morbidity and mortality in patients with gastric or esophageal cancer. Materials and Methods: This was a retrospective study in which we reviewed the medical records and abdominal CT scans of patients with gastric or esophageal cancer who underwent surgery in 2015 at a cancer center. CT scans performed during routine preoperative evaluation were retrospectively assessed to measure the area of lean body mass at the level of the third lumbar vertebra, as well as the area of visceral and subcutaneous fat. Results: Seventy patients were included in the study. The mean age was 59.9 years (range, 33-82 years), and 47 patients (67.1%) were men. The mean postoperative follow-up period was 14.9 months. Neither postoperative morbidity nor postoperative mortality correlated significantly with gender, age, the type of primary tumor, the presence of comorbidities, smoking status, body mass index, nutritional status, or visceral fat area. The survival rate was higher for patients with normal lean body mass than for those with low lean body mass (hazard ratio = 0.116; 95% confidence interval: 0.015-0.906; p = 0.040). Conclusion: Our data suggest that lean body mass can be a relevant prognostic factor in patients with gastric or esophageal cancer, and that CT measurements should be included in the routine preoperative evaluation, because it may provide information that aids nutritional and clinical care for these patients. [ABSTRACT FROM AUTHOR]

In 2018, there were some important trials presented over multiple international meetings. The objective of this article is to summarize the most important and practice changing studies in gastrointestinal oncology this year. Some studies in gastroesophageal, pancreatic, colorectal and anal canal have been selected, including adjuvant therapy in pancreatic cancer, immunotherapy in metastatic gastroesophageal cancer, as well as strategies in regorafenib dose escalation and the role of hyperthermic intraperitoneal chemotherapy in metastatic colorectal.

Introdução: O câncer de esôfago é a terceira neoplasia mais comum do trato digestivo e apresenta prognóstico ruim quando diagnosticado em estádios avançados da doença. Objetivo: Descrever as características sociodemográficas, clínicas e de tratamento dos pacientes diagnosticados com câncer de esôfago no Brasil, no período de 2001 a 2010. Método: Estudo transversal de base secundária em pacientes com câncer de esôfago, cadastrados entre 2001 e 2010, nos Registros Hospitalares de Câncer. Foram analisadas as variáveis sociodemográficas, clínicas e de tratamento. Foi realizada análise descritiva utilizando média e desvio-padrão para as variáveis contínuas, e frequência absoluta e relativa para as categóricas. Resultados: Foram incluídos 24.204 pacientes, com média de idade de 60,8 anos (±11,5). A maioria da população era do sexo masculino (78,3%), de baixa escolaridade (75,2%), etilista (62,9%), tabagista (76,0%) e com estádio avançado ao diagnóstico (41,3% em estádio clínico III e 26,9%, IV), sendo o grupo topográfico de maior prevalência o esôfago superior e médio (76,4%). Não foram submetidos a nenhum tratamento oncológico 12,7% dos pacientes. Os tratamentos mais frequentes foram a combinação entre radioterapia e quimioterapia (25,6%), e o tratamento isolado com radioterapia (21,9%). Ao final do primeiro tratamento oncológico, 10,7% estavam sem evidência de doença, 8,4% com remissão parcial, 26,6% com doença estável e, os demais, com doença em progressão ou óbito (54,4%). Conclusão: No Brasil, os casos diagnosticados por câncer de esôfago são, em sua maioria, diagnosticados em estádios avançados da doença, o que representou maior agressividade terapêutica e pior resposta ao tratamento.

Pseudoachalasia is a condition that mimics idiopathic achalasia of the lower esophageal sphincter. It accounts for 2.4 to 4% of patients presenting with achalasia-like symptoms1. It is estimated that about 50% of cases of pseudoachalasia correspond to primary malignancies of the esophagus and the esophagogastric junction and 18% to secondary malignancies such as metastases1,2. Benign causes are also described. In this report we emphasize radiological findings of a case of pseudoachalasia. We also review clinical and radiological aspects that might be auxiliary in the differential diagnosis between achalasia and pseudoachalasia. [ABSTRACT FROM AUTHOR]

Introducción: la esofagectomía continúa siendo el tratamiento de elección del cáncer esofágico. Objetivos: describir la frecuencia de complicaciones y mortalidad tras esofagectomía por cáncer esofágico. Material y método: estudio retrospectivo, multicéntrico, entre los años 2001 y 2011. Se incluyeron pacientes sometidos a esofagectomía programada por cáncer esofágico durante la estadía en unidades de cuidados intensivos. Resultados: se incluyeron 224 pacientes, hombres 72%, media de edad 61 años y desvío estándar ± 11 años. El abordaje quirúrgico fue transhiatal en 69,7% y transtorácico en 30,3%. La morbilidad fue de 70,5% y la mortalidad de 13,8%. Las complicaciones detectadas fueron respiratorias 50,8%, infecciosas 51,3%, cardiovasculares 27,6% y quirúrgicas 23,6%. El síndrome de dificultad respiratoria aguda (p = 0,03), fugas anastomóticas (p = 0,001), sepsis grave (p = 0,001), mediastinitis (p = 0,02) e injuria renal aguda (p = 0,01) se asociaron con la mortalidad. La sepsis grave fue la principal causa de muerte a foco mediastinal o respiratorio, o ambos. En el análisis multivariado las variables asociadas de forma independiente con la mortalidad fueron el fracaso de extubación (OR 3,9; IC 95% 1,02-15,30; p = 0,03), radioterapia preoperatoria (OR 6,0; IC 95% 1,70-21,30; p = 0,02), transfusión intraoperatoria (OR 5,6; IC 95% 2,07-15,60; p = 0,001) y sepsis grave (OR 29; IC 95% 1,72-21,30; p = 0,001). Conclusiones: la morbimortalidad en esofagectomía es elevada. Las complicaciones más frecuentes fueron las respiratorias e infecciosas. La principal causa de muerte fue la sepsis grave. Se asociaron a mayor mortalidad el fracaso de extubación, radioterapia preoperatoria, transfusión intraoperatoria y la sepsis grave.

ABSTRACT BACKGROUND: Barrett’s esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett’s esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher’s exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett’s esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett’s esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett’s esophagus than short segments. Barrett’s esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett’s esophagus represented globally 0.3% and 1.1% in GERD patients.

Introduction: Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim: To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods: Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results: We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion: The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count. [ABSTRACT FROM AUTHOR]

Introduction: Esophageal cancer affects more than 450 thousand people worldwide each year, while stomach cancer is the second leading cause of death by cancer across the globe. Objective: To evaluate and compare the sociodemographic and clinical profile of patients with stomach and esophageal cancer. Method: We evaluated 24 subjects admitted to a teaching hospital in the preoperative period. They answered a questionnaire with sociodemographic data and underwent clinical evaluation. The degree of independence was considered, according to the Performance Status scale. Descriptive and inferential statistics were applied by unpaired Student's t-test to compare the sociodemographic and physical variables of patients, with statistically significant difference of p-values ≤0.05. Results: Of patients with esophageal cancer, 100,00% (n=8) were men; and of the patients with stomach cancer, 68.75% (n=11) were men. As for education and income, most patients with both types of cancer had attended primary education and would receive one minimum wage. On the Performance Status scale, the highest score was 2 for esophageal cancer and 0 to stomach. As to physical characteristics, there was a significant difference (p=0.01) regarding body mass index between men (21.68±2.62 kg/m2) and women (27.91±5.97 kg/m2). For muscle strength, most patients were level 5 for upper and lower limbs. Conclusion: The profile of these patients is characterized by prevalence of white and brown-skinned elderly men, with low education, low income, and independent in daily-living activities. [ABSTRACT FROM AUTHOR]

The study of esophageal diseases requires multiple diagnostic tests since no one test alone can provide full information on upper digestive tract anatomy and functionality. For general surgeons and gastrointestinal surgeons, the esophagogram is an essential tool that can suggest a diagnosis while simultaneously providing an idea of the anatomy of the organ and outlining an easily evaluated map without the need of a radiologist. This information can be used to establish a surgical plan. The aim of this article is to show readers the usefulness of esophagograms at referral centers for study and treatment of esophageal diseases while providing representations of several frequent diseases. [ABSTRACT FROM AUTHOR]

INTRODUÇÃO: Leiomiomas são as neoplasias esofagianas mais comuns. Seu tratamento de escolha é cirúrgico. A enucleação por toracotomia aberta é o procedimento padrão. Com o avanço das técnicas de cirurgia minimamente invasiva, novas alternativas se impõem. OBJETIVO: Apresentar técnica videoendoscópica para o tratamento desses miomas evitando-se toracotomia. TÉCNICA: Enucleação do leiomioma por: A) toracoscopia para tumores do esôfago torácico ou B) laparoscopia aos do esôfago abdominal. A) As operações são realizadas sob anestesia geral com entubação seletiva do pulmão esquerdo. Os pacientes são colocados em posição de decúbito lateral esquerdo e leve dorsoflexão. São utilizados quatro trocárteres de trabalho, dois de 11 mm e dois de 5 mm. Os de 11 mm, um no 6º espaço intercostal, na linha axilar posterior, para ótica de 30°; outro na mesma altura na linha hemi-clavicular para afastar o pulmão. Os outros dois trocárteres de 5 mm são instalados para dar passagem aos instrumentos de trabalho do cirurgião no 4º espaço, na linha axilar posterior, e no 7º, também na linha axilar posterior. As operações se iniciavam sempre pela abertura da pleura mediastinal, dissecção do tumor com abertura da parte muscular da parede esofágica, enucleação simples do tumor e fechamento da incisão muscular esofágica. B) As intervenções são feitas com os pacientes submetidos à anestesia geral e colocados em posição francesa. A abordagem é a mesma realizada para correção da hérnia hiatal e a enucleação é feita sem dificuldades. CONCLUSÃO: O acesso videocirúrgico é perfeitamente exequível para as ressecções de leiomiomas esofágicos e proporciona resultados satisfatórios muito semelhantes aos encontrados com aos procedimentos abertos.

Context Despite progress in recent years in methods of diagnosis and surgical treatment of esophageal cancer, there is still controversy about the benefits from neoadjuvant chemoradiotherapy. Objective To analise the survival of patients submitted to esophagectomy for squamous cell carcinoma of the esophagus with or without neoadjuvant chemoradiotherapy. Method A retrospective, non-randomized study conducted using the medical charts of patients operated for squamous cell carcinoma of the esophagus at the School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil between 1979 and 2006. The Kaplan-Meier analysis was used to calculate survival curves and the log-rank test to compare data in each group. The significance level was settled as 5%. Results A total of 123 patients were evaluated in this study, divided into three groups: I - 26 (21.2%) patients submitted to esophagectomy alone; II - 81 (65.8%) patients submitted to neoadjuvant radiotherapy plus esophagectomy and III - 16 (13%) patients submitted to neoadjuvant chemoradiotherapy plus esophagectomy. A statistically significant survival was recorded between the groups (log rank = 6.007; P = 0.05), survival being greatest in the group submitted to neoadjuvant chemoradiotherapy, followed by the group submitted to neoadjuvant radiotherapy compared to the group submitted to esophagectomy alone as the initial treatment of choice. Conclusion Radiotherapy and chemotherapy neoadjuvants in patients with squamous cell carcinoma of the esophagus offers benefits and increases survival.

Objective This study aimed to evaluate the feasibility and clinicopathological characteristics of early gastric and esophageal cancers treated with endoscopic submucosal dissection (ESD) at five centers in Brazil. Methods Five centers in Brazil reported their initial experience with ESD. The cases reported had already been collected by each center before pooled analysis. Results Were resected 62 gastric lesions; 52(83,8%) of the gastric lesions were well-differentiated adenocarcinoma, 31(50%) from the antrum, 24 (38.7%) type IIa. 51 (82.2%) lesions had en-block resection with three showing lateral margin compromise. Concerning invasion, 25 (40.3%) tumors were M1. Mean tumor diameter was 18.9 mm (range, 0.6-5.0 cm) and mean procedure duration was 119.45 minutes. Gastric perforation occurred in three (4.8%) patients. Mean follow-up duration was 11.3 months, with two local recurrences and one death from pneumonia Seven months after treatment. Of the 16 esophageal lesions resected, 14 (87.4%) were squamous cell carcinoma, 10 (62.5%) were located proximally and 8 (50.0%) type IIa. Mean tumor diameter was 23.8 mm (range, 6-60 mm). Thirteen (81.2%) lesions had en-block resection with five cases of lateral margin compromise. Eight (50.0%) lesions were M1. Mean procedure duration was 78 minutes (range, 20-150 min). Complications included pneumomediastinum in two (12.5%) patients and stenosis in one (6.2%). Mean duration of follow-up was 8.6 months, with no local recurrence despite the presence of lateral margin compromise. Conclusion Different centers in Brazil feasibly perform ESD with a high success rate.

CONTEXT AND OBJECTIVESEsophageal cancer is the eighth commonest type of cancer worldwide, occupying sixth place in terms of mortality. Smoking and alcohol use are known risk factors for this type of cancer. The aim here was to evaluate the risk factors for esophageal cancer in a low-incidence area.DESIGN AND SETTINGCase-control study in Goiânia, with 99 cases of esophageal cancer and 223 controls.METHODSThe variables were sociodemographic, dietary, occupational and lifestyle data. The sample was analyzed using the chi-square test, Mann-Whitney test and Mantel-Haenszel approach for multivariate analysis. Odds ratios (OR) were calculated with 5% significance and 95% confidence intervals.RESULTSThe risk of esophageal cancer was higher in patients ≥ 55 years (OR = 1.95; P < 0.001). Patients from rural areas were at greater risk of esophageal cancer (OR = 4.9; P < 0.001). Smoking was a risk factor among the cases (OR = 3.8; P < 0.001), as was exposure to woodstoves (OR = 4.42; P < 0.001). The practice of oral sex was not a risk factor (OR = 0.45; P = 0.04). Consumption of apples, pears, vegetables, cruciferous vegetables and fruit juices were protective against esophageal cancer.CONCLUSIONIn a region in which the incidence of esophageal cancer is low, the most significant risk factors were exposure to woodstoves, smoking and living in rural areas.CONTEXTO E OBJETIVOSO câncer de esôfago é o oitavo tipo mais comum em todo o mundo, ocupando o sexto lugar em termos de mortalidade. Fatores de risco conhecidos para esse tipo de câncer são o consumo de tabaco e o álcool. O objetivo foi avaliar os fatores de risco para câncer de esôfago em uma área de baixa incidência.TIPO DE ESTUDO E LOCALEstudo caso-controle em Goiânia, com 99 casos de câncer de esôfago e 223 controles.MÉTODOSAs variáveis foram dados sociodemográficos, alimentares, ocupacionais e de estilo de vida. A amostra foi analisada pelo teste do qui-quadrado, Mann-Whitney e de Mantel-Haenszel para análise multivariada. Foram calculados a odds ratio (OR) com significância em 5% e o intervalo de confiança de 95%.RESULTADOSO risco de câncer de esôfago foi maior em pacientes ≥ 55 anos (OR = 1,95, P < 0,001). Pacientes de áreas rurais estavam em risco maior de câncer de esôfago (OR = 4,9; P < 0,001). O tabagismo foi um fator de risco entre os casos (OR = 3,8; P < 0,001), bem como exposição ao fogão a lenha (OR = 4,42; P < 0,001). A prática do sexo oral não foi fator de risco (OR = 0.45; P = 0,04). Consumo de maçãs, peras, legumes, vegetais crucíferos e sucos de frutas foi protetor contra o câncer de esôfago.CONCLUSÃOEm uma região em que a incidência de câncer de esôfago é baixa, os fatores de risco mais significativos foram a exposição a fogão a lenha, tabagismo e viver em zona rural.

La esofagectomía es el manejo de elección en pacientes con enfermedades como el cáncer esofágico, entre otras. Existen diferentes abordajes y opciones, las cuales se han ampliado con la cirugía asistida con video que permite estancias hospitalarias cortas, menores tasas de infección, menos dolor y un pronto regreso a las actividades diarias. En este artículo se describe el abordaje de una esofagectomía híbrida transtorácica, con ascenso gástrico laparoscópico y anastomosis intratorácica latero-lateral mecánica, que mezcla las ventajas de la laparoscopia con un abordaje abierto transtorácico