BACKGROUND: Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE: To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS: A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS: The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION: PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.

Background and Aims: An association between non-alcoholic fatty liver disease (NAFLD) and pancreatic ductal adenocarcinoma (PDAC) has been previously suggested. This study aims at investigating this association and at identifying potential links between variables of the NAFLD spectrum and PDAC. Methods: A cross-sectional case-matched analytical and comparative study was carried out to analyze patients undergoing surgical resection of PDAC and compare them to a control group of individuals undergoing cholecystectomy at a public tertiary teaching hospital, matched by sex, age and BMI. Hepatic histopathological examinations were compared between cases and controls. Results: Of 56 individuals, 36 were male (64.3%) and the median age was 61.5 years old (interquartile range: 57.5 - 70). The participants’ median BMI was 24.3 kg/m2 (interquartile range: 22.1-26.2 kg/m2). Microvesicular steatosis (p=0.04), hepatocellular ballooning (p=0.02), fibrosis (p=0.0003) and steatohepatitis (p=0.03) were significantly more frequent in the group of cases. Odds ratios for hepatocellular ballooning (6.2; 95%CI: 1.2-31.8; p=0.03), fibrosis (9.3; 95%CI: 2.5-34.1; p=0.0008) and steatohepatitis (3.9; 95%CI: 1.1-14.3; p=0.04) were statistically significant in relation to the PDAC prevalence. Conclusions: Significant associations were identified between histopathological aspects of NAFLD (microvesicular steatosis, hepatocellular ballooning, fibrosis, and steatohepatitis) and PDAC.

Introdução: O megaesôfago consiste na dilatação da luz esofágica secundária a progressiva lesão do plexo intramural do esôfago, levando a um déficit no relaxamento ou não relaxamento do esfíncter esofágico inferior (EEI), a Acalasia, com aparecimento de contrações não peristálticas (ondas terciárias), ondas peristálticas com menor amplitude, até aperistalse do corpo esofageano, sendo atualmente a maioria dos casos de origem idiopática. Segundo classificação de Mascarenhas, que varia de I a IV conforme o seu diâmetro transverso observado na radiografia baritada do esôfago. Em estágios iniciais, a cardiomiotomia é preconizada, no megaesôfago avançado (grau IV) prioriza-se a esofagectomia, entretanto, quando o paciente não apresenta um PS (Performance-status) adequado, pode-se empregar cirurgia de Serra-Dória ou Thal Hatafuku. Objetivo: Apresentar caso de um paciente com megaesôfago Grau IV submetido à mucosectomia esofágica no serviço público de Rondônia, como alternativa viável a esofagectomia. Relato de caso: Paciente masculino, 58 anos, diagnosticado com megaesôfago de origem idiopática, Mascarenhas IV pelo REED. Realizou endoscopia com cromoscopia, sem evidências para displasia. Bom PS, sem comorbidades. Procedimento realizado através de laparotomia xifo-umbilical e cervicotomia lateral esquerda. Com mucosa íntegra após dissecção, possibilitando a transposição do tubo gástrico recém confeccionado até a região cervical, através da túnica muscular do esôfago. Recebeu alta após 3 semanas de internação por fístula da anastomose esôfago-gástrica, com tratamento conservador.  Discussão: O tratamento ideal do megesôfago avançado (Grau IV) consiste na esofagectomia, porém, esta cirurgia apresenta alta morbidade cirúrgica com manipulação do mediastino posterior promovendo maiores complicações quando comparados à mucosectomia, principalmente, complicações pleuropulmonares como demonstrado por Oliveira et al. (2008), onde houve o dobro de complicações pós-operatórias (65% vs 35%, p < 0,05), além do maior tempo cirúrgico e de hospitalização. Conclusão: Considera-se a mucosectomia como alternativa plausível, com técnica reprodutível, segura e de menor tempo cirúrgico para tratar megaesôfago de origem idiopática.

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