We conducted an integrative literature review of published studies on pesticide and cancer exposure, focusing on farmers, rural population, pesticide applicators, and rural workers. The Medline/PubMed was used as searching database. After the retrieval, 74 articles were selected according to pre-established criteria, which design involved 39 case-controls, 32 cohorts, 2 ecological ones, and 1 cross-sectional. Among them, 64 studies showed associations between pesticides and cancer while 10 did not find any significant association. The studies found 53 different types of pesticides significantly associated with at least one type of cancer and 19 different types of cancers linked to at least one type of pesticide. Although few studies presented contradictory results, the sole fact of being a farmer or living near crops or high agricultural areas have also been used as a proxy for pesticide exposure and significantly associated with higher cancer risk. The literature well illustrates the case of prostate cancer, Non-Hodgkin lymphoma, leukemia, multiple myeloma, bladder and colon cancers. Studies are recommended to further investigate the relationship between pesticide and neoplasm of testis, breast, esophagus, kidney, thyroid, lip, head and neck, and bone.

Background and Objectives The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high‐dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. Methods A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow‐up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. Results Most conducts and management strategies reviewed were strongly recommended by the participants. Conclusions Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

Background Approximately 70% of cancer‐related deaths occur in low‐ and middle‐income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. Objectives The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. Methods The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. Results For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. Conclusions It is possible to provide adequate treatment for most EC patients in resource‐limited areas, but the first option should be referral to specialized centers with more resources.

RESUMO Objetivos: Analisar os resultados de morbidade e sobrevida após cirurgias curativas e paliativas em pacientes com câncer cervical recidivado após tratamento primário com radioterapia e quimioterapia. Outro objetivo foi avaliar os fatores associados aos procedimentos curativos e não curativos. Métodos: Coorte retrospectiva de pacientes submetidos à cirurgias curativas e paliativas, entre janeiro de 2011 a dezembro de 2017, em um centro de alta complexidade em oncolologia. O desfecho da morbidade foi relatado de acordo com a classificação de Clavien-Dindo e a análise de sobrevida foi realizada pelo método de Kaplan-Meir. Para avaliar os fatores associados aos procedimentos, foi realizada análise univariada pelo teste U de Mann-Whitney. Resultados: Foram realizadas duas histerectomias radicais, três exenterações pélvicas com intenção curativa e cinco exenterações pélvicas paliativas. No grupo curativo, houve complicações maiores em 40% dos casos, e o tempo mediano de sobrevida foi 16 meses. No grupo paliativo, houve complicações maiores em 60% dos casos, e o tempo mediano de sobrevida foi 5 meses. Estadiamento avançado (p=0,02), sintomas (p=0,04), tamanho do tumor maior que cinco centímetros (p=0,04) e mais de três órgãos envolvidos (p=0,003) foram fatores significativamente associados a cirurgia não curativa. Conclusões: As taxas de morbidade foram maiores no grupo paliativo, e o tempo mediano de sobrevida foi menor no grupo paliativo do que no grupo curativo, entretanto esta diferença na sobrevida não teve significância estatística. Estádio avançado, sintomas, tamanho tumoral e número de órgãos envolvidos são fatores que devem ser levados em consideração na indicação de resgate cirúrgico.

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RESUMO O consumo de agrotóxicos aumentou consideravelmente nos últimos anos. Embora os agrotóxicos tenham ajudado a aumentar a produtividade das culturas, também têm sido associados ao câncer. O objetivo deste estudo foi descrever o perfil epidemiológico de pacientes oncológicos localizados em uma área com alto uso de agrotóxicos. Empregou-se coorte retrospectiva para descrever os casos de câncer. Incluíram-se pacientes diagnosticados com algum tipo de câncer entre 2005 e 2016, residindo, no momento do diagnóstico, em uma das 69 cidades brasileiras estudadas e com idade igual ou superior a 12 anos. Utilizou-se regressão multinível para modelar o coeficiente de morbidade por câncer. Estudaram-se 10.640 pacientes com câncer. Os coeficientes de morbidade por câncer aumentaram com a idade e foram significativamente maiores entre as pessoas que residiam em áreas rurais, quando comparadas com as residentes das áreas urbanas (p<0,0001). Em ambas as áreas, os homens apresentaram coeficientes de morbidade por câncer significativamente maiores do que as mulheres. Este estudo sugere que a maior incidência de câncer está relacionada a fatores da vida rural, como a exposição à agrotóxicos, visto que a área estudada é conhecida por sua economia baseada na agricultura e no elevado uso de agrotóxicos.

Objective Several controversies remain on conservative management of cervical cancer. Our aim was to develop a consensus recommendation on important and novel topics of fertility‐sparing treatment of cervical cancer. Methods The consensus was sponsored by the Brazilian Society of Surgical Oncology (BSSO) from March 2020 to September 2020 and included a multidisciplinary team of 55 specialists. A total of 21 questions were addressed and they were assigned to specialists' groups that reviewed the literature and drafted preliminary recommendations. Further, the coordinators evaluated the recommendations that were classified by the level of evidence, and finally, they were voted by all participants. Results The questions included controversial topics on tumor assessment, surgical treatment, and surveillance in conservative management of cervical cancer. The two topics with lower agreement rates were the role of minimally invasive approach in radical trachelectomy and parametrial preservation. Additionally, only three recommendations had <90% of agreement (fertility preservation in Stage Ib2, anti‐stenosis device, and uterine transposition). Conclusions As very few clinical trials have been developed in surgery for cervical cancer, most recommendations were supported by low levels of evidence. We addressed important and novel topics in conservative management of cervical cancer and our study may contribute to literature.

selective management of anterior abdominal stabs is safe, when a rigorous selection of patients is observed, Isolated serial clinical exam may be performed without computer tomography, without increase of hospitalization time or morbidity, reducing costs, exposure to radiation, mortality and morbidity and non-therapeutic laparotomies.