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OBJECTIVE:To analyze the impact of model for end‐stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT).INTRODUCTION:Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process.METHODS:A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post‐LT survival as end‐points.RESULTS:Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112). Although at 6 and 36‐months the difference between pre‐ vs. post‐MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long‐term post‐LT survival were observed in the post‐MELD period. Subgroups analysis showed special benefits to patients categorized as non‐hepatocellular carcinoma (non‐HCC) and moderate risk, as determined by MELD score (15‐20).DISCUSSION:This study ensured a more robust estimate of how the MELD policy affected post‐LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes.CONCLUSION:Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non‐HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival.

Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.

Careful preoperative histological evaluation of cervix in cases of uterine prolapse and postoperative cytologic and colposcopic follow-up of the vagina after hysterectomies are important because possible association with cervical carcinoma and occurrence of late vaginal cancer. Surgery and radiotherapy were effectively combined in this case that remains with no recurrence after 2 years follow-up.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is certainly a promising treatment option for patients with advanced ovarian cancer, since this disease often remains limited to the peritoneal cavity and this is also the preferred site of recurrence. However, there is insufficient evidence in scientific literature to advocate this approach as a formal therapy for ovarian cancer, and HIPEC still needs to be evaluated by means of randomized trials, which may surely provide additional information on this matter. In this setting, we read with great interest the recently published article by Spiliotis et al. in Annals of Surgical Oncology 1 describing the first phase III trial exploring use of HIPEC for ovarian cancer. Despite the scientific merit of this pioneering study, we noticed some drawbacks in the presentation that we would like to point out as follows: Firstly, I believe that the statistical analysis was not clearly described and applied. The authors mainly focused their presentation on ''mean overall survival,'' whereas the survival estimation was also presented as Kaplan-Meier plots and (probably) compared by the log-rank test. Another main point is that the median survival was not reached during the follow-up period according to the survival plots presented in the article, an important fact that was not mentioned by the authors. Accordingly, to present survival rates as ''means'' is probably not appropriate to a nonparametric approach (i.e., Kaplan-Meier plus log-rank test) as presented. Instead of

This study confirms the poor prognosis of Gallbladder cancer even when incidentally diagnosed following cholecystectomy and supposes a 3-year prevalence estimate of 0.34% for incidental gallbladder cancer in our Center from Pernambuco State, Brazil.

Ovarian ectopic S. mansoni is rarely reported in the most current literature; however, this actual proportion of ovarian Manson's schistosomiasis may not represent the real female genital involvement rates and reflect an underestimation of internal genital disease.

Class II radical hysterectomy has provided appropriated disease control of cervix cancer with low morbidity in our experience. Furthermore, tumor size and compromised vaginal margin were significantly associated to recurrence. These factors and lymph node metastasis were also associated to lower 5-year survival according to our analysis.