RAFAEL FERREIRA COELHO

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: PAULO AFONSO DE CARVALHO ×

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  • article
    ROBOT-ASSISTED EXTENDED PELVIC LYMPH NODE DISSECTION IN PROSTATE CANCER, WHEN AND HOW?
    (2019) SIERRA, Pablo S.; LESTINGI, Jean F. P.; ALBUQUERQUE, Emanuel V.; PONTES JR., Jose; CARVALHO, Paulo A. de; CAVALCANTE, Alexandre; GUGLIELMETTI, Giuliano B.; NAHAS, William C.; COELHO, Rafael F.
    OBJECTIVE: To review the literature evaluating the role of the extended pelvic lymph node dissection ePLND during robot assisted radical prostatectomy (RARP) in the management of PCa patients, as well as the preoperative clinic pathologic factors that predict lymph node metastases (LNM). The technique and current outcomes of robotic ePLND will be presented. METHODS: Medline (R)/Pubmed (R) were searched up to august 2018 to find comparative studies of different anatomic limits of pelvic lymph node dissection (PLND) during RARP, open or pure laparoscopic surgery that reported number of nodes retrieved, oncologic outcomes and complications. The search was complemented to identify studies that evaluated diagnostic images and factors that predict LNM. Overall, 44 articles were included for full text review. RESULTS: There is not an imaging technique with an acceptable performance to select patients for PLND, the decision to perform a PLND is based on clinical characteristics described on validated nomograms. Median lymph node yield at RARP range from 5 to 21 depending on the extent of PLND, positivity rate of LN as high as 37% depending on the risk stratification of patients. Robot-assisted can be carried out to any extent with lymph node yields and safety concerns comparable to the open approach. CONCLUSION: Extended pelvic lymph node dissection is recommended to be performed at the time of RARP in intermediate and high-risk patients and cannot be replaced by other modalities. A benefit in terms of oncologic outcomes remains to be established. The robot assisted approach offers shorter length of hospital stay, lower transfusion rates and comparable outcomes compared to other surgical approaches.
  • article 9 Citação(ões) na Scopus
    Neutrophil-to-Lymphocyte Ratio Predicts Cancer Outcome in Locally Advanced Clear Renal Cell Carcinoma
    (2022) CORDEIRO, Mauricio Dener; ILARIO, Eder Nisi; ABE, Daniel Kanda; CARVALHO, Paulo Afonso de; MUNIZ, David Queiroz Borges; SARKIS, Alvaro Sadek; COELHO, Rafael Ferreira; GUIMARAES, Ronaldo Morales; HADDAD, Michel Vitor; NAHAS, William Carlos
    Background: To evaluate the association of neutrophil-to-lymphocyte ratio (NLR) with recurrence-free survival (RFS) and overall survival (OS) in patients with locally advanced nonmetastatic clear cell renal cell carcinoma (ccRCC) under-going radical nephrectomy. Material and Methods: We retrospectively identified 880 nephrectomies performed between January 2009 and December 2016 in a single center, reviewed data from 478 radical nephrectomies for kidney tumors and identified 187 patients with locally advanced nonmetastatic ccRCC (pT3-T4 N0M0). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count. OS and RFS were evaluated by the Kaplan-Meier method. Cox proportional-hazards regression models were used to evaluate predictors of RFS and OS. Results: Among 187 patients with ccRCC (mean age 63.4 +/- 11.5 years; 118 [63.1%] male), the median follow-up was 48.7 months. On univariate analysis, in patients with Fuhrman nuclear grade of differentiation 3-4, the median time to recurrence was significantly shorter with NLR >= 4 than < 4 (24 vs. 55 months, P = .045). On multivariable analysis adjusted for NLR >= 4, among all variables analyzed (NLR, microvascular invasion, sarcomatoid differentiation, tumor size and body mass index), only nuclear grade of differentiation was an independent predictor of recurrence (hazard ratio 2.18; 95% confidence interval 1.07-4.92, P = .03). The 3-year OS had no statistically significant difference between patients with NLR >= 4 or < 4. Conclusion: For patients with locally advanced, nonmetastatic ccRCC, RFS was reduced with high nuclear grade of differentiation and high preoperative NLR. These findings suggest an association between higher NLR and worse outcomes in locally advanced ccRCC.
  • article 2 Citação(ões) na Scopus
    Robotic-assisted radical cystectomy: the first multicentric Brazilian experience
    (2020) MOSCHOVAS, Marcio Covas; CHADE, Daher Cesar; ARAP, Marco Antonio; SARKIS, Alvaro Sadek; NAHAS, William Carlos; TANURE, Luiz Henrique Rodrigues; EBAID, Gustavo; FAZOLI, Arnaldo Jose de Carvalho; GUGLIELMETTI, Giuliano Betoni; BISTACCO, Carolina; CORDEIRO, Mauricio; AFONSO, Paulo; SIGHINOLFI, Maria Chiara; ROCCO, Bernardo; COELHO, Rafael Ferreira
    The objective of this study is to report the first multicentric Brazilian series and learning curve of robotic radical cystectomy (RARC) with related intra- and postoperative outcomes. We retrospectively analyzed 37 RARC prospectively collected at four different centers in Brazil, from 2013 to 2019. We analyzed the patient's demographics, pathological tumor, and nodal status, as well as intra- and postoperative outcomes. Statistical analysis was performed with the IBM (SPSS version 25) software. Overall, 86% were male, and the median age was 69 years. 83% had muscle-invasive bladder cancer, and 17% a high-grade, recurrent non-muscle-invasive tumor. The median operative time was 420 min with 300 min as console time. Median blood loss was 350 ml and transfusion rate was 10%. In 68% of the cases, we performed an intracorporeal Bricker urinary diversion, 24% intracorporeal neobladder, and 8% ureterostomy. Six patients (16%) had a Clavien 1-2, 8% had Clavien 3, 2.5% had a Clavien 4, and 5% had Clavien 5. The median length of hospital stay was 7 days. The final pathological exam pointed out pT0 in 16%, pT1 in 8%, pT2 in 32%, >= pT3 in 27%, and 16% pTis. 95% had negative surgical margins. The survival at 30, 90, and 180 days was 98%, 95%, and 95%, respectively. To our knowledge, this is the first multicentric series of RARC reporting the learning curve in Brazil; even if still representing a challenging procedure, RARC could be safely and effectively faced by experienced surgeons at centers with high volumes of robotic surgery.
  • article 4 Citação(ões) na Scopus
    MCT1 expression is independently related to shorter cancer-specific survival in clear cell renal cell carcinoma
    (2021) CARVALHO, Paulo Afonso de; BONATELLI, Murilo; CORDEIRO, Mauricio Dener; COELHO, Rafael Ferreira; REIS, Sabrina; SROUGI, Miguel; NAHAS, Willian Carlos; PINHEIRO, Celine; LEITE, Katia Ramos Moreira
    Clear cell renal cell carcinoma (ccRCC) has been considered a metabolic disease, with loss of von Hippel-Lindau (VHL) gene and consequent overexpression of hypoxia-inducible factor 1 alpha (HIF-1a), which is central for tumor development and progression. Among other effects, HIF-1a is involved in the metabolic reprogramming of cancer cells towards the Warburg effect involved in tumor cell proliferation, migration and survival. In this context, several proteins are expressed by cancer cells, including glucose and lactate transporters as well as different pH regulators. Among them, monocarboxylate transporters (MCTs) can be highlighted. Our aim is to comprehensively analyze the immunoexpression of MCT1, MCT2, MCT4, CD147, CD44, HIF-1 alpha, GLUT1 and CAIX in ccRCC surgical specimens correlating with classical prognostic factors and survival of patients with long follow-up. Surgical specimens from 207 patients with ccRCC who underwent radical or partial nephrectomy were used to build a tissue microarray. Immunostaining was categorized into absent/weak or moderate/strong and related to all classic ccRCC prognostic parameters. Kaplan-Meier curves were generated to assess overall and cancer-specific survival, and multivariate analysis was performed to identify independent prognostic factors of survival. Multivariate analysis showed that MCT1 together with tumor size and TNM staging, were independently related to cancerspecific survival. MCT1, CD147, CD44 and GLUT1 expression were significantly associated with poor prognostic factors. We show that MCT1 is an independent prognostic factor for cancer-specific survival in ccRCC justifying the use of new target therapies already being tested in clinical trials.
  • conferenceObject
    Oncological outcomes of positive surgical margins in partial nephrectomy for renal cell carcinoma.
    (2017) NONEMACHER, Henrique T. S.; CORDEIRO, Mauricio; ALBUQUERQUE, George Lins De; GALUCCI, Fabio; CARVALHO, Paulo Afonso de; BORGES, Leonardo; GUGLIELMETTI, Giuliano Betuni; BASTOS, Diogo Assed; COELHO, Rafael; SARKIS, Alvaro; DZIK, Carlos; NAHAS, William Carlos
  • conferenceObject
    ONCOLOGICAL OUTCOMES OF POSITIVE SURGICAL MARGINS IN PATIENTS WHO UNDERWENT PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA.
    (2017) NONEMACHER, Henrique; CORDEIRO, Mauricio; ALBUQUERQUE, George Lins de; BRUNHARA, Joao; CARVALHO, Paulo Afonso; GALLUCCI, Fabio; BORGES, Leornardo; COELHO, Rafael; PATEL, Vipul; NAHAS, Willian
  • conferenceObject
    NEPHROMETRY SCORES ARE USELESS FOR EXPERIENCED UROLOGISTS IN CLINICAL PRACTICE
    (2017) NONEMACHER, Henrique; GUGLIELMETTI, Giuliano; ALBUQUERQUE, George Lins de; COELHO, Rafael; CORDEIRO, Mauricio; FAZOLI, Arnaldo; CARVALHO, Paulo Afonso; FREIRE, Tiago Magalhaes; HAYEK, Kayann Kaled R. el; PAGOTTO, Vitor; ALBUQUERQUE, George Lins de; ROCHA, Bruno Aragao; RODRIGUES, Diego Parga; KANAS, Alexandre Fligelman; VIANA, Publio Cesar Cavalcanti; NAHAS, Willian
  • article 49 Citação(ões) na Scopus
    Retrograde Release of the Neurovascular Bundle with Preservation of Dorsal Venous Complex During Robot -assisted Radical Prostatectomy: Optimizing Functional Outcomes
    (2020) CARVALHO, Paulo Afonso de; BARBOSA, Joao A. B. A.; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio Dener; ROCCO, Bernardo; NAHAS, William C.; PATEL, Vipul; COELHO, Rafael Ferreira
  • conferenceObject
    Neutrophil-to-lymphocyte ratio as a predictor of oncologic outcomes in locally advanced non-metastatic clear cell renal carcinoma
    (2020) RODRIGUES, Gilberto; SIERRA, Pablo; ALBUQUERQUE, Emanuel; GALLUCCI, Fabio Pescarmona; ILARIO, Eder Nisi; CARVALHO, Paulo Afonso de; MUNIZ, David Queiroz Borges; SARKIS, Alvaro; COELHO, Rafael; CORDEIRO, Mauricio; NAHAS, William Carlos
  • article 2 Citação(ões) na Scopus