RAFAEL FERREIRA COELHO
Projetos de Pesquisa
Unidades Organizacionais
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
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
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- Correlation of a microRNA expression profile and the prognosis of penile cancer: A prospective study using microarray data analysis(2018) FURUYA, Tatiane K.; MURTA, Claudio B.; PONTES JR., Jose; UNO, Miyuki; CARRASCO, Alexis; SICHERO, Laura C.; VILLA, Luisa L.; COELHO, Rafael F.; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio D.; LEITE, Katia R.; SROUGI, Miguel; CHAMMAS, Roger; NAHAS, William C.
- Predictive factors for prolonged hospital stay after retropublic radical prostatectomy in a high-volume teaching center(2018) COELHO, Rafael F.; CORDEIRO, Mauricio D.; PADOVANI, Guilherme P.; LOCALLI, Rafael; FONSECA, Limirio; PONTES JUNIOR, Jose; GUGLIELMETTI, Giuliano B.; SROUGI, Miguel; NAHAS, William CarlosObjective: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution, and analyze the rate of unplanned visits to the office, emergency care, hospital readmissions and perioperative complications rates. Materials and Methods: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution between January/2010 - January/2012. A logistic regression model including preoperative variables was initially built in order to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Results: 1011 patients underwent RRP at our institution were evaluated. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICC (OR. 1.40 p=0.003), age (OR 1.050 p<0.001), ASA score of 3 (OR. 3.260 p<0.001), prostate volume on USG-TR (OR, 1.005 p=0.038) and African-American race (OR 2.235 p=0.004); among intra and postoperative factors, operative time (OR 1.007 p=0.022) and the presence of any complications (OR 2.013 p=0.009) or major complications (OR 2.357 p=0.01) were also correlated independently with prolonged hospital stay. The complication rate was 14.5%. Conclusions: The independent predictors of prolonged hospitalization among preoperative variables were CCI, age, ASA score of 3, prostate volume on USG-TR and African-American race; amongst intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay.
- Technical modifications for salvage and complex radical prostatectomy(2018) GANAPATHI, H. P.; PINIES, G. Ogaya; HERNANDEZ, E.; COELHO, R.; PATEL, V. R.Robotic radical prostatectomy is a procedure that has evolved considerably in the last 15 years as one of the main treatments for localized prostate cancer. Published literature currently describes in detail the procedure and outcomes. However, as widespread as it may be, we believe that certain technical modifications have greatly improved our technique, hence improving early and medium-term outcomes. After having performed close to 10,000 cases (single surgeon series—VP), our technique has evolved significantly, including several refinements to reduce patient morbidity and further improve the functional outcomes. In the present manuscript, we perform a detailed description of our surgical technique of Robotic-Assisted Laparoscopic Radical Prostatectomy and provide practical recommendations based on available reports and personal experience. © Springer International Publishing AG, part of Springer Nature 2018.
- Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution(2018) BONET, Xavier; OGAYA-PINIES, Gabriel; WOODLIEF, Tracey; HERNANDEZ-CARDONA, Eduardo; GANAPATHI, Hariharan; ROGERS, Travis; COELHO, Rafael F.; ROCCO, Bernardo; VIGUES, Francesc; PATEL, VipulObjectivePatients and MethodsTo show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan-Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). ResultsConclusionsThe potency rate at 12months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12months after salvage RARP (P = 0.033). Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.
- Can tumor contact length predict extracapsular extension, lymph node involvement, and biochemical recurrence?(2018) VIANA, Publio; RODRIGUES, Thiana; PACHANI, Danilo; HORVAT, Natally; CARVALHO, Arnaldo Fazoli; GUGLIELMETTI, Giuliano; COELHO, Rafael; BASTOS, Diogo Assed; NAHAS, William Carlos
- Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion(2018) PADOVANI, Guilherme P.; MELLO, Marcos F.; COELHO, Rafael F.; BORGES, Leonardo L.; NESRALLAH, Adriano; SROUGI, Miguel; NAHAS, William C.Objective: To present our technique of ureteroileal bypass to treat uretero-enteric strictures in urinary diversion. Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral implantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by ""ureteroileal bypass"", one of them was treated with robotic surgery. Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diagnosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120 +/- 17.9 minutes (98 to 142 min) and hospital stay was 3.3 +/- 0.62 days (3 to 4 days). Mean follow-up was 24 +/- 39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ureterohydronephrosis. Serum creatinine of all patients had been stable. Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.
- Current concepts in multiparametric magnetic resonance imaging for active surveillance of prostate cancer(2018) CAVALCANTE, Alexandre; VIANA, Publio Cesar C.; GUGLIELMETTI, Giuliano B.; PONTES, Jose; NONEMACHER, Henrique; CORDEIRO, Mauricio D.; BEZERRA, Regis Otaviano F.; COELHO, Rafael F.; NAHAS, William Carlos
- Influence of Modified Posterior Reconstruction of the Rhabdosphincter on Early Recovery of Continence and Anastomotic Leakage Rates after Robot-Assisted Radical Prostatectomy (vol 59, pg 72, 2011)(2018) COELHO, Rafael F.; CHAUHAN, Sanket; ORVIETO, Marcelo A.; SIVARAMAN, Ananthakrishnan; PALMER, Kenneth J.; COUGHLIN, Geoff; PATEL, Vipul R.
- A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy(2018) PATEL, Vipul R.; SANDRI, Marco; GRASSO, Angelica A. C.; LORENZIS, Elisa De; PALMISANO, Franco; ALBO, Giancarlo; COELHO, Rafael F.; MOTTRIE, Alexander; HARVEY, Tadzia; KAMEH, Darian; PALAYAPALAYAM, Hariharan; WIKLUND, Peter; BOSARI, Silvano; PULIATTI, Stefano; ZUCCOLOTTO, Paola; BIANCHI, Giampaolo; ROCCO, BernardoObjectives To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve-sparing (NS) approach that can be safely performed during radical prostatectomy (RP). Patients and Methods A total of 11 794 lobes, from 6 360 patients who underwent robot-assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width of > 1, > 2, > 3, and > 4 mm. Afive-zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount together with the areas identified by the decision rule. Results Of the 6 360 patients, 1 803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1 351 lobes (11.4%) and extended beyond the capsule for > 1, > 2, > 3, and > 4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (interquartile range 1.00-2.00). The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of > 1, > 2, > 3, and > 4 mm, respectively. Conclusion This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning.
- Correlation of microRNA expression profile and prognosis of penile cancer: A prospective study using microarray data analysis(2018) MURTA, Claudio Bovolenta; PONTES JR., Jose; FURUYA, Tatiane Katsue; UNO, Miyuki; CARRASCO, Alexis; SICHERO, Laura; VILLA, Luisa Lina; CORDEIRO, Mauricio; GUGLIELMETTI, Giuliano; COELHO, Rafael; LEITE, Katia Ramos Moreira; SROUGI, Miguel; CHAMMAS, Roger; NAHAS, William Carlos