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
18 resultados
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- Pentafecta: A New Concept for Reporting Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy(2011) PATEL, Vipul R.; SIVARAMAN, Ananthakrishnan; COELHO, Rafael F.; CHAUHAN, Sanket; PALMER, Kenneth J.; ORVIETO, Marcelo A.; CAMACHO, Ignacio; COUGHLIN, Geoff; ROCCO, BernardoBackground: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. Design, setting, and participants: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients' expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease.
- Does the Presence of Median Lobe Affect Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy?(2012) COELHO, Rafael F.; CHAUHAN, Sanket; GUGLIELMETTI, Giuliano B.; ORVIETO, Marcelo A.; SIVARAMAN, Ananthakrishnan; PALMER, Kenneth J.; ROCCO, Bernardo; COUGHLIN, Geoff; HASSAN, Rayan El; DALL'OGLIO, Marcos F.; PATEL, Vipul R.Purpose: To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates, and recovery of urinary continence after robot-assisted radical prostatectomy (RARP). Patients and Methods: We analyzed 1693 consecutive patients undergoing RARP performed by a single surgeon. Patients were analyzed in two groups based on the presence or not of a ML identified during RARP. Perioperative outcomes, PSM rates, and recovery of urinary continence were compared between the groups. Continence was assessed using validated questionnaires, and it was defined as the use of ""no pads"" postoperatively. Results: A ML was identified in 323 (19%) patients. Both groups had similar estimated blood loss, length of hospital stay, pathologic stage, complication rates, anastomotic leakage rates, overall PSM rates, and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs 75 min, P < 0.001); however, there was no difference in the operative time when stratifying this result by prostate weight. Continence rates were also similar between patients with and without ML at 1 week (27.8% vs 27%, P = 0.870), 4 weeks (42.3% vs 48%, P = 0.136), 12 weeks (82.5% vs 86.8%, P = 0.107), and 24 weeks (91.5% vs 94.1%, P = 0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5 wks, 95% confidence interval [CI]: 4.41-5.59 vs median: 5 wks, CI 4.66-5.34; log rank test, P = 0.113). Conclusion: The presence of a ML does not affect outcomes of RARP performed by an experienced surgeon.
- Posterior Musculofascial Reconstruction After Radical Prostatectomy: A Systematic Review of the Literature(2012) ROCCO, Bernardo; COZZI, Gabriele; SPINELLI, Matteo G.; COELHO, Rafael F.; PATEL, Vipul R.; TEWARI, Ashutosh; WIKLUND, Peter; GRAEFEN, Markus; MOTTRIE, Alex; GABOARDI, Franco; GILL, Inderbir S.; MONTORSI, Francesco; ARTIBANI, Walter; ROCCO, FrancescoContext: In 2001, Rocco et al. described a surgical technique whose aim was the reconstruction of the posterior musculofascial plate after radical prostatectomy (RP) to improve early return to urinary continence. Since then, many surgeons have applied this technique-either as it was described or with some modification-to open, laparoscopic, and robot-assisted RP. Objective: To review the outcomes reported in comparative studies analysing the influence of reconstruction of the posterior aspect of the rhabdosphincter after RP. The main outcome evaluated was urinary continence at 3-7 d, 30-45 d, 90 d, 180 d, and 1 yr after catheter removal. Evidence acquisition: A systematic review of the literature was performed in November 2011, searching the Medline, Embase, Scopus, and Web of Science databases. A ""freetext'' protocol using the terms posterior reconstruction of the rhabdosphincter, posterior rhabdosphincter, and early continence was applied. Studies published only as abstracts and reports from meetings were not included in this review. One thousand seven records were retrieved from the Medline database, 1541 from the Embase database, 1357 from the Scopus database, and 1041 from the Web of Science database. The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. Only papers evaluating use of this technique as the only technical modification among the groups were included. A cumulative analysis was conducted using Review Manager v. 5.1 software (Cochrane Collaboration, Oxford, UK). Evidence synthesis: Eleven studies were identified in the literature search, including two randomised controlled trials (RCTs), which were negative studies. The cumulative analysis of comparative studies showed that reconstruction of the posterior musculofascial plate improves early return of continence within the first 30 d after RP (p = 0.004), while continence rates 90 d after surgery are not affected by use of the reconstruction technique. The statistical significance of the reconstruction seems to decrease when higher continence rates are reported. Use of posterior rhabdosphincter reconstruction does not seem to be related to positive surgical margin (PSM) rates or with complications like acute urinary retention (AUR) and bladder neck stricture (BNS). Some studies suggested lower anastomotic leakage rates with the posterior musculofascial plate reconstruction technique. Conclusions: The role of reconstruction of the posterior musculofascial plate in terms of earlier continence recovery is encouraging but still controversial. Methodological flaws and poor surgical standardisation seem to be the major causes. In two RCTs and one parallel (not randomised) group trial, posterior rhabdosphincter reconstruction offered no significant advantage for return of early continence after RP. No significant complications related to the posterior musculofascial plate reconstruction technique have been reported so far. A multicentre RCT is necessary to clarify the possible role of the technique in terms of earlier continence recovery. (c) 2012 Published by Elsevier B.V. on behalf of European Association of Urology.
- Positive Surgical Margins After Robotic Assisted Radical Prostatectomy: A Multi-Institutional Study(2011) PATEL, Vipul R.; COELHO, Rafael F.; ROCCO, Bernardo; ORVIETO, Marcelo; SIVARAMAN, Ananthakrishnan; PALMER, Kenneth J.; KAMEH, Darien; SANTORO, Luigi; COUGHLIN, Geoff D.; LISS, Michael; JEONG, Wooju; MALCOLM, John; STERN, Joshua M.; SHARMA, Saurabh; ZORN, Kevin C.; SHIKANOV, Sergey; SHALHAV, Arieh L.; ZAGAJA, Gregory P.; AHLERING, Thomas E.; RHA, Koon H.; ALBALA, David M.; FABRIZIO, Michael D.; LEE, David I.; CHAUHAN, SanketPurpose: Positive surgical margins are an independent predictive factor for biochemical recurrence after radical prostatectomy. We analyzed the incidence of and associative factors for positive surgical margins in a multi-institutional series of 8,418 robotic assisted radical prostatectomies. Materials and Methods: We analyzed the records of 8,418 patients who underwent robotic assisted radical prostatectomy at 7 institutions. Of the patients 323 had missing data on margin status. Positive surgical margins were categorized into 4 groups, including apex, bladder neck, posterolateral and multifocal. The records of 6,169 patients were available for multivariate analysis. The variables entered into the logistic regression models were age, body mass index, preoperative prostate specific antigen, biopsy Gleason score, prostate weight and pathological stage. A second model was built to identify predictive factors for positive surgical margins in the subset of patients with organ confined disease (pT2). Results: The overall positive surgical margin rate was 15.7% (1,272 of 8,095 patients). The positive surgical margin rate for pT2 and pT3 disease was 9.45% and 37.2%, respectively. On multivariate analysis pathological stage (pT2 vs pT3 OR 4.588, p <0.001) and preoperative prostate specific antigen (4 or less vs greater than 10 ng/ml OR 2.918, p <0.001) were the most important independent predictive factors for positive surgical margins after robotic assisted radical prostatectomy. Increasing prostate weight was associated with a lower risk of positive surgical margins after robotic assisted radical prostatectomy (OR 0.984, p <0.001) and a higher body mass index was associated with a higher risk of positive surgical margins (OR 1.032, p <0.001). For organ confined disease preoperative prostate specific antigen was the most important factor that independently correlated with positive surgical margins (4 or less vs greater than 10 ng/ml OR 3.8, p <0.001). Conclusions: The prostatic apex followed by a posterolateral site was the most common location of positive surgical margins after robotic assisted radical prostatectomy. Factors that correlated with cancer aggressiveness, such as pathological stage and preoperative prostate specific antigen, were the most important factors independently associated with an increased risk of positive surgical margins after robotic assisted radical prostatectomy.
- The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy(2017) DIAS NETO, Jose Anastacio; DALL'OGLIO, Marcos F.; COLOMBO JR., Joao Roberto; COELHO, Rafael F.; NAHAS, William CarlosIntroduction: This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP. Patients and Methods: 110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used. Results: The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p= 0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P= 0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad). Conclusions: The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.
- 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.
- Factors Affecting Return of Continence 3 Months After Robot-Assisted Radical Prostatectomy: Analysis From a Large, Prospective Data by a Single Surgeon(2012) KO, Young Hwii; COELHO, Rafael F.; CHAUHAN, Sanket; SIVARAMAN, Ananthakrishnan; SCHATLOFF, Oscar; CHEON, Jun; PATEL, Vipul R.Purpose: In this study we identified preoperative or intraoperative factors responsible for the early return of continence after robot-assisted radical prostatectomy using data from a high volume center. Materials and Methods: Data from 1,299 patients who underwent robot-assisted radical prostatectomy performed by a single surgeon from January 2008 to June 2010 were collected prospectively and analyzed retrospectively. Patients were categorized according to whether they regained continence (no pad and no urinary leakage) within 3 months and variables were then compared. A self-administered validated questionnaire (Expanded Prostate Cancer Index Composite) was used for assessment of continence status and time to recovery. Results: Within 3 months after surgery 86.3% of patients (1,121/1,299) had recovered continence. Multivariable Cox regression analysis revealed that only age (p < 0.001, hazard ratio 0.98, 95% CI 0.97-0.99) and performance of a nerve sparing procedure were independent predictors. After adjusting for age, the hazard ratio was 1.61 (95% CI 1.25-2.07, p < 0.001) for partial nerve sparing and 1.44 (1.13-1.83, p = 0.003) for bilateral nerve sparing compared to the nonnerve sparing group. Median time (95% CI) to the recovery of continence was prolonged in the nonnerve sparing group compared to nerve sparing counterparts at 6 (5.12-6.88), 4 (3.60-4.40) and 5 weeks (4.70-5.30) in the nonnerve sparing, partial nerve sparing and bilateral nerve sparing groups, respectively, with log rank p < 0.01. Conclusions: Findings from our analysis indicate that the likelihood of postoperative urinary control was significantly higher in younger patients and when a nerve sparing procedure was performed.
- Significant Heterogeneity in terms of Diagnosis and Treatment of Renal Cell Carcinoma at a Private and Public Hospital in Brazil(2011) DALL'OGLIO, Marcos F.; COELHO, Rafael; LOPES, Roberto; ANTUNES, Alberto A.; CRIPPA, Alexandre; CAMARA, Cesar; LEITE, Katia R. M.; SROUGI, MiguelPurpose: A great number of small renal lesions have now been detected. Nowadays, partial nephrectomy has more frequently been adopted for surgical treatment of earlier stage disease. Previous studies have associated patient, institutional, and health care system factors with surgery type. The aim of this study was to compare the diagnosis and treatment of renal cell carcinoma (RCC) according to hospital type, public versus private, in our country. Materials and Methods: We retrospectively evaluated 183 patients with RCC who underwent radical nephrectomy or nephron-sparing surgery between 2003 and 2007 in two hospitals, one private and one public. Patient demographic, clinical, surgery, and pathologic characteristics were analyzed. Results: The radical nephrectomy rate was higher at the public hospital than at the private hospital (75% vs. 57%, p = 0.008). Overall, patients at the public hospital presented larger tumors than did the patients who were cared for privately. Furthermore, small renal masses were significantly more prevalent in private care (57.8% vs. 28.3%). Patients at the public hospital showed a higher incidence of capsular invasion (p = 0.008), perirenal fat invasion (p < 0.01), lymph node involvement (p < 0.001), and a lower incidence of initial tumors. pT1 tumors were reported in 41% of patients at the public hospital and in 72% at the private hospital (p < 0.001). Conclusion: Patients with RCC cared for at our public referral hospital showed a more advanced stage than RCC treated at the private institution.
- miRNA and mRNA Expression Profiles Associated with Lymph Node Metastasis and Prognosis in Penile Carcinoma(2022) MURTA, Claudio B.; FURUYA, Tatiane K.; CARRASCO, Alexis G. M.; UNO, Miyuki; SICHERO, Laura; VILLA, Luisa L.; FARAJ, Sheila F.; COELHO, Rafael F.; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio D.; LEITE, Katia R. M.; NAHAS, William C.; CHAMMAS, Roger; PONTES JR., JosePenile cancer (PeC) is a rare disease, and no prognostic biomarkers have been adopted in clinical practice yet. The objective of the present study was to identify differentially expressed miRNAs (DEmiRs) and genes (DEGs) as potential biomarkers for lymph node metastasis and other prognostic factors in PeC. Tumor samples were prospectively obtained from 24 patients with squamous cell carcinoma of the penis. miRNA microarray analysis was performed comparing tumors from patients with inguinal lymph node metastatic and localized disease, and the results were validated by qRT-PCR. Eighty-three gene expression levels were also compared between groups through qRT-PCR. Moreover, DEmiRs and DEGs expression levels were correlated with clinicopathological variables, cancer-specific (CSS), and overall survival (OS). TAC software, TM4 MeV 4.9 software, SPSS v.25.0, and R software v.4.0.2 were used for statistical analyses. We identified 21 DEmiRs in microarray analysis, and seven were selected for validation. miR-744-5p and miR-421 were overexpressed in tissue samples of metastatic patients, and high expression of miR-421 was also associated with lower OS. We found seven DEGs (CCND1, EGFR, ENTPD5, HOXA10, IGF1R, MYC, and SNAI2) related to metastatic disease. A significant association was found between increased MMP1 expression and tumor size, grade, pathological T stage, and perineural invasion. Other genes were also associated with clinicopathological variables, CSS and OS. Finally, we found changes in mRNA-miRNA regulation that contribute to understanding the mechanisms involved in tumor progression. Therefore, we identified miRNA and mRNA expression profiles as potential biomarkers associated with lymph node metastasis and prognosis in PeC, in addition to disruption in mRNA-miRNA regulation during disease progression.
- Robotic-assisted radical prostatectomy in young adults: age-stratified oncological and functional outcomes(2022) BHAT, K. R. Seetharam; ONOL, Fikret Fatih; MOSCHOVAS, Marcio Covas; REDDY, Sunil; NOEL, Jonathan; ROGERS, Travis; COELHO, Rafael; ROCCO, Bernardo; PATEL, VipulThere is a scarcity of information on the outcomes of robotic-assisted prostatectomy (RALP) in young men. To compare the age-stratified functional and oncological outcomes of RALP in men aged <= 55 years. Among 10,997 patients in our RALP series, 2243 were <= 55 years old. These men were divided into 3 age-stratified groups (group 1 <= 45 years, group 2 46-50 years, and group 3 51-55 years old). Age-stratified groups were compared for clinical, oncological, and trifecta outcomes. Kaplan-Meier curves and Cox regression models were used to identify survival estimations and their predictors. Overall, 33% and 22% of men had non-organ confined (>= pT3) and Gleason >= 4 + 3 prostate cancer at final pathology, respectively. Younger patients had a higher incidence of low-risk disease and better erectile function at presentation. Organ-confined and Gleason 3 + 3 cancer rates for men <= 45 and 51-55 years were 82 vs. 74% and 41 vs. 30%, respectively (p < 0.05). Biochemical recurrence-free survival was similar among age-stratified groups. Bilateral full nerve-sparing (NS) rate was significantly higher in younger patients (74% in group 1 vs. 56% in group 3, p < 0.001). One-year trifecta rates were 79.8%, 71.6%, and 63.9% for increasing age groups, respectively (p < 0.001). Age, comorbidity score, and extent of NS were independent predictors of functional recovery. This study is limited by its retrospective design. At RALP, one-third of patients <= 55 years have locally advanced or high-risk prostate cancer. Age <= 45 years is associated with higher incidence of favorable tumor characteristics, which gives the surgeon increased ability to perform bilateral full NS, resulting in better functional recovery. In this report, we compared the age-stratified outcomes of RALP in a large series of men <= 55 years. We found that younger age was associated with more favorable tumor characteristics and better functional outcomes. We conclude that earlier diagnosis may lead to improved RALP outcomes.