FABIO FERRARI MAKDISSI
Índice h a partir de 2011
12
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- Robotic ALPPS(2020) MACHADO, Marcel Autran C.; SURJAN, Rodrigo C.; MAKDISSI, FabioBackground The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure is a useful strategy to treat patients with advanced liver tumors and small future liver remnants. This video presents a robotic ALPPS procedure to treat synchronous colorectal liver metastases. Methods A 71-year-old man with liver metastases from sigmoid cancer was referred. A multidisciplinary team decided on chemotherapy followed by liver resection (first), then colon resection. After four cycles, objective response was observed and the multidisciplinary team then chose the ALPPS procedure. The future liver remnant (segments 3 and 4 and the Spiegel lobe) was 24%. A robotic approach was proposed. Colon resection was performed after the ALPPS procedure, also using the robotic approach. Results The duration of the first stage was 293 min, and the technique used in the first stage was partial ALPPS (parenchymal transection deep to 2 cm above the inferior vena cava) with preservation of the right hepatic duct. The patient was discharged on the fourth day. The second stage of the procedure took 245 min. Recovery was uneventful and the patient was discharged on the fourth day. Finally, the patient underwent robotic resection of the primary colorectal neoplasm. The surgery lasted 182 min, recovery was uneventful, and the patient was discharged on the fifth postoperative day. Final pathology disclosed a T3N1bM1 adenocarcinoma. Liver pathology confirmed colorectal metastases with partial response. All surgical margins were free. Currently, the patient is well, with no signs of disease 5 months post-procedure. Conclusions Robotic ALPPS is feasible and safe. The robotic approach may have some advantages over the laparoscopic and open ALPPS approaches. This video may help oncological surgeons to perform this complex procedure.
- Right Trisectionectomy with Principle En Bloc Portal Vein Resection for Right-Sided Hilar Cholangiocarcinoma: No-Touch Technique(2012) MACHADO, Marcel Autran; MAKDISSI, Fabio F.; SURJAN, Rodrigo C.Background. The most favorable long-term survival rate for hilar cholangiocarcinoma is achieved by a R0 resection. A surgical concept involving a no-touch technique, with extended right hepatic resections and principle en bloc portal vein resection was described by Neuhaus et al.(1) According to Neuhaus et al.,(1) their technique may increase the chance of R0, because the right branch of the portal vein and hepatic artery is in close contact with the tumor and is frequently infiltrated. The left artery runs on the left margin of the hilum and often is free. The 5-year survival rate for their patients is 61% but 60-day mortality rate is 8%.(1,2) Given the increased morbidity, some authors do not agree with routine resection of portal vein and may perform the resection of portal vein only on demand, after intraoperative assessment and confirmation of portal vein invasion.(3) This video shows en bloc resection of extrahepatic bile ducts, portal vein bifurcation, and right hepatic artery, together with extended right trisectionectomy (removal of segments 1, 4, 5, 6, 7, and 8). Methods. A 75-year-old man with progressive jaundice due to right-sided hilar cholangiocarcinoma underwent percutaneous biliary drainage with metallic stents for palliation. The patient was referred for a second opinion. Serum bilirubin levels were normal, and CT scan showed a resectable tumor, but volumetry showed a small left liver remnant. Right portal vein embolization was then performed, and CT scan performed after 4 weeks showed adequate compensatory hypertrophy of the future liver remnant (segments 2 and 3). Surgical decision was to perform a right trisectionectomy with en bloc portal vein and bile duct resection using the no-touch technique. Results. The operation began with hilar lymphadenectomy. The common bile duct is sectioned. Right hepatic artery is ligated. Left hepatic artery is encircled. Portal vein is dissected and encircled. Right liver is mobilized and detached from retrohepatic vena cava. Right and middle hepatic veins are divided. A right trisectionectomy along with segment 1 is performed, leaving specimen attached only by the portal vein. Portal vein is severed above and below the tumor, and specimen is removed. Portal vein anastomosis is done end-to-end with 6-0 Prolene. Doppler confirms normal portal flow. The procedure ends with Roux-Y hepaticojejunostomy. The patient recovered uneventfully, without transfusion, and was discharged on the tenth postoperative day. Final pathology confirmed hilar cholangiocarcinoma and R0 resection. Portal vein showed microscopic invasion. Patient is well with no evidence of the disease 14 months after the procedure. Conclusions. Right trisectionectomy with en bloc portal vein and bile duct resection is feasible and may enhance chance for R0 resection and a better late outcome, especially in cases when portal vein is microscopically involved. Although described in 1999, there are few detailed descriptions of this procedure, and to the best of our knowledge, no multimedia articles are available. This video may help oncological surgeons to perform and standardize this challenging procedure.
- Laparoscopic glissonean approach: Making complex something easy or making suitable the unsuitable?(2020) MACHADO, Marcel A.; MAKDISSI, Fabio; SURJAN, RodrigoBackground: The use of laparoscopic glissonean approach has many potential benefits such as shorter operative times, lower blood loss with low morbidity. Methods: The aim with this study was to perform an evaluation of 12 years of our experience with laparoscopic glissonean approach in liver surgery, from a technical standpoint using a prospective database. Anatomical laparoscopic liver resections using hilar dissection and non-anatomical resections were excluded from this study. Results: 327 patients (170 females and 157 males) with mean age of 56 years were included. 196 (60%) of procedures were major resections. 65% of procedures were performed in the last 5 years. 208 patients were operated on for secondary lesions. In 38 patients the liver was cirrhotic. Morbidity was 37.3% and 90-day mortality occurred in 2 patients (0.6%). Blood transfusion was necessary in 10.7% of patients. Median hospital stay was 4 days. Conclusions: Laparoscopic glissonean approach is a safe and feasible technique. It may be preferred in some clinical situations as it is associated with shorter operative times, lower blood loss, and low morbidity. It is superior to standard laparoscopic hepatectomy when an anatomical resection, especially if a segment or section is to be removed. However, application of this technique requires accurate preoperative tumor localization, identification of potential anatomic pedicle variations, as well as surgeon expertise.
- Totally Laparoscopic Right Hepatectomy with Roux-en-Y Hepaticojejunostomy for Right-Sided Intraductal Papillary Mucinous Neoplasm of the Bile Duct(2014) MACHADO, Marcel Autran; MAKDISSI, Fabio F.; SURJAN, Rodrigo C.Intraductal papillary neoplasm of the bile duct is a precursor lesion of cholangiocarcinoma. We present a video of a totally laparoscopic right hepatectomy with hilar dissection and lymphadenectomy, en-bloc resection of the extrahepatic bile duct, and Roux-en-Y hepaticojejunostomy in a patient with intraductal papillary neoplasm of the right hepatic duct. A 58-year-old woman with right upper quadrant pain was referred for evaluation. Abdominal ultrasonography revealed dilatation of intrahepatic and extrahepatic bile ducts. Magnetic resonance imaging showed a stop in the right bile duct, with dilatation of the distal bile duct. The decision was to perform a totally laparoscopic right hepatectomy with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy. The operative time was 400 min. Estimated blood loss was 400 ml, without the need for transfusions. Postoperative recovery was uneventful, and the patient was discharged on the 10th postoperative day. The abdominal drain was removed on the 14th postoperative drain with no signs of biliary leakage. Final pathology confirmed the diagnosis of intraductal papillary neoplasm without malignant transformation. Surgical margins were free. Patient is well with no evidence of the disease 14 months after the procedure. Laparoscopic right hepatectomy with hepaticojejunostomy is feasible and safe, provided it is performed in a specialized center and with staff with experience in hepatobiliary surgery and advanced laparoscopic surgery. Currently this operation is reserved for selected cases. This video can help oncologic surgeons to perform this complex procedure.
- Laparoscopic resection of caudate lobe. Technical strategies for a difficult liver segment - Video article(2018) MACHADO, Marcel Autran; SURJAN, Rodrigo; BASSERES, Tiago; MAKDISSI, Fabio
- Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer(2015) MACHADO, Marcel Autran; MAKDISSI, Fabio F.; SURJAN, Rodrigo C.Background. Gallbladder cancer is suspected preoperatively in only 30 % of all patients, while the remaining 70 % of cases are discovered incidentally by the pathologist. The increasing rate of cholecystectomies via laparoscopy has led to the detection of more gallbladder cancers in an early stage, and extended resection with regional lymph node dissection has been suggested. We present a video of a totally laparoscopic liver resection (segments 5 and 4b) with regional lymphadenectomy in a patient with an incidental gallbladder cancer. Methods. A 50-year-old woman underwent laparoscopic cholecystectomy, and pathology revealed a T1b gallbladder carcinoma. The patient was referred for further treatment. Contact with the primary surgeon revealed that no intraoperative cholangiogram was performed, and the gallbladder was removed intact, with no perforation, and inside a plastic retrieval bag. Pathology revision confirmed T1b, and positron emission tomography/computed tomography was negative. The multidisciplinary tumor board recommended radical re-resection, and a decision was made to perform a laparoscopic extended hilar lymphadenectomy, along the resection of segments 5 and 4b. Results. Operative time was 5 h, with an estimated blood loss of 240 mL. Recovery was uneventful and the patient was discharged on the fourth postoperative day. Final pathology showed no residual disease and no lymph node metastasis. Conclusions. Laparoscopic resection of liver segments 5 and 4b combined with a locoregional lymphadenectomy of the hepatoduodenal ligament is an oncologically appropriate technique, provided it is performed in a specialized center with experience in hepatobiliary surgery and advanced laparoscopic surgery. This video may help oncological surgeons to perform this complex procedure.
- Robotic Left Hepatectomy and Roux-en-Y Hepaticojejunostomy After Bile Duct Injury(2019) MACHADO, Marcel Autran; SURJAN, Rodrigo C.; ARDENGH, Andre O.; MAKDISSI, FabioBackground Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. This video presents a robotic left hepatectomy and Roux-en-Y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. Methods A 52-year-old man underwent laparoscopic cholecystectomy at another institution 8 years previously, which resulted in a bile duct injury. His postoperative period was complicated by jaundice and cholangitis. He was treated with endoscopic retrograde cholangiopancreatography and multiple endoprostheses for 3 years, after which the endoprostheses were removed, and he was sent to the authors' institution. Computed tomography showed that the left liver had signs of disturbed perfusion and dilation of the left intrahepatic bile duct. The patient was asymptomatic and refused any further attempt at surgical correction of the lesion. He was accompanied for 5 years. Magnetic resonance imaging showed progressive atrophy of the left liver. Finally, 3 months before this writing, he presented with intermittent episodes of cholangitis. A multidisciplinary team decided to perform left hepatectomy with Roux-en-Y hepatojejunostomy via a robotic approach. The left liver was atrophied, and left hepatectomy was performed. Fluorescence imaging was used to identify the right bile duct. At opening of the right bile duct, small stones were found and removed. Antecolic Roux-en-Y hepaticojejunostomy then was performed. Results The operative time was 335 min. Recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions Robotic repair of bile duct injuries is feasible and safe, even when liver resection is necessary. This video may help oncologic surgeons to perform this complex procedure.
- Evolution in the surgical management of colorectal liver metastases: Propensity score matching analysis (PSM) on the impact of specialized multidisciplinary care across two institutional eras(2018) KRUGER, Jaime A. P.; FONSECA, Gilton M.; MAKDISSI, Fabio F.; JEISMANN, Vagner B.; COELHO, Fabricio F.; HERMAN, PauloBackground and Objectives: Liver metastases are indicators of advanced disease in patients with colorectal cancer. Liver resection offers the best possibility of long-term survival. Surgical strategies have evolved in complexity in order to offer resection to a greater number of patients, requiring specialized multidisciplinary care. The current paper focused on analyzing outcomes of patients treated after the development of a dedicated cancer center in our institution. Methods: Patients operated on for CLM from our databank were paired through propensity score matching (PSM), and the initial experience of surgery for CLM was compared with the treatment performed after specialized multidisciplinary management. The demographic, oncological, and surgical features were analyzed between groups. Results: Overall, 355 hepatectomies were performed in 336 patients. Patients operated on during the second era of had greater use of preoperative chemotherapy (P<0.001) as well as exposure to more effective oxaliplatin-based regimens (P<0.001). Surgical management also changed, with minor (P=0.002) and non-anatomic (P=0.006) resections preferred over major operations. We also noted an increased number of minimally invasive resections (P<0.001). Conclusion: Treatment in a multidisciplinary cancer center led to changes in oncological and surgical management. Perioperative chemotherapy was frequently employed, and surgeons adopted a conservative approach to liver parenchyma.
- Total Laparoscopic Reversal ALPPS(2017) MACHADO, M. A.; SURJAN, R.; BASSERES, T.; MAKDISSI, F.Background. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver. Patient. A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment. The computed tomography (CT) scan showed a predominance of metastases in the left liver and in the right anterior section. The right posterior section had three metastases. The plan was to perform a laparoscopic reversal ALPPS (left portal vein ligation combined with in situ splitting in a two-stage left trisectionectomy). Technique. Three metastases in the right posterior section were resected, followed by liver partition and left portal vein ligature. The CT scan showed a 70 % increase in the future liver remnant. The second stage constituted left trisectionectomy. At laparoscopy after division of adhesions, the left Glissonian pedicle was divided with an endostapler. A stapler also was used to transect the left and middle hepatic veins, and the specimen was removed through a suprapubic incision. The operative times were respectively 5 and 3 h, and the patient was discharged on days 4 and 5, respectively. No blood transfusion or intensive care unit stay was necessary. At this writing, the patient shows no evidence of the disease 18 months after the procedure. Conclusions. Reversal laparoscopic ALPPS is feasible and safe. Laparoscopy is useful for decreasing blood loss and optimizing visualization during liver transection.
- Laparoscopic Parenchymal-Sparing Liver Resections Using the Intrahepatic Glissonian Approach(2017) MACHADO, Marcel Autran C.; SURJAN, R.; BASSERES, T.; MAKDISSI, F.Background. One of the main criticisms of laparoscopic liver resection is that it is difficult, or not possible, to perform liver-sparing resections. Our aim was to present short videos where the intrahepatic Glissonian approach was used to perform anatomical liver segmental resections, instead of a larger operation, to avoid unnecessary sacrifice of the liver parenchyma. Methods. We selected six types of anatomical liver resections to exemplify the use of the intrahepatic Glissonian approach to perform segment-oriented liver resections. These types of hepatectomies were used as an alternative to right or left hepatectomy, or as an alternative to extended liver resections. Results. The intrahepatic Glissonian approach was feasible in all cases. The use of anatomical landmarks previously described was essential to reach and control the Glissonian pedicles. Among the liver-sparing resections, we were able to perform right anterior (S5 + S8) and posterior (S6 + S7) sectionectomies, resection of segments 2, 3, and 4, and mesohepatectomy (S4 + S5 + S8). No patient presented postoperative liver failure. Conclusions. Laparoscopic liver-sparing resections are feasible and may be a good alternative to hemihepatectomies or extended liver resections. The use of the intrahepatic Glissonian approach can be useful.