MARCELO SIMAS DE LIMA

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 16 Citação(ões) na Scopus
    Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer
    (2017) RETES, Felipe A.; KAWAGUTI, Fabio S.; LIMA, Marcelo S. de; MARTINS, Bruno da Costa; UEMURA, Ricardo S.; PAULO, Gustavo A. de; PENNACCHI, Caterina M. P.; GUSMON, Carla; RIBEIRO, Adriana V. S.; BABA, Elisa R.; GEIGER, Sebastian N.; SORBELLO, Mauricio P.; KULCSAR, Marco A.; RIBEIRO JR., Ulysses; MALUF-FILHO, Fauze
    Background and study aims: Percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients is associated with higher complication and mortality rates when compared to a general patient population. The pull technique is still the preferred technique worldwide but it has some limitations. The aim of this study is to compare the pull and introducer PEG techniques in patients with HNC. Patients and methods: This study is based on a retrospective analysis of a prospectively collected database of 309 patients with HNC who underwent PEG in the Cancer Institute of SAo Paulo. Results: The procedure was performed with the standard endoscope in 205 patients and the introducer technique was used in 137 patients. There was one procedure-related mortality. Age, sex and albumin level were similar in both groups. However in the introducer technique group, patients had a higher tumor stage, a lower Karnofsky status, and presented more frequently with tracheostomy and trismus. Overall, major, minor, immediate and late complications and 30-day mortality rates were similar but the introducer technique group presented more minor bleeding and tube dysfunctions. Conclusion: The push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.
  • article
    Long-term results of an endoscopic screening program for superficial esophageal cancer in patients with head and neck squamous cell carcinoma
    (2022) MOURA, Renata Nobre; KUBOKI, Yeda; BABA, Elisa Ryoka; SAFATLE-RIBEIRO, Adriana; MARTINS, Bruno; PAULO, Gustavo Andrade de; TOLENTINO, Luciano Lenz; LIMA, Marcelo Simas de; KULCSAR, Marco Aurelio; SALLUM, Rubens Antonio Aissar; JR, Ulysses Ribeiro; MALUF-FILHO, Fauze
    Background and study aims Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of a second primary tumor in the gastrointestinal tract, most commonly in the esophagus. Screening these patients for esophageal carcinoma may help detect asymptomatic dysplasia and early cancer, thus allowing curative treatment and more prolonged survival, but the impact of endoscopic screening remains uncertain. Here we aimed to describe the long-term results of an esophageal SCC screening program in patients with head and neck cancer in terms of prevalence, associated risk factors, and survival. Patients and methods We performed an observational study of a prospectively collected database including patients with HNSCC who had undergone high-definition endoscopy with chromoscopy between 2010 and 2018 at a Brazilian tertiary academic center. Results The study included 1,888 patients. The esophageal SCC prevalence was 7.9 %, with the majority (77.8 %) being superficial lesions. Significant risk factors for esophageal high-grade dysplasia (HGD) and invasive cancer included tumors of the oral cavity and oropharynx and the presence of low-grade dysplasia (LGD). Overall survival (OS) was significantly shorter among patients in whom esophageal cancer was diagnosed at an advanced stage (P < .001). OS did not significantly differ between patients with HGD and early esophageal cancer versus those without esophageal cancer (P = .210) Conclusions Endoscopic screening for superficial esophageal neoplasia in patients with HNSCC improves esophageal cancer detection. Screening could potentially benefit patients with primary cancer located at the oropharynx or oral cavity. In addition, the detection of esophageal LGD indicates a need for endoscopic surveillance.
  • article
    Pancreatic Metastasis from Papillary Thyroid Carcinoma: A Case Report
    (2020) MACHADO, Andressa A.; LENZ, Luciano; DOMINGUES, Regina B.; LIMA, Gustavo R. A.; JOSINO, Iatagan R.; CORDERO, Martin A. C.; V, Adriana Safatle-Ribeiro; MARTINS, Bruno C.; PENNACCHI, Caterina M. P. S.; GUSMON, Carla C.; PAULO, Gustavo A.; LIMA, Marcelo S.; BABA, Elisa R.; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; MALUF-FILHO, Fauze
    Introduction differentiated thyroid carcinoma presents with distant metastasis in 4% of cases, usually occurring in the lungs, bones and thoracic lymph nodes. Pancreatic involvement is extremely rare, with few cases reported in the literature. Case report A 47-years-old female patient presented abdominal pain. She had a history of papillary thyroid carcinoma surgically resected in 2009. After 10 years, computed tomography revealed hepatic lesions suggestive of secondary involvement and a solid mass in the pancreatic head. Endoscopic ultrasound fine-needle aspiration was performed in a heterogeneous hypoechoic mass located at pancreatic head. Cell block with immunohistochemistry was positive for thyroglobulin, suggesting papillary thyroid carcinoma metastasis. The patient still survives at present, treating metastasis with Cabozantinib. Conclusion endoscopic ultrasound fine-needle aspiration is a minimally invasive and accurate method of sampling lesions of the pancreas. In combination with clinical history and immunohistochemistry, can confirm diagnosis and define management.
  • article 8 Citação(ões) na Scopus
    Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer
    (2018) GUSMON-OLIVEIRA, Carla Cristina; KUBOKI, Yeda Mayumi; PAULO, Gustavo Andrade de; LIMA, Marcelo Simas de; UEMURA, Ricardo Sato; MARTINS, Bruno Costa; TOLENTINO, Luciano Lenz; SAFATLE-RIBEIRO, Adriana Vaz; KULCSAR, Marco Aurelio; RIBEIRO JR., Ulysses; MALUF-FILHO, Fauze
    Background. Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge. It is not uncommon that PES is refractory to dilation sessions. This study aimed at evaluating the efficacy of Mitomycin C (MMC) endoscopic injection for the treatment of refractory pharyngoesophageal stenosis. Patients and methods. This is a prospective study in patients with dysphagia following head and neck cancer treatment, without evidence suggestive of tumor recurrence, and refractory to endoscopic treatment. These patients were submitted to endoscopic dilation of the stenotic segment with thermoplastic bougies, followed by injection of MMC. We repeated the endoscopic sessions every three weeks. Results. From January 2015 to May 2015, we treated 13 patients with PES. Three patients were initially enrolled in the study for refractory stricture. We observed adverse events in all of them, with intense neck pain and ulcer development, justifying the interruption of the trial. Conclusion. The repeated injection in the short interval of MMC in refractory PES is not recommended, because it resulted in serious adverse events.
  • conferenceObject
    COMPARISON OF PLASTIC STENTS AND SELF-EXPANDING METAL STENTS IN THE ENDOSCOPIC DRAINAGE OF MALIGNANT HILAR BILIARY OBSTRUCTION
    (2023) MENDIETA, Pastor Joaquin Ortiz; MARTINS, Bruno; CENTENO, Deborah; GREGORIO, Julia; SUETA, Rafael; SAFATLE-RIBEIRO, Adriana; PENNACCHI, Caterina; GUSMON, Carla; KAWAGUTI, Fabio; PAULO, Gustavo De; LENZ, Luciano; LIMA, Marcelo; UEMURA, Ricardo; NOBRE, Renata; GEIGER, Sebastian; MALUF-FILHO, Fauze
  • conferenceObject
    COMPARISON OF PLASTIC STENTS AND SELFEXPANDING METAL STENTS IN THE ENDOSCOPIC DRAINAGE OF MALIGNANT HILAR BILIARY OBSTRUCTION
    (2023) MENDIETA, Pastor Joaquin Ortiz; MARTINS, Bruno; CENTENO, Deborah; GREGORIO, Julia; SUETA, Rafael; SAFATLE-RIBEIRO, Adriana; PENNACCHI, Caterina; GUSMON, Carla; KAWAGUTI, Fabio; PAULO, Gustavo De; LENZ, Luciano; LIMA, Marcelo; UEMURA, Ricardo; NOBRE, Renata; GEIGER, Sebastian; MALUF, Fauze
  • conferenceObject
    THE ROLE OF PROBE-BASED CONFOCAL ENDOMICROSCOPY (PCLE) IN THE DIAGNOSIS OF SUSTAINED CLINICAL COMPLETE RESPONSE UNDER WATCH-AND-WAIT STRATEGY AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED RECTAL ADENOCARCINOMA
    (2022) SAFATLE-RIBEIRO, Adriana V.; LATA, John; FERREIRA, Marina Tucci Gammaro Baldavira; FLOR, Marcelo M.; PEREZ, Caio; BABA, Elisa R.; LENZ, Luciano H.; MARTINS, Bruno Da Costa; KAWAGUTI, Fabio S.; PAULO, Gustavo A. De; LIMA, Marcelo S. De; MOURA, Renata N.; PENNACCHI, Caterina; GUSMON, Carla; GEIGER, Sebastian; UEMURA, Ricardo; NAHAS, Caio Sergio R.; MARQUES, Carlos F.; IMPERIALE, Antonio R.; COTTI, Guilherme C.; RIBEIRO, Ulysses; MALUF-FILHO, Fauze; NAHAS, Sergio C.
  • article 19 Citação(ões) na Scopus
    Argon plasma coagulation for the endoscopic treatment of gastrointestinal tumor bleeding: A retrospective comparison with a non-treated historical cohort
    (2016) MARTINS, Bruno Costa; WODAK, Stephanie; GUSMON, Carla C.; SAFATLE-RIBEIRO, Adriana Vaz; KAWAGUTI, Fabio Shiguehissa; BABA, Elisa Ryoka; PENNACCHI, Caterina M. P.; LIMA, Marcelo Simas; RIBEIRO JR., Ulysses; MALUF-FILHO, Fauze
    Background: The endoscopic use of argon plasma coagulation (APC) to achieve hemostasis for upper gastrointestinal tumor bleeding (UGITB) has not been adequately evaluated in controlled trials. This study aimed to evaluate the efficacy of APC for the treatment of upper gastrointestinal bleeding from malignant lesions. Methods: Between January and September 2011, all patients with UGITB underwent high-potency APC therapy (up to 70 Watts). This group was compared with a historical cohort of patients admitted between January and December 2010, when the endoscopic treatment of bleeding malignancies was not routinely performed. Patients were stratified into two categories, grouping the Eastern Cooperative Oncology Group (ECOG) performance status scale: Category I (ECOG 0-2) patients with a good clinical status and Category II (ECOG 3-4) patients with a poor clinical status. Results: Our study had 25 patients with UGITB whom underwent APC treatment and 28 patients whom received no endoscopic therapy. The clinical characteristics of the groups were similar, except for endoscopic active bleeding, which was more frequently detected in APC group. We had 15 patients in the APC group whom had active bleeding, and initial hemostasis was obtained in 11 of them (73.3%). In the control group, four patients had active bleeding. There were no differences in 30-day re-bleeding (33.3% in the APC group versus 14.3% in the control group; p=0.104) and 30-day mortality rates (20.8% in the APC group, versus 42.9% in the control group; p=0.091). When patients were categorized according to their ECOG status, we found that APC therapy had no impact in re-bleeding and mortality rates (Group I: APC versus no endoscopic treatment: re-bleeding p=0.412, mortality p=0.669; Group II: APC versus no endoscopic treatment: re-bleeding p=0.505, mortality p=0.580). Hematemesis and site of bleeding located at the esophagus or duodenum were associated with a higher 30-day mortality. Conclusions: Endoscopic hemostasis of UGITB with APC has no significant impact on 30-day re-bleeding and mortality rates, irrespective of patient performance status.
  • conferenceObject
    INTRALESIONAL STEROID INJECTION VERSUS ORAL PREDNISOLONE FOR THE PREVENTION OF ESOPHAGEAL STRICTUTE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION: A RANDOMIZED CLINICAL TRIAL
    (2023) OLIVEIRA, Joel; MARTINS, Bruno Da Costa; NOBRE, Renata; PAULO, Gustavo De; LENZ, Luciano; LIMA, Marcelo De; SAFATLE-RIBEIRO, Adriana; MALUF-FILHO, Fauze
  • article 1 Citação(ões) na Scopus
    Results of endoscopic biliary drainage in patients with malignant hilar stricture
    (2023) MARTINS, Bruno Costa; PEREZ, Caio A.; RUAS, Jennifer N.; BENTO, Luiza H.; MENDONCA, Ernesto Q.; PAULO, Gustavo A. de; UEMURA, Ricardo S.; GEIGER, Sebastian N.; LIMA, Marcelo Simas de; JUKEMURA, Jose; JR, Ulysses Ribeiro; MALUF-FILHO, Fauze
    In Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the qual-ity of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drain-age by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hos-pital de Sao Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients pre-senting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60 +/- 13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logis-tic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28-20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal stric-tures (Bismuth IV) were associated with poor drainage outcomes.