RODRIGO OLIVA PEREZ
Índice h a partir de 2011
25
Projetos de Pesquisa
Unidades Organizacionais
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: potential pitfalls of a multicentre observational study(2018) PEREZ, R. O.; HABR-GAMA, A.; JULIAO, G. P. Sao; VAILATI, B. B.
- Putting down the scalpel in rectal cancer management - a historical perspective(2018) PEREZ, R. O.; HABR-GAMA, A.The surgical management of rectal cancer has evolved from a disease without any possibility of cure in the early 1700s where surgical management consisted of the palliative drainage of disease related abscesses to the present day where surgical cure is not only possible but also possible with sphincter or even organ preservation. Prof Habr-Gama's lecture describes the evolution of the surgical management of rectal cancer and the current focus on organ preservation.
- Session 4: Trying to augment response with chemotherapy: a triumph of hope over experience?(2018) BATTERSBY, N. J.; PEREZ, R. O.; BAXTER, N.; MORAN, B.; BROWN, G.As part of an approach to improve tumour regression and increase the proportion of patients with complete clinical and radiological response, Dr Perez reviews the methods and evidence base for augmenting therapy and thus augmenting response rates preoperatively. Much of the data reviewed were in the context of patients undergoing a watch-and-wait approach for rectal cancer after initial treatment with chemoradiotherapy.
- Is neoadjuvant chemoradiation with dose-escalation and consolidation chemotherapy sufficient to increase surgery-free and distant metastases-free survival in baseline cT3 rectal cancer?(2018) JULIAO, Guilheime Pagin Sao; HABR-GAMA, Angelita; VAILATI, Bruna Borba; AGUILAR, Patricia Bailao; SABBAGA, Jorge; ARAUJO, Sergio Eduardo Alonso; MATTACHEO, Adrian; ALEXANDRE, Flavia Andrea; FERNANDEZ, Laura Melina; GOMES, Diogo Bugano; GAMA-RODRIGUES, Joaquim; PEREZ, Rodrigo OlivaPatients with cT3 rectal cancer are less likely to develop complete response to neoadjuvant chemoradiation (nCRT) and still face significant risk for systemic relapse. In this setting, radiation (RT) dose-escalation and consolidation chemotherapy in ""extended"" nCRT regimens have been suggested to improve primary tumor response and decrease the risks of systemic recurrences. For these reasons we compared surgery-free and distant-metastases free survival among cT3 patients undergoing standard or extended nCRT. Methods: Patients with distal and non-metastatic T3 rectal cancer managed by nCRT were retrospectively reviewed.. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5FU-based chemotherapy) were compared to those undergoing extended CRT (54 Gy and 6 cycles of 5FU-based chemotherapy). Patients were assessed for tumor response at 8-10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (Watch & Wait). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Cox's logistic regression was performed to identify independent features associated with improved surgery-free survival after cCR and distant-metastases-free survival. Results: 155 patients underwent standard and 66 patients extended CRT. Patients undergoing extended CRT were more likely to harbor larger initial tumor size (p = 0.04), baseline nodal metastases (cN+; p < 0.001) and higher tumor location (p = 0.02). Cox-regression analysis revealed that the type of nCRT regimen was not independently associated with distinct surgery-free survival after cCR or distant-metastases-free survival (p > 0.05). Conclusions: Dose-escalation and consolidation chemotherapy are insufficient to increase long-term surgery-free survival among cT3 rectal cancer patients and provides no advantage in distant metastases-free survival.
- Contact X-Ray Brachytherapy in Organ Preservation for Rectal Cancer(2018) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; PEREZ, Rodrigo O.
- Lateral Node Dissection in Rectal Cancer in the Era of Minimally Invasive Surgery: A Step-by-Step Description for the Surgeon Unacquainted with This Complex Procedure with the Use of the Laparoscopic Approach(2018) PEREZ, Rodrigo Oliva; JULIAO, Guilherme P. Sao; VAILATI, Bruna Borba; FERNANDEZ, Laura M.; MATTACHEO, Adrian E.; KONISHI, TsuyoshiINTRODUCTION: Lateral node dissection in rectal cancer has been routinely performed in Eastern countries. Technical and anatomical challenges and potential significant postoperative morbidity associated with the procedure have prevented its implementation into clinical practice in Western countries. However, the minimally invasive approach may offer the opportunity of performing this complex procedure with precise anatomical dissection and minimal intraoperative blood loss. In this setting, proper training and standardization of technical steps is highly warranted for surgeons not fully acquainted with the procedure. TECHNIQUE: Access to the lateral nodes along the obturator and internal iliac vessels is described by using specific anatomical landmarks. Opening of the peritoneum along the ureter provides access to the region of interest. Dissection of the medial limit is performed preserving the neurovascular bundle and ureter. The lateral dissection is performed along the external iliac vein to provide access to the obturator muscle. Identification of the obturator nerve with blunt dissection of the fat is a critical part of the procedure. Once the lymphatic connections between the inguinal and iliac nodes are transected, dissection is performed along the internal iliac vessels, and branches are separated from the lymphadenectomy specimen. RESULTS: Evidence supports that lateral node dissection performed for highly selected patients with minimally invasive access leads to less intraoperative blood loss and similar oncological outcomes. Technical steps illustrated in the present video may aid surgeons in performing this procedure with precise anatomical landmarks and minimal risk for intraoperative complications. CONCLUSIONS: Lateral node dissection for rectal cancer is a procedure that may follow standardized technical steps by using precise anatomical landmarks with the use of minimally invasive approach.
- MRI Linac and How It May Potentially Lead to More Complete Response in Rectal Cancer(2018) CHAND, Manish; PEREZ, Rodrigo Oliva
- eContact Radiation Therapy for Achieving Organ Preservation in Rectal Cancer After Standard Neoadjuvant Chemoradiation: Looking for a Place in the Sun(2018) HABR-GAMA, Angelita; PEREZ, Rodrigo O.
- Alternative treatment to surgery for rectal cancer(2018) HABR-GAMA, Angelita; FERNANDEZ, Laura Melina; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; PEREZ, Rodrigo OlivaThe traditional concept of rectal cancer management has changed significantly over the last few years. Although surgical resection remains central the treatment of distal rectal cancer by proctectomy and total mesorectal excision (TME), there has been increased interest in organ preservation strategies. Neoadjuvant chemoradiation (nCRT) may result in significant tumor regression and complete pathological response may be observed in up to 42% of patients. In order to avoid the morbidity, mortality and functional consequences of major surgery, selected patients with clinical and radiological evidence of significant tumor regression after nCRT have been managed non-operatively with strict follow-up (Watch & Wait Strategy-WW) with acceptable outcomes and minimal functional consequences. In addition, close surveillance may allow early detection of local recurrences and salvage alternatives with no oncological compromise.
- The Estimate of the Impact of Coccyx Resection in Surgical Field Exposure During Abdominal Perineal Resection Using Preoperative High-Resolution Magnetic Resonance(2018) JULIAO, Guilherme Pagin Sao; ORTEGA, Cinthia D.; VAILATI, Bruna Borba; COUTINHO, Francisco A. B.; ROSSI, Gustavo; HABR-GAMA, Angelita; FERNANDEZ, Laura Melina; ARAUJO, Sergio Eduardo Alonso; BROWN, Gina; PEREZ, Rodrigo OlivaObjective To estimate the improvement in surgical exposure by removal of the coccyx, during abdomino-perineal resection (APR), in rectal cancer patients. Methods Retrospective study of 29 consecutive patients with rectal cancer was carried out. Using MR T2 sagittal series, the solid angle was estimated using the angle determined by the anterior resection margin and the tip of coccyx (no coccyx resection) or the tip of last sacral vertebra (coccyx resection). The solid angle provides an estimate of the tridimensional surface area provided by an original angle resulting in the best estimate of the surgeon's view/exposure to the critical dissecting point of choice (anterior rectal wall). The difference (""Gain"") in surgical field exposure by removal of the coccyx was compared by the solid angle variation between the two estimates (with and without the coccyx). Results Routine removal of the coccyx determines an average 42% (95% CI 27-57%) gain in surgical field exposure area facing the anterior rectal wall at the level of the prostate/vagina by the surgeon. Fifteen (51%) patients had >= 30% (median) estimated gain in surgical field exposure by coccygectomy. There was no association between BMI, age or gender and estimated gain in surgical field exposure area. Conclusions Routine removal of the coccyx during APR may result in an average increase in 42% in surgical field exposure during APR's perineal dissection. Precise estimation of surgical field exposure gain by removal of the coccyx may be predicted by MR sagittal series for each individual patient.