LUCAS SOUTO NACIF
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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- PREOPERATIVE COMPUTED TOMOGRAPHY VOLUMETRY AND GRAFT WEIGHT ESTIMATION IN ADULT LIVING DONOR LIVER TRANSPLANTATION(2017) PINHEIRO, Rafael S.; CRUZ-JR, Ruy J.; ANDRAUS, Wellington; DUCATTI, Liliana; MARTINO, Rodrigo B.; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; ARANTES, Rubens M; LAI, Quirino; IBUKI, Felicia S.; ROCHA, Manoel S.; D´ALBUQUERQUE, Luiz A. C.ABSTRACT Background: Computed tomography volumetry (CTV) is a useful tool for predicting graft weights (GW) for living donor liver transplantation (LDLT). Few studies have examined the correlation between CTV and GW in normal liver parenchyma. Aim: To analyze the correlation between CTV and GW in an adult LDLT population and provide a systematic review of the existing mathematical models to calculate partial liver graft weight. Methods: Between January 2009 and January 2013, 28 consecutive donors undergoing right hepatectomy for LDLT were retrospectively reviewed. All grafts were perfused with HTK solution. Estimated graft volume was estimated by CTV and these values were compared to the actual graft weight, which was measured after liver harvesting and perfusion. Results: Median actual GW was 782.5 g, averaged 791.43±136 g and ranged from 520-1185 g. Median estimated graft volume was 927.5 ml, averaged 944.86±200.74 ml and ranged from 600-1477 ml. Linear regression of estimated graft volume and actual GW was significantly linear (GW=0.82 estimated graft volume, r2=0.98, slope=0.47, standard deviation of 0.024 and p<0.0001). Spearman Linear correlation was 0.65 with 95% CI of 0.45 - 0.99 (p<0.0001). Conclusion: The one-to-one rule did not applied in patients with normal liver parenchyma. A better estimation of graft weight could be reached by multiplying estimated graft volume by 0.82.
conferenceObject Congenital extrahepatic portosystemic shunts (Abernethy malformation): International observational study of clinical manifestations and outcome.(2017) AZNAR, Anna Baiges; TURON, Fanny; SIMON-TALERO, Macarena; TASAYCO, Stephanie; BUENO, Javier; ZEKRINI, Kamal; PLESSIER, Aurelie; COENEN, Sandra; MAJUMDAR, Avik; GOTTARDI, Andrea De; SHUKLA, Akash; CARRILHO, Flair J.; NACIF, Lucas S.; PRIMIGNANI, Massimo; NEVENS, Frederik; WITTERS, Peter; PROCOPET, Bogdan; PISCAGLIA, Fabio; ALVAREZ-NAVASCUES, Carmen; GONZALEZ, Javier Martinez; HERNANDEZ-GEA, Virginia; LALEMAN, Wim; HARTOG, Hermien; VALLA, Dominique C.; PEREZ, Mercedes; GENESCA, Joan; GARCIA-PAGAN, Juan Carlos- Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality(2015) ANDRAUS, Wellington; PINHEIRO, Rafael Soares; LAI, Quirino; HADDAD, Luciana B. P.; NACIF, Lucas S.; D'ALBUQUERQUE, Luiz Augusto C.; LERUT, JanBackground: Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial. Methods: A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality. Results: The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028). Conclusions: Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy.
- Congenital Extrahepatic Portosystemic Shunts (Abernethy Malformation): An International Observational Study(2020) BAIGES, Anna; TURON, Fanny; SIMON-TALERO, Macarena; TASAYCO, Stephanie; BUENO, Javier; ZEKRINI, Kamal; PLESSIER, Aurelie; FRANCHI-ABELLA, Stephanie; GUERIN, Florent; MUKUND, Amar; EAPEN, C. E.; GOEL, Ashish; SHYAMKUMAR, Nidugala Keshava; COENEN, Sandra; GOTTARDI, Andrea De; MAJUMDAR, Avik; ONALI, Simona; SHUKLA, Akash; CARRILHO, Flair Jose; NACIF, Lucas; PRIMIGNANI, Massimo; TOSETTI, Giulia; MURA, Vicenzo La; NEVENS, Frederik; WITTERS, Peter; TRIPATHI, Dhiraj; TELLEZ, Luis; MARTINEZ, Javier; ALVAREZ-NAVASCUES, Carmen; LOPEZ, Miguel Lopez Fraile; PROCOPET, Bogdan; PISCAGLIA, Fabio; KONING, Barbara de; LLOP, Elba; ROMERO-CRISTOBAL, Mario; TJWA, Eric; MONESCILLO-FRANCIA, Alberto; SENZOLO, Marco; PEREZ-LAFUENTE, Mercedes; SEGARRA, Antonio; SARIN, Shiv Kumar; HERNANDEZ-GEA, Virginia; PATCH, David; LALEMAN, Wim; HARTOG, Hermien; VALLA, Dominique; GENESCA, Joan; GARCIA-PAGAN, Juan Carlos; GARCIA-CRIADO, Angeles; DARNELL, Anna; BELMONTE, Ernest; FERRUSQUIA-ACOSTA, Jose; MAGAZ, Marta; VIDAL-GONZALEZ, Judit; HORIA, Stefanescu; NICOARA-FARCAU, Oana; JOSEPH, Philip; ZACHARIAH, Uday; MOSES, Vinu; MAMMEN, Suraj; AHMED, Munawwar; KOSHY, George; EAPEN, Anu; SAJITH, K. G.; VYAS, F. L.; RAJU, R. S.; RYMBAI, Manbha L.; ARULKUMAR, S.; RAMACHANDRAN, Jeyamani; ELIAS, ElwynCongenital extrahepatic portosystemic shunt (CEPS) or Abernethy malformation is a rare condition in which splanchnic venous blood bypasses the liver draining directly into systemic circulation through a congenital shunt. Patients may develop hepatic encephalopathy (HE), pulmonary hypertension (PaHT), or liver tumors, among other complications. However, the actual incidence of such complications is unknown, mainly because of the lack of a protocolized approach to these patients. This study characterizes the clinical manifestations and outcome of a large cohort of CEPS patients with the aim of proposing a guide for their management. This is an observational, multicenter, international study. Sixty-six patients were included; median age at the end of follow-up was 30 years. Nineteen patients (28%) presented HE. Ten-, 20-, and 30-year HE incidence rates were 13%, 24%, and 28%, respectively. No clinical factors predicted HE. Twenty-five patients had benign nodular lesions. Ten patients developed adenomas (median age, 18 years), and another 8 developed HCC (median age, 39 years). Of 10 patients with dyspnea, PaHT was diagnosed in 8 and hepatopulmonary syndrome in 2. Pulmonary complications were only screened for in 19 asymptomatic patients, and PaHT was identified in 2. Six patients underwent liver transplantation for hepatocellular carcinoma or adenoma. Shunt closure was performed in 15 patients with improvement/stability/cure of CEPS manifestations. Conclusion: CEPS patients may develop severe complications. Screening for asymptomatic complications and close surveillance is needed. Shunt closure should be considered both as a therapeutic and prophylactic approach.
- Laparoscopic cholecystectomy and cirrhosis: patient selection and technical considerations(2017) PINHEIRO, Rafael S.; WAISBERG, Daniel R.; LAI, Quirino; ANDRAUS, Wellington; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; D'ALBUQUERQUE, Luiz A. C.The incidence of cholelithiasis in cirrhotic patients is higher than in general population. In the past, open cholecystectomy (OC) was the standard approach for patients requiring cholecystectomy. However, laparoscopic cholecystectomy (LC) was introduced in 1980's and gradually became the preferred technique even to cirrhotic patients. The performance of gastrointestinal surgery procedures in cirrhotics patients is well-known to be associated with higher technical difficulty and increased morbidity-mortality. Cirrhosis is a major key intraoperative finding that contributes to surgical difficulty in LC. Model of End Stage Liver Disease (MELD) score and Child-Pugh Classification are the best devices to evaluate the underlying liver disease and to predict morbidity-mortality. Acute cholecystitis has higher incidence in patients with cirrhosis, emergency procedures in cirrhotics patients are associated with higher morbidity, longer postoperative hospitalization and a seven-fold higher mortality in comparison to elective surgery. LC in cirrhotics has a higher conversion rate to open procedure; however, LC demonstrated substantial advantage over OC providing shorter convalescence period and hospital stay.
- Living donor liver transplantation for hepatocellular cancer: An (almost) exclusive Eastern procedure?(2017) PINHEIRO, R. S.; WAISBERG, D. R.; NACIF, L. S.; ROCHA-SANTOS, V.; ARANTES, R. M.; DUCATTI, L.; MARTINO, R. B.; LAI, Q.; ANDRAUS, W.; DALBUQUERQUE, L. A. C.Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer and it is linked with chronic liver disease. Liver transplantation (LT) is the best curative treatment modality, since it can cure simultaneously the underlying liver disease and HCC. Milan criteria (MC) are the benchmark for selecting patients with HCC for LT, achieving up to 91% 1-year survival post transplantation. However, when considering intention-to-treat (ITT) rates are substantially lower, mainly due dropout. Additionally, Milan criteria (MC) are too restrictive and more inclusive criteria have been reported with good outcomes. Mainly, in Eastern countries, deceased donors are scarce, therefore Asian centers have developed living-donor liver transplantation (LDLT) to a state-of-art status. There are many eastern centers reporting huge numbers of LDLT with outstanding results. Regarding HCC patients, they have reported many criteria including more advanced tumors achieving reasonable outcomes. Western countries have well-established deceased-donor liver transplantation (DDLT) programs. However, organ shortage and restrictive criteria for listing patients with HCC endorses LDLT as a good option to offer curative treatment to more HCC patients. However, there are some controversial reports claiming higher rates of HCC recurrence after LDLT than DDLT. An extensive review included 30 studies with cohorts of HCC patients who underwent LDLT in both East and West countries. We reported also the results of our Institution, in Brazil, where it was performed the first LDLT. This review also addresses the eligibility criteria for transplanting patients with HCC developed in Western and Eastern countries. © Translational Gastroenterology and Hepatology. All rights reserved.
- Resection for intrahepatic cholangiocellular cancer: new advances(2018) WAISBERG, Daniel R.; PINHEIRO, Rafael S.; NACIF, Lucas S.; ROCHA-SANTOS, Vinicius; MARTINO, Rodrigo B.; ARANTES, Rubens M.; DUCATTI, Liliana; LAI, Quirino; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz C.Intrahepatic cholangiocarcinoma (ICC) is the second most prevalent primary liver neoplasm after hepatocellular carcinoma (HCC), corresponding to 10% to 15% of cases. Pathologies that cause chronic biliary inflammation and bile stasis are known predisposing factors for development of ICC. The incidence and cancer-related mortality of ICC is increasing worldwide. Most patients remain asymptomatic until advance stage, commonly presenting with a liver mass incidentally diagnosed. The only potentially curative treatment available for ICC is surgical resection. The prognosis is dismal for unresectable cases. The principle of the surgical approach is a margin negative hepatic resection with preservation of adequate liver remnant. Regional lymphadenectomy is recommended at time of hepatectomy due to the massive impact on outcomes caused by lymph node (LN) metastasis. Multicentric disease, tumor size, margin status and tumor differentiation are also important prognostic factors. Staging laparoscopy is warranted in high-risk patients to avoid unnecessary laparotomy. Exceedingly complex surgical procedures, such as major vascular, extrahepatic bile ducts and visceral resections, ex vivo hepatectomy and autotransplantation, should be implemented in properly selected patients to achieve negative margins. Neoadjuvant therapy may be used in initially unresectable lesions in order to downstage and allow resection. Despite optimal surgical management, recurrence is frustratingly high. Adjuvant chemotherapy with radiation associated with locoregional treatments should be considered in cases with unfavorable prognostic factors. Selected patients may undergo re-resection of tumor recurrence. Despite the historically poor outcomes of liver transplantation for ICC, highly selected patients with unresectable disease, especially those with adequate response to neoadjuvant therapy, may be offered transplant. In this article, we reviewed the current literature in order to highlight the most recent advances and recommendations for the surgical treatment of this aggressive malignancy.