LEANDRO CARDOSO BARCHI
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- II BRAZILIAN CONSENSUS ON GASTRIC CANCER BY THE BRAZILIAN GASTRIC CANCER ASSOCIATION(2020) BARCHI, Leandro Cardoso; RAMOS, Marcus Fernando Kodama Pertille; DIAS, Andre Roncon; ANDREOLLO, Nelson Adami; WESTON, Antonio Carlos; LOURENCO, Laercio Gomes; MALHEIROS, Carlos Alberto; KASSAB, Paulo; ZILBERSTEIN, BrunoBackground: Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. Aim: This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. Methods: Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree A consensus was adopted when at least 80% of the sum of the answers ""fully agree"" and ""partially agree"" was reached. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. Results: Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. Conclusion: The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
- GASTRIC NEUROENDOCRINE TUMOR: REVIEW AND UPDATE(2017) DIAS, Andre Roncon; AZEVEDO, Beatriz Camargo; ALBAN, Luciana Bastos Valente; YAGI, Osmar Kenji; RAMOS, Marcus Fernando Kodama Pertille; JACOB, Carlos Eduardo; BARCHI, Leandro Cardoso; CECCONELLO, Ivan; RIBEIRO-JR, Ulysses; ZILBERSTEIN, BrunoABSTRACT Introduction: The frequency of gastric neuroendocrine tumors is increasing. Reasons are the popularization of endoscopy and its technical refinements. Despite this, they are still poorly understood and have complex management. Aim: Update the knowledge on gastric neuroendocrine tumor and expose the future perspectives on the diagnosis and treatment of this disease. Method: Literature review using the following databases: Medline/PubMed, Cochrane Library and SciELO. Search terms were: gastric carcinoid, gastric neuroendocrine tumor, treatment. From the selected articles, 38 were included in this review. Results: Gastric neuroendocrine tumors are classified in four clinical types. Correct identification of the clinical type and histological grade is fundamental, since treatment varies accordingly and defines survival. Conclusion: Gastric neuroendocrine tumors comprise different subtypes with distinct management and prognosis. Correct identification allows for a tailored therapy. Further studies will clarify the diseases biology and improve its treatment.
conferenceObject OUTCOME OF GASTRIC CANCER PATIENTS SUBMITTED TO D1 LYMPH NODE DISSECTION DUE TO UNFAVORABLE MEDICAL CONDITIONS(2017) RAMOS, Marcus Kodama; PEREIRA, Marina; DIAS, Andre R.; YAGI, Osmar K.; BARCHI, Leandro C.; JACOB, Carlos E.; MUCERINO, Donato R.; LOPASSO, Fabio; MESTER, Marcelo; BRESCIANI, Claudio C.; CHARRUF, Amir Z.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, Ulyssesarticle Surgical outcome of Gastric Cancer in patients older than 80 years(2016) OLIVEIRA, Rodrigo José de; CHARRUF, Amir Zeide; JACOB, Carlos Eduardo; RAMOS, Marcus Kodama P.; DIAS, André Roncon; YAGI, Osmar K.; MUCERINO, Donato R.; BARCHI, Leandro; MESTER, Marcelo; BRESCIANI, Cláudio J. C.; LOPASSO, Fábio P.; ZILBERSTEIN, Bruno; CECCONELLO, Ivanarticle Morbimortality of extended local resection for advanced gastric cancer(2016) OLIVEIRA, Rodrigo José de; CHARRUF, Amir Zeide; JACOB, Carlos Eduardo; RAMOS, Marcus Kodama P.; DIAS, André Roncon; YAGI, Osmar K.; MUCERINO, Donato R.; BARCHI, Leandro; MESTER, Marcelo; BRESCIANI, Cláudio J. C.; LOPASSO, Fábio P.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan- TOTAL OMENTECTOMY IN GASTRIC CANCER SURGERY: IS IT ALWAYS NECESSARY?(2019) BARCHI, Leandro Cardoso; RAMOS, Marcus Fernando Kodama Pertille; DIAS, Andre Roncon; YAGI, Osmar Kenji; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBackground: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce. Alm: To evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing curative gastrectomy for GC, as well as its risk factors and patients' outcomes. Methods: All consecutive patients submitted to D2/modified D2 gastrectomy due to gastric adenocarcinoma from March 2009 to April 2016 were retrospectively reviewed from a prospective collected database. Results: Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor's size (p=0.018), N stage (p<0.001), clinical stage (p=0.022), venous invasion growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). Conclusion: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low. Total omentectomy may be avoided in tumors smaller than 5.25 cm and T1/T2 tumors. However, the presence of lymph node metastases in the greater omentum is associated with recurrence in the peritoneum, liver, ovary and death.
- MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: PARADIGM SHIFT(2019) RAMOS, Marcus Fernando Kodama Pertille; BARCHI, Leandro Cardoso; WESTON, Antonio Carlos; ZILBERSTEIN, Bruno
- Gastric partitioning for the treatment of malignant gastric outlet obstruction(2019) RAMOS, Marcus Fernando Kodama Pertille; BARCHI, Leandro Cardoso; OLIVEIRA, Rodrigo Jose de; PEREIRA, Marina Alessandra; MUCERINO, Donato Roberto; RIBEIRO JR., Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBACKGROUND Gastric outlet obstruction (GOO) is one of the main complications in stage IV gastric cancer patients. This condition is usually managed by gastrojejunostomy (GJ). However, gastric partitioning (GP) has been described as an alternative to overcoming possible drawbacks of GJ, such as delayed gastric emptying and tumor bleeding. AIM To compare the outcomes of patients who underwent GP and GJ for malignant GOO. METHODS We retrospectively analyzed 60 patients who underwent palliative gastric bypass for unresectable distal gastric cancer with GOO from 2009 to 2018. Baseline clinicopathological characteristics including age, nutritional status, body mass index, and performance status were evaluated. Obstructive symptoms were graded according to GOO score (GOOS). Surgical outcomes evaluated included duration of the procedure, surgical complications, mortality, and length of hospital stay. Acceptance of oral diet after the procedure, weight gain, and overall survival were the long-term outcomes evaluated. RESULTS GP was performed in 30 patients and conventional GJ in the other 30 patients. The mean follow-up was 9.2 mo. Forty-nine (81.6%) patients died during that period. All variables were similar between groups, with the exception of worse performance status in GP patients. The mean operative time was higher in the GP group (161.2 vs 85.2 min, P < 0.001). There were no differences in postoperative complications and surgical mortality between groups. The median overall survival was 7 and 8.4 mo for the GP and GJ groups, respectively (P = 0.610). The oral acceptance of soft solids (GOOS 2) and low residue or full diet (GOOS 3) were reached by 28 (93.3%) GP patients and 22 (75.9%) GJ patients (P = 0.080). Multivariate analysis demonstrated that GOOS 2 and GOOS 3 were the main prognostic factors for survival (hazard ratio: 8.90, 95% confidence interval: 3.3823.43, P < 0.001). CONCLUSION GP is a safe and effective procedure to treat GOO. Compared to GJ, it provides similar surgical outcomes with a trend to better solid diet acceptance by patients.
- Surgical results of remnant gastric cancer treatment(2020) RAMOS, MARCUS FERNANDO KODAMA PERTILLE; PEREIRA, MARIA CLAUDIA MACHADO; OLIVEIRA, YARA SOUZA; PEREIRA, MARINA ALESSANDRA; BARCHI, LEANDRO CARDOSO; DIAS, ANDRE RONCON; ZILBERSTEIN, BRUNO; RIBEIRO JUNIOR, ULYSSES; CECCONELLO, IVANABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p<0.001), hemoglobin values (10.9 vs. 12.3; p<0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. Conclusion: despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered.
- ROBOTIC GASTRECTOMY: TECHNIQUE STANDARDIZATION(2020) DIAS, Andre Roncon; RAMOS, Marcus Fernando Kodama Pertille; SZOR, Daniel Jose; ABDALLA, Ricardo; BARCHI, Leandro; YAGI, Osmar Kenji; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBackground: Robotic gastrectomy is gaining popularity worldwide. It allows reduced blood loss and lesser pain. However, it widespread use is limited by the extensive learning curve and costs. Aim: To describe our standard technique with reduced use of robotic instruments. Methods: We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and meticulous surgical description. Results: After standardizing the procedure, 28 patients were operated with this budget technique. For each procedure material used was: 1 (Xi model) or 2 disposable trocars (Si) and 4 robotic instruments. Stapling and clipping were performed by the assistant through an auxiliary port, limiting the use of robotic instruments and reducing the cost. Conclusion: This standardization helps implementing a robotic program for gastrectomy in the daily practice or in one's institution.