LEANDRO CARDOSO BARCHI
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- Robotic digestive tract reconstruction after total gastrectomy for gastric cancer: a simple way to do it(2016) BARCHI, Leandro Cardoso; JACOB, Carlos Eduardo; FRANCISS, Maurice Youssef; KAPPAZ, Guilherme Tommasi; RODRIGUES FILHO, Edison Dias; ZILBERSTEIN, BrunoBackground Intracorporeal digestive tract reconstruction after minimally invasive total gastrectomy may be challenging, even when using the da Vinci (R) Surgical System. This may be due to intrinsic difficulties during oesophagojejunal anastomosis (EJA). The aim of this study was to describe a simple way to perform digestive tract reconstruction after robotic total gastrectomy (RTG) for gastric cancer and the results of its application in a small series of cases. Methods In the last 2 years, six patients with gastric adenocarcinoma have been treated by RTG, four male and two female, with mean age of 59.8 (range 48-74) years. The tumour was located in the gastric body in three patients, the gastric antrum in two patients and the fundus in one patient with no need of splenectomy. In all cases, D2 lymphadenectomy was completed. A modified robotic reconstruction technique proposed by the authors was used in these operations, which consists in a latero-lateral EJA using a linear stapler. An entero-enterostomy is also performed in the upper abdomen. Results The mean operative time was 408 (range 340-481) min. The mean time for digestive tract reconstruction was 57 (range 47-68) min. There were no conversions to open or laparoscopic surgery. The number of lymph nodes removed varied in the range 28-52 (average 40). There was no mortality. Postoperative staging showed three T1N0M0s, one T2N0M0, one T3N0M0 and one T3N2M0. Conclusion This series, which despite being small, demonstrates that this robotic reconstruction technique is safe, with no major complications, demands a relatively short time for its accomplishment, even when dealing with initial experience.
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, Ulysses- Minimally invasive surgery for gastric cancer in Brazil: current status and perspectives-a report from the Brazilian Laparoscopic Oncologic Gastrectomy Group (BLOGG)(2017) KASSAB, Paulo; COSTA JR., Wilson Luiz da; JACOB, Carlos Eduardo; CORDTS, Roberto de Moraes; CASTRO, Osvaldo Antonio Prado; BARCHI, Leandro Cardoso; CECCONELLO, Ivan; CHARRUF, Amir Zeide; COIMBRA, Felipe Jose Fernandez; CURY, Antonio Moris; DINIZ, Alessandro Landskron; FARIAS, Igor Correia de; FREITAS JR., Wilson Rodrigues de; GODOY, Andre Luis de; ILIAS, Elias Jirjoss; MALHEIROS, Carlos Alberto; RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO, Heber Salvador de Castro; DIAS, Andre Roncon; THULER, Fabio Rodrigues; YAGI, Osmar Kenji; LOURENCO, Laercio Gomes; ZILBERSTEIN, BrunoThe minimally invasive surgery for gastric cancer in Brazil has begun about two years after the first laparoscopic gastrectomy (LG) performed by Kitano in Japan, in 1991. Although the report of first surgeries shows the year of 1993, there was no dissemination of the technique until the years 2010. At that time with the improvement of optical devices, laparoscopic instruments and with the publications coming from Asia, several Brazilian surgeons felt encouraged to go to Korea and Japan to learn the standardization of the LG. After that there was a significant increase in that type of surgery, especially after the IRCAD opened a branch in Brazil. The growing interest for the subject led some services to begin their own experience with the LG and, since the beginning, the results were similar with those found in the open surgery. Nevertheless, there were some differences with the papers published initially in Japan and Korea. In those countries, the surgeries were laparoscopic assisted, meaning that, in the majority of cases, the anastomoses were done through a mini-incision in the end of the procedure. In Brazil since the beginning it was performed completely through laparoscopic approach due to the skills acquired by Brazilian surgeons in bariatric surgeries. Another difference was the stage. While in the east the majority of cases were done in T1 patients, in Brazil, probably due to the lack of early cases, the surgeries were done also in advanced cases. The initial experience of Zilberstein et al. revealed low rates of morbidity without mortality. Comparing laparoscopic and open surgery, the group from Barretos/IRCAD showed shorter surgical time (216x255 minutes), earlier oral or enteral feeding and earlier hospital discharge, with a smaller number of harvested lymph nodes (28 in laparoscopic against 33 in open surgery). There was no significant difference regarding morbidity, mortality and reoperation rate. In the first efforts to publish a multicentric study the Brazilian Gastric Cancer Association (BGCA) collected data from three institutions analyzing 148 patients operated from 2006 to 2016. There were 98 subtotal, 48 total and 2 proximal gastrectomies. The anastomoses were totally laparoscopic in 105, laparoscopic assisted in 21, cervical in 2, and 20 open (after conversion). The reconstruction methods were: 142 Roux-en-Y, two Billroth I, and three other types. The conversion rate was 13.5% (20/148). The D2 dissection was performed in 139 patients. The mean number of harvested lymph nodes was 34.4. If we take only the D2 cases the mean number was 39.5. The morbidity rate was 22.3%. The mortality was 2.7%. The stages were: IA-59, IB-14, IIA-11, IIB-15, IIIA-9, IIIB-19, IIIC-11 and stage IV-three cases. Four patients died from the disease and 10 are alive with disease. The participating services have already begun the robotic gastrectomy with satisfactory results. The intention of this group is to begin now a prospective multicentric study to confirm the data already obtained with the retrospective studies.
- Esophagojejunal anastomotic fistula: a major issue after radical total gastrectomy(2019) BARCHI, Leandro Cardoso; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; DIAS, Andre Roncon; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanGastric cancer surgery has evolved considerably over the past years, with substantial improvement on outcomes. Meanwhile, esophagojejunal anastomotic fistula (EJF) continues to impair postoperative results. This study aimed to assess EJF regarding its incidence, risk factors, management and the impact on overall survival. We retrospectively analyzed 258 consecutive patients who underwent total or completion gastrectomy for GC from 2009 and 2017. Clinicopathological characteristics analysis was performed comparing patients who developed EJF with patients with other clinical or surgical complications, as well as patients without any postoperative complications. Fifteen (5.8%) patients had EJF and 81 (31.4%) had other complications (including other surgical fistulas). The median time of EJF diagnosis was on the eighth postoperative day (range 3-76). Completion gastrectomy (p = 0.048) and longer hospital stay (p < 0.001) were associated with the occurrence of EJF. The surgical mortality of patients with EJF was higher than in non-EJF patients (26.7% vs. 4.5%; p < 0.001). Nine patients were treated conservatively and six required surgery. The mortality rate of EJF was 11.1% and 50% in patients who underwent conservative and surgical treatment, respectively. Patients with other complications and patients with EJF had worse survival compared to patients without any complication (p = 0.004 and p = 0.013, respectively). Completion gastrectomy is the main risk factor for EJF occurrence. Still, EJF is associated with high postoperative mortality, longer hospital stay and has a negative impact on long-term survival.
- Oncological Robot-Assisted Gastrectomy: Technical Aspects and Ongoing Data(2020) BARCHI, Leandro Cardoso; SOUZA, Willy Petrini; FRANCISS, Maurice Youssef; RAMOS, Marcus Fernando Kodama Pertille; DIAS, Andre Roncon; HYUNG, Woo Jin; ZILBERSTEIN, BrunoRobotic surgery through the da Vinci Surgical System has been widely spread for many procedures across the globe for several years. At the same time, robot-assisted gastrectomy for gastric cancer (GC) remains mostly available only in specialized centers in minimally invasive surgery and stomach neoplasm. The robotic platform has been introduced to overcome possible drawbacks of the laparoscopic approach. The safety and the feasibility of robotic radical gastrectomy have been reported in many retrospective case series and nonrandomized prospective studies. However, the superiority of robotic gastrectomy over the laparoscopic access has not yet been proven. This study aimed to report the technical aspects of robot-assisted gastrectomy for GC as well as the latest evidence on this subject.
- Laparoscopic D2 Gastrectomy for Gastric Cancer: Mid-Term Results and Current Evidence(2019) DIAS, Andre Roncon; JACOB, Carlos Eduardo; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; SZOR, Daniel Jose; YAGI, Osmar Kenji; BARCHI, Leandro Cardoso; RIBEIRO JR., Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanIntroduction: Although the first laparoscopic gastrectomy was performed in 1991, there was a long delay until it was incorporated into the regular practice of western surgeons. In Brazil, there are only few case series reported and data on its safety and efficacy along with mid- and long-term results are desired. Objective: Present the mid-term results of laparoscopic gastrectomy with curative intent in the treatment of gastric adenocarcinoma and review the current evidence on the therapy of this neoplasia with the laparoscopic access. Methods: Patients who underwent D2 laparoscopic gastrectomy for gastric adenocarcinoma were retrospectively reviewed. Results: Sixty-nine patients met the inclusion criteria. The mean age was 59.2 years and the mean body mass index was 24.2 kg/m(2). Subtotal gastrectomy was performed in 73.9%. The mean number of harvested lymph nodes was 36.7, increased lymph node count and shorter operative time were observed in the last 34 cases. Median hospital stay was 8 days. Postoperative complications occurred in 22 (31.9%) cases. Surgical mortality was 4.3%. Conclusion: Laparoscopic gastrectomy can be performed safely with excellent short- and mid-term results. As experience increases, surgical duration is reduced and lymph node count rises.
- Predicting recurrence after curative resection for gastric cancer: External validation of the Italian Research Group for Gastric Cancer (GIRCG) prognostic scoring system(2016) BARCHI, L. C.; YAGI, O. K.; JACOB, C. E.; MUCERINO, D. R.; RIBEIRO JR., U.; MARRELLI, D.; ROVIELLO, F.; CECCONELLO, I.; ZILBERSTEIN, B.Background: Most nomograms for Gastric Cancer (GC) were developed to predict overall survival (OS) after curative resection. The Italian Research Group for Gastric Cancer (GIRCG) prognostic scoring system (PSS) was designed to predict the recurrence risk after curative treatment based on pathologic tumor stage and treatment performed (D1 D2/D3 lymphadenectomy). This study was carried out to externally validate the GIRCG's PSS. Patients and methods: Adopting the same criteria used by GIRCG to build the PSS, 185 patients with GC operated with curative intention were selected. The median follow-up period was 77.8 months (1.93-150.8) for all patients and 102.5 months (60.9-150.8) for patients free of disease. The NRI (net reclassification improvement) was calculated to estimate the overall improvement in the reclassification of patients using the PSS in place of the TNM stage system. Results: GC recurrence occurred in 70 (37.8%) patients. The mean time to recurrence was 22.2 (range 1.9-98.1) months. For patients with recurrence, the gain in the proportion of reclassification was 0.257 (p < 0.001), indicating an improvement of 26%. For patients without recurrence, the gain in the proportion of reclassification was 0.122 (p < 0.001), indicating a worsening of 12%. The NRI calculated was 0.135 (p = 0.0527). Conclusion: The GIRCG's PSS, which predicts the likelihood of recurrence after radical surgical treatment for GC, is more accurate than TNM system to predict recurrence mainly for high-risk patients. Yet, the PSS does not have the same effectiveness for low-risk patients, overestimating the chance of recurrence occurs even for disease-free patients.
- Duodenal fistula: The most lethal surgical complication in a case series of radical gastrectomy(2018) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; BARCHI, Leandro Cardoso; YAGI, Osmar Kenji; DIAS, Andre Roncon; SZOR, Daniel Jose; ZILBERSTEIN, Bruno; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Despite all advances regarding the surgical treatment of gastric cancer (GC), duodenal stump fistula (DF) continues to negatively affect postoperative outcomes. This study aimed to assess DF regarding its incidence, risk factors, management and impact on overall survival. Methods: We retrospectively analyzed 562 consecutive patients who underwent gastrectomy for GC between 2009 and 2017. Clinicopathological characteristics analysis was performed comparing DF, other surgical fistulas and patients with uneventful postoperative course. Results: DF occurred in 15 (2.7%) cases, and 51 (9%) patients had other surgical fistulas. Tumor located in the lower third of the stomach (p=0.021) and subtotal gastrectomy (p=0.002) were associated with occurrence of DF. The overall mortality rate was 40% for DF and 15.7% for others surgical fistulas (p=0.043). The median time of DF onset was on postoperative day 9 (range 1-75). Conservative approach was performed in 8 patients and surgical intervention in 7 cases. Age (OR 7.41, p=0.012) and DF (OR 9.06, p=0.020) were found to be independent risk factors for surgical mortality. Furthermore, patients without fistula had better long-term survival outcomes comparing to patients with any type of fistulas (p=0.006). Conclusion: DF is related with distal tumors and patients submitted to subtotal gastrectomy. It affects not only the postoperative period with high morbidity and mortality rates, but may also have a negative impact on long-term survival.
conferenceObject GLUCOSE LEVEL BEHAVIOR IN TYPE 2 DIABETIC PATIENTS WITH GASTRIC CANCER SUBMITTED TO GASTRECTOMY AND ROUX EN Y RECONSTRUCTION: THE FOREGUT HYPOTHESIS(2015) BARCHI, Leandro Cardoso; ZILBERSTEIN, Bruno; LOPASSO, Fabio Pinatel; YAGI, Osmar Kenji; MUCERINO, Donato; JACOB, Carlos Eduardo; BRESCIANI, Claudio Jose Caldas; RAMOS, Marcus Fernando Kodama Pertille; DIAS, Andre Roncon; FRANCISS, Maurice Youssef; CECONNELLO, Ivan- Management of postoperative complications of lymphadenectomy(2016) BARCHI, Leandro Cardoso; CHARRUF, Amir Zeide; OLIVEIRA, Rodrigo Jose de; JACOB, Carlos Eduardo; CECCONELLO, Ivan; ZILBERSTEIN, BrunoGastric cancer remains a disease with poor prognosis, mainly due to its late diagnosis. Surgery remains as the only treatment with curative intent, where the goal is radical resection with free-margin gastrectomy and extended lymphadenectomy. Over the last two decades there has been an improvement on postoperative outcomes. However, complications rate is still not negligible even in high volume specialized centers and are directly related mainly to the type of gastric resection: total or subtotal, combined with adjacent organs resection and the extension of lymphadenectomy (D1, D2 and D3). The aim of this study is to analyze the complications specific-related to lymphadenectomy in gastric cancer surgery.