IVAN CECCONELLO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Laparoscopic Total Mesorectal Excision for Rectal Cancer after Neoadjuvant Treatment: Targeting Sphincter-Preserving Surgery(2011) ARAUJO, Sergio Eduardo Alonso; SEID, Victor Edmond; BERTONCINI, Alexandre; CAMPOS, Fabio Guilherme; SOUSA JUNIOR, Afonso; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground/Aims: Laparoscopic total mesorectal excision for rectal cancer is under scrutiny. This study aimed at analyzing feasibility, adequacy of resection, impact on early outcomes after neoadjuvant chemoradiation therapy, and to investigate trend towards indication of laparoscopy for sphincter-preservation in a single university medical center. Methodology: Patients with distal rectal cancer submitted to neoadjuvant treatment followed by laparoscopic total mesorectal excision were prospectively enrolled. The studied parameters were: demographics, previous surgery, BMI, type of operation, rate of sphincter-preserving surgery, duration of surgery, conversion, specimen retrieval, lymphadenectomy, distal and radial margins, intra and postoperative morbidity, reoperations, hospital stay, and mortality. Results: From January 2000 to July 2010, 68 patients were enrolled. Mean age was 60 (30-87) years. There were 27 anterior and 41 abdominoperineal resections. Six patients underwent a totally laparoscopic resection and coloanal anastomosis. There was a trend (p=0.003) towards more sphincter-preserving surgery. Conversion was 4.5%. Intraoperative complication was 7.4%. Postoperative complications occurred in 15%. Mortality was 3%. Lymph-node harvest was 11 (0-33). Mean distal margin was 2.5cm (1-4). Radial margins were positive in 3 (10%) cases. Conclusions: Laparoscopic total mesorectal excision after neoadjuvant treatment is feasible and safe. Sphincter-preserving laparoscopic oncologic rectal surgery has been accomplished more frequently.
- A novel approach for the treatment of pelvic abscess: transrectal endoscopic drainage facilitated by transanal endoscopic microsurgery access(2012) MARTINS, B. C.; MARQUES, Carlos Frederico Sparapan; NAHAS, Caio Sergio Rizkallah; HONDO, Fabio Yuji; POLLARA, Wilson; NAHAS, Sergio Carlos; RIBEIRO JUNIOR, U.; CECCONELLO, Ivan; MALUF-FILHO, FauzePostoperative pelvic abscesses in patients submitted to colorectal surgery are challenging. The surgical approach may be too risky, and image-guided drainage often is difficult due to the complex anatomy of the pelvis. This article describes novel access for drainage of a pelvic collection using a minimally invasive natural orifice approach. A 37 year-old man presented with sepsis due to a pelvic abscess during the second postoperative week after a Hartmann procedure due to perforated rectal cancer. Percutaneous drainage was determined by computed tomography to be unsuccessful, and another operation was considered to be hazardous. Because the pelvic fluid was very close to the rectal stump, transrectal drainage was planned. The rectal stump was opened using transanal endoscopic microsurgery (TEM) instruments. The endoscope was advanced through the TEM working channel and the rectal stump opening, accessing the abdominal cavity and pelvic collection. The pelvic collection was endoscopically drained and the local cavity washed with saline through the scope channel. A Foley catheter was placed in the rectal stump. The patient's recovery after the procedure was successful, without the need for further intervention. Transrectal endoscopic drainage may be an option for selected cases of pelvic fluid collection in patients submitted to Hartmann's procedure. The technique allows not only fluid drainage but also visualization of the local cavity, cleavage of multiloculated abscesses, and saline irrigation if necessary. The use of TEM instrumentation allows safe access to the peritoneal cavity.
- Short-Term Surgical Outcomes of Robotic Gastrectomy Compared to Open Gastrectomy for Patients with Gastric Cancer: a Randomized Trial(2022) RIBEIRO, Ulysses; DIAS, Andre Roncon; RAMOS, Marcus Fernando Kodama Pertille; YAGI, Osmar Kenji; OLIVEIRA, Rodrigo Jose; PEREIRA, Marina Alessandra; ABDALLA, Ricardo Zugaib; ZILBERSTEIN, Bruno; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground Robotic gastrectomy (RG) has been shown to be a safe and feasible method in gastric cancer (GC) treatment. However, most studies are in Eastern cohorts and there is great interest in knowing whether the method can be used routinely, especially in the West. Objectives The aim of this study was to compare the short-term surgical outcomes of D2-gastrectomy by RG versus open gastrectomy (OG). Methods Single-institution, open-label, non-inferiority, randomized clinical trial performed between 2015 and 2020. GC patients were randomized (1:1 allocation) to surgical treatment by RG or OG. Da Vinci Si platform was used. Inclusion criteria: gastric adenocarcinoma, stage cT2-4 cNO-1, potentially curative surgery, age 18-80 years, and ECOG performance status 0-1. Exclusion criteria: emergency surgery and previous gastric or major abdominal surgery. Primary endpoint was short-term surgical outcomes. The study is registered at clinicaltrials.gov (NCT02292914). Results Of 65 randomized patients, 5 were excluded (3 palliatives, 1 obstruction and emergency surgery, and 1 for material shortage). Consequently, 31 and 29 patients were included for final analysis in the OG and RG groups, respectively. No differences were observed between groups regarding age, sex, BMI, comorbidities, ASA, and frequency of total gastrectomy. RG had similar mean number of harvested lymph nodes (p = 0.805), longer surgical time (p < 0.001), and less bleeding (p <0.001) compared to OG. Postoperative complications, length of hospital stay, and readmissions in 30 days were equivalent between OG and RG. Conclusions RG reduces operative bleeding by more than 50%. The short-term outcomes were non-inferior to OG, although surgical time was longer in RG.
- 18F-FDG-PET/CT-measured parameters as potential predictors of residual disease after neoadjuvant chemoradiotherapy in patients with esophageal carcinoma(2022) TUSTUMI, Francisco; ALBENDA, David Gutiérrez; SALLUM, Rubens Antonio Aissar; NAHAS, Sergio Carlos; RIBEIRO JUNIOR, Ulysses; BUCHPIGUEL, Carlos Alberto; CECCONELLO, Ivan; DUARTE, Paulo SchiavomAbstract Objective: To evaluate the maximum and mean standardized uptake values, together with the metabolic tumor value and the total lesion glycolysis, at the primary tumor site, as determined by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT), performed before and after neoadjuvant chemoradiotherapy (nCRT), as predictors of residual disease (RD) in patients with esophageal cancer. Materials and Methods: The standardized uptake values and the volumetric parameters (metabolic tumor value and total lesion glycolysis) were determined by 18F-FDG-PET/CT to identify RD in 39 patients before and after nCRT for esophageal carcinoma. We used receiver operating characteristic curves to analyze the diagnostic performance of 18F-FDG-PET/CT parameters in the definition of RD. The standard of reference was histopathological analysis of the surgical specimen. Results: Eighteen patients (46%) presented RD after nCRT. Statistically significant areas under the curve (approximately 0.72) for predicting RD were obtained for all four of the variables evaluated after nCRT. Considering the presence of visually detectable uptake (higher than the background level) at the primary tumor site after nCRT as a positive result, we achieved a sensitivity of 94% and a specificity of 48% for the detection of RD. Conclusion: The use of 18F-FDG-PET/CT can facilitate the detection of RD after nCRT in patients with esophageal cancer.
- Lymph Node Yield After Neoadjuvant Chemoradiotherapy in Rectal Cancer Specimens: A Randomized Trial Comparing Two Fixatives(2018) DIAS, Andre R.; PEREIRA, Marina Alessandra; MELLO, Evandro Sobroza de; NAHAS, Sergio Carlos; CECCONELLO, Ivan; RIBEIRO JR., UlyssesBACKGROUND: It is widely reported that neoadjuvant chemoradiation reduces lymph node yield in rectal cancer specimens. Some have questioned the adequacy of finding 12 lymph nodes for accurate staging, and fewer nodes were correlated with good response. Others reported that low lymph node count raises the chance for understaging and correlates with worse survival. In addition, a few studies demonstrated that diligent specimen analysis increases lymph node count. OBJECTIVE: The aim of this study was to compare Carnoy's solution and formalin concerning lymph node yield in specimens of patients with rectal cancer after neoadjuvant chemoradiation. DESIGN: This is a prospective randomized trial that was conducted from 2012 to 2015. SETTINGS: This study was performed in a reference cancer center in Brazil. PATIENTS: Patients who underwent low anterior resection with total mesorectal excision after neoadjuvant chemoradiation for rectal adenocarcinoma were included. INTERVENTION: Rectosigmoid specimens were randomized for fixation with Carnoy's solution or formalin. MAIN OUTCOME MEASURES: A total of 130 specimens were randomized. After dissection, the residual fat from the formalin group was immersed in Carnoy's solution in search for missed lymph nodes (Revision). RESULTS: The Carnoy's solution group had superior lymph node count (24.0 vs 16.3, p < 0.01) and fewer cases with <12 lymph nodes (6 vs 22, p = 0.001). The Revision group found lymph nodes in all cases (mean, 11.1), retrieving metastatic lymph nodes in 6 patients. It reduced the formalin cases with <12 lymph nodes from 33.8% to 4.6% and upstaged 2 patients. Tumor response to neoadjuvant chemoradiotherapy was not associated with lymph node count. LIMITATIONS: This was a unicentric study. CONCLUSIONS: Compared with formalin, the Carnoy's solution increases lymph node count and reduces the cases with <12 lymph nodes. Harvested lymph nodes are missed following routine analysis and this is clinically relevant. Finding <12 lymph nodes is not a sign of good response to neoadjuvant chemoradiation (www.clinicaltrials.gov. Unique identifier: NCT02629315). See Video Abstract at http://links.lww.com/DCR/A694.
article 1 Citação(ões) na Scopus T <= 2N0 TRG1-2 in Post-Chemoradiation Therapy MRI: What can it Predict?(2019) NAHAS, Caio Sergio Rizkallah; NAHAS, Sergio Carlos; BUSTAMANTE-LOPEZ, Leonardo; SPARAPAN, Carlos Marques Frederico; ORTEGA, Cinthia; AZAMBUJA, Rodrigo; JR, Ulysses Ribeiro; COTTI, Guilherme Cutait; IMPERIALE, Antonio Rocco; CECCONELLO, IvanBackground: Total mesorectal excision is the standard radical operation after neoadjuvant chemoradiotherapy for patients with middle/low locally advanced rectal cancer. However, it carries significant rates of morbidity, sexual/urinary dysfunction, fecal impairment and permanent stoma. The ability to identify patients with a complete or nearly-complete response could help steer patients to less-invasive surgery or a watch-and-wait strategy. Objective: To assess the ability to predict good responders and a favorable prognosis among rectal cancer patients by post-chemoradiation therapy MRI. Patients: Consecutive patients stage T3-4N0M0 or T(any)N+M0 located within 10cm from the anal verge were enrolled. Patients were staged and re-staged 8.8 weeks after the completion of chemoradiation by digital exam, colonoscopy, pelvic-MRI, and thorax and abdominal CT scans. All patients underwent total mesorectal excision with curative intent. Results: Of the total 309 patients, 275 were eligible, and 199 (72.4%) of these were stage III. Restaging-MRI identified 59 (21.4%) T <= 2N0/TRG1-2. Specimen pathologic evaluation revealed 43 (15.6%) patients with a complete pathologic response. Estimates of the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRIyT=2N0/TRG1-2 for the identification of ypT0N0 were 79.7%, 84.5%, 53.5%, 39%, and 90.7%, respectively. Estimates for the identification of ypN0 were 48.4%, 27.8%, 92%, 88.1%, and 48.4%, respectively. In a multivariate analysis, the only pre-CRT/MRI variables that were associated with an increased risk of lymph node involvement at the specimen were N+ (OR=2.22) and extramural vascular invasion (OR=2.28). MRI yT <= 2N0/TRG1-2 patients showed improved estimated 5-year disease-free survival, but no difference in estimated 5-year survival. Conclusion: Although MRIyT <= 2N0/TRG1-2 cannot predict all cases of a complete pathologic response, it can effectively predict a low rate of lymph node involvement and a better prognosis in patients who undergo total mesorectal excision.- Desmoid tumors: clinical features and outcome of an unpredictable and challenging manifestation of familial adenomatous polyposis(2015) CAMPOS, Fabio Guilherme; MARTINEZ, Carlos Augusto Real; NOVAES, Marleny; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground/Aims Desmoid tumors (DTs) are rare, locally invasive neoplasms that may affect 10-25 % of familial adenomatous polyposis (FAP) patients. Our aim was to evaluate incidence and clinical presentation among our patients, the potential impact on FAP outcome and to discuss treatment. Materials and methods Charts from 133 FAP (1977-2013) were reviewed. Patients with DTs were separated to retrieve demographic, clinical and management data. Follow-up was focused on disease evolution causing complications or death. Results 19 (14.3 %) DTs were diagnosed, either after previous trauma (16) or during FAP surgery (3). This group comprised 8 men (42.1 %) and 11 women (57.9 %) with an average age of 32.9 years. Intervals from surgical trauma to DTs ranged from 7 to 60 months. ECMs were detected in 12 (63.1 %) patients. DTs were located in the abdominal wall (8), abdominal cavity (8), abdominal wall and cavity (2) and left arm (1). Five patients (26.3 %) referred family history of DTs. Patients presented severe complications such as small bowel obstruction (4) and hydronephrosis (2), being directly responsible for death in three patients. Conclusions (1) DTs developed in 14.3 % of FAP, mostly after surgical trauma; (2) 30 % caused severe morbidity; (3) identification of clinical risk factors may help surgeons to develop screening and therapeutic decisions.
- PROGNOSTIC FACTORS FOR LEFT COLECTOMY FOR COLON CANCER: A TEN YEARS EXPERIENCE OF A SINGLE UNIVERSITY INSTITUTION(2017) NAHAS, Sergio Carlos; NAHAS, Caio Sergio; BUSTAMANTE-LOPEZ, Leonardo Alfonso; PINTO, Rodrigo Ambar; MARQUES, Carlos Frederico Sparapan; CAMPOS, Fabio Guilherme; CECCONELLO, IvanABSTRACT Background: Colorectal cancer is the third most common cancer in the world. In Brazil, it is the leading cause of cancer in the gastrointestinal tract. Aim: To evaluate the preoperative, perioperative, and postoperative risk factors for recurrence and overall survival of patients with left colon cancer operated during a ten-year period. Methods: Patients with left colon cancer surgically treated underwent clinical preoperative workout and cancer staging. The following factors were studied: gender, age, tumor location, T stage, lymph node yield, N stage, M stage, histological type, and tumor differentiation. It was analyzed the influence in five-year overall survival. Results: A total of 173 patients underwent left colectomy for colon cancer. There was a slight predominance of male gender with 50.9%. The mean age was 60.8 years old. Fifteen (8.7%) tumors were located at splenic flexure, 126 (72.8%) at sigmoid colon, and 32 (18.5%) at descending colon. The median length of hospital stay was seven days. Mean survival was 47.5 months. At 60 months seven patients (4%) lost follow-up, 38 patients (21.9%) deceased and 135 patients (78%) were alive. Overall survival time was 48 months. Conclusion: Advanced stages (T3-T4, N+ and M+) were the only factors associated with poor long term survival in left colon cancer.
- The life of John Cedric Goligher (1912-1998) revisited(2016) CAMPOS, Fabio Guilherme; NAHAS, Sergio Carlos; CECCONELLO, IvanJohn Cedric Goligher was one of the great figures in British surgery. Although he practised general surgery as well, the medical community around the world elected him the pre-eminent colon and rectal surgeon of his time. Technically he was considered a master surgeon with enormous personal experience that was expressed in many papers and books written throughout his life. As the Chairman of the University Department of Surgery at the General Infirmary at Leeds, he developed many prospective controlled studies that granted him a national and international reputation. This paper aims to render him posthumous credit by remembering his career, literature contributions and the importance of his legacy to the surgical community.
- A NEW APPROACH FOR HEMORRHOID DISEASE: SELECTIVE DEARTERIALIZATION AND MUCOPEXY WITHOUT DOPPLER GUIDANCE(2021) SOBRADO, Carlos Walter; SOBRADO, Lucas Faraco; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground: Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Methods: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. Results: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. Conclusion: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.