ANDRE RONCON DIAS
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
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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.
- Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case-control study(2020) CHARRUF, Amir Zeide; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; DIAS, Andre Roncon; CASTRIA, Tiago Biachi de; ZILBERSTEIN, Bruno; CECCONELO, Ivan; RIBEIRO, UlyssesBackground and Objective Neoadjuvant chemotherapy (NACT) followed by radical surgery represents a treatment option for patients with advanced gastric cancer (GC). This case-control study aimed to evaluate the clinicopathological characteristics and surgical outcomes of GC patients who received NACT, and its impact on survival. Methods We retrospectively reviewed all patients with GC who underwent gastrectomy. A total of 45 cases with NACT were matched with consecutive 45 patients who underwent upfront gastrectomy for the following characteristics: gender, age, gastrectomy type, lymphadenectomy extent, American Society of Anesthesiologists class, histological type, cT and cN. Results NACT group had smaller tumors (4.9 vs 6.8 cm P = .006), lower lymphatic invasion rate (40% vs 73.3%, P = .001), lower venous invasion rate (18% vs 46.7%, P = .003) and lower perineural invasion rate (35% vs 77.8%, P < .0001). The ypTNM stage was lower in patients treated with NACT (P < .001). The major postoperative complication (POC) rate was lower in NACT patients (6.7% vs 24.4%, P = .02), as was hospital length of stay (10.8 vs 17 days, P = .005). Conclusions NACT allowed nodal and tumor downstaging. In addition, patients who underwent NACT had fewer POC and shorter length of hospital stay.
- Prediction scores for complication and recurrence after multivisceral resection in gastric cancer(2020) DIAS, Andre Roncon; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; OLIVEIRA, Rodrigo Jose; RIBEIRO JR., Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBackground: Multivisceral resection (MVR) is indicated in T4b gastric cancer (GC) when R0 can be achieved. Patient's selection for MVR is imperative, since it carries an increased risk for postoperative complications (POC) and disease recurrence. This study aims to elaborate prediction scores for POC and recurrence after MVR for cT4b GC. Methods: Patients who underwent MVR with curative intent due to cT4b gastric adenocarcinoma were selected from our prospective database. Scoring models were based on the variables identified as risk factors for the studied outcome. Through binary regression the model that best predicted the outcome was created. Results: From 237 MVRs, 58 fulfilled the inclusion criteria. Males were 70.7%, mean age was 61.8 years. A pT4b was confirmed in 34 patients, 29 had 2 or more adjacent organs removed. Major POC occurred in 25.9%, mortality was 8.6%. Overall survival (OS) and disease-free survival (DFS) were similar for pT4b and non-pT4b. DFS was worse for pNthorn and when >2 adjacent organs were removed. Scoring models included 5 and 6 parameters for POC and recurrence, respectively, and their accuracy was 80.6% (95%CI = 0.69 -0.92) and 78% (95%CI = 0.66-0.90). The POC and recurrence rates in low- and high-score groups were statistically different (p < 0.001 and p = 0.004, respectively). Patients with high-risk for POC had lower OS (p = 0.036) and DFS was worse in the high-recurrence risk group (p = 0.008). Conclusion: The proposed scoring systems accurately predict POC and recurrence in GC patients undergoing MVR. These models are easy to use and can assist in the adoption of an individualized approach.
- Multivisceral resection vs standard gastrectomy for gastric adenocarcinoma(2020) DIAS, Andre R.; PEREIRA, Marina A.; OLIVEIRA, Rodrigo J.; RAMOS, Marcus F. K. P.; SZOR, Daniel J.; RIBEIRO, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanIntroduction Multivisceral resection (MVR) is potentially curative for selected gastric cancer patients, supposedly at the cost of increased complications. However, current data comparing MVR to standard gastrectomy (SG) is lacking. Objectives Compare complications and survival after MVR and SG. Methods In a retrospective cohort of 1015 patients with gastric adenocarcinoma, 58 underwent MVR and 466 SG. Groups were compared concerning their characteristics, complications, and survival. Results One hundred seventy-six patients had postoperative complications. Major complications were more frequent after MVR (P = .002). Surgical mortality was 8.6% and 4.9% for MVR and SG (P = .221). Older age, higher morbidities, and MVR were independent risk factors for major complications. The odds ratio for major complications was 5.89 for MVR with one or two organs and 38.01 for MVR with three or more organs. The pancreas was the most commonly removed organ and pT4b disease were confirmed in 34 (58.6%) of the MVR cases. Disease-free survival (DFS) was lower in MVR patients (51% vs 77.8%; P < .001), being worse according to the number of organs resected. In pN+ patients, DFS was worse after MVR. DFS was equivalent to pT4b and non-pT4b in the MVR group. Conclusions Increased morbidity and lower survival are expected for gastric cancer patients undergoing MVR.
- Preparing a high-performance surgical team: lessons from 11,000 surgeries(2020) DIAS, Andre RonconINTRODUCTION: In the future, surgery will be centralized in hospitals with the best value (excellent results with reduced cost). High-performance teams will be required; however, available data concerning the specific abilities necessary to build and manage them are poor. OBJECTIVES: Share the set of competencies and skills established to build and lead a high-performance general surgery team. METHODS: In November 2012, a general surgery team started its activities at a tertiary hospital in Sao Paulo, Brasil. The model consisted of high volume performed by a small team. Experienced surgeons, motivated, and with technical and moral excellence were selected. A sense of unity was created and goals were shared. Complex cases were discussed daily and a prospective database to follow outcomes was established. The payment value was above the market. RESULTS: In 6 years and 4 months, 11,006 surgical procedures were performed (8,597 electives and 2,409 in an urgent setting). Cholecystectomy was the most common procedure (4,101; being 3,676 electives), followed by inguinal hernioplasty (n: 1,827) and appendectomy (n: 925). A total of 449 elective oncologic procedures were performed. The surgical site infection rate in clean procedures was 0.12%, 80 patients required re-do surgery (2.4% in an urgent setting and 0.2% of the electives). There were 22 postoperative deaths (0.66% for urgent and 0.07% for electives), 5 of the 6 deaths in elective patients were in oncologic cases. CONCLUSION: A competent surgical team, inserted in a model that favors performance and values the individual can deliver high volume with exceptional results.
- Neutrophil-lymphocyte ratio change after curative gastrectomy for gastric cancer: a subgroup analysis(2020) SZOR, Daniel Jose; DIAS, Andre Roncon; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; ZLBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO JUNIOR, UlyssesObjective: To evaluate the impact of neutrophil-lymphocyte ratio change after curative surgery for gastric cancer. Methods: A retrospective analysis of patients with gastric cancer who underwent curative surgery between 2009 and 2017 was performed. A cutoff value was established for the neutrophil-lymphocyte ratio in the pre- and postoperative periods, according to the median value, and four subgroups were formed (low-low/low-high/high-low/high-high). Clinical-pathological and survival data were analyzed and related to these subgroups. Results: A total of 325 patients were included in the study. The cutoff values of the neutrophil-lymphocyte ratio were 2.14 and 1.8 for the pre and postoperative periods, respectively. In patients with stages I and II, the high-high subgroup presented worse overall survival (p=0.016) and disease-free survival (p=0.001). Complications were higher in the low-high subgroup of patients. Conclusion: The neutrophil-lymphocyte ratio is a low cost, efficient and reproducible marker. The prognosis individualization can be performed according to the identification of subgroups at a higher risk of complications and worse prognosis.
- 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.
- 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.
- GASTRECTOMY IN OCTOGENARIANS WITH GASTRIC CANCER: IS IT FEASIBLE?(2020) SILVA, Francisco Diogo Almeida; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; DIAS, Andre RonconBackground: The octogenarian population is expanding worldwide and demand for gastrectomy due to gastric cancer in this population is expected to grow. However, the outcomes of surgery with curative intent in this age group are poorly reported and it is unclear what matters most to survival: age, clinical status, disease's stage, or the extent of the surgery performed. Aim: Evaluate the results of gastrectomy in octogenarians with gastric cancer and to verify the factors related to survival. Methods: From prospective database, patients aged 80 years or older with histologically confirmed adenocarcinoma who had undergone gastrectomy with curative intent were selected. Factors related to postoperative complications and survival were studied. Results: Fifty-one patients fulfilled the inclusion criteria. A total of 70.5% received subtotal gastrectomy and in 72.5% D1 lymphadenectomy was performed. Twenty-five (49%) had complications, in eleven major complications occurred (seven of these were clinical complications). Hospital length of stay was longer (8.5 vs. 17.8 days, p=0.002), and overall survival shorter (median of 1.4 vs. 20.5 months, p=0.009) for those with complications. D2 lymphadenectomy and the presence of postoperative complications were independent factors for worse overall survival. Conclusion: Octogenarians undergoing gastrectomy with curative intent have high risk for postoperative clinical complications. D1 lymphadenectomy should be the standard of care in these patients.