SERGIO CARLOS NAHAS

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Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 9 Citação(ões) na Scopus
    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, Ivan
    Background/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.
  • article 6 Citação(ões) na Scopus
    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, Fauze
    Postoperative 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.
  • article 1 Citação(ões) na Scopus
    Surgical Technique and Considerations about Transanal Transection and Single-Stapled (TTSS) Anastomosis: The Search for a Perfect Anastomosis
    (2021) CAMPOS, Fábio Guilherme; PANDINI, Rafael Vaz; BUSTAMANTE-LOPEZ, Leonardo Alfonso; NAHAS, Sérgio Carlos
    Abstract The evaluation of preventivemeasures and risk factors for anastomotic leakage has been a constant concern among colorectal surgeons. In this context, the description of a new way to perform a colorectal, coloanal or ileoanal anastomosis, known as transanal transection and single-stapled (TTSS) anastomosis, deserves an appreciation of its qualities, and a discussion about its properties and technical details. In the present paper, the authors review themost recent efforts aiming to reduce anastomotic dehiscence, and describe the TTSS technique in a patient submitted to laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for familial adenomatous polyposis. Surgical perception raises important advantages such as distal rectal transection under visualization, elimination of double-stapling lines (with cost-effectiveness and potential protection against suture dehiscence), elimination of dog ears, and the opportunity to be accomplished via a transanal approach after open, laparoscopic, or robotic colorectal resections. Future studies to confirm these supposed advantages are needed.
  • article 6 Citação(ões) na Scopus
    Validation of the Brazilian Portuguese version of the pelvic floor bother questionnaire
    (2019) PETERSON, Thais Villela; PINTO, Rodrigo Ambar; DAVILA, G. Willy; NAHAS, Sergio Carlos; BARACAT, Edmund Chada; HADDAD, Jorge Milhem
    Introduction and hypothesisThe Pelvic Floor Bother Questionnaire (PFBQ) was designed to identify the presence and degree of bother associated with common pelvic floor symptoms. The PFBQ can be used in clinical practice and for research purposes, but it is not available in Brazilian Portuguese. We aimed to validate a cross-culturally adapted Brazilian Portuguese version of the PFBQ.MethodsA pilot-tested version of the PFBQ translated from English was evaluated with Brazilian patients suffering from pelvic floor disorders. Internal reliability, test-retest reliability, validity, and responsiveness to change were assessed.ResultsA total of 147 patients (mean age, 60.49years) were enrolled in the study. The Brazilian Portuguese version of the PFBQ demonstrated good reliability (=0.625; ICC=0.981). There was strong agreement beyond chance for each item (=0.895-1.00). The PFBQ correlated with stage of prolapse (p<0.01), number of urinary (=0.791, p<0.001) and fecal (=0.78, p<0.001) incontinence episodes, and obstructed defecation (=0.875, p<0.001).ConclusionsThe Brazilian Portuguese version of the PFBQ is a reliable, valid, and user-friendly instrument that can be used for assessing the presence and severity of pelvic floor symptoms in clinical and research settings in Brazil.
  • article 4 Citação(ões) na Scopus
    Long-term follow up of abdominal rectosigmoidectomy with posterior end-to-side stapled anastomosis for Chagas megacolon
    (2011) NAHAS, S. C.; PINTO, R. A.; DIAS, A. R.; NAHAS, C. S. R.; ARAUJO, S. E. A.; MARQUES, C. F. S.; CECCONELLO, I.
    Aim Chagas' disease is an endemic parasitosis found in Latin America. The disease affects different organs, such as heart, oesophagus, colon and rectum. Megacolon is the most frequent long-term complication, caused by damage to the myoenteric and submucous plexus, ultimately leading to a functional barrier to the faeces. Patients with severe constipation are managed surgically. The study aimed to analyse the 10-year minimum functional outcome after rectosigmoidectomy with posterior end-to-side anastomosis (RPESA). Method A total of 21 of 46 patients were available for follow up. Patients underwent clinical, radiological and manometric evaluation, and the results were compared with preoperative parameters. Results Of the 21 patients evaluated, 81% (17) were female, with a mean age of 60.6 years. Good function was achieved in all patients, with significant improvement in defaecatory frequency (P < 0.0001), usage of enemas (P < 0.0001) and patient satisfaction. Barium enema also showed resolution of the colonic and rectal dilatation in 19 cases evaluated postoperatively. Conclusion Minimal 10-year follow up of RPESA showed excellent functional results, with no recurrence of constipation.
  • conferenceObject
    OUTCOMES OF PATIENTS WITH LOCAL REGROWTH AFTER NONOPERATIVE MANAGEMENT OF RECTAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY.
    (2020) COTTI, G. C.; PANDINI, R. V.; BRAGHIROLI, O. F.; NAHAS, C. R.; MARQUES, C. F. Sparapan; IMPERIALE, A. Rocco; BUSTAMANTE-LOPEZ, L. A.; RIBEIRO, U.; SALVAJOLI, B.; HOFF, P.; NAHAS, S. C.
  • article 1 Citação(ões) na Scopus
    Salvage Surgery for Anal Squamous Cell Carcinoma: Still a Difficult Challenge
    (2023) PAIVA, Aline Costa Mendes de; NAHAS, Sergio Carlos; KIMURA, Cintia M. S.; MONIZ, Camila Motta Venchiarutti; MARQUES, Carlos Frederico Sparapan; RIBEIRO JUNIOR, Ulysses; NAHAS, Caio Sergio Rizkallah
  • article 5 Citação(ões) na Scopus
    Diagnosis of Clinical Complete Response by Probe-Based Confocal Laser Endomicroscopy (pCLE) After Chemoradiation for Advanced Rectal Cancer
    (2021) SAFATLE-RIBEIRO, Adriana Vaz; MARQUES, Carlos Frederico Sparapan; PIRES, Clelma; ARRAES, Livia; BABA, Elisa Ryoka; MEIRELLES, Luciana; KAWAGUTI, Fabio Shigehissa; MARTINS, Bruno da Costa; LENZ, Luciano Tolentino; LIMA, Marcelo Simas de; GUSMON-OLIVEIRA, Carla Cristina; RIBEIRO JR., Ulysses; MALUF-FILHO, Fauze; NAHAS, Sergio Carlos
    Background Neoadjuvant chemoradiotherapy (nCRxt) followed by radical surgery is the optimal treatment for advanced rectal adenocarcinoma. Patients with clinical complete response (cCR) may be followed closely without immediate surgery. Probe-based confocal laser endomicroscopy (pCLE) is a real-time in vivo method that allows acquisition of optical biopsies with 1000 times magnification, evaluating both epithelial and vascular patterns. Aim To evaluate the role of pCLE in the diagnosis of cCR after nCRxt for advanced rectal adenocarcinoma. Methods pCLE was performed in 47 patients with locally advanced rectal adenocarcinoma (T3/T4, or N+) who underwent nCRxt (5-fluorouracil, 5040 cGy). Results Twenty-seven (57.5%) patients were men, and the mean age was 62.8 years. Thirty-seven had partial response confirmed by pCLE. Ten (21.3%) patients had good endoscopic response and presented small ulcer (n = 5) or residual scar (n = 5). After nCRxt, the essential features to differentiate malignancy from post-radiation alterations at pCLE were the presence of irregular crypts, budding, back-to-back glands, cribriform pattern, increased vessel/crypt ratio, and fluorescein leakage. A scoring system was created considering these epithelial and vascular features, with high accuracy for differentiating patients with complete response from those with residual neoplasia (p < 0.00001). pCLE sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 71.4%, 95.2%, 100%, and 95.7%, respectively. Conclusions (1) pCLE evaluation of epithelial and vascular features may improve the diagnosis of cCR and may alter patient management; (2) pCLE might be valuable for identifying patients with advanced rectal cancer who will benefit from watch and wait strategy, avoiding immediate surgical treatment.
  • article 12 Citação(ões) na Scopus
    Outcomes of Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects
    (2017) COLTRO, Pedro S.; BUSNARDO, Fabio F.; MONACO FILHO, Franklin C.; OLIVAN, Marcelo V.; MILLAN, Lincoln S.; GRILLO, Victor A.; MARQUES, Carlos F.; NAHAS, Caio S.; NAHAS, Sergio C.; RIBEIRO JR., Ulysses; GEMPERLI, Rolf
    BACKGROUND: There are many previous reports for using the internal pudendal artery perforator flap in vulvovaginal reconstruction; however, reports of this flap for perineal reconstruction after abdominoperineal excision of the rectum are scarce. OBJECTIVE: The purpose of this study was to evaluate the outcomes of immediate internal pudendal artery perforator flap reconstruction for irradiated abdominoperineal resection defects. DESIGN: This was a prospective case series. SETTINGS: This flap could represent a step forward over other perineal flap approaches or primary closure. PATIENTS: A total of 73 consecutive patients with anorectal tumors were included. INTERVENTIONS: The study included immediate perineal reconstruction using 122 internal pudendal artery perforator flaps after abdominoperineal excision of the rectum. MAIN OUTCOME MEASURES: Dimensions of the perineal defect (in centimeters squared), hospital stay (days), healing time (days), and postoperative complications (Clavien-Dindo grades) were measured. RESULTS: The means of the perineal defect, hospital stay, and healing time were 51.62 cm(2), 15.94 days, and 38.52 days. The higher the patient BMI, the longer healing time (p = 0.02); Clavien-Dindo complications grades III to IV were greater in patients with perineal defect >= 60 cm(2) (p = 0.03; OR = 10.56); postoperative complications were higher both in patients with anal squamous cell carcinoma (p = 0.005; OR = 6.09) and in patients with comorbidities (p = 0.04; OR = 2.78); hospital stay (p = 0.001) and healing time (p < 0.001) were higher in patients who had postoperative complications. The complete perineal wound healing at 12 weeks was achieved by 95% of patients, and our 30-day mortality rate was 4%. LIMITATIONS: As a nonrandomized study, our results have to be interpreted with caution. CONCLUSIONS: Multiple previously described advantages associated with internal pudendal artery perforator flap were also observed here, reinforcing the idea that it is reliable, versatile, and a useful option for perineal reconstruction after abdominoperineal excision of the rectum. Therefore, we propose that this flap could be considered as the first choice for perineal reconstruction in selected patients with moderate and some large defects after abdominoperineal excision of the rectum. See Video Abstract at http://links.lww.com/DCR/A367.
  • conferenceObject
    LONG-TERM SURVIVAL ANALYSIS AFTER ENDOSCOPIC STENTING AS A BRIDGE TO SURGERY FOR MALIGNANT COLONIC OBSTRUCTION: COMPARISON WITH EMERGENCY SURGERY
    (2019) SCOMPARIN, Rodrigo Corsato; MARTINS, Bruno da Costa; MARQUES, Carlos F.; NAHAS, Caio Sergio R.; KAWAGUTI, Fabio S.; LENZ, Luciano; SAFATLE-RIBEIRO, Adriana V.; PAULO, Gustavo A. de; RIBEIRO, Ulysses; NAHAS, Sergio C.; MALUF-FILHO, Fauze