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 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.
  • conferenceObject
    MINIMALLY INVASIVE PELVIC LATERAL LYMPHADENECTOMY IN LOCALLY ADVANCED RECTAL CANCER AFTER NEOADJUVANT TREATMENT.
    (2022) COTTI, G.; BUSTAMANTE-LOPEZ, L.; NAHAS, C. S.; MARQUES, C. F.; IMPERIALE, A.; BRAGHIROLI, O.; HORVAT, N.; SOBRADO, L. F.; AVERBACH, P.; CIRENZA, C.; NAHAS, S. C.
  • article 3 Citação(ões) na Scopus
    Magnifying chromoendoscopy is a reliable method in the selection of rectal neoplasms for local excision
    (2023) KIMURA, C. M. S.; KAWAGUTI, F. S.; HORVAT, N.; NAHAS, C. S. R.; MARQUES, C. F. S.; PINTO, R. A.; REZENDE, D. T. de; SEGATELLI, V.; SAFATLE-RIBEIRO, A. V.; JUNIOR, U. R.; MALUF-FILHO, F.; NAHAS, S. C.
    Purpose Adequate staging of early rectal neoplasms is essential for organ-preserving treatments, but magnetic resonance imaging (MRI) frequently overestimates the stage of those lesions. We aimed to compare the ability of magnifying chromoendoscopy and MRI to select patients with early rectal neoplasms for local excision. Methods This retrospective study in a tertiary Western cancer center included consecutive patients evaluated by magnifying chromoendoscopy and MRI who underwent en bloc resection of nonpedunculated sessile polyps larger than 20 mm, laterally spreading tumors (LSTs) >= 20 mm, or depressed-type lesions of any size (Paris 0-IIc). Sensitivity, specificity, accuracy, and positive and negative predictive values of magnifying chromoendoscopy and MRI to determine which lesions were amenable to local excision (i.e., <= T1sm1) were calculated. Results Specificity of magnifying chromoendoscopy was 97.3% (95% CI 92.2-99.4), and accuracy was 92.7% (95% CI 86.7-96.6) for predicting invasion deeper than T1sm1 (not amenable to local excision). MRI had lower specificity (60.5%, 95% CI 43.4-76.0) and lower accuracy (58.3%, 95% CI 43.2-72.4). Magnifying chromoendoscopy incorrectly predicted invasion depth in 10.7% of the cases in which the MRI was correct, while magnifying chromoendoscopy provided a correct diagnosis in 90% of the cases in which the MRI was incorrect (p = 0.001). Overstaging occurred in 33.3% of the cases in which magnifying chromoendoscopy was incorrect and 75% of the cases in which MRI was incorrect. Conclusion Magnifying chromoendoscopy is reliable for predicting invasion depth in early rectal neoplasms and selecting patients for local excision.
  • article 1 Citação(ões) na Scopus
    Outcomes of surgical treatment for patients with distal rectal cancer: A retrospective review from a single university hospital
    (2020) NAHAS, S. C.; NAHAS, C. S. R.; BUSTAMANTE-LOPEZ, L. A.; PINTO, R. A.; MARQUES, C. F. S.; CECCONELLO, I.
    introduction and aim: Surgery for distal rectal cancer (DRC) can be performed with or without sphincter preservation. The aim of the present study was to analyze the outcomes of two surgical techniques in the treatment of DRC patients: low anterior resection (LAR) and abdominoperineal resection (APR). Methods: Patients with advanced DRC that underwent surgical treatment between 2002 and 2012 were evaluated. We compared the outcomes of the type of surgery (APR vs LAR) and analyzed the associations of survival and recurrence with the following factors: age, sex, tumor location, lymph nodes obtained, lymph node involvement, and rectal wall involvement. Patients with distant metastases were excluded. Results: A total of 148 patients were included, 78 of whom were females (52.7%). The mean patient age was 61.2 years. Neoadjuvant chemoradiation therapy was performed in 86.5% of the patients. APR was performed on 86 (58.1%) patients, and LAR on 62 (41.9%) patients. No differences were observed between the two groups regarding clinical and oncologic characteristics. Eighty-seven (62%) patients had pT3-4 disease, and 41 patients (27.7%) had lymph node involvement. In the multivariate analysis, only poorly differentiated tumors (P=.026) and APR (P=.009) correlated with higher recurrence rates. Mean follow-up time was 32 (16-59.9) months. Overall 5 -year survival was 58.1%. The 5 -year survival rate was worse in patients that underwent APR (46.5%) than in the patients that underwent LAR (74.2%) (P=.009). Conclusions: Patients with locally advanced DRC that underwent APR presented with a lower survival rate and a higher local recurrence rate than patients that underwent LAR. In addition, advanced T/stage, lymph node involvement, and poor tumor differentiation were associated with recurrence and a lower survival rate, regardless of the procedure. 2020 Asociacion Mexicana de Gastroenterologia.
  • article 17 Citação(ões) na Scopus
    Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment
    (2017) BUSTAMANTE-LOPEZ, L.; NAHAS, C. S.; NAHAS, S. C.; RIBEIRO JR., U.; MARQUES, C. F.; COTTI, G.; ROCCO, A.; CECCONELLO, I.
    Introduction Rectal cancer patients frequently present with locally advanced disease for which the standard of care includes neoadjuvant chemoradiotherapy followed by total mesorectal excision. Positive lymph nodes are one of the most powerful risk factors for recurrence and survival in colorectal cancer. In the absence of specific rectal guidelines, the literature recommends to the pathologist to optimize the number of rectal lymph nodes (LN) retrieved. We made a literature review in order to identify factors that could potentially affect the number of LN retrieved in specimens of patients with rectal cancer treated by chemoradiotherapy (CRT) followed by total mesorectal excision (TME). Results Age did not have a significant effect on LN yield. The effect of sex on LN number is not consistent in the literature. Most of the papers did not find a relationship between lower LN obtained and gender. Laparoscopy for primary rectal cancer is associated with a greater number of LN as well as shortterm benefits. Tumors in the upper rectum are associated with a higher number of LN than those in the mid and lower rectum. The type of surgery had no effect on lymph node yield either. Tumors with complete or almost complete pathologic regression were exactly the ones with lower number of lymph nodes detected. Approximately one-third of patients with neoadjuvant treatment had less than 12 LN yield. Conclusion The tumor regression grade is the most important factor for the decrease in the number of lymph nodes.
  • article 1 Citação(ões) na Scopus
    Is there a higher frequency of anal dysplasia and infection by human papillomavirus in Crohn?s disease patients?
    (2022) GUZELA, V. R.; SOBRADO JR., C. W.; NADAL, S. R.; VILLA, L. L.; MOTA, G. R.; GONCALVES, A. P.; NADAL, C. R. M.; NAHAS, C. S. R.; NAHAS, S. C.
    The aim of this study was to compare the frequency of dysplasia and human papillomavirus (HPV) infection in the anal canal of patients with Crohn???s disease (CD) with a control group and assess whether there is a correlation between use of immunosuppressants and anal manifestation of CD. Patients with CD and control individuals were submitted to anal cytology and material collection for polymerase chain reaction (PCR). The cytology was classified as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade (HSIL). PCR was considered positive or negative according to virus presence or absence. A total of 117 patients were included (54 in the control group and 63 in the CD group, being 32 without and 31 with immunosuppressants). ASCUS and LSIL were found in 25.9 and 22.2% of control patients and 28.6 and 39.7% of CD patients. HPV was identified in 14.8% of the control group and 27% of the CD group. In CD patients, HPV was found in 37.5 and 16.1% of those without and with immunosuppressants, respectively. Patients with perianal involvement had 15.6% of PCR positivity. There was no statistical difference in dysplasia and infection by HPV between the groups. Use of immunosuppressants did not influence the result, but anal manifestation was inversely proportional to viral detection.
  • conferenceObject
    SALVAGE SURGICAL TREATMENT IN PATIENTS WITH PERSISTENT OR RECURRENT ANAL SQUAMOUS CELL CARCINOMA AFTER CHEMOTHERAPY AND RADIOTHERAPY TREATMENT.
    (2020) PAIVA, A. C.; NAHAS, C. R.; KIMURA, C. M.; RIBEIRO, U.; NAHAS, S. C.; CECCONELO, I.; MARQUES, C. S.
  • article 0 Citação(ões) na Scopus
    Fournier’s Gangrene During Pregnancy in a Patient with Crohn’s Disease
    (2022) SOBRADO, L. F.; AVERBACH, P.; JAYME, V. R.; CAMARGO, M. G. M. de; SOBRADO, C. W.; NAHAS, S. C.
    Patient: Female, 29-year-old Final Diagnosis: Crohn’s associated Perianal and perirectal abscess • Fournier’s gangrene Symptoms: Anal pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Background: Case Report: Conclusions: Unusual clinical course Fournier’s gangrene (FG) is a rapidly progressive necrotizing infection of the perineum. Risk factors include male sex and immunosuppression. Inflammatory bowel disease and pregnancy may alter immune response by complex mechanisms but have rarely been associated with necrotizing infections of the perineum. To the best of our knowledge, only 5 cases of FG in association with IBD have been reported in the literature, and none of them occurred during pregnancy. We report the case of a young woman with long-standing Crohn’s disease in clinical remission with Infliximab monotherapy who developed FG in the third trimester of pregnancy. A cesarean section was undertaken at 35 weeks due to fetal distress, followed by debridement, diverting stoma, and vacuum-assisted therapy. The perineal defect was closed following 4 debridements and vacuum-therapy exchanges with a unilateral medial thigh advancement flap, and a draining seton was placed in the suprasphincteric fistula. The patient was dis-charged after 28 days and her recovery was unremarkable. The neonate also recovered well. The treatment of FG is multidisciplinary and includes early debridement and intestinal diversion. Perianal pain should not be disregarded, as it may be the initial symptom of severe perianal sepsis in the immunosuppressed. To the best of our knowledge, this is the first case report of FG during pregnancy in a patient with Crohn’s disease. © Am J Case Rep, 2022.
  • article 0 Citação(ões) na Scopus
    One-level step section histological analysis is insufficient to confirm complete pathological response after neoadjuvant chemoradiation for rectal cancer (vol 21, pg 745, 2017)
    (2017) PEREIRA, M. A.; DIAS, A. R.; FARAJ, S. F.; NAHAS, C. S. R.; IMPERIALE, A. R.; MARQUES, C. F. S.; COTTI, G. C.; AZEVEDO, B. C.; NAHAS, S. C.; MELLO, E. S. de; RIBEIRO JR., U.
    Unfortunately, one of the author name was wrongly published in the original publication. The complete correct name should read as follows ""Beatriz Camargo Azevedo"". The original article was updated.