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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Autor e Coautores FMUSP-HC Normalizados: CARLOS FREDERICO SPARAPAN MARQUES ×

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  • 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 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
  • 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.