RUBENS ANTONIO AISSAR SALLUM
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
32 resultados
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- Induction Chemotherapy for Locally Advanced Esophageal Cancer(2020) HARADA, Guilherme; BONADIO, Renata Rodrigues da Cunha Colombo; ARAUJO, Frederico Cantarino Cordeiro de; VICTOR, Carolina Ribeiro; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, Ivan; TAKEDA, Flavio Roberto; CASTRIA, Tiago Biachi deBackground Concurrent chemoradiotherapy followed by surgery is the standard treatment for locally advanced esophageal cancer (EC), and the role of induction chemotherapy (IC) remains unclear. We aimed to study if the addition of IC to standard treatment increases the rate of pathologic complete response (pCR). Methods We assembled a retrospective analysis of patients (pts) diagnosed with locally advanced EC and treated with preoperative chemoradiotherapy followed by esophagectomy (CRT+S), preceded or not by IC, between 2009 and 2017. Patients' characteristics, tumor variables, and treatment outcomes were evaluated. The Kaplan-Meier method was used to estimate overall survival and the Cox proportional hazard model to evaluate prognostic factors. Results One hundred and three patients were studied, with a median age of 62 years (range 37-84). Seventy-five patients (73%) were male, 67 (65%) had squamous cell carcinoma, and 31 (30%) had adenocarcinoma. Forty-three patients (41.7%) received IC followed by CRT+S (IC+CRT+S). The most frequent IC consisted of paclitaxel and platinum chemotherapy (90%), and the median number of cycles was 2. All patients received CRT+S. Concurrent chemotherapy was a combination of paclitaxel and platinum in 94 patients (91%). There was no statistically significant difference in pCR between the IC group and the standard CRT+S group. The pCR was 41.9% and 46.7% in the IC+CRT+S and CRT+S groups (p = 0.628), respectively. In the multivariate analysis, pCR was an independent prognostic factor for time to treatment failure (TTF) (HR 0.35, p = 0.021), but not for overall survival (OS) (p = 0.863). The factor that significantly affected OS in the multivariate analysis was positive lymph node (HR 5.9, 95%, p = 0.026). Conclusions Our data suggest that the addition of IC to standard CRT + S does not increase the pCR rate in locally advanced EC. No difference in OS was observed between pts. that received or not IC. Regardless of the treatment received, pts. achieving a pCR presented improved TTF.
- PROGNOSTIC FACTORS AND SURVIVAL ANALYSIS IN ESOPHAGEAL CARCINOMA(2016) TUSTUMI, Francisco; KIMURA, Cintia Mayumi Sakurai; TAKEDA, Flavio Roberto; UEMA, Rodrigo Hideki; SALUM, Rubens Antonio Aissar; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Despite recent advances in diagnosis and treatment, esophageal cancer still has high mortality. Prognostic factors associated with patient and with disease itself are multiple and poorly explored. Aim: Assess prognostic variables in esophageal cancer patients. Methods: Retrospective review of all patients with esophageal cancer in an oncology referral center. They were divided according to histological diagnosis (444 squamous cell carcinoma patients and 105 adenocarcinoma), and their demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival. Results: No difference was noted between squamous cell carcinoma and esophageal adenocarcinoma overall survival curves. Squamous cell carcinoma presented 22.8% survival after five years against 20.2% for adenocarcinoma. When considering only patients treated with curative intent resection, after five years squamous cell carcinoma survival rate was 56.6 and adenocarcinoma, 58%. In patients with squamous cell carcinoma, poor differentiation histology and tumor size were associated with worse oncology stage, but this was not evidenced in adenocarcinoma. Conclusion: Weight loss (kg), BMI variation (kg/m(2)) and percentage of weight loss are factors that predict worse stage at diagnosis in the squamous cell carcinoma. In adenocarcinoma, these findings were not statistically significant.
- Predictive factors of recurrence in adenocarcinoma of the esophagogastric junction in the multimodal era(2021) TAKEDA, Flavio Roberto; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; MUNIZ, Renan Rosetti; TUSTUMI, Francisco; CASTRIA, Tiago Biachi de; SALLUM, Rubens Antonio Aissar; ZILBERSTEIN, Bruno; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanIntroduction: Adenocarcinoma of the esophagogastric junction (AEGJ) represents a poor prognostic tumor. We evaluated the recurrence pattern and risk factors associated with recurrence in patients undergoing surgical resection by AEJG. Methods: Recurrences were categorized as locoregional, peritoneal, or distant. These three recurrence groups and a non-recurrence group were compared, and overall survival (OS) and disease-free survival (DFS) for each one was obtained. Results: We analyzed 188 patients with curative surgical treatment. Recurrence was observed in 72 (38.3%) patients. Locoregional recurrence was observed in 17 (23.6%); 20 (27.8%) peritoneal recurrence and 35 (48.6%) distant metastasis. DFS was 9, 5, and 8 months, and OS was 21.8, 13.2, and 20.8, respectively. Tumors larger than 5 cm are risk factors for peritoneal recurrence (OR:2.88, p = 0.012). Positive lymph nodes were related to distant metastasis (OR:9.15, p = 0.040), and lymphatic invasion for locoregional recurrence (OR:3.81, p = 0.028). Conclusion: AEGJ is associated with high rates of early recurrence.
conferenceObject Robotic-assisted (RAMIE) x thoracoscopic esophagectomy (MIE): Comparison on safety and lymph nodal dissection in 181 cases.(2018) SALLUM, Rubens Antonio Aissar; TAKEDA, Flavio Roberto; SANTO, Marco Aurelio; CECCONELLO, Ivan- Prognostic value of F-18-fluorodeoxyglucose PET/computed tomography metabolic parameters measured in the primary tumor and suspicious lymph nodes before neoadjuvant therapy in patients with esophageal carcinoma(2021) TUSTUMI, Francisco; DUARTE, Paulo Schiavom; ALBENDA, David Gutierrez; TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; BUCHPIGUEL, Carlos Alberto; CECCONELLO, IvanBackground F-18-fluorodeoxyglucose PET/computed tomography (F-18-FDG PET/CT) metabolic parameters are prognostic indicators in several neoplasms. This study aimed to evaluate the prognostic value of the maximum and average standardized uptake value (SUVmax and SUVavg), metabolic tumor value (MTV), and total lesion glycolysis (TLG) measured in the primary tumor and suspicious lymph nodes preneoadjuvant therapy in patients submitted to surgical resection for esophageal cancer. Methods A cohort of 113 patients with esophageal cancer who performed F-18-FDG PET/CT preneoadjuvant therapy was assessed. The association of the SUV, MTV, and TLG measured in the primary tumor and in the suspicious lymph nodes with the overall survival was assessed. It was also analyzed other potentially confounding variables such as age, sex, clinical stage, and histologic subtype. The analyses were performed using Kaplan-Meier curve, log-rank test, and Cox regression. Results The univariate analyses showed that the MTV and TLG in the primary tumor, the SUV in the suspicious lymph nodes, the age, the histologic subtype, and the clinical stage were associated with survival after surgery (P <= 0.05). In the Cox regression multivariate analyses, all variables identified in the univariate analyses but the clinical stage were associated with survival after surgery (P <= 0.05). Conclusion In esophageal cancer patients, some of the F-18-FDG PET/CT metabolic parameters measured in the primary tumor and in the suspicious lymph nodes before the neoadjuvant therapy are independent indicators of overall survival and appear to be more important than the clinical stage in the prognostic definition of this group of patients.
- TRANSHIATAL ESOPHAGECTOMY IS NOT ASSOCIATED WITH POOR QUALITY LYMPHADENECTOMY(2019) TAKEDA, Flavio Roberto; TUSTUMI, Francisco; NIGRO, Bruna de Camargo; SALLUM, Rubens Antonio Aissar; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Esophageal cancer neoadjuvant therapy followed by surgery increases the likelihood of treatment success. Aim: To evaluate variables that can influence the number of retrieved lymph nodes, the number of retrieved metastatic lymph nodes and lymphnodal recurrence in esophagectomy after neoadjuvant chemoradiotherapy. Methods: Patients of a single institute were evaluated after completion of trimodal therapy. Univariate and multivariate analyses were performed to evaluate variables that can influence in the number of retrieved lymph nodes and retrieved metastatic lymph nodes. Results: One hundred and forty-nine patients were included. Thoracoscopy access was considered an independent factor for the number of lymph nodes retrieved, but was neither related to the number of positive lymph nodes retrieved nor to lymphnodal recurrence. Pathological complete response on the primary tumor and male were independent variables associated with the number of positive lymph node retrieved. Pathological complete response on the primary tumor site did not statistically influence the likelihood of a lower number of lymph nodes retrieved. Conclusion: Patients submitted to esophagectomy after neoadjuvant chemoradiotherapy, thoracoscopic access is more accurate for pathological staging, even in a complete pathological response. With a proper patient selection, transhiatal surgery may preserve the quality of lymphadenectomy of the positive lymph nodes.
- ESOPHAGEAL CARCINOMA: IS SQUAMOUS CELL CARCINOMA DIFFERENT DISEASE COMPARED TO ADENOCARCINOMA? A transversal study in a quaternary high volume hospital in Brazil(2016) TUSTUMI, Francisco; TAKEDA, Flavio Roberto; KIMURA, Cintia Mayumi Sakurai; SALLUM, Rubens Antônio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanABSTRACT Background Esophageal cancer is one of the leading causes of mortality among the neoplasms that affect the gastrointestinal tract. There are several factors that contribute for development of an epidemiological esophageal cancer profile in a population. Objective This study aims to describe both clinically and epidemiologically the population of patients with diagnosis of esophageal cancer treated in a quaternary attention institute for cancer from January, 2009 to December, 2011, in Sao Paulo, Brazil. Methods The charts of all patients diagnosed with esophageal cancer from January, 2009, to December, 2011, in a Sao Paulo (Brazil) quaternary oncology institute were retrospectively reviewed. Results Squamous cell cancer made up to 80% of the cases of esophageal cancer. Average age at diagnosis was 60.66 years old for esophageal adenocarcinoma and 62 for squamous cell cancer, average time from the beginning of symptoms to the diagnosis was 3.52 months for esophageal adenocarcinoma and 4.2 months for squamous cell cancer. Average time for initiating treatment when esophageal cancer is diagnosed was 4 months for esophageal adenocarcinoma and 4.42 months for squamous cell cancer. There was a clear association between squamous cell cancer and head and neck cancers, as well as certain habits, such as smoking and alcoholism, while adenocarcinoma cancer showed more association with gastric cancer and gastroesophageal reflux disease. Tumoral bleeding and pneumonia were the main causes of death. No difference in survival rate was noted between the two groups. Conclusion Adenocarcinoma and squamous cell carcinoma are different diseases, but both are diagnosed in advanced stages in Brazil, compromising the patients' possibilities of cure.
- Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors(2021) TAKEDA, Flavio Roberto; OBREGON, Carlos de Almeida; NAVARRO, Yasmin Peres; MOURA, Diogo Turiani Hourneaux; JR, Ulysses Ribeiro; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanBACKGROUND & nbsp; Thoracoscopic esophagectomy is related to an extended lymphadenectomy, and a high number of retrieved lymph nodes, compared to the transhiatal approach; however, its association with an improvement in overall survival (OS) is debatable. & nbsp; AIM & nbsp; To compare thoracoscopic esophagectomy with transhiatal esophagectomy in patients with adenocarcinoma of the esophagogastric junction (AEGJ) in terms of survival, number of lymph nodes, and complications. & nbsp; METHODS & nbsp; In total, 147 patients with AEGJ were selected retrospectively from 2002 to 2019, and divided into Group A for thoracoscopic esophagectomy, and group B for transhiatal esophagectomy. OS, disease-free survival, postoperative complications, and number of nodes, were similarly evaluated. & nbsp; RESULTS & nbsp; One hundred and thirty (88%) were male; the mean age was 64 years. Group A had a mean age of 61.1 years and group B 65.7 years (P = 0.009). Concerning the extent of lymphadenectomy, group A showed a higher number of retrieved lymph nodes (mean of 31.89 +/- 8.2 vs 20.73 +/- 7; P < 0.001), with more perioperative complications, such as hoarseness, surgical site infections, and respiratory complications. Although both groups had similar OS rates, subgroup analysis showed better survival of transthoracic esophagectomy in patients with earlier diseases. & nbsp; CONCLUSION & nbsp; Both methods are safe, having similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a more extensive resection of the lymph nodes and may have better oncological outcomes during earlier stages of the disease. Prospective studies are warranted to better evaluate these findings.
- Prognostic Value of Tumor Regression Grade Based on Ryan Score in Squamous Cell Carcinoma and Adenocarcinoma of Esophagus(2020) TAKEDA, Flavio Roberto; TUSTUMI, Francisco; OBREGON, Carlos de Almeida; YOGOLARE, Gustavo Goncalves; NAVARRO, Yasmin Peres; SEGATELLI, Vanderlei; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanPurposes Tumor regression grade (TRG) of the primary tumor after neoadjuvant therapy is one of the most sensitive prognostic factors among patients with locally advanced esophageal cancer, although no TRG system is fully accepted. The Ryan score was proposed in 2005 to evaluate TRG in rectal cancer and could be adaptable for pathological evaluation of esophageal cancer. The objective of this study is to evaluate the prognostic value of the Ryan score for esophageal cancer in the setting of trimodal therapy. Methods We performed a retrospective cohort study in which patients with locally advanced esophageal cancer, submitted to neoadjuvant therapy followed by surgical resection, were selected. One hundred thirty-four patients were selected. All tissue specimens were assessed as per the TRG system proposed by Ryan et al. Survival curves were assessed by the Kaplan-Meier method and log-rank test. Chi-square test or likelihood-ratio test was used for absolute and relative variables. Kruskal-Wallis and analysis of variance tests were used to assess significant differences on a continuous dependent variable by a categorical independent variable. Results Of the 134 included patients, 94 (70.1%) had squamous cell carcinoma, and 40 (29.9%) adenocarcinoma. Ryan score was correlated with histological type (p < 0.001), and clinical (p = 0.044) and pathological (p < 0.001) staging. Mean follow-up was 31.1 months. Multivariate analysis showed that Ryan score can safely predict survival, and systemic and lymphatic recurrence (p < 0.05). Conclusions Ryan score is an effective system to evaluate TRG and can predict risk for lymph node or distant metastasis, overall survival, and disease-free survival.
- Transhiatal laparoscopic esophagectomy with extended lymphadenectomy guided by green-indocyanine imaging for adenocarcinoma of the esophagogastric junction(2020) TAKEDA, Flavio Roberto; RIBEIRO JUNIOR, Ulysses; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanIntroduction: Surgical treatment for adenocarcinoma of the esophagogastric junction (AEGJ) has been long-established, from resection margins to the extension of lymphadenectomy [1,2,4]. The addition of cyanine dye, namely indocyanine green (ICG), to identify suspicious lymph nodes (LN) and evaluate organ vascularization may improve results and outcomes [3]. Video: A 58-year-old female patient with Siewert type II AEGJ was administered mFLOX neoadjuvant treatment. After three cycles, she underwent surgical treatment. The day before surgery, an upper endoscopy was performed to inject 0.2 ml ICG 0.5 cm from the proximal and distal tumor margins. The patient underwent laparoscopic transhiatal esophagectomy with extended lymphadenectomy due to a 4 cm distal esophagus compromised margin. We describe the primary steps of the procedure and demonstrate the role of the ICG in the lymphadenectomy. Results: Surgery was carried out lapamscopically with a cervical approach (McKeown access), and posterior mediastinal gastric tube reconstruction and cervical gastroplasty were performed. During the standard lymphadenectomy, we observed an ICG-positive LN in station 10, which was found positive in the subsequent pathology examination. After these findings, we performed an extended lymphadenectomy through the splenic hilum. The final pathologic assessment was T3N2 (two perigastric and one positive LN at station 10 among 60 retrieved LN). The operative time was 360 min. The patient started a liquid diet on the seventh postoperative day, and she was discharged on the tenth postoperative day. Conclusions: ICG may be helpful to guide both extended lymphadenectomy and distal margin evaluation in transhiatal lapamscopic esophagectomy.