RUBENS ANTONIO AISSAR SALLUM
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Endoscopic polymer injection and endoluminal plication in treatment of gastroesophageal reflux disease: evaluation of long-term results(2018) MOURA, Eduardo Guimaraes Hourneaux De; SAIIUM, Rubens A. A.; NASI, Ary; CORONEL, Martin; MOURA, Diogo Turiani Hourneaux De; MOURA, Eduardo Turiani Hourneaux De; MINATA, Mauricio Kazuyoshi; CURY, Marcelo; FALCAO, Angela; CECCONELLO, Ivan; SAKAI, PauloBackground and study aims Us of proton pump inhibitors (PPIs) has made endoscopic treatment of gastroesophageal reflux disease (GERD) more efficient, with reduction in morbidity and complications. However, some patients persist with symptoms despite medical treatment and some are not compliant with it or cannot afford it for financial reasons, and thus they require non-pharmacological therapeutic options such as surgical fundoplication. Surgery may be effective in the short term, but there is related morbidity and concern about its long-term efficacy. The possibility of minimally invasive endoluminal surgeries has resulted in interest in and development of newly endoscopic devices. Good short-term results with surgical fundoplication lack of studies of is with long follow-up justify our interest in this study. The aim of this study was to investigate the efficacy of endoscopic polymer injection and endoluminal full-thickness plication in the long-term control of GERD. Patients and methods Forty-seven patients with GERD who underwent an endoscopic procedure were followed up for 60 months and evaluated for total response (RT), partial response (RP) and no response (SR) to endoscopic treatment with reintroduction of PPIs. Results Twenty-one patients received polymer injection (G0) and 26 endoluminal plication (G1). The number of patients with no response to endoscopic treatment with reintroduction of PPIs increased in time for both techniques (G0 P = 0.006; G1 P < 0.001). There was symptomatic improvement up to 12 months, with progressive loss of this trending up to 60 months in G0 and G1 (P < 0.001). Health-related quality of life score (GERD-HRQL) demonstrated TR in G0 and G1 at 1, 3, 6 and 12 months. The 60-month analysis showed an increased number of patients with SR in both groups. The quality of life assessment (SF-36) showed benefit in G0 up to 3 months. G0 showed a higher rate of complications. There were no deaths. There was healing of esophagitis at 3 months in 45 % of patients in G0 and 40 % in G1. There was no improvement in manometric or pH findings. Conclusion Endoscopic therapies were ineffective in controlling GERD in the long term.
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- The 2018 ISDE achalasia guidelines(2018) ZANINOTTO, G.; BENNETT, C.; BOECKXSTAENS, G.; COSTANTINI, M.; FERGUSON, M. K.; PANDOLFINO, J. E.; PATTI, M. G.; RIBEIRO JR., U.; RICHTER, J.; SWANSTROM, L.; TACK, J.; TRIADAFILOPOULOS, G.; MARKAR, S. R.; SALVADOR, R.; FACCIO, L.; ANDREOLLO, N. A.; CECCONELLO, I.; COSTAMAGNA, G.; ROCHA, J. R. M. da; HUNGNESS, E. S.; FISICHELLA, P. M.; FUCHS, K. H.; GOCKEL, I.; GURSKI, R.; GYAWALI, C. P.; HERBELLA, F. A. M.; HOLLOWAY, R. H.; HONGO, M.; JOBE, B. A.; KAHRILAS, P. J.; KATZKA, D. A.; DUA, K. S.; LIU, D.; MOONEN, A.; NASI, A.; PASRICHA, P. J.; PENAGINI, R.; PERRETTA, S.; SALLUM, R. A. A.; SARNELLI, G.; SAVARINO, E.; SCHLOTTMANN, F.; SIFRIM, D.; SOPER, N.; TATUM, R. P.; VAEZI, M. F.; HERWAARDEN-LINDEBOOM, M. van; VANUYTSEL, T.; VELA, M. F.; WATSON, D. I.; ZERBIB, F.; GITTENS, S.; PONTILLO, C.; VERMIGLI, S.; INAMA, D.; LOW, D. E.Achalasia is a relatively rare primary motor esophageal disorder, characterized by absence of relaxations of the lower esophageal sphincter and of peristalsis along the esophageal body. As a result, patients typically present with dysphagia, regurgitation and occasionally chest pain, pulmonary complication and malnutrition. New diagnostic methodologies and therapeutic techniques have been recently added to the armamentarium for treating achalasia. With the aim to offer clinicians and patients an up-to-date framework for making informed decisions on the management of this disease, the International Society for Diseases of the Esophagus Guidelines proposed and endorsed the Esophageal Achalasia Guidelines (I-GOAL). The guidelines were prepared according the Appraisal of Guidelines for Research and Evaluation (AGREE-REX) tool, accredited for guideline production by NICE UK. A systematic literature search was performed and the quality of evidence and the strength of recommendations were graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Given the relative rarity of this disease and the paucity of high-level evidence in the literature, this process was integrated with a three-step process of anonymous voting on each statement (DELPHI). Only statements with an approval rate > 80% were accepted in the guidelines. Fifty-one experts from 11 countries and 3 representatives from patient support associations participated to the preparations of the guidelines. These guidelines deal specifically with the following achalasia issues: Diagnostic workup, Definition of the disease, Severity of presentation, Medical treatment, Botulinum Toxin injection, Pneumatic dilatation, POEM, Other endoscopic treatments, Laparoscopic myotomy, Definition of recurrence, Follow up and risk of cancer, Management of end stage achalasia, Treatment options for failure, Achalasia in children, Achalasia secondary to Chagas' disease.
conferenceObject PERORAL ENDOSCOPIC MYOTOMY VERSUS SURGICAL MYOTOMY FOR THE TREATMENT OF ACHALASIA: SYSTEMATIC REVIEW AND META-ANALYSIS(2018) MARTINS, Rafael K.; BERNARDO, Wanderlei M.; MOURA, Eduardo T.; COUTINHO, Lara M.; FARIAS, Galileu F.; MADRUGA NETO, Antonio C.; DELGADO, Aureo; RIBEIRO, Igor B.; SAKAI, Paulo; SALLUM, Rubens A.; MOURA, Eduardo G. de- Neoadjuvant therapy or upfront surgery? A systematic review and meta-analysis of T2N0 esophageal cancer treatment options(2018) MOTA, F. C.; CECCONELLO, I.; TAKEDA, F. R.; TUSTUMI, F.; SALLUM, R. A. A.; BERNARDO, W. M.Background: Esophageal carcinoma usually shows poor long-term survival rates, even when esophagectomy, the standard curative treatment is performed. As a result, there has been increasing interest in the neoadjuvant therapy, which could potentially downstage cancer, eliminate micrometastasis and ergo increase resectability and curative (R0) resection. Currently, for the earliest stage esophageal cancers, most guidelines point out to the role of endoscopic treatment, and for T1bN0 upfront surgery. For locally advanced cases, several studies have demonstrated the benefits of neoadjuvant therapy to increase resectability. For clinical stage T2N0 esophageal cancer, there is no consensus as to the optimal treatment strategy. Methods: A systematic review and meta-analysis was performed to compare neoadjuvant therapy with surgery alone on clinical stage T2N0 esophageal cancer patients, concerning overall survival, recurrence, post-operative mortality, anastomotic leak, and R0 resection rate. Results: For overall survival at the mean follow-up point, the neoadjuvant therapy was not associated to a higher probability of survival than upfront surgery in cT2N0 patients (risk difference: 0.00; 95% CI: -0.09, 0.09). There was no difference between neoadjuvant therapy and primary surgery concerning recurrence (risk difference: 0.21; 95% CI: -0.03, 0.45); perioperative mortality (risk difference: 0.00; 95% CI: -0.02, 0.01); and risk for anastomotic leak (risk difference: -0.08; 95% CI: -0.21, 0.05). Pooled data showed that neoadjuvant therapy was associated to a higher risk for positive margins after resection (risk difference: 0.04; 95% CI: 0.02, 0.06). Conclusions: This review showed that neoadjuvant therapy is not associated to better results than surgery alone, for the management of clinical stage T2N0 esophageal cancer patients, concerning overall survival, recurrence rate, perioperative mortality, anastomotic leak, and seems to be associated to a higher risk for resection with positive margins.
conferenceObject ENDOSCOPIC SUBMUCOSAL DISSECTION OF SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA - COMPARISON BETWEEN PATIENTS WITH AND WITHOUT HEAD AND NECK SQUAMOUS CELL CANCER(2018) MOURA, Renata N.; ARANTES, Vitor N.; RIBEIRO, Tarso M.; GUIMARAES, Roberto G.; OLIVEIRA, Joel F.; KULCSAR, Marco A.; SALLUM, Rubens A.; RIBEIRO, Ulysses; MALUF-FILHO, FauzeconferenceObject Induction chemotherapy for locally advanced esophageal cancer(2018) HARADA, G.; BONADIO, R. R. D. C. C.; ARAUJO, F. C. C. de; VICTOR, C. R.; TAKEDA, F. R.; SALLUM, R. A. A.; JUNIOR, U. R.; CECCONELLO, I.; CASTRIA, T. B. de- Variables Associated to Pathologic Complete Response, Overall Survival and Disease-Free Survival in the Neoadjuvant Setting for Esophageal Cancer: A Retrospective Cohort Analysis(2018) TAKEDA, Flavio Roberto; VIYUELA, Mateus Silva; CRUZ JUNIOR, Jurandir Batista da; TUSTUMI, Francisco; BRAGHIROLI, Oddone Freitas Melro; NOBRE, Karolyne Ernesto Luiz; RIBEIRO JUNIOR, Ulysses; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanObjective: The aim of the study was to evaluate prognostic factors during neoadjuvant therapy that can predict pathologic complete response (pCR), overall survival (OS), or disease-free survival (DFS). Summary of background data: Variables that can predict tumor response to neoadjuvant therapy are required for esophageal cancer management. Methods: A retrospective cohort was performed with esophageal cancer patients submitted to neoadjuvant therapy. pCR, OS, and DFS were evaluated. Logistic regression was used to evaluate prognostic factors. This study covered 140 patients, 94 squamous cell carcinomas (SCC), and 44 adenocarcinomas. SCC is more often associated with pCR (compared to adenocarcinoma, OR: 8.07, 95% CI: 2.91-22.38); it has higher probability of DFS (HR for death or recurrence was 0.6, 95% CI: 0.37-0.98); and a higher probability of OS (HR for death was 0.59, 95% CI: 0.35-1). Gender, age, grade of cellular differentiation, chemotherapy regimen, and neoplasm circumferential involvement before neoadjuvant therapy are variables that are unrelated to DFS. Relief of dysphagia, and weight gain were also unrelated to the outcomes. In the multivariate analysis, the weight loss during neoadjuvant therapy was related to higher risk for recurrence or death (HR 1.02, 95% CI: 1-1.04). SCC histologic type was associated with higher probability of pCR, and higher OS and DFS rates. Gender, grade of cellular differentiation, and chemotherapy regimen are variables that are unrelated to pCR, OS, and DFS. Relief of dysphagia and increased levels of albumin after neoadjuvant therapy were also unrelated to the studied outcomes. Weight loss during neoadjuvant chemotherapy was associated with poor DFS rate in the multivariate analysis.
- Self-expandable metal stent for malignant esophagorespiratory fistula: predictive factors associated with clinical failure(2018) RIBEIRO, Maria Sylvia Ierardi; MARTINS, Bruno da Costa; LIMA, Marcelo Simas de; FRANCO, Matheus Cavalcante; SAFATLE-RIBEIRO, Adriana Vaz; MEDEIROS, Vitor de Sousa; BASTOS, Victor Rossi; KAWAGUTI, Fabio Shiguehissa; SALLUM, Rubens Antonio Aissar; RIBEIRO JR., Ulysses; MALUF-FILHO, FauzeBackground and Aims: Malignant esophagorespiratory fistulas (MERFs) usually are managed by the placement of self-expandable metal stents (SEMSs) but with conflicting results. This study aimed to identify risk factors associated with clinical failure after SEMS placement for the treatment of MERFs. Methods: This was a retrospective analysis of a prospectively maintained database used at a tertiary-care cancer hospital, with patients treated with SEMS placement for MERFs between January 2009 and February 2016. Logistic regression was used to identify predictive factors for clinical outcomes and to estimate the odds ratio (OR) and the 95% confidence interval (CI). The Kaplan-Meier method was used for survival analysis, and comparisons were made by using the log-rank test. Results: A total of 71 patients (55 male, mean age 59 years) were included in the study, and 70 were considered for the final analysis (1 failed stent insertion). Clinical failure occurred in 44% of patients. An Eastern Cooperative Oncology Group (ECOG) performance status of 3 or 4 and fistula development during esophageal cancer treatment were associated with an increased risk of clinical failure. ECOG status of 3 or 4, pulmonary infection at the time of SEMS placement, and prior radiation therapy were predictive factors associated with lower overall survival. Dysphagia scores improved significantly 15 days after stent insertion. The overall stent-related adverse event rate was 30%. Stent migration and occlusion caused by tumor overgrowth were the most common adverse events. Conclusion: SEMS placement is a reasonable treatment option for MERFs; however, ECOG status of 3 or 4 and fistula development during esophageal cancer treatment may be independent predictors of clinical failure after stent placement.
conferenceObject THE EFFICACY OF ENDOSCOPIC PROCEDURES FOR CHRONIC GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS(2018) CORONEL, Martin A.; BERNARDO, Wanderlei M.; MOURA, Diogo T. de; MOURA, Eduardo T.; CLEMENTE JUNIOR, Cesar C. de; MADRUGA NETO, Antonio C.; RIBEIRO, Igor B.; JOSINO, Iatagan R.; CORONEL, Emmanuel; IDE, Edson; SALLUM, Rubens A.; NASI, Ary; CECCONELLO, Ivan; SAKAI, Paulo; MOURA, Eduardo G. de