RUBENS ANTONIO AISSAR SALLUM
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
8 resultados
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Agora exibindo 1 - 8 de 8
- MANAGEMENT OF SYMPTOMS RECURRENCE AFTER MYOTOMY FOR ACHALASIA. A PRACTICAL APPROACH(2023) TUSTUMI, Francisco; SZACHNOWICZ, Sergio; ANDREOLLO, Nelson Adami; SEGURO, Francisco Carlos Bernal da Costa; BIANCHI, Edno Tales; DUARTE, Andre Fonseca; NASI, Ary; SALLUM, Rubens Antonio AissarBACKGROUND: Achalasia is an esophageal motility disorder, and myotomy is one of the most used treatment techniques. However, symptom persistence or recurrence occurs in 9 to 20% of cases. AIMS: This study aims to provide a practical approach for managing the recurrence or persistence of achalasia symptoms after myotomy. METHODS: A critical review was performed to gather evidence for a rational approach for managing the recurrence or persistence of achalasia symptoms after myotomy. RESULTS: To properly manage an achalasia patient with significant symptoms after myotomy, such as dysphagia, regurgitation, thoracic pain, and weight loss, it is necessary to classify symptoms, stratify severity, perform appropriate tests, and define a treatment strategy. A systematic differential diagnosis workup is essential to cover the main etiologies of symptoms recurrence or persistence after myotomy. Upper digestive endoscopy and dynamic digital radiography are the main tests that can be applied for investigation. The treatment options include endoscopic dilation, peroral endoscopic myotomy, redo surgery, and esophagectomy, and the decision should be based on the patient's individual characteristics. CONCLUSIONS: A good clinical evaluation and the use of proper tests jointly with a rational assessment, are essential for the management of symptoms recurrence or persistence after achalasia myotomy.
- CHARACTERIZATION OF THE PSYCHOLOGICAL TYPOLOGY IN ESOPHAGEAL CANCER PATIENTS(2022) PINTO, Stela Duarte; RODRIGUEZ, Lorgio Henrique Diaz; TAKEDA, Flavio Roberto; TACCONI, Marcos Roberto; SALLUM, Rubens Antonio Aissar; CECCONELLO, Ivan; RIBEIRO JUNIOR, UlyssesBackground: Esophageal cancer is an environment-related disease, and the most important risk factors are alcohol intake and smoking, in addition to gastroesophageal reflux in obese patients. The characterization of the patients' personality can contribute to the perception of how everyone adapts to the social environment and what relationship one can establish with themselves and with others.Aim: The aim of this study was to identify the psychological typology in patients with esophageal cancer.Methods: The psychological typology of patients was defined using the Typological Assessment Questionnaire. In addition, the aspects of psychological assessment were studied to access the particularities of each patient, especially their reaction to the diagnosis and the meaning attributed to the disease.Results: A total of 90 patients with esophageal cancer, aged over 18 years, who completed high school, and were interviewed at the first medical appointment, were included. The introverted attitude was predominant (83.33%). The most common psychological type was introverted sensation, with feeling as a secondary function (43.3%), and the second most frequent was introverted feeling, with sensation as a secondary function (24.4%). From this psychological assessment, a variety of defensive mechanisms were found to minimize distress. Most patients made use of adaptive defenses in the face of the illness process.Conclusion: The identification of the psychological typology allows the most effective assistance in directing the peculiar needs of each patient. In addition, it contributes to the care team to individualize treatments based on specific psychological characteristics.
- A case report of esophageal leiomyoma in Alport's syndrome treated with robotic-assisted distal myotomy: A surgical technique to avoid esophagectomy(2023) TAKEDA, Flavio Roberto; JUNIOR, Jose Donizeti de Meira; SALLUM, Rubens Antonio AissarIntroduction: Alport's syndrome is the most common hereditary nephropathy, characterized by progressive renal failure, sensorineural deafness, and ocular abnormalities. It may rarely coexist with diffuse leiomyomatosis of the digestive tract, respiratory tract, or female genitalia, and in this setting, it is called Alport-leiomyomatosis syndrome. The leiomyomas most commonly affect the esophagus, and the symptoms have early onset. Treatment is usually esophagectomy.Case presentation: We report the case of an 8 years-old girl in which we performed a novel strategy of an esophagus-sparing approach with a robotic-assisted myotomy. This conservative approach has never been described in the literature to our knowledge. Discussion: The underpinning rationale was to resolve the patient's symptoms with partial resection of the benign tumor, avoiding an esophagectomy. Although it is likely related to a higher relapsing rate, it is more tolerable by an 8 years-old patient, and was highly effective in resolving her symptoms.Conclusion: The video of a successful minimally invasive conservative approach to esophageal leiomyomatosis is presented.
- Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy(2021) TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; FERNANDES, Felipe Alexandre; CECCONELLO, IvanEsophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.
- Robotic Myotomy and Partial Fundoplication for Achalasia(2023) SALLUM, Rubens Antonio Aissar; FERNANDES, Felipe Alexandre; BRANCO, Leonardo Torres; PEREIRA, Luna Serena Arguelho; CAMARA, Camila Maria Arruda Vilanova de; SIMOES, italo Beltrao Pereira; MEIRA JUNIOR, Jose Donizeti de; MAZEPA, Melissa Mello; CORBI, Leonardo Ervolino; GARCIA, Rodrigo Nicida; TAKEDA, Flavio RobertoLaparoscopic Heller myotomy is currently considered the standard definitive treatment of achalasia. With the advancements in technology, robotic Heller myotomy has emerged as an alternative approach to traditional laparoscopy due to threedimensional (3D) visualization, fine motor control, and improved ergonomics provided by the robot. Although there is a lack of randomized controlled trials, robotic-assisted Heller myotomy seems to be associated with lower rates of intraoperative perforations compared to the laparoscopic approach. A robotic approach may also improve surgical outcomes by providing a more complete myotomy. Here, we describe the detailed steps of robotic myotomy and partial fundoplication for achalasia.
- McKeown-cervical anastomosis in minimally invasive esophagectomy(2022) TAKEDA, F. R.; SALLUM, R. A. A.; FERNANDES, F. A.; CECCONELLO, I.Esophagectomy is the preferred treatment in advanced esophageal cancer, but the location of the anastomosis after esophagectomy is debatable. Here, we discuss leakage rates between cervical or intrathoracic anastomosis and complications related to fistulae. The aim of this review article is to describe the McKeown procedure with step-by-step cervical anastomosis. We also update evidence in the literature and discuss the experience of our institution. We report our experience with the cervical anastomosis in minimally invasive esophagectomy and performed a brief review of patients operated in our institution mainly related the rate of cervical fistulas. From 2009 to 2019, more than 345 esophagectomy with cervical anastomosis were performed, and fistula was diagnosed in 46 (13.3%). The spontaneous preferred locations of the liquid drainage after leakage were cervical (38/46, 82.6%), upper mediastinum (4/46, 8.7%), and mediastinum with mediastinitis (4/46, 8.7%). The main risk factors for anastomosis leak are gastric tube perfusion, obesity, heart failure, coronary heart disease, vascular disease, smoking, and cervical anastomosis. The literature shows different opinions and results based on surgeon and center experiences. The McKeown procedure is a feasible, standardized, and secure procedure. Anastomosis leak increases the morbidity and mortality and the frequency of anastomotic leakage in the literature. The rate is around 10% with low mortality. © 2022 Journal of Innovation Management. All rights reserved.
- Hybrid laparoscopic versus fully robot-assisted minimally invasive esophagectomy: an international propensity-score matched analysis of perioperative outcome(2023) JUNG, Jin-On; GROOT, Eline M. de; KINGMA, B. Feike; BABIC, Benjamin; RUURDA, Jelle P.; GRIMMINGER, Peter P.; HOELZEN, Jens P.; CHAO, Yin-Kai; HAVEMAN, Jan W.; DET, Marc J. van; ROUANET, Philippe; BENEDIX, Frank; LI, Hecheng; SARKARIA, Inderpal; HENEGOUWEN, Mark van Berge I.; BOXEL, Gijs I. van; CHIU, Philip; EGBERTS, Jan-Hendrik; SALLUM, Rubens; IMMANUEL, Arul; TURNER, Paul; LOW, Donald E.; HUBKA, Michal; PEREZ, Daniel; STRIGNANO, Paolo; BIEBL, Matthias; CHAUDRY, M. Asif; BRUNS, Christiane J.; HILLEGERSBERG, Richard van; FUCHS, Hans F.BackgroundCurrently, little is known regarding the optimal technique for the abdominal phase of RAMIE. The aim of this study was to investigate the outcome of robot-assisted minimally invasive esophagectomy (RAMIE) in both the abdominal and thoracic phase (full RAMIE) compared to laparoscopy during the abdominal phase (hybrid laparoscopic RAMIE).MethodsThis retrospective propensity-score matched analysis of the International Upper Gastrointestinal International Robotic Association (UGIRA) database included 807 RAMIE procedures with intrathoracic anastomosis between 2017 and 2021 from 23 centers.ResultsAfter propensity-score matching, 296 hybrid laparoscopic RAMIE patients were compared to 296 full RAMIE patients. Both groups were equal regarding intraoperative blood loss (median 200 ml versus 197 ml, p = 0.6967), operational time (mean 430.3 min versus 417.7 min, p = 0.1032), conversion rate during abdominal phase (2.4% versus 1.7%, p = 0.560), radical resection (R0) rate (95.6% versus 96.3%, p = 0.8526) and total lymph node yield (mean 30.4 versus 29.5, p = 0.3834). The hybrid laparoscopic RAMIE group showed higher rates of anastomotic leakage (28.0% versus 16.6%, p = 0.001) and Clavien Dindo grade 3a or higher (45.3% versus 26.0%, p < 0.001). The length of stay on intensive care unit (median 3 days versus 2 days, p = 0.0005) and in-hospital (median 15 days versus 12 days, p < 0.0001) were longer for the hybrid laparoscopic RAMIE group.ConclusionsHybrid laparoscopic RAMIE and full RAMIE were oncologically equivalent with a potential decrease of postoperative complications and shorter (intensive care) stay after full RAMIE.
- Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer(2023) JOSINO, Iatagan R.; MARTINS, Bruno C.; MACHADO, Andressa A.; LIMA, Gustavo R. de A.; CORDERO, Martin A. C.; POMBO, Amanda A. M.; SALLUM, Rubens A. A.; JR, Ulysses Ribeiro; BARON, Todd H.; MALUF-FILHO, FauzeBackground/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMSERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. Methods: This retrospective study was performed at the Instituto do Cancer do Estado de Sao Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. Results: Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15-5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01- 4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26-0.85; p=0.01). No difference was observed in overall survival. Conclusions: The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.