FABRICIO FERREIRA COELHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
7 resultados
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- Extended right hepatectomy with caudate lobe resection using the hilar ""en bloc"" resection technique with a modified hanging maneuver(2016) PERINI, Marcos V.; COELHO, Fabricio F.; KRUGER, Jaime A.; ROCHA, Flavio G.; HERMAN, PauloThe hanging liver maneuver is a useful technique to guide the transection of liver parenchyma by lifting a tape passed between the anterior surface of the inferior vena cava and the liver. Modified hanging liver maneuvers have been described in different types of liver resection. Surgical resection of hilar cholangiocarcinoma can involve the portal vein and the caudate lobe for margin clearance. However, hilar dissection and resection of the caudate lobe can be a challenging during the hanging maneuver once the tape is positioned. Herein, we describe a modified hanging liver maneuver for a hilar en bloc extended right hepatectomy with portal vein resection for the treatment of hilar cholangiocarcinoma including the caudate lobe. J. Surg. Oncol. 2016;113:427-431. (c) 2016 Wiley Periodicals, Inc.
article Serous Cystadenocarcinoma of the Pancreas Presenting with Liver Metastases: Case Report and Literature Review(2016) PERINI, Marcos Vinicius; LIMA, Fabiana Roberto; FRENK, Nathan Elie; LEDO FILHO, Hilton Muniz; COELHO, Fabricio Ferreira; KRUGER, Jaime Arthur; ROCHA, Manoel de Souza; HERMAN, PauloSerous cystic neoplasms of the pancreas are usually benign. Malignant serous cystic neoplasm is a rare clinical entity. We report a case of a 45-year-old man presenting with metastatic liver lesions on ultrasound. Computed tomography scan showed a hypervascular solid lesion arising in the pancreatic body and invading the celiac axis and portal vein with liver metastases. Ultrasound-guided liver biopsy diagnosed a serous cystic neoplasm, indistinguishable from serous cystadenoma. Based on clinical, radiological and pathological correlation, the diagnosis of cystadenocarcinoma was established. There are few reported cases of malignant serous cystic neoplasms in which malignancy was confirmed. Although rare in males, cystadenocarcinoma should be considered in the differential diagnosis of patients presenting with a pancreatic mass and liver metastasis.- Favorable Long-term Outcome in Patients Submitted to Liver Transplantation After Downstaging of Hepatocellular Carcinoma According to a Brazilian Selection Protocol(2016) MASSAROLLO, P. C. B.; COPPINI, A. Z.; SALZEDAS-NETTO, A. A.; COELHO, F. F.; MINAMI, T.; GONZALEZ, A. M.Background. In October 2008, the Brazilian Ministry of Health authorized listing of downstaged hepatocellular carcinoma (HCC) for liver transplantation, according to a standardized protocol. The aim of this study was to compare the outcome of patients submitted to liver transplantation after downstaging of HCC with the results other standard indications in Brazil. Methods. We conducted a retrospective analysis of 2,667 adult 1st elective deceased donor liver transplantations registered at the database of the Transplant Notification Center of the Sao Paulo State Health Secretariat. These cases are classified into 3 groups: ""cirrhosis,"" including 1,709 patients transplanted because of end-stage liver disease; ""Milan-HCC,"" including 873 HCC patients initially meeting the Milan criteria; and ""downstaging"" group, including 85 HCC patients submitted to tumor downstaging to the Milan criteria before liver transplantation. Results. One-, 3-, 5-, and 6-year patients survivals were, respectively, 82.7%, 72.0%, 66.1%, and 66.1%, in the ""downstaging"" group and 76.7%, 68.4%, 63.9%, and 63.5% in the ""Milan-HCC"" group (P = .483). At the same time intervals, patient survivals were 67.8%, 62.9%, 60.9%, and 60.2% in the ""cirrhosis"" group. These probabilities were significantly lower than those of both ""downstaging"" (P = .047) and ""Milan-HCC"" (P = .001) groups. Conclusions. Patients submitted to liver transplantation after downstaging of HCC, according to a Brazilian selection protocol, present long-term outcomes similar to HCC patients initially within the Milan criteria and better survival than recipients with end-stage liver disease.
- CENTRAL HEPATECTOMY FOR BILIARY CYSTADENOMA: PARENCHYMA-SPARING APPROACH FOR BENIGN LESIONS(2016) ARAUJO, Raphael L. C.; CESCONETTO, Danielle; JEISMANN, Vagner Birk; FONSECA, Gilton Marques; COELHO, Fabricio Ferreira; KRUGER, Jaime Arthur Pirola; HERMAN, Paulo
- IS RESECTION OF HEPATOCELLULAR CARCINOMA IN THE ERA OF LIVER TRANSPLANTATION WORTHWILE? A single center experience(2016) HERMAN, Paulo; LOPES, Felipe de Lucena Moreira; KRUGER, Jaime Arthur Pirola; FONSECA, Gilton Marques; JEISMANN, Vagner Birk; COELHO, Fabricio FerreiraABSTRACT Background - Liver resection for hepatocellular carcinoma is a potentially curative therapeutic procedure that can be performed readily after its indication, without the need of a long waiting time and lower costs when compared to liver transplantation, being a good alternative in patients with preserved/good liver function. Objective - Evaluate long-term results of liver resection from a high volume single center for selected patients with hepatocellular carcinoma in a context of a long waiting list for liver transplant. Methods - One hundred and one patients with hepatocellular carcinoma, with a mean age of 63.1 years, and preserved liver function were submitted to liver resection. Clinical and pathological data were evaluated as prognostic factors. Mean follow-up was 39.3 months. Results - All patients had a single nodule and 57 (58.2%) patients were within the Milan criteria. The size of the nodule ranged from 1 to 24 cm in diameter. In 74 patients, liver resection was performed with the open approach and in 27 (26.7%) was done laparoscopically. Postoperative morbidity was 55.3% being 75.5% of the complications classified as Dindo-Clavien I and II and operative mortality was 6.9%. Five-year overall and disease free survival rates were 49.9% and 40.7%, respectively.After a log-rank univariate analysis, the levels of preoperative alpha-fetoprotein (P=0.043), CA19-9 (P=0.028), capsule invasion (P=0.03), positive margin (R1-R2) (P=0.004) and Dindo-Claviens' morbidity classification IV (P=0.001) were the only parameters that had a significant negative impact on overall survival. On the odds-ratio evaluation, the only significant factors for survival were high levels of alpha-fetoprotein (P=0.037), and absence of free margins (P=0.008). Conclusion - Resection, for selected cases, is a potentially curative treatment with acceptable morbidity and mortality and, in a context of a long waiting list for transplant, plays an important role for the treatment of hepatocellular carcinoma.
- INFLUÊNCIA DA CAUSA DO CARCINOMA HEPATOCELULAR NA SOBREVIDA DE PACIENTES APÓS RESSECÇÃO(2016) LOPES, Felipe de Lucena Moreira; COELHO, Fabricio Ferreira; KRUGER, Jaime Arthur Pirolla; FONSECA, Gilton Marques; ARAUJO, Raphael Leonardo Cunha de; JEISMANN, Vagner Birk; HERMAN, PauloABSTRACT Background: Hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer and its incidence is increasing around the world in the last decades, making it the third cause of death by cancer in the world. Hepatic resection is one of the most effective treatments for HCC with five-year survival rates from 50-70%, especially for patients with a single nodule and preserved liver function. Some studies have shown a worse prognosis for HCC patients whose etiology is viral. That brings us to the question about the existence of a difference between the various causes of HCC and its prognosis. Aim: To compare the prognosis (overall and disease-free survival at five years) of patients undergoing hepatectomy for the treatment of HCC with respect to various causes of liver disease. Method: Was performed a review of medical records of patients undergoing hepatectomy between 2000 and 2014 for the treatment of HCC. They were divided into groups according to the cause of liver disease, followed by overall and disease-free survival analysis for comparison. Results: There was no statistically significant difference in the outcomes of the groups of patients divided according to the etiology of HCC. Overall and disease-free survival at five years of the patients in this sample were 49.9% and 40.7%, respectively. Conclusion: From the data of this sample, was verified that there was no prognostic differences among the groups of HCC patients of the various etiologies.
- Laparoscopic liver resection: Experience based guidelines(2016) COELHO, Fabricio Ferreira; KRUGER, Jaime Arthur Pirola; FONSECA, Gilton Marques; ARAUJO, Raphael Leonardo Cunha; JEISMANN, Vagner Birk; PERINI, Marcos Vinicius; LUPINACCI, Renato Micelli; CECCONELLO, Ivan; HERMAN, PauloLaparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.