ANDRE RONCON DIAS
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
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- GASTRIC NEUROENDOCRINE TUMOR: REVIEW AND UPDATE(2017) DIAS, Andre Roncon; AZEVEDO, Beatriz Camargo; ALBAN, Luciana Bastos Valente; YAGI, Osmar Kenji; RAMOS, Marcus Fernando Kodama Pertille; JACOB, Carlos Eduardo; BARCHI, Leandro Cardoso; CECCONELLO, Ivan; RIBEIRO-JR, Ulysses; ZILBERSTEIN, BrunoABSTRACT Introduction: The frequency of gastric neuroendocrine tumors is increasing. Reasons are the popularization of endoscopy and its technical refinements. Despite this, they are still poorly understood and have complex management. Aim: Update the knowledge on gastric neuroendocrine tumor and expose the future perspectives on the diagnosis and treatment of this disease. Method: Literature review using the following databases: Medline/PubMed, Cochrane Library and SciELO. Search terms were: gastric carcinoid, gastric neuroendocrine tumor, treatment. From the selected articles, 38 were included in this review. Results: Gastric neuroendocrine tumors are classified in four clinical types. Correct identification of the clinical type and histological grade is fundamental, since treatment varies accordingly and defines survival. Conclusion: Gastric neuroendocrine tumors comprise different subtypes with distinct management and prognosis. Correct identification allows for a tailored therapy. Further studies will clarify the diseases biology and improve its treatment.
- Prognostic Role of Neutrophil/Lymphocyte Ratio in Resected Gastric Cancer: A Systematic Review and Meta-analysis(2018) SZOR, Daniel Jose; DIAS, Andre Roncon; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO-JUNIOR, UlyssesHigh levels of inflammatory markers and the neutrophil-lymphocyte ratio appear to be associated with worse overall survival in solid tumors. However, few studies have analyzed the role of the neutrophil-lymphocyte ratio in gastric cancer patients scheduled to undergo curative resection. In the present study, a systematic review and meta-analysis was performed to analyze the relationship between the neutrophil-lymphocyte ratio and overall survival in patients with gastric cancer submitted to curative resection and to identify the clinicopathological features (age, gender, tumor depth, nodal involvement and tumor differentiation) that are correlated with high neutrophil-lymphocyte ratios. A literature search of PubMed, Scopus, Cochrane and EMBASE through November 2017 was conducted. Articles that included gastric cancer patients submitted to curative resection and preoperatory neutrophil-lymphocyte ratio values were included. A total of 7 studies comprising 3264 patients from 5 different countries were included. The meta-analysis revealed an association of high neutrophil-lymphocyte ratios with older age, male gender, lower 5-year overall survival, increased depth of tumor invasion, positive nodal involvement but not with histological differentiation. Evaluation of the neutrophil-lymphocyte ratio is a cost-effective method that is widely available in preoperatory settings. Furthermore, it can effectively predict prognosis, as high values of this biomarker are related to more aggressive tumor characteristics. This ratio can also be used to stratify risk in patients within the same disease stage and may be used to assist in individualized follow-up and treatment.
- Gastric Remnant Carcinosarcoma: Case Report and Review of the Literature(2021) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; DIAS, Andre Roncon; MELLO, Evandro Sobroza de; ALMEIDA, Jose Luiz; ZILBERSTEIN, Bruno; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, Ivan
- The impact of venous resection in pancreatoduodectomy A systematic review and meta-analysis(2021) PINHEIRO FILHO, Joao Emilio Lemos; TUSTUMI, Francisco; COELHO, Fabricio Ferreira; SILVEIRA JUNIOR, Sergio; HONORIO, Fernanda Cavalcanti Cabral; HENRIQUES, Alexandre Cruz; DIAS, Andre Roncon; WAISBERG, JaquesBackground: Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial. Objective: This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD). Methods: A systematic review and meta-analysis of studies comparing VRPD and PD were performed. Results: VRPD was associated with a higher risk for postoperative mortality (risk difference: -0.01; 95% confidence interval [CI] -0.02 to -0.00) and complications (risk difference: -0.05; 95% CI -0.09 to -0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: -0.65; 95% CI -2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: -69.09; 95% CI -88.4 to -49.78), with a higher blood loss rate (MD: -314.04; 95% CI -423.86 to -195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03-1.23). Conclusion: VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.
- Minimally invasive surgery for gastric cancer in Brazil: current status and perspectives-a report from the Brazilian Laparoscopic Oncologic Gastrectomy Group (BLOGG)(2017) KASSAB, Paulo; COSTA JR., Wilson Luiz da; JACOB, Carlos Eduardo; CORDTS, Roberto de Moraes; CASTRO, Osvaldo Antonio Prado; BARCHI, Leandro Cardoso; CECCONELLO, Ivan; CHARRUF, Amir Zeide; COIMBRA, Felipe Jose Fernandez; CURY, Antonio Moris; DINIZ, Alessandro Landskron; FARIAS, Igor Correia de; FREITAS JR., Wilson Rodrigues de; GODOY, Andre Luis de; ILIAS, Elias Jirjoss; MALHEIROS, Carlos Alberto; RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO, Heber Salvador de Castro; DIAS, Andre Roncon; THULER, Fabio Rodrigues; YAGI, Osmar Kenji; LOURENCO, Laercio Gomes; ZILBERSTEIN, BrunoThe minimally invasive surgery for gastric cancer in Brazil has begun about two years after the first laparoscopic gastrectomy (LG) performed by Kitano in Japan, in 1991. Although the report of first surgeries shows the year of 1993, there was no dissemination of the technique until the years 2010. At that time with the improvement of optical devices, laparoscopic instruments and with the publications coming from Asia, several Brazilian surgeons felt encouraged to go to Korea and Japan to learn the standardization of the LG. After that there was a significant increase in that type of surgery, especially after the IRCAD opened a branch in Brazil. The growing interest for the subject led some services to begin their own experience with the LG and, since the beginning, the results were similar with those found in the open surgery. Nevertheless, there were some differences with the papers published initially in Japan and Korea. In those countries, the surgeries were laparoscopic assisted, meaning that, in the majority of cases, the anastomoses were done through a mini-incision in the end of the procedure. In Brazil since the beginning it was performed completely through laparoscopic approach due to the skills acquired by Brazilian surgeons in bariatric surgeries. Another difference was the stage. While in the east the majority of cases were done in T1 patients, in Brazil, probably due to the lack of early cases, the surgeries were done also in advanced cases. The initial experience of Zilberstein et al. revealed low rates of morbidity without mortality. Comparing laparoscopic and open surgery, the group from Barretos/IRCAD showed shorter surgical time (216x255 minutes), earlier oral or enteral feeding and earlier hospital discharge, with a smaller number of harvested lymph nodes (28 in laparoscopic against 33 in open surgery). There was no significant difference regarding morbidity, mortality and reoperation rate. In the first efforts to publish a multicentric study the Brazilian Gastric Cancer Association (BGCA) collected data from three institutions analyzing 148 patients operated from 2006 to 2016. There were 98 subtotal, 48 total and 2 proximal gastrectomies. The anastomoses were totally laparoscopic in 105, laparoscopic assisted in 21, cervical in 2, and 20 open (after conversion). The reconstruction methods were: 142 Roux-en-Y, two Billroth I, and three other types. The conversion rate was 13.5% (20/148). The D2 dissection was performed in 139 patients. The mean number of harvested lymph nodes was 34.4. If we take only the D2 cases the mean number was 39.5. The morbidity rate was 22.3%. The mortality was 2.7%. The stages were: IA-59, IB-14, IIA-11, IIB-15, IIIA-9, IIIB-19, IIIC-11 and stage IV-three cases. Four patients died from the disease and 10 are alive with disease. The participating services have already begun the robotic gastrectomy with satisfactory results. The intention of this group is to begin now a prospective multicentric study to confirm the data already obtained with the retrospective studies.
- Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis(2016) TUSTUMI, Francisco; BERNARDO, Wanderley Marques; DIAS, Andre Roncon; RAMOS, Marcus Fernando Kodama Pertille; CECCONELLO, Ivan; ZILBERSTEIN, Bruno; RIBERIO-JUNIOR, UlyssesIntraperitoneal free cancer cells in gastric adenocarcinoma are associated with a poor outcome. However, the true prognostic value of intraperitoneal free cancer cells is still unclear, leading to a lack of consensus in the management of gastric cancer. The aim of the present study is to perform a systematic review and meta-analysis to analyze intraperitoneal free cancer cells-positive patients with regard to tumor oncologic stage, recurrence, grade of cellular differentiation, and survival rates and to analyze the clinical significance of intraperitoneal free cancer cells with regard to prognosis. Databases were searched up to January 2016 for prognostic factors associated with intraperitoneal free cancer cells, including oncologic stage, depth of neoplasm invasion, lymph nodal spread, differentiation grade of the tumor, and recurrence and survival rates. A total of 100 studies were identified. Meta-analysis revealed a clear association between intraperitoneal free cancer cells and a poor prognosis. intraperitoneal free cancer cells positive patients had higher rates of nodal spread (risk difference: 0.29; p<0.01), serosal invasion (risk difference: 0.43; p<0.01), recurrence (after 60 months of follow-up, risk] difference: 0.44; p<0.01), and mortality (after 60 months of follow-up, risk difference: 0.34; p<0.01). Intraperitoneal free cancer cells are associated with a poor outcome in gastric cancer. This surrogate biomarker should be used to guide therapy both prior to and after surgery.
- MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM(2016) BARCHI, Leandro Cardoso; JACOB, Carlos Eduardos; BRESCIANI, Cláudio José Caldas; YAGI, Osmar Kenji; MUCERINO, Donato Roberto; LOPASSO, Fábio Pinatel; MESTER, Marcelo; RIBEIRO-JÚNIOR, Ulysses; DIAS, André Roncon; RAMOS, Marcus Fernando Kodama Pertille; CECCONELLO, Ivan; ZILBERSTEIN, BrunoABSTRACT Introduction: Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. Objective: To evaluate and summarize the current status of minimally invasive resection of gastric cancer. Methods: A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. Results: 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Conclusion: Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale.
- Characteristics of Early-Onset vs Late-Onset Colorectal Cancer A Review(2021) ZABOROWSKI, Alexandra M.; ABDILE, Ahmed; ADAMINA, Michel; AIGNER, Felix; D'ALLENS, Laura; ALLMER, Caterina; ALVAREZ, Andrea; ANULA, Rocio; ANDRIC, Mihailo; ATALLAH, Sam; BACH, Simon; FAES, Seraina; FAIZ, Omar; FLEMING, Fergal; FOPPA, Caterina; FOWLER, George; FRASSON, Matteo; FIGUEIREDO, Nuno; FORGAN, Tim; FRIZELLE, Frank; KRONBERGER, Irmgard; SCHNEIDER, Martin; GADAEV, Shamil; GELLONA, Jose; GLYN, Tamara; GONG, Jianping; GORAN, Barisic; GREENWOOD, Emma; GUREN, Marianne G.; GUILLON, Stephanie; GUTLIC, Ida; HAHNLOSER, Dieter; SEISHIMA, Ryo; KROON, Hidde Maarten; HAMPEL, Heather; HANLY, Ann; HASEGAWA, Hirotoshi; IVERSEN, Lene Hjerrild; HILL, Andrew; HILL, James; HOCH, Jiri; HOFFMEISTER, Michael; HOMPES, Roel; SEKULIC, Aleksandar; HURTADO, Luis; BALA, Miklosh; IAQUINANDI, Fabiano; IMBRASAITE, Ugne; ISLAM, Rumana; JAFARI, Mehrenah Dorna; KANEMITSU, Yukihide; KARACHUN, Aleksei; KARIMUDDIN, Ahmer A.; KELLER, Deborah S.; SEPPALA, Toni; KELLY, Justin; KENNELLY, Rory; KRYZAUSKAS, Marius; KHRYKOV, Gleb; KURAL, Said; KUSTERS, Miranda; LAKKIS, Zaher; LANKOV, Timur; LARSON, Dave; LAZAR, Gyorgy; SHEAHAN, Kieran; LEE, Kai-Yin; LEE, Suk Hwan; LEFEVRE, Jeremie H.; BARUSSAUD, Marie; LEPISTO, Anna; LIEU, Christopher; LOI, Lynette; LYNCH, Craig; MAILLOU-MARTINAUD, Helene; MAROLI, Annalisa; SHINE, Rebecca; MARTIN, Sean; MARTLING, Anna; MATZEL, Klaus E.; MAYOL, Julio; BAUSYS, Augustinas; MCDERMOTT, Frank; MEURETTE, Guillaume; MILLAN, Monica; MITTEREGGER, Martin; MOISEENKO, Andrei; SHLOMINA, Alexandra; MONSON, John R. T.; MORARASU, Stefan; MORITANI, Konosuke; MOSLEIN, Gabriela; MUNINI, Martino; BEBINGTON, Brendan; NAHAS, Caio; NAHAS, Sergio; NEGOI, Ionut; NOVIKOVA, Anastasia; SICA, Guiseppe S.; OCARES, Misael; OKABAYASHI, Koji; OLKINA, Alexandra; ONATE-OCANA, Luis; OTERO, Jaime; OZEN, Cihan; BEGGS, Andrew; PACE, Ugo; JULIAO, Guilherme Pagin Sao; PANAIOTTI, Lidiia; SINGNOMKLAO, Tongplaew; PANIS, Yves; PAPAMICHAEL, Demetris; PARK, Jason; PATEL, Swati; URIBURU, Juan Carlos Patron; PERA, Miguel; PEREZ, Rodrigo O.; BELLOLIO, Felipe; PETROV, Alexei; PFEFFER, Frank; BEVAN, Vicki; PHANG, P. Terry; POSKUS, Tomas; PRINGLE, Heather; PROUD, David; RAGUZ, Ivana; RAMA, Nuno; RASHEED, Shahnawaz; RAVAL, Manoj J.; BENNETT, Melissa-Rose; REGA, Daniela; KOCIAN, Peter; REISSFELDER, Christoph; MENESES, Juan Carlos Reyes; RIS, Frederic; RISS, Stefan; RODRIGUEZ-ZENTNER, Homero; ROXBURGH, Campbell S.; SAKLANI, Avanish; SALIDO, Andrea Jimenez; SAMMOUR, Tarik; BERDINSKIKH, Anton; SIRAGUSA, Leandro; SARASTE, Deborah; SMART, Neil; SOLIS, Alejandro; SPINELLI, Antonino; STAIGER, Roxane D.; STAMOS, Michael J.; STEELE, Scott; SUNDERLAND, Michael; TAN, Ker-Kan; TANIS, Pieter J.; KOH, Cherry; BIONDO, Sebastiano; TEKKIS, Paris; TEKLAY, Biniam; TENGKU, Sabrina; JIMENEZ-TOSCANO, Marta; TSARKOV, Petr; TURINA, Matthias; ULRICH, Alexis; VAILATI, Bruna B.; HARTEN, Meike van; KOK, Neils; VERHOEF, Cornelis; BISLENGHI, Gabriele; WARRIER, Satish; WEXNER, Steve; WILT, Hans de; WEINBERG, Benjamin A.; WELLS, Cameron; WOLTHUIS, Albert; XYNOS, Evangelos; YOU, Nancy; KNIGHT, Katrina A.; ZAKHARENKO, Alexander; ZEBALLOS, Justino; BLUDAU, Marc; WINTER, Des C.; BOUTALL, Adam; BROUWER, Nelleke; BROWN, Carl; BRUNS, Christiane; BUCHANAN, Daniel D.; BUCHWALD, Pamela; KNOL, Joep; BURGER, Jacobus W. A.; BURLOV, Nikita; CAMPANELLI, Michela; CAPDEPONT, Maylis; CARVELLO, Michele; CHEW, Hwee-Hoon; CHRISTOFORIDIS, Dimitri; CLARK, David; CLIMENT, Marta; COLOGNE, Kyle G.; KONTOVOUNISIOS, Christos; CONTRERAS, Tomas; CRONER, Roland; DANIELS, Ian R.; DAPRI, Giovanni; DAVIES, Justin; DELRIO, Paolo; DENOST, Quentin; DEUTSCH, Michael; DIAS, Andre; D'HOORE, Andre; KORNER, Hartwig; DROZDOV, Evgeniy; DUEK, Daniel; DUNLOP, Malcolm; DZIKI, Adam; EDMUNDSON, Aleksandra; EFETOV, Sergey; EL-HUSSUNA, Alaa; ELLIOT, Brodie; EMILE, Sameh; ESPIN, Eloy; KRIVOKAPIC, Zoran; EVANS, MartynIMPORTANCE The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. OBSERVATIONS Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include aWesternized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. CONCLUSIONS AND RELEVANCE The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.