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
42 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 42
- II BRAZILIAN CONSENSUS ON GASTRIC CANCER BY THE BRAZILIAN GASTRIC CANCER ASSOCIATION(2020) BARCHI, Leandro Cardoso; RAMOS, Marcus Fernando Kodama Pertille; DIAS, Andre Roncon; ANDREOLLO, Nelson Adami; WESTON, Antonio Carlos; LOURENCO, Laercio Gomes; MALHEIROS, Carlos Alberto; KASSAB, Paulo; ZILBERSTEIN, BrunoBackground: Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. Aim: This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. Methods: Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree A consensus was adopted when at least 80% of the sum of the answers ""fully agree"" and ""partially agree"" was reached. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. Results: Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. Conclusion: The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
- Long-term follow up of abdominal rectosigmoidectomy with posterior end-to-side stapled anastomosis for Chagas megacolon(2011) NAHAS, S. C.; PINTO, R. A.; DIAS, A. R.; NAHAS, C. S. R.; ARAUJO, S. E. A.; MARQUES, C. F. S.; CECCONELLO, I.Aim Chagas' disease is an endemic parasitosis found in Latin America. The disease affects different organs, such as heart, oesophagus, colon and rectum. Megacolon is the most frequent long-term complication, caused by damage to the myoenteric and submucous plexus, ultimately leading to a functional barrier to the faeces. Patients with severe constipation are managed surgically. The study aimed to analyse the 10-year minimum functional outcome after rectosigmoidectomy with posterior end-to-side anastomosis (RPESA). Method A total of 21 of 46 patients were available for follow up. Patients underwent clinical, radiological and manometric evaluation, and the results were compared with preoperative parameters. Results Of the 21 patients evaluated, 81% (17) were female, with a mean age of 60.6 years. Good function was achieved in all patients, with significant improvement in defaecatory frequency (P < 0.0001), usage of enemas (P < 0.0001) and patient satisfaction. Barium enema also showed resolution of the colonic and rectal dilatation in 19 cases evaluated postoperatively. Conclusion Minimal 10-year follow up of RPESA showed excellent functional results, with no recurrence of constipation.
- RECURRENCE IN PN0 GASTRIC CANCER: RISK FACTORS IN THE OCCIDENT(2021) NOBRE, Karolyne Ernesto Luiz; PEREIRA, Marina Alessandra; RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; DIAS, Andre RonconBackground: Nearly 10% of node negative gastric cancer patients who underwent curative surgery have disease recurrence. Western data is extremely poor on this matter and identifying the risk factors that associate with relapse may allow new strategies to improve survival. Aim: Verify the clinical and pathological characteristics that correlate with recurrence in node negative gastric cancer. Methods: All gastric cancer patients submitted to gastrectomy between 2009 and 2019 at our institution and pathologically classified as N0 were considered. Their data were available in a prospective database. Inclusion criteria were: gastric adenocarcinoma, node negative, gastrectomy with curative intent, R0 resection. Main outcomes studied were: disease-free survival and overall survival. Results: A total of 270 patients fulfilled the inclusion criteria. Mean age was 63-year-old and 155 were males. Subtotal gastrectomy and D2 lymphadenectomy were performed in 64% and 74.4%, respectively. Mean lymph node yield was 37.6. Early GC was present in 54.1% of the cases. Mean follow-up was 40.8 months and 19 (7%) patients relapsed. Disease-free survival and overall survival were 90.9% and 74.6%, respectively. Independent risk factors for worse disease-free survival were: total gastrectomy, lesion size >= 3.4 cm, higher pT status and <16 lymph nodes resected. Conclusion: In western gastric cancer pN0 patients submitted to gastrectomy, lymph node count <16, pT3-4 status, tumor size >= 3.4 cm, total gastrectomy and presence of lymphatic invasion, are all risk factors for disease relapse.
conferenceObject OUTCOME OF GASTRIC CANCER PATIENTS SUBMITTED TO D1 LYMPH NODE DISSECTION DUE TO UNFAVORABLE MEDICAL CONDITIONS(2017) RAMOS, Marcus Kodama; PEREIRA, Marina; DIAS, Andre R.; YAGI, Osmar K.; BARCHI, Leandro C.; JACOB, Carlos E.; MUCERINO, Donato R.; LOPASSO, Fabio; MESTER, Marcelo; BRESCIANI, Claudio C.; CHARRUF, Amir Z.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, Ulysses- Short-Term Surgical Outcomes of Robotic Gastrectomy Compared to Open Gastrectomy for Patients with Gastric Cancer: a Randomized Trial(2022) RIBEIRO, Ulysses; DIAS, Andre Roncon; RAMOS, Marcus Fernando Kodama Pertille; YAGI, Osmar Kenji; OLIVEIRA, Rodrigo Jose; PEREIRA, Marina Alessandra; ABDALLA, Ricardo Zugaib; ZILBERSTEIN, Bruno; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground Robotic gastrectomy (RG) has been shown to be a safe and feasible method in gastric cancer (GC) treatment. However, most studies are in Eastern cohorts and there is great interest in knowing whether the method can be used routinely, especially in the West. Objectives The aim of this study was to compare the short-term surgical outcomes of D2-gastrectomy by RG versus open gastrectomy (OG). Methods Single-institution, open-label, non-inferiority, randomized clinical trial performed between 2015 and 2020. GC patients were randomized (1:1 allocation) to surgical treatment by RG or OG. Da Vinci Si platform was used. Inclusion criteria: gastric adenocarcinoma, stage cT2-4 cNO-1, potentially curative surgery, age 18-80 years, and ECOG performance status 0-1. Exclusion criteria: emergency surgery and previous gastric or major abdominal surgery. Primary endpoint was short-term surgical outcomes. The study is registered at clinicaltrials.gov (NCT02292914). Results Of 65 randomized patients, 5 were excluded (3 palliatives, 1 obstruction and emergency surgery, and 1 for material shortage). Consequently, 31 and 29 patients were included for final analysis in the OG and RG groups, respectively. No differences were observed between groups regarding age, sex, BMI, comorbidities, ASA, and frequency of total gastrectomy. RG had similar mean number of harvested lymph nodes (p = 0.805), longer surgical time (p < 0.001), and less bleeding (p <0.001) compared to OG. Postoperative complications, length of hospital stay, and readmissions in 30 days were equivalent between OG and RG. Conclusions RG reduces operative bleeding by more than 50%. The short-term outcomes were non-inferior to OG, although surgical time was longer in RG.
conferenceObject PREOPERATIVE CHEMOTHERAPY VERSUS UPFRONT SURGERY FOR STAGE CT4 GASTRIC CANCER: WHAT IS THE BEST STRATEGY?(2022) DIAS, Andre R.; PEREIRA, Marina A.; RAMOS, Marcus F.; RIBEIRO, Ulysses; ZILBERSTEIN, Bruno; NAHAS, Sergio Carlos- INTRAPERITONEAL CHEMOTHERAPY FOR GASTRIC CANCER WITH PERITONEAL CARCINOMATOSIS: STUDY PROTOCOL OF A PHASE II TRIAL(2023) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; CHARRUF, Amir Zeide; VICTOR, Carolina Ribeiro; GREGORIO, Joao Vitor Antunes Marques; ALBAN, Luciana Bastos Valente; MONIZ, Camila Motta Venchiarutti; ZILBERSTEIN, Bruno; MELLO, Evandro Sobroza De; HOFF, Paulo Marcelo Gehm; JUNIOR, Ulysses Ribeiro; DIAS, Andre RonconBackground: Peritoneal carcinomatosis in gastric cancer is considered a fatal disease, without expectation of definitive cure. As systemic chemotherapy is not sufficient to contain the disease, a multimodal approach associating intraperitoneal chemotherapy with surgery may represent an alternative for these cases.Aims: The aim of this study was to investigate the role of intraperitoneal chemotherapy in stage IV gastric cancer patients with peritoneal metastasis.Methods: This study is a single institutional single-arm prospective clinical trial phase II (NCT05541146). Patients with the following inclusion criteria undergo implantation of a peritoneal catheter for intraperitoneal chemotherapy: Stage IV gastric adenocarcinoma; age 18-75 years; Peritoneal carcinomatosis with peritoneal cancer index<12; Eastern Cooperative Oncology Group 0/1; good clinical status; and lab exams within normal limits. The study protocol consists of four cycles of intraperitoneal chemotherapy with paclitaxel associated with systemic chemotherapy. After treatment, patients with peritoneal response assessed by staging laparoscopy undergo conversion gastrectomy.Results: The primary outcome is the rate of complete peritoneal response. Progression-free and overall survivals are other outcomes evaluated. The study started in July 2022, and patients will be screened for inclusion until 30 are enrolled.Conclusions: Therapies for advanced gastric cancer patients have been evaluated in clinical trials but without success in patients with peritoneal metastasis. The treatment proposed in this trial can be promising, with easy catheter implantation and ambulatory intraperitoneal chemotherapy regime. Verifying the efficacy and safety of paclitaxel with systemic chemotherapy is an important progress that this study intends to investigate.
- 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
- Lymph Node Yield After Neoadjuvant Chemoradiotherapy in Rectal Cancer Specimens: A Randomized Trial Comparing Two Fixatives(2018) DIAS, Andre R.; PEREIRA, Marina Alessandra; MELLO, Evandro Sobroza de; NAHAS, Sergio Carlos; CECCONELLO, Ivan; RIBEIRO JR., UlyssesBACKGROUND: It is widely reported that neoadjuvant chemoradiation reduces lymph node yield in rectal cancer specimens. Some have questioned the adequacy of finding 12 lymph nodes for accurate staging, and fewer nodes were correlated with good response. Others reported that low lymph node count raises the chance for understaging and correlates with worse survival. In addition, a few studies demonstrated that diligent specimen analysis increases lymph node count. OBJECTIVE: The aim of this study was to compare Carnoy's solution and formalin concerning lymph node yield in specimens of patients with rectal cancer after neoadjuvant chemoradiation. DESIGN: This is a prospective randomized trial that was conducted from 2012 to 2015. SETTINGS: This study was performed in a reference cancer center in Brazil. PATIENTS: Patients who underwent low anterior resection with total mesorectal excision after neoadjuvant chemoradiation for rectal adenocarcinoma were included. INTERVENTION: Rectosigmoid specimens were randomized for fixation with Carnoy's solution or formalin. MAIN OUTCOME MEASURES: A total of 130 specimens were randomized. After dissection, the residual fat from the formalin group was immersed in Carnoy's solution in search for missed lymph nodes (Revision). RESULTS: The Carnoy's solution group had superior lymph node count (24.0 vs 16.3, p < 0.01) and fewer cases with <12 lymph nodes (6 vs 22, p = 0.001). The Revision group found lymph nodes in all cases (mean, 11.1), retrieving metastatic lymph nodes in 6 patients. It reduced the formalin cases with <12 lymph nodes from 33.8% to 4.6% and upstaged 2 patients. Tumor response to neoadjuvant chemoradiotherapy was not associated with lymph node count. LIMITATIONS: This was a unicentric study. CONCLUSIONS: Compared with formalin, the Carnoy's solution increases lymph node count and reduces the cases with <12 lymph nodes. Harvested lymph nodes are missed following routine analysis and this is clinically relevant. Finding <12 lymph nodes is not a sign of good response to neoadjuvant chemoradiation (www.clinicaltrials.gov. Unique identifier: NCT02629315). See Video Abstract at http://links.lww.com/DCR/A694.
- One-level step section histological analysis is insufficient to confirm complete pathological response after neoadjuvant chemoradiation for rectal cancer (vol 21, pg 745, 2017)(2017) PEREIRA, M. A.; DIAS, A. R.; FARAJ, S. F.; NAHAS, C. S. R.; IMPERIALE, A. R.; MARQUES, C. F. S.; COTTI, G. C.; AZEVEDO, B. C.; NAHAS, S. C.; MELLO, E. S. de; RIBEIRO JR., U.Unfortunately, one of the author name was wrongly published in the original publication. The complete correct name should read as follows ""Beatriz Camargo Azevedo"". The original article was updated.