CAIO SERGIO RIZKALLAH NAHAS
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
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conferenceObject OUTCOMES OF NONSURGICAL TREATMENT IN PATIENTS WITH CLINICAL COMPLETE RESPONSE AFTER NEOADJUVANT THERAPY FOR RECTAL CANCER.(2016) COTTI, G.; NAHAS, C.; MARQUES, C.; IMPERIALE, A.; RIBEIRO JUNIOR, U.; NAHAS, S.; CECCONELLO, I.; HOFF, P.conferenceObject ANALYSIS OF RISK FACTORS FOR POSTOPERATIVE COMPLICATIONS IN PATIENTS WHO UNDERWENT CLOSURE OF ILEOSTOMY AFTER COLORECTAL CANCER RESECTION.(2016) SOARES, D.; NAHAS, C.; CAMARGO, M.; PINTO, R.; MARQUES, C.; RIBEIRO JUNIOR, U.; NAHAS, S.; CECCONELLO, I.conferenceObject Conventional Histological Analysis is Insufficient to Confirm Complete Pathological Response After Neoadjuvant Chemoradiation for Rectal Cancer(2016) PEREIRA, M. A.; DIAS, A. R.; FARAJ, S. F.; AZEVEDO, B. A.; MELLO, E. S. de; MARQUES, C. S.; NAHAS, C.; IMPERIALE, A. R.; COTTI, G. C.; NAHAS, S.; RIBEIRO, U.- The expression profile of biomarkers in squamous cell carcinoma of the anal canal and their influence on treatment outcomes: Preliminary results(2016) MONIZ, Camila Motta Venchiarutti; RIECHELMANN, Rachel Pimenta; RIBEIRO, Suilane Coelho; BARIANI, Giovanni Mendonca; RIVELLI, Thomas Giollo; ORTEGA, Cintia; PEREIRA, Allan Andresson Lima; MEIRELES, Sibele Inacio; CHEN, Andre; NAHAS, Caio; SABAGGA, Jorge; COUDRY, Renata A.; HOFF, Paulo Marcelo
- Pathologic Complete Response in Rectal Cancer: Can We Detect It? Lessons Learned From a Proposed Randomized Trial of Watch-and-Wait Treatment of Rectal Cancer(2016) NAHAS, Sergio Carlos; NAHAS, Caio Sergio Rizkallah; MARQUES, Carlos Frederico Sparapan; RIBEIRO JR., Ulysses; COTTI, Guilherme Cutait; IMPERIALE, Antonio Rocco; CAPARELI, Fernanda Cunha; CHEN, Andre Tsin Chih; HOFF, Paulo M.; CECCONELLO, IvanBACKGROUND: Chemoradiotherapy has the potential to downsize and downstage tumors before surgery, decrease locoregional recurrence, and induce a complete sterilization of tumor cells for middle and low locally advanced rectal cancer. A watch-and-wait tactic has been proposed for patients with clinical complete response.(7 R8 R9 R10 R11 R12 R13 R14 R15 R16 R17 R18 R19""> 7-19) OBJECTIVE: The purpose of this study was to verify our ability to identify complete clinical response in patients with rectal cancer based on clinical and radiologic criteria. DESIGN: This was a prospective study. SETTINGS: The study was conducted at a single institution, in the setting of a watch-and-wait randomized trial. PATIENTS: Consecutive patients with stage T3 to T4N0M0 or T(any)N+M0 cancer located within 10 cm from anal verge or T2N0 within 7 cm from anal verge were included in the study. Patients were staged and restaged 8 weeks after completion of chemoradiation (5-fluorouracil, 5040 cGy) by digital examination, colonoscopy, pelvic MRI, and thorax and abdominal CT scans. MAIN OUTCOME MEASURES: Clinical and radiologic judgments of tumor response were compared with pathologic response of patients treated by total mesorectal excision or clinical follow-up of patients selected for nonoperative treatment. RESULTS: A total of 118 patients were treated. Six patients were considered clinic complete responders (2 randomly assigned for surgery (1 ypT0N0 and 1 ypT2N0) and 4 patients randomly assigned for observation (3 sustained clinic complete response and 1 had tumor regrowth)). The 112 clinic incomplete responders underwent total mesorectal excision, and 18 revealed pathologic complete response. These 18 patients were not considered complete responders at restaging because they presented at least 1 of the following conditions: mucosal ulceration and/or deformity and/or substenosis of rectal lumen at digital rectal examination and colonoscopy (n = 16), ymrT1 to T4 (n = 16), ymrN+ (n = 2), involvement of circumferential resection margin on MRI (n = 3), extramural vascular invasion on MRI (n = 4), MRI tumor response grade 2 to 4 (n = 15), and pelvic side wall lymph node involvement on MRI (n = 1). Sensitivity for identification of ypT0N0 or sustained clinic complete response was 18.2%. LIMITATIONS: This study has a short follow-up and small sample size. Radiologists who reviewed the restaging examination were not blinded to the pretreatment stage. Only 1 radiologist read the images of each patient. CONCLUSIONS: Evaluation of clinic complete response according to current adopted criteria has low sensitivity because pathologic complete response more frequently presented as clinic incomplete response (see Video, Supplemental Digital Content 1, [GRAPHICS] ).
conferenceObject PROGNOSTIC FACTORS AFFECTING OUTCOMES IN MULTIVISCERAL EN BLOC RESECTION FOR COLORECTAL CANCER.(2016) NAHAS, C.; NAHAS, S.; MARQUES, C.; PINTO, R.; BUSTAMANTE, L.; COTTI, G.; IMPERIALE, A.; RIBEIRO JUNIOR, U.; NAHAS, W.; SOARES, D.; HOFF, P.; CECCONELLO, I.- A novel technique for correction of total rectal prolapse: Endoscopic-assisted percutaneous rectopexy with the aid of the EndoLifter(2016) BUSTAMANTE-LOPEZ, L.; SULBARAN, M.; SAKAI, C.; MOURA, E. G. de; BUSTAMANTE-PEREZ, L.; NAHAS, C. S.; NAHAS, S. C.; CECCONELLO, I.; SAKAI, P.Introduction and aims: Rectal prolapse is common in the elderly, having an incidence of 1% in patients over 65 years of age. The aim of this study was to evaluate the safety and feasibility of a new endoluminal procedure for attaching the previously mobilized rectum to the anterior abdominal wall using an endoscopic fixation device. Materials and methods: The study is a single-arm phase I experimental trial. Under general anesthesia, total rectal prolapse was surgically reproduced in five pigs. Transanal endoscopic reduction of the rectal prolapse was performed. The best site for transillumination of the abdominal wall, suitable for rectopexy, was identified. The EndoLifter was used to approximate the anterior wall of the proximal rectum to the anterior abdominal wall. Two percutaneous rectopexies were performed by puncture with the Loop Fixture II Gastropexy Kit at the preset site of transillumination. After the percutaneous rectopexies, rectoscopy and exploratory laparotomy were performed. Finally, the animals were euthanized. Results: The mean procedure time was 16 min (11-21) and the mean length of the mobilized specimen was 4.32 cm (range 2.9-5.65cm). A total of 10 fixations were performed with a technical success rate of 100%. There was no evidence of postoperative rectal prolapse in any of the animals. The EndoLifter facilitated the process by allowing the mucosa to be held and manipulated during the repair. Conclusions: Endoscopic-assisted percutaneous rectopexy is a safe and feasible endoluminal procedure for fixation of the rectum to the anterior abdominal wall in experimental animals. (C) 2016 Asociacion Mexicana de Gastroenterologia.
- Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course(2016) MARQUES, Carlos Frederico S.; NAHAS, Caio Sergio R.; RIBEIRO JR., Ulysses; BUSTAMANTE, Leonardo A.; PINTO, Rodrigo Ambar; MORY, Eduardo Kenzo; CECCONELLO, Ivan; NAHAS, Sergio CarlosTransanal endoscopic microsurgery (TEM) is a safe and efficient minimally invasive treatment for rectal benign and early malignant neoplasia, but postoperative complications may be severe. We aimed to evaluate the risk factors related to the incidence, severity, and time course of postoperative complications of TEM. This is a prospective study of postoperative complications in 53 patients (> 18 years old) with benign or early rectal neoplasia who underwent TEM with curative intention or, for higher stages, palliation. Outcome measures included age, sex, American Society of Anesthesiologists score, neoadjuvant chemoradiotherapy, lesion height and size, pathologic margins, tumor histology, and suture type. Overall morbidity was 50 %. Temporary fecal incontinence was the most frequent complication (17.3 %). Complication rates of Clavien-Dindo grades I and II were 21.1 % and those of grades III and IV 3.8 %. Of patients with complications, more had lesions under the first rectal valve than over the first valve (61.54 % vs 38.46 %, p = 0.04). Patients submitted to chemoradiotherapy had a 24-fold greater chance of presenting grade II complications (p = 0.002). When the surgical defect was treated using the TEM device to perform the suture, the chance of having grade III complications was reduced 16-fold (p = 0.04). Fifty-three percent of complications occurred in the first 10 days and 95 % within 20 days. Postoperative complications after transanal endoscopic microsurgery for the treatment of rectal neoplasia are frequent, acceptable, and usually controllable with pharmacologic treatment. Over time the nature of complications is continuous, centered on the first 20 days after surgery.