AMIR ZEIDE CHARRUF
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
12 resultados
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- Laparoscopic Completion Total Gastrectomy for Remnant Gastric Cancer(2021) SAKAMOTO, Erica; DIAS, Andre Roncon; RAMOS, Marcus Fernando Kodama Pertille; CHARRUF, Amir Zeide; RIBEIRO-JUNIOR, Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBackground: Remnant gastric cancer (RGC) is increasing due to past use of subtotal gastrectomy to treat benign diseases, improvements in the detection of gastric cancer, and increased survival rates after gastrectomy for gastric cancer. Laparoscopic access provides the advantages and benefits of minimally invasive surgery. However, laparoscopic completion total gastrectomy (LCTG) for RGC is technically demanding, even for experienced surgeons. Because of its rarity and heterogeneity, no standard surgical strategy has been established and few surgeons will develop technical expertise to carry out this procedure. Aim: To describe our standard technique, giving surgeons a head start in LCTG and report the early experience with this stepwise approach. Materials and Methods: We detail all the steps involved in the procedure, including trocar placement and surgical description. Results: Between 2009 and 2019, a total of 8 patients with past history of RGC were operated with this technique. All patients had been previously operated by open method, 7 due to peptic ulcer disease and 1 due to gastric cancer. Their mean age at the time of the first surgery was 38.9 years (range 25-56 years) and the mean interval between the first and the second gastrectomy was 32.1 years (range 13.6-49). Billroth II was the previous reconstruction in all cases. A 5-trocar technique was used followed by total gastrectomy with side-to-side stapled intracorporeal esophagojejunostomy anastomosis and Roux-en-Y reconstruction. The mean operation time was 272 minutes (range 180-330) and median blood loss was 247 mL (range 50-500). There was no conversion and no major intraoperative complication. Major postoperative complications occurred in 3 patients. Conclusion: Completion total gastrectomy for RGC is a morbid procedure and laparoscopic access is technically feasible, hopefully carrying the benefits of faster recovery, reduced postoperative pain, and wound complications. By standardizing the approach, the learning curve may be shortened and better results achieved.
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- 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.
conferenceObject Clinicopathological Characteristics and Prognostic Value of HER2, PD-L1 and MSI Expression in Curative Resectable Gastric Cancer Patients(2019) PEREIRA, M. A.; RAMOS, M. F.; FARAJ, S. F.; DIAS, A. R.; CIRQUEIRA, C. D.; CHARRUF, A. Z.; PERROTTA, F. S.; MELLO, E. S.; ZILBERSTEIN, B.; CECCONELLO, I.; YAGI, O. K.; ALVES, V. A.; JUNIOR, U. R.conferenceObject PREDICTORS OF PATHOLOGICAL TUMOR RESPONSE IN GASTRIC CANCER PATIENTS AFTER NEOADJUVANT THERAPY(2017) RAMOS, Marcus Kodama; PEREIRA, Marina; CHARRUF, Amir Z.; DIAS, Andre R.; YAGI, Osmar K.; FARAJ, Sheila F.; PEREIRA, Guilherme L.; MELO, Evandro Sobroza de; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, Ulyssesarticle Risk factors for lymph node metastasis after optimal surgical treatment in early gastric cancer: the western view(2016) ZILBERSTEIN, B; PEREIRA, MA; RAMOS, MFKP; CHARRUF, A; OLIVEIRA, RJ; FARAJ, SF; DIAS, AR; YAGI, OK; MELLO, ES; CECCONELLO, I; RIBEIRO JR, U- Surgical treatment of gastric cancer: a 10-year experience in a high-volume university hospital(2018) RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; YAGI, Osmar Kenji; DIAS, Andre Roncon; CHARRUF, Amir Zeide; OLIVEIRA, Rodrigo Jose de; ZAIDAN, Evelise Pelegrinelli; ZILBERSTEIN, Bruno; RIBEIRO-JÚNIOR, Ulysses; CECCONELLO, IvanOBJECTIVES: Surgery remains the cornerstone treatment modality for gastric cancer, the fifth most common type of tumor in Brazil. The aim of this study was to analyze the surgical treatment outcomes of patients with gastric cancer who were referred to a high-volume university hospital. METHODS: We reviewed all consecutive patients who underwent any surgical procedure due to gastric cancer from a prospectively collected database. Clinicopathological characteristics, surgical and survival outcomes were evaluated, with emphasis on patients treated with curative intent. RESULTS: From 2008 to 2017, 934 patients with gastric tumors underwent surgical procedures in our center. Gastric adenocarcinoma accounted for the majority of cases. Of the 875 patients with gastric adenocarcinoma, resection with curative intent was performed in 63.5%, and palliative treatment was performed in 22.4%. The postoperative surgical mortality rate for resected cases was 5.3% and was related to D1 lymphadenectomy and the presence of comorbidities. Analysis of patients treated with curative intent showed that resection extent, pT category, pN category and final pTNM stage were related to disease-free survival (DFS) and overall survival (OS). The DFS rates for D1 and D2 lymphadenectomy were similar, but D2 lymphadenectomy significantly improved the OS rate. Additionally, clinical factors and the presence of comorbidities had influence on the OS. CONCLUSIONS: TNM stage and the type of lymphadenectomy were independent factors related to prognosis. Early diagnosis should be sought to offer the optimal surgical approach in patients with less-advanced disease.
- Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case-control study(2020) CHARRUF, Amir Zeide; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; DIAS, Andre Roncon; CASTRIA, Tiago Biachi de; ZILBERSTEIN, Bruno; CECCONELO, Ivan; RIBEIRO, UlyssesBackground and Objective Neoadjuvant chemotherapy (NACT) followed by radical surgery represents a treatment option for patients with advanced gastric cancer (GC). This case-control study aimed to evaluate the clinicopathological characteristics and surgical outcomes of GC patients who received NACT, and its impact on survival. Methods We retrospectively reviewed all patients with GC who underwent gastrectomy. A total of 45 cases with NACT were matched with consecutive 45 patients who underwent upfront gastrectomy for the following characteristics: gender, age, gastrectomy type, lymphadenectomy extent, American Society of Anesthesiologists class, histological type, cT and cN. Results NACT group had smaller tumors (4.9 vs 6.8 cm P = .006), lower lymphatic invasion rate (40% vs 73.3%, P = .001), lower venous invasion rate (18% vs 46.7%, P = .003) and lower perineural invasion rate (35% vs 77.8%, P < .0001). The ypTNM stage was lower in patients treated with NACT (P < .001). The major postoperative complication (POC) rate was lower in NACT patients (6.7% vs 24.4%, P = .02), as was hospital length of stay (10.8 vs 17 days, P = .005). Conclusions NACT allowed nodal and tumor downstaging. In addition, patients who underwent NACT had fewer POC and shorter length of hospital stay.
- D2 Lymphadenectomy According to the Arterial Variations in Gastric and Hepatic Irrigation(2021) DIAS, Andre Roncon; CHARRUF, Amir Zeide; RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO JR., Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanBackground D2 lymphadenectomy for gastric cancer is technically demanding and requires clearance of the lymph node stations along the main arteries that irrigate the stomach and the liver. As gastric and hepatic irrigation have a different pattern from the classic branching of the celiac trunk in approximately 25% of patients, acquaintance with these variations and knowledge on how to adequately perform the lymphadenectomy in different anatomic settings is of utmost importance for surgeons who manage gastric cancer.1 Methods This video demonstrates, step-by-step, how to perform D2 lymphadenectomy in accordance with gastric and hepatic irrigation. Illustrations of the arterial variation correlate with the corresponding computed tomography image and operative management of the lymph node stations. Discussion D2 lymphadenectomy is the standard of care in advanced gastric cancer.2 It implies clearing the lymph node stations along the celiac trunk, left gastric artery, and common and proper hepatic arteries. However, the celiac trunk and hepatic irrigation are highly variable and surgeons must be aware of how to properly and safely address the lymph node stations in all scenarios. Vessel anatomical variations increase the risk of vascular injuries and its complications, such as bleeding, necrosis, liver function impairment, liver necrosis, and conversion to open surgery.3-5 Additionally, the lymphadenectomy cannot be compromised if a variation is found.6 Preoperative knowledge of the gastric blood supply also shortens the surgical duration.7 Conclusions The present video demonstrates how to recognize the most common variations found during D2 gastrectomy, and provides strategies to adequately approach them.
article Immunohistochemically detected micrometastases in node-negative patients with gastric carcinoma(2016) ZILBERSTEIN, B; PEREIRA, MA; RAMOS, MFKP; CHARRUF, A; OLIVEIRA, RJ; FARAJ, SF; DIAS, AR; YAGI, OK; MELLO, ES; CECCONELLO, I; RIBEIRO JR, U