RICARDO JORDAO DUARTE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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conferenceObject Impact of surgery and chemotherapy over renal function in bilateral Wilms tumor patients(2012) DUARTE, R. J.; CRISTOFANI, L. M.; GIRON, A. M.; DENES, F. T.; ODONE-FILHO, V; TANNURI, U.; SROUGI, M.INTRODUCTION & OBJECTIVES: Bilateral Wilms’ tumor represents 3% of all cases. The challenge of this situation is curing these patients preserving their renal function and quality of life (dialysis free status). Our purpose was to evaluate the success of renal function preservation in children treated for bilateral Wilms’ tumor. MATERIAL & METHODS: From January/1982 through June/2009, 13 children with bilateral Wilms’ tumor (4F: 9M, median age 16 months) were diagnosed. All patients received preoperative chemotherapy with VCR/ACTD (13 patients), VCR/ACTD/ADRIA (10 patients), VCR/ACTD/ADRIA/CBDCA/ETO (3 patients), VCR/ACTD/ADRIA/CBDCA/ETO/IFO (2 patients), for 8 through 40 weeks (median 16 weeks). All patients were submitted to surgical procedure nephron sparing objective. RESULTS: Radical unilatera l nephrectomy was performed in 9 patients (combined with contralateral nodulectomy in 8), bilateral nodulectomy in 3, and unilateral nodulectomy in 1. Two patients presented unilateral disappearing of the disease after preoperative chemotherapy on image and surgical evaluation. The histhopatological analysis revealed the classic triphasic Wilms’ tumor in 9 patients, rhabdomyoblastic differentiation in 3 and blastematous rests in one patient. Four patients relapsed: 2 in the remaining kidney, 1 in the tumoral bed and 1 in lungs (9mo, 1mo, 5mo and 6 mo after surgery). A ll, except the lung relapsed patient, were rescued, achieving a second remission, but one presented a second diffuse abdominal relapse and died. 11/13 patients have normal renal function and are alive and free of disease for 23+ months to 28+years. 1/13 patients presents microalbuminuria and mild systemic hypertension, requiring medication support. CONCLUSIONS: Bilateral Wilms’ tumor was successfully treated and renal function was preserved in 84.6% of surviving patients, even those cases that received nephrotoxic drugs.conferenceObject Misdiagnosis in Wilms tumor: Concerns on the use of preoperative chemotherapy(2012) DUARTE, R. J.; CRISTOFANI, L. M.; DENES, F. T.; GIRON, A. M.; ODONE-FILHO, V; SROUGI, M.INTRODUCTION & OBJECTIVES: Modern image armamentarium allows the preoperative diagnosis of Wilms tumor and the use of preoperative chemotherapy as precluded by SIOP protocols without a biopsy specimen. However, misdiagnosis is possible even with very accurate examination. This paper describes our experience with children who were preoperatively considered as having Wilms tumor and who received preoperative chemotherapy as SIOP 2001 protocol, and after delayed surgery, a different diagnosis was revealed. MATERIAL & METHODS: The charts of children admitted to our institution with diagnosis of Wilms tumor from January 2000 through December 2010 were reviewed in order to disclose all those who were submitted to preoperative chemotherapy followed by surgical removal of the tumor. The histopathological diagnosis and the subsequent treatment were reviewed. RESULTS: 81 children were admitted to our institution with the diagnosis of Wilms tumor during the analyzed period. Median age was 3.2 years (range 7 mo trough 5 years). All children presented with renal mass suggestive of Wilms tumor on abdominal ultrasonography and computerized tomography. All received preoperative chemotherapy with vincristine plus dactinomycin for four weeks, been afterwards submitted to nephrectomy. Histopathological analysis confirmed Wilms tumor in 78/81 cases (96%), but in 3/81 (4%) of the cases the diagnosis was clear cell sarcoma (1/81), multicystic kidney (1/81) and neuroblastoma (1/81). No further chemotherapy was administered to the child with multicystic kidney and the other two children were treated according to specific protocols. CONCLUSIONS: In spite of the refined image methods available in our days, misdiagnosis of Wilms tumor is still possible and it should be a concern when preoperative chemotherapy is the first line treatment.- Videolaparoscopic radical nephrectomy after chemotherapy in the treatment of Wilms' tumor: Long-term results of a pioneer group(2017) DUARTE, Ricardo Jordao; CRISTOFANI, Lilian Maria; ODONE FILHO, Vicente; SROUGI, Miguel; DENES, Francisco TiborIntroduction A high cure rate for Wilms' tumor has been achieved using a multidisciplinary approach. The natural step forward is to offer the benefits of a minimally invasive technique for surgery, which is an obligatory part of treatment. Nevertheless, some authors resist using videolaparoscopic radical nephrectomy (VRN) because of concerns about reducing the cure index. Methods The present study included children with unilateral Wilms' tumor treated from December 2003 to December 2015 with neoadjuvant chemotherapy followed by VRN. Patients were selected based on the size of their tumors compared with the contralateral kidney, and on their stature. Results VRN was performed in 24 patients of age range 10-93 months, with an average of 38.04 +/- 23.37 months. The tumoral kidney's largest diameter after chemotherapy averaged 10% of a patient's height. There was no tumor rupture or spillage and no patient presented intra or immediate postoperative complications, except for prolonged ileum in two patients. One patient required intraoperative transfusion because of preoperative anemia. Another developed a late herniation in the umbilical port that required surgical correction. After an average of 6.65 years of follow-up, two patients presented relapse: one with a stage IV disease had relapse in the lung and another with a stage III, involving the liver, had local relapse because of an unwanted delay in the adjuvant treatment. Conclusion VRN can be considered a feasible alternative to open surgery in selected cases of children with Wilms' tumor. The present experience shows that besides the benefits of minimally invasive procedures and better cosmetic results, there is no evidence of increased tumor rupture or spillage, peritoneal or port site metastasis, and the long-term oncological results are the same as open procedures.
- Wilms Tumor: A Retrospective Study of 32 Patients Using Videolaparoscopic and Open Approaches(2014) DUARTE, Ricardo Jordao; CRISTOFANI, Lilian Maria; DENES, Francisco Tibor; ODONE FILHO, Vicente; TANNURI, Uenis; SROUGI, MiguelOBJECTIVE To compare videolaparoscopic nephrectomy and the open technique as treatments for Wilms tumor, specifically the surgical results, immediate and long-term complications, and patient survival. METHODS A review of charts of children with unilateral Wilms tumor was performed. There were 2 surgical groups: (1) only open surgery and (2) videolaparoscopy. Complications, transfusion, ruptures, margins, conversions, lymph nodes, and relapse were analyzed. RESULTS Seventeen children underwent laparoscopic nephrectomy and 15 underwent open nephrectomy. Mean surgical time was 164.71 +/- 26.07 minutes for the laparoscopic group, and there were no conversions or ruptures. The mean specimen weight was 145.01 +/- 105.85 g for the laparoscopic group and 257.40 +/- 162.70 g for the open surgery group. There was 1 preoperative rupture in the open surgery group. Transfusions were not required in either group. The surgical margins were positive in 1 of 17 cases (5.9%) in the laparoscopic group and in 3 of 15 cases (20%) in the open surgery group. One of the 17 (5.9%) laparoscopy-treated patients and 2 of the 15 open surgery-treated patients (13.3%) presented with local tumor relapse. The 5-year event-free survival rate was 93.3% (95% confidence interval, 0.61-0.99) for the laparoscopic group and 79.6% (95% confidence interval, 0.37-0.95] for the open surgery group (P = .446). CONCLUSION Both techniques showed similar immediate and long-term results. (C) 2014 Elsevier Inc.
- Laparoscopic ureterocalicostomy for complicated upper urinary tract obstruction: mid-term follow-up(2014) ARAP, Marco Antonio; ANDRADE, Hiury; TORRICELLI, Fabio Cesar Miranda; DENES, Francisco Tibor; MITRE, Anuar Ibrahim; DUARTE, Ricardo Jordao; SROUGI, MiguelTo report on the largest series of laparoscopic ureterocalicostomies done for complicated upper urinary obstruction. We retrospectively reviewed the data from 6 transperitoneal laparoscopic ureterocalicostomies performed in our institution from January 2008 to January 2012. Symptomatic complicated upper urinary obstruction was the main reason for all the procedures. The recorded data included age, gender, clinical presentation, duration of symptoms, laterality, mean operative time, hospital stay, complications and clinical and functional outcomes. The median patient age was 20.1 (2-44) years, and all patients were females. Patients underwent laparoscopic ureterocalicostomy due to previous failed procedures (3 patients), anatomic abnormalities (2 patients) and a severe upper ureteral stenosis (1 patient). The median operative time was 215 (180-270) min. There were no major complications. There were no conversions to open surgery. In a median follow-up of 30 (8-56) months, all patients presented with clinical and radiological improvement with no signs of obstruction. In all cases, the postoperative renal scintigraphy revealed a T1/2 lower than 10 min. Laparoscopic ureterocalicostomy is feasible and associated with high success rate in well-selected cases with complicated upper urinary obstructions.
- Malignant paraganglioma in children treated with embolization prior to surgical excision(2016) MIRANDA, Eduardo de Paula; LOPES, Roberto Iglesias; PADOVANI, Guilherme Philomeno; MOSCARDI, Paulo Renato Marcelo; NISHIMURA, Fernanda Gardini Maciel; MENDONCA, Berenice Bilharinho de; CARNEVALE, Francisco Cesar; CRISTOFANI, Lilian Maria; DUARTE, Ricardo Jordao; SROUGI, Miguel; DENES, Francisco TiborBackground: Paragangliomas (PGL) are rare tumors derived from neural crest cells, whose origins may vary along the chain of the sympathetic nervous system. Such tumors are often characterized by secretion of catecholamines, but sometimes they are biochemically inactive, which makes diagnosis often challenging. Malignant paraganglioma is defined by the presence of this tumor at sites where chromaffin cells are usually not found or by local invasion of the primary tumor. Recurrence, either regional or metastatic, usually occurs within 5 years of the initial complete resection but long-term recurrence is also described. Malignancy is often linked to a SDHB mutation. Preoperative embolization has been applied in the surgical management of PGLs with the objective to decrease intra-operative blood loss and surgery length without complications. Case Presentation: We report two cases of patients with abdominal or pelvic malignant PGLs who have been treated surgically at our center after preoperative embolization. Surgery was a very challenging procedure with multiple surgical teams involved and embolization did not prevent major blood loss and intraoperative complications. Patients required adjuvant treatment with either chemotherapy or radiotherapy. Conclusions: Many studies in the adult population have established recommendations for the diagnosis and therapeutic management of PGL, but few studies concern the pediatric population. Because malignant PGL is more important in the pediatric population, screening and early diagnosis of PGL is advisable in children with genetic predisposing. Surgical resection is the mainstay of treatment, but a multimodal approach is often required due to the complexity of cases. The role of preoperative embolization is not established and in our experience it has provided little benefit and major complications.
- Pediatric genitourinary oncology(2013) DENES, Francisco Tibor; DUARTE, Ricardo Jordao; CRISTOFANI, Lilian Maria; LOPES, Roberto IglesiasTumors of the kidney, bladder, prostate, testis, and adrenal represent a large part of the adult urologic practice, but are relatively infrequent in children. The natural history and management of these tumors in the pediatric age is different from that of the adults. As result of the successful work of several clinical trial groups in recent decades, there has been a significant improvement in their cure rates. The aim of this article is to review their most significant clinical aspects, as well as to present an update in their management.