JEAN FELIPE PRODOCIMO LESTINGI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
article ROBOT-ASSISTED EXTENDED PELVIC LYMPH NODE DISSECTION IN PROSTATE CANCER, WHEN AND HOW?(2019) SIERRA, Pablo S.; LESTINGI, Jean F. P.; ALBUQUERQUE, Emanuel V.; PONTES JR., Jose; CARVALHO, Paulo A. de; CAVALCANTE, Alexandre; GUGLIELMETTI, Giuliano B.; NAHAS, William C.; COELHO, Rafael F.OBJECTIVE: To review the literature evaluating the role of the extended pelvic lymph node dissection ePLND during robot assisted radical prostatectomy (RARP) in the management of PCa patients, as well as the preoperative clinic pathologic factors that predict lymph node metastases (LNM). The technique and current outcomes of robotic ePLND will be presented. METHODS: Medline (R)/Pubmed (R) were searched up to august 2018 to find comparative studies of different anatomic limits of pelvic lymph node dissection (PLND) during RARP, open or pure laparoscopic surgery that reported number of nodes retrieved, oncologic outcomes and complications. The search was complemented to identify studies that evaluated diagnostic images and factors that predict LNM. Overall, 44 articles were included for full text review. RESULTS: There is not an imaging technique with an acceptable performance to select patients for PLND, the decision to perform a PLND is based on clinical characteristics described on validated nomograms. Median lymph node yield at RARP range from 5 to 21 depending on the extent of PLND, positivity rate of LN as high as 37% depending on the risk stratification of patients. Robot-assisted can be carried out to any extent with lymph node yields and safety concerns comparable to the open approach. CONCLUSION: Extended pelvic lymph node dissection is recommended to be performed at the time of RARP in intermediate and high-risk patients and cannot be replaced by other modalities. A benefit in terms of oncologic outcomes remains to be established. The robot assisted approach offers shorter length of hospital stay, lower transfusion rates and comparable outcomes compared to other surgical approaches.- Extended versus limited pelvic lymphadenectomy during radical prostatectomy for intermediate- and high-risk prostate cancer: Early outcomes from a randomized controlled phase III study.(2017) LESTINGI, Jean Felipe Prodocimo; GUGLIELMETTI, Giuliano; PONTES JR., Jose; MITRE, Anuar Ibrahim; SARKIS, Alvaro; BASTOS, Diogo Assed; RIECHELMANN, Rachel; MATTEDI, Romulo Loss; CORDEIRO, Mauricio; COELHO, Rafael; SROUGI, Miguel; NAHAS, William Carlos
conferenceObject EXTENDED VS LIMITED PELVIC LYMPHADENECTOMY DURING RADICAL PROSTATECTOMY FOR INTERMEDIATE- AND HIGH-RISK PROSTATE CANCER: A PROSPECTIVERANDOMIZED TRIAL(2015) LESTINGI, Jean F. P.; PONTES JR., Jose; BORGES, Leonardo L.; RAVANINI, Juliana; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio D.; COELHO, Rafael F.; NAHAS, William C.- Reply to: Axel Heidenreich. Still Unanswered: The Role of Extended Pelvic Lymphadenectomy in Improving Oncological Outcomes in Prostate Cancer. Eur Urol 2021;79:605-6(2021) LESTINGI, Jean F. P.; GUGLIELMETTI, Giuliano B.; TRINH, Quoc-Dien; COELHO, Rafael F.; JR, Jose Pontes; BASTOS, Diogo A.; CORDEIRO, Mauricio D.; SARKIS, Alvaro S.; FARAJ, Sheila F.; MITRE, Anuar I.; SROUGI, Miguel; NAHAS, William C.
- Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial(2021) LESTINGI, Jean F. P.; GUGLIELMETTI, Giuliano B.; TRINH, Quoc-Dien; COELHO, Rafael F.; PONTES, Jose Jr Jr; BASTOS, Diogo A.; CORDEIRO, Mauricio D.; SARKIS, Alvaro S.; FARAJ, Sheila F.; I, Anuar Mitre; SROUGI, Miguel; NAHAS, William C.Background: The role of extended pelvic lymph node dissection (EPLND) in the surgical management of prostate cancer (PCa) patients remains controversial, mainly because of a lack of randomized controlled trials (RCTs). Objective: To determine whether EPLND has better oncological outcomes than limited PLND (LPLND. Design, setting and participants: This was a prospective, single-center phase 3 trial in patients with intermediate-or high-risk clinically localized PCa. Intervention: Randomization (1:1) to LPLND (obturator nodes) or EPLND (obturator, external iliac, internal iliac, common iliac, and presacral nodes) bilaterally. Outcome measurements and statistical analysis: The primary endpoint was biochemi-cal recurrence & ndash;free survival (BRFS). Secondary outcomes were metastasis-free survival (MFS), cancer-specific survival (CSS), and histopathological findings. The trial was designed to show a minimal 15% advantage in 5-yr BRFS by EPLND. Results and limitations: In total, 300 patients were randomized from May 2012 to December 2016 (150 LPLND and 150 EPLND). The median BRFS was 61.4 mo in the LPLND group and not reached in the EPLND group (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.63 & ndash;1.32; p = 0.6). Median MFS was not reached in either group (HR 0.57, 95% CI 0.17 & ndash;1.8; p = 0.3). CSS data were not available because no patient died from PCa before the cutoff date. In exploratory subgroup analysis, patients with preoperative biopsy International Society of Urological Pathology (ISUP) grade groups 3 & ndash;5 who were allocated to EPLND had better BRFS (HR 0.33, 95% CI 0.14 & ndash;0.74, interaction p = 0.007). The short follow-up and surgeon heterogeneity are limitations to this study. Conclusion: This RCT confirms that EPLND provides better pathological staging, while differences in early oncological outcomes were not demonstrated. Our subgroup analy-sis suggests a potential BCRFS benefit in patients diagnosed with ISUP grade groups 3 & ndash;5; however, these findings should be considered hypothesis-generating and further RCTs with larger cohorts and longer follow up are necessary to better define the role of EPLND during RP. Patient summary: In this study, we investigated early outcomes in prostate cancer patients undergoing prostatectomy according to the anatomic extent of lymph node resection. We found that extended removal of lymph nodes did not reduce biochemical recurrence of prostate cancer in the expected range.
- Lymphadenectomy in Prostate Cancer: Technique and Outcomes(2022) LESTINGI, J. F. P.; SALAS, R. S.; YOSHIOKA, K.; COELHO, R. F.Despite recent advances in imaging, pelvic lymph node dissection (PLND) remains the gold standard modality for nodal staging in prostate cancer (PCa) patients. There remains significant debate about PLND: the odds of finding positive pelvic lymph nodes are proportional to the extent of the PLND; however, the therapeutic benefits of more extensive PLND remain an area of controversy, besides the increasing number of surgical risks. This chapter will review indications, techniques, and results of extended pelvic lymphadenectomy (ePLND) in the surgical treatment of PCa patients. Two recent randomized controlled trials comparing extended to limited PLND have not demonstrated differences in early biochemical recurrence. Limited lymphadenectomy significantly underestimates the actual incidence of lymph node metastasis and should no longer be performed for staging. EPLND is currently the gold standard in lymph node staging. It should be reserved for patients at higher risk of lymph node invasion. The oncological role of ePLND is not defined. It can help patients directly (up to two positive lymph nodes), indirectly (select for adjuvant treatments), or may benefit patients with ISUP Gleason Grade in biopsy 3-5. EPLND is also associated with significantly worse intra- and postoperative non-oncological outcomes, such as bleeding, lymphocele, and increased surgical time. The oncological role of salvage lymphadenectomy also is not clear. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
- Totally laparoscopic ureteroneocystostomy with intracorporeal tailoring for primary obstructive megaureter(2011) MITRE, Anuar Ibrahim; LESTINGI, Jean Felipe Prodocimo; ARAP, Marco Antonio; LUCON, Antonio Marmo; SROUGI, Miguel
- Reply to Alberto Briganti, Giorgio Gandaglia, Markus Graefen, Steven Joniau, R. Jeffrey Karnes, and Francesco Montorsi's Letter to the Editor re: Jean FP Lestingi, Giuliano B. Guglielmetti, Quoc-Dien Trinh, et al. Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Eur Urol 2021;79:595-604. Time for a Change? Clinically Meaningful Reasons Why We Will Continue Performing Extended Pelvic Lymph Node Dissection in Selected Patients with Prostate Cancer(2021) LESTINGI, Jean F. P.; Quoc-Dien Trinh; COELHO, Rafael F.; PONTES JR., Jose; BASTOS, Diogo A.; NAHAS, William C.