GUILHERME CUTAIT DE CASTRO COTTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject OUTCOMES OF PATIENTS WITH LOCAL REGROWTH AFTER NONOPERATIVE MANAGEMENT OF RECTAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY.(2020) COTTI, G. C.; PANDINI, R. V.; BRAGHIROLI, O. F.; NAHAS, C. R.; MARQUES, C. F. Sparapan; IMPERIALE, A. Rocco; BUSTAMANTE-LOPEZ, L. A.; RIBEIRO, U.; SALVAJOLI, B.; HOFF, P.; NAHAS, S. C.conferenceObject MINIMALLY INVASIVE PELVIC LATERAL LYMPHADENECTOMY IN LOCALLY ADVANCED RECTAL CANCER AFTER NEOADJUVANT TREATMENT.(2022) COTTI, G.; BUSTAMANTE-LOPEZ, L.; NAHAS, C. S.; MARQUES, C. F.; IMPERIALE, A.; BRAGHIROLI, O.; HORVAT, N.; SOBRADO, L. F.; AVERBACH, P.; CIRENZA, C.; NAHAS, S. C.- Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment(2017) BUSTAMANTE-LOPEZ, L.; NAHAS, C. S.; NAHAS, S. C.; RIBEIRO JR., U.; MARQUES, C. F.; COTTI, G.; ROCCO, A.; CECCONELLO, I.Introduction Rectal cancer patients frequently present with locally advanced disease for which the standard of care includes neoadjuvant chemoradiotherapy followed by total mesorectal excision. Positive lymph nodes are one of the most powerful risk factors for recurrence and survival in colorectal cancer. In the absence of specific rectal guidelines, the literature recommends to the pathologist to optimize the number of rectal lymph nodes (LN) retrieved. We made a literature review in order to identify factors that could potentially affect the number of LN retrieved in specimens of patients with rectal cancer treated by chemoradiotherapy (CRT) followed by total mesorectal excision (TME). Results Age did not have a significant effect on LN yield. The effect of sex on LN number is not consistent in the literature. Most of the papers did not find a relationship between lower LN obtained and gender. Laparoscopy for primary rectal cancer is associated with a greater number of LN as well as shortterm benefits. Tumors in the upper rectum are associated with a higher number of LN than those in the mid and lower rectum. The type of surgery had no effect on lymph node yield either. Tumors with complete or almost complete pathologic regression were exactly the ones with lower number of lymph nodes detected. Approximately one-third of patients with neoadjuvant treatment had less than 12 LN yield. Conclusion The tumor regression grade is the most important factor for the decrease in the number of lymph nodes.
article 1 Citação(ões) na Scopus T <= 2N0 TRG1-2 in Post-Chemoradiation Therapy MRI: What can it Predict?(2019) NAHAS, Caio Sergio Rizkallah; NAHAS, Sergio Carlos; BUSTAMANTE-LOPEZ, Leonardo; SPARAPAN, Carlos Marques Frederico; ORTEGA, Cinthia; AZAMBUJA, Rodrigo; JR, Ulysses Ribeiro; COTTI, Guilherme Cutait; IMPERIALE, Antonio Rocco; CECCONELLO, IvanBackground: Total mesorectal excision is the standard radical operation after neoadjuvant chemoradiotherapy for patients with middle/low locally advanced rectal cancer. However, it carries significant rates of morbidity, sexual/urinary dysfunction, fecal impairment and permanent stoma. The ability to identify patients with a complete or nearly-complete response could help steer patients to less-invasive surgery or a watch-and-wait strategy. Objective: To assess the ability to predict good responders and a favorable prognosis among rectal cancer patients by post-chemoradiation therapy MRI. Patients: Consecutive patients stage T3-4N0M0 or T(any)N+M0 located within 10cm from the anal verge were enrolled. Patients were staged and re-staged 8.8 weeks after the completion of chemoradiation by digital exam, colonoscopy, pelvic-MRI, and thorax and abdominal CT scans. All patients underwent total mesorectal excision with curative intent. Results: Of the total 309 patients, 275 were eligible, and 199 (72.4%) of these were stage III. Restaging-MRI identified 59 (21.4%) T <= 2N0/TRG1-2. Specimen pathologic evaluation revealed 43 (15.6%) patients with a complete pathologic response. Estimates of the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRIyT=2N0/TRG1-2 for the identification of ypT0N0 were 79.7%, 84.5%, 53.5%, 39%, and 90.7%, respectively. Estimates for the identification of ypN0 were 48.4%, 27.8%, 92%, 88.1%, and 48.4%, respectively. In a multivariate analysis, the only pre-CRT/MRI variables that were associated with an increased risk of lymph node involvement at the specimen were N+ (OR=2.22) and extramural vascular invasion (OR=2.28). MRI yT <= 2N0/TRG1-2 patients showed improved estimated 5-year disease-free survival, but no difference in estimated 5-year survival. Conclusion: Although MRIyT <= 2N0/TRG1-2 cannot predict all cases of a complete pathologic response, it can effectively predict a low rate of lymph node involvement and a better prognosis in patients who undergo total mesorectal excision.- Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision(2018) BUSTAMANTE-LOPEZ, Leonardo Alfonso; NAHAS, Caio Sergio Rizkallah; NAHAS, Sergio Carlos; MARQUES, Carlos Frederico Sparapan; PINTO, Rodrigo Ambar; COTTI, Guilherme Cutait; IMPERIALE, Antonio Rocco; MELLO, Evandro Sobroza de; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanStudies have suggested that the use of neoadjuvant chemoradiation results in a lower lymph nodes yield in rectal cancer patients. Objective: To evaluate factors associated with less than 12 lymph nodes harvested on patients with rectal cancer treated with preoperative chemoradiotherapy followed by total mesorectal excision. Patients: This was a cohort/retrospective single cancer center study. Low and mid locally advanced rectal cancer or T2N0 under risk of sphincter resection underwent chemoradiotherapy followed by total mesorectal excision with curative intent. Chemotherapy consisted of 5-FU and leucovorin IV. Total dose of pelvic radiation was 5040 Gys. All patients were staged and restaged by digital rectal examination, proctoscopy, colonoscopy, CT of abdomen and chest, and MRI of the pelvis. Patients were stratified in two groups: >= 12 and < 12 L N retrieved. The possible factors affecting number of LN were analyzed. Results: 95 patients ma the inclusion criteria. Mean LN harvest was 23.2 (3-67). 81 patients (85%) had >= 12 L N. Gender, age, tumor size, tumor stage, tumor location, length of specimen, presence of LN involvement, type of surgery, and surgical access showed no association with number of LN retrieved. Only pathological complete response showed a statistically significant association with < 12 L N on univariate (p = 0.004) and multivariate analyses (p = 0.002). Limitations: Data were collected retrospectively. The number of patients disparity between the two groups. Conclusions: Complete pathologic response is associated with < 12 L N harvested. Thus, the number of lymph nodes should not be used as a surrogate for oncologic adequacy of resection in patients with pathologic complete response.
conferenceObject PROGNOSTIC IMPACT OF LYMPH NODE YIELD IN PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY.(2020) BUSTAMANTE-LOPEZ, L. A.; NAHAS, C. R.; COTTI, G. C.; MARQUES, C. F. Sparapan; RIBEIRO JUNIOR, U.; IMPERIALE, A. Rocco; CECCONELLO, I.; NAHAS, S. C.- Are All Patients Suitable for the Watch-and-Wait Approach After Clinical Complete Response? Reply(2022) COTTI, Guilherme Cutait; BUSTAMANTE-LOPEZ, Leonardo A.; BRAGHIROLI, Oddone F. M.
- Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer(2017) NAHAS, Caio Sergio Rizkallah; NAHAS, Sergio Carlos; RIBEIRO-JUNIOR, Ulysses; BUSTAMANTE-LOPEZ, Leonardo; MARQUES, Carlos Frederico Sparapan; PINTO, Rodrigo Ambar; IMPERIALE, Antonio Rocco; COTTI, Guilherme Cutait; NAHAS, William Carlos; CHADE, Daher Cezar; PIATO, Dariane Sampaio; BUSNARDO, Fabio; CECCONELLO, IvanOBJECTIVES: This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer. METHODS: Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155. RESULTS: The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement. CONCLUSIONS: Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes.
conferenceObject T <= 2N0, TRG1-2 IN POST CHEMORADIATION THERAPY MRI: WHAT IT CAN PREDICT?(2017) NAHAS, C.; NAHAS, S.; BUSTAMANTE, L.; MARQUES, C.; IMPERIALE, A.; COTTI, G.; AZAMBUJA, R.; ORTEGA, C.- Outcomes of Patients With Local Regrowth After Nonoperative Management of Rectal Cancer After Neoadjuvant Chemoradiotherapy(2022) COTTI, Guilherme Cutait; PANDINI, Rafael Vaz; BRAGHIROLI, Oddone F. M.; NAHAS, Caio S. R.; BUSTAMANTE-LOPEZ, Leonardo A.; MARQUES, Carlos Frederico S.; IMPERIALE, Antonio R.; JR, Ullysses Ribeiro; SALVAJOLI, Bernardo; HOFF, Paulo M.; NAHAS, Sergio C.BACKGROUND: Clinical complete responders after chemoradiation for rectal cancer are increasingly being managed by a watch-and-wait strategy. Nonetheless, a significant proportion will experience a local regrowth, and the long-term oncological outcomes of these patients is not totally known. OBJECTIVE: The purpose of this study was to analyze the outcomes of patients who submitted to a watch-and-wait strategy and developed a local regrowth, and to compare these results with sustained complete clinical responders. DESIGN: This was a retrospective study. SETTING: Single institution, tertiary cancer center involved in alternatives to organ preservation. PATIENTS: Patients with a biopsy-proven rectal adenocarcinoma (stage II/III or low lying cT2N0M0 at risk for an abdominoperineal resection) treated with chemoradiation who were found at restage to have a clinical complete response. INTERVENTIONS: Rectal cancer patients treated with chemoradiation who underwent a watch-and-wait strategy (without a full thickness local excision) and developed a local regrowth were compared to the remaining patients of the watch-and-wait strategy. MAIN OUTCOME MEASURES: Overall survival between groups, incidence of regrowth, and results of salvage surgery. RESULTS: There were 67 patients. Local regrowth occurred in 20 (29.9%) patients treated with a watch-and-wait strategy. Mean follow-up was 62.7 months. Regrowth occurred at mean 14.2 months after chemoradiation, half of them within the first 12 months. Patients presented with comparable initial staging, lateral pelvic lymph-node metastasis, and extramural venous invasion. The regrowth group had a statistically nonsignificant higher incidence of mesorectal fascia involvement (35.0% vs 13.3%, p = 0.089). All regrowths underwent salvage surgery, mostly (75%) a sphincter-sparing procedure. 5-year overall survival was 71.1% in patients with regrowth and 91.1% in patients with a sustained complete clinical response (p = 0.027). LIMITATIONS: This study was limited by its retrospective evaluation of patient selection for a watch-and-wait strategy and outcomes, as well as its small sample size. CONCLUSIONS: Local regrowth is a frequent event when following a watch-and-wait policy (29.9%); however, patients could undergo salvage surgical treatment with adequate pelvic control. In this series, overall survival showed a statistically significant difference from patients managed with a watch-and-wait strategy who experienced a local regrowth compared to those who did not.