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
4 resultados
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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.conferenceObject THE ROLE OF PROBE-BASED CONFOCAL ENDOMICROSCOPY (PCLE) IN THE DIAGNOSIS OF SUSTAINED CLINICAL COMPLETE RESPONSE UNDER WATCH-AND-WAIT STRATEGY AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED RECTAL ADENOCARCINOMA(2022) SAFATLE-RIBEIRO, Adriana V.; LATA, John; FERREIRA, Marina Tucci Gammaro Baldavira; FLOR, Marcelo M.; PEREZ, Caio; BABA, Elisa R.; LENZ, Luciano H.; MARTINS, Bruno Da Costa; KAWAGUTI, Fabio S.; PAULO, Gustavo A. De; LIMA, Marcelo S. De; MOURA, Renata N.; PENNACCHI, Caterina; GUSMON, Carla; GEIGER, Sebastian; UEMURA, Ricardo; NAHAS, Caio Sergio R.; MARQUES, Carlos F.; IMPERIALE, Antonio R.; COTTI, Guilherme C.; RIBEIRO, Ulysses; MALUF-FILHO, Fauze; NAHAS, Sergio C.- Impact of a Routine Colorectal Endoscopic Submucosal Dissection in the Surgical Management of Nonmalignant Colorectal Lesions Treated in a Referral Cancer Center(2023) KAWAGUTI, Fabio S.; KIMURA, Cintia Mayumi Sakurai; MOURA, Renata Nobre; SAFATLE-RIBEIRO, Adriana Vaz; NAHAS, Caio Sergio Rizkallah; MARQUES, Carlos Frederico Sparapan; REZENDE, Daniel Tavares de; SEGATELLI, Vanderlei; COTTI, Guilherme Cutait de Castro; RIBEIRO JUNIOR, Ulysses; MALUF-FILHO, Fauze; NAHAS, Sergio CarlosBACKGROUND: Recent data show an increasing number of abdominal surgeries being performed for the treatment of nonmalignant colorectal polyps in the West but in settings in which colorectal endoscopic submucosal dissection is not routinely performed. This study evaluated the number of nonmalignant colorectal lesions referred to surgical treatment in a tertiary cancer center that incorporated magnification chromoendoscopy and endoscopic submucosal dissection as part of the standard management of complex colorectal polyps. OBJECTIVE: The study aimed to estimate the number of patients with nonmalignant colorectal lesions referred to surgical resection at our institution after the standardization of routine endoscopic submucosal dissection and to describe outcomes for patients undergoing colorectal endoscopic submucosal dissection. DESIGN: Single-center retrospective study from a prospectively collected database of endoscopic submucosal dissections and colorectal surgeries performed between January 2016 and December 2019. SETTING: Reference cancer center. PATIENTS: Consecutive adult patients with complex nonmalignant colorectal polyps were included. INTERVENTIONS: Patients with nonmalignant colorectal polyps were treated by endoscopic submucosal dissection or surgery (elective colectomy, rectosigmoidectomy, low anterior resection, or proctocolectomy). MAIN OUTCOMES MEASURES: The primary outcome measure was the percentage of patients referred to colorectal surgery for nonmalignant lesions. RESULTS: In the study period, 1.1% of 825 colorectal surgeries were performed for nonmalignant lesions, and 97 complex polyps were endoscopically removed by endoscopic submucosal dissection. The en bloc, R0, and curative resection rates of endoscopic submucosal dissection were 91.7%, 83.5%, and 81.4%, respectively. The mean tumor size was 59 (SD 37.8) mm. Perforations during endoscopic submucosal dissection occurred in 3 cases, all treated with clipping. One patient presented with a delayed perforation 2 days after the endoscopic resection and underwent surgery. The mean follow-up period was 3 years, with no tumor recurrence in this cohort. LIMITATIONS: Single-center retrospective study. CONCLUSIONS: A workflow that includes assessment of the lesions with magnification chromoendoscopy and resection through endoscopic submucosal dissection can lead to a very low rate of abdominal surgery for nonmalignant colorectal lesions.
- The Role of Probe-Based Confocal Laser Endomicroscopy (pCLE) in the Diagnosis of Sustained Clinical Complete Response Under Watch-and-Wait Strategy After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Adenocarcinoma: a Score Validation(2023) SAFATLE-RIBEIRO, Adriana Vaz; JR, Ulysses Ribeiro; LATA, John; BABA, Elisa Ryoka; LENZ, Luciano; MARTINS, Bruno da Costa; KAWAGUTI, Fabio; MOURA, Renata Nobre; PENNACCHI, Caterina; GUSMON, Carla; LIMA, Marcelo Simas de; PAULO, Gustavo Andrade de; NAHAS, Caio Sergio; MARQUES, Carlos Frederico; IMPERIALE, Antonio Rocco; COTTI, Guilherme C. C.; MALUF-FILHO, Fauze; NAHAS, Sergio CarlosBackgroundWatch-and-wait strategy has been increasingly accepted for patients with clinical complete response (cCR) after multimodal treatment for locally advanced rectal adenocarcinoma. Close follow-up is essential to the early detection of local regrowth. It was previously demonstrated that probe-based confocal laser endomicroscopy (pCLE) scoring using the combination of epithelial and vascular features might improve the diagnostic accuracy of cCR.AimTo validate the pCLE scoring system in the assessment of patients with cCR after neoadjuvant chemoradiotherapy (nCRxt) for advanced rectal adenocarcinoma.MethodsDigital rectal examination, pelvic magnetic resonance imaging (MRI), and pCLE were performed in 43 patients with cCR, who presented either a scar (N = 33; 76.7%) or a small ulcer with no signs of tumor, and/or biopsy negative for malignancy (N = 10; 23.3%).ResultsTwenty-five (58.1%) patients were men, and the mean age was 58.4 years. During the follow-up, 12/43 (27.9%) patients presented local regrowth and underwent salvage surgery. There was an association between pCLE diagnostic scoring and final histological report (for patients who underwent surgical resection) or final diagnosis at the latest follow-up (p = 0.0001), while this association was not observed with MRI (p = 0.49). pCLE sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 93.5%, 80%, 88.9%, and 86%, respectively. MRI sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 48.4%, 66.7%, 78.9%, and 53.5%, respectively.ConclusionspCLE scoring system based on epithelial and vascular features improved the diagnosis of sustained cCR and might be recommended during follow-up. pCLE might add some valuable contribution for identifying local regrowth.Trial RegistrationThis protocol was registered at the Clinical Trials (ClinicalTrials.gov identifier NCT02284802).