THIAGO NOGUEIRA COSTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Insights of Outcome after Resection of Small Nonfunctioning Neuroendocrine Pancreatic Tumors(2021) FIGUEIRA, Estela Regina Ramos; RIBEIRO, Julia Fray; RIBEIRO, Thiago Costa; JUREIDINI, Ricardo; NAMUR, Guilherme Naccache; COSTA, Thiago Nogueira; BACCHELLA, Telesforo; CECCONELLO, IvanBackground. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. Surgical resection was once considered the treatment of choice but has been questioned in the direction of a more conservative approach for selected patients. Our aim was to analyze the outcome of surgical resection of small (<= 3cm) NF-PNETs. Methods. We retrospectively evaluated 14 patients with sporadic NF-PNETs who underwent pancreatic resection. Data were collected from patients' medical records. Results. Of the 14 patients included, 35.71% were men, and the average age was 52.36 +/- 20.36 years. Comorbidities were present in 92.86% of the cases. The incidence of postoperative complications was 42.86%, the 30-day mortality was zero, and the length of follow-up was 3.31 +/- 3.0 years. The results of pathological evaluations revealed WHO grade I in 42.86% of cases, II in 21.43%, and neuroendocrine carcinoma in 35.71%. The median tumor size was 1.85cm (range, 0.5-3cm), and 2 cases had synchronous metastasis. The median TNM stage was IIa (range, I-IV). The disease-free and patient survival rates were 87.5% and 100% at 3 years and 43.75% and 75% at 10 years, respectively. The tumor pathological grade was significantly higher in head tumors than body-tail tumors, but there were no differences with respect to tumor size and TNM staging. Conclusion. A surgical approach to treat small sporadic NF-PNETs is safe with low mortality and high patient survival. Based on these data, small pancreatic head tumors can be more aggressive, suggesting that surgical resection is still the best option to treat small nonfunctioning PNETS. Thus, conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery.
- ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: DIFFERENCES IN DIRECT COSTS FROM A BRAZILIAN PUBLIC INSTITUTE PERSPECTIVE(2022) COSTA, Thiago Nogueira; TUSTUMI, Francisco; FERROS, Lucas Sousa Maia; COLONNO, Barbara Buccelli; ABDALLA, Ricardo Zugaib; JR, Ulysses Ribeiro; CECCONELLO, IvanBackground: Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias.Aims: This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution.Methods: This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$).Results: A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91 +/- 644.79; LVIHR: 1,989.67 +/- 763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57 +/- 211.51; LVIHR: 84.55 +/- 252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43 +/- 894.97; LVIHR: 2,120.16 +/- 663.78; p<0.001), material resources (RVIHR: 3,204.32 +/- 351.55; LVIHR: 736.51 +/- 972.32; p<0.001), and medications (RVIHR: 823.40 +/- 175.47; LVIHR: 288.50 +/- 352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24 +/- 3,520.82; LVIHR: 10,295.95 +/- 3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes.Conclusion: Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.
- Management of biliary stones in bariatric surgery(2022) TUSTUMI, Francisco; PINHEIRO FILHO, Joao Emilio Lemos; STOLZEMBURG, Lucas Cata Preta; SERIGIOLLE, Leonardo Carvalho; COSTA, Thiago Nogueira; PAJECKI, Denis; SANTO, Marco Aurelio; NAHAS, Sergio CarlosMorbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.
- ELEVATED CA 19-9 IN AN ASYMPTOMATIC PATIENT: WHAT DOES IT MEAN?(2022) MEIRA-JUNIOR, Jose Donizeti de; COSTA, Thiago Nogueira; MONTAGNINI, Andre Luis; NAHAS, Sergio Carlos; JUKEMURA, Jose