GIULIANO BETONI GUGLIELMETTI
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
3 resultados
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- A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy. Reply.(2023) ANJOS, Gabriel C. Dos; GUGLIELMETTI, Giuliano B.; JUNIOR, Jose P.; CORDEIRO, Mauricio; COELHO, Rafael F.; NAHAS, William C.
- Recommendations and optimal approaches to robotic-assisted partial nephrectomy: A consensus of Brazilian experts(2023) FARIA, E. F.; MOSCHOVAS, M. C.; VAZ, C.; POMPEO, A.; SANTOS, A.; STIEVANO, A.; BERGER, A.; CARNEIRO, A.; DOURADO, A.; COLOMBO, J. R.; PASSEROTTI, C.; ANDREONI, C.; FRAGA, C.; GUGLIELMETTI, G.; LEMOS, G.; GUIMARãES, G.; NOGUEIRA, L.; ROCHA, M.; MELO, P.; ARANTES, P.; ROMANELLI, P.; TOURINHO, R.; NISHIMOTO, R.; MACHADO, R.; REIS, R.; FROTA, R.; GUIDA, R.; DUBEUX, V.; GUALBERTO, R.; TOBIAS-MACHADO, M.Objective: Robotic-assisted partial nephrectomy (RAPN) is established as the gold standard approach to treating small renal masses. However, numerous technical challenges and concepts related to this approach are still under discussion and are not consensus among surgeons from different centers. We performed an online questionnaire with multiple topics about RAPN and selected high-volume surgeons from referral centers in Brazil to achieve a consensus. Methods: We implemented an online consensus of 29 experts selected based on surgical expertise and competence in analyzing the published literature. Based on the collected literature and current Guidelines (NCCN, AUA, and EAU) we created a questionnaire with 131 questions and administered it to all participants. The statements and the Delphi technique design were combined in a single round of questions. The answers were reviewed, 70% of concordance was considered a consensus, and a final manuscript with recommendations was developed. Results: We divided our results into 25 subtopics that included all questions and discussions of the questionnaire, including preoperative settings, surgical technique, pathological analysis, technology use, and challenging cases. Some areas had limited data in the literature, and these potential limitations were addressed and discussed on each topic. Conclusion: RAPN is the standard surgical treatment for renal masses in the centers of robotic surgery. Among the important topics of this study, we recommend always performing the first RAPN cases with proctors’ assistance, conducting preoperative planning using good-quality imaging exams, minimizing the amount of renal parenchyma removed, and achieving appropriate hemostatic suture while reducing renal parenchyma ischemia.
- Perioperative Morbidity of Radical Prostatectomy After Intensive Neoadjuvant Androgen Blockade in Men With High-Risk Prostate Cancer: Results of Phase II Trial Compared to a Control Group(2023) ILARIO, Eder N.; BASTOS, Diogo A.; GUGLIELMETTI, Giuliano B.; MURTA, Claudio B.; CARDILI, Leonardo; CORDEIRO, Mauricio D.; JUNIOR, Jose P.; COELHO, Rafael F.; NAHAS, William C.In this study, we investigated whether intense neoadjuvant therapy could increase the risk of complications in radical prostatectomy. After analyzing 124 patients we concluded that intense neoadjuvant therapy doesn't increase morbidity of radical prostatectomy and reduces positive surgical margins. The association of neoad-juvant therapy with extended pelvic lymphadenectomy may increase the risk of perioperative thromboembolic events.Introduction: Recent studies about intense neoadjuvant therapy followed by Radical Prostatectomy (RP) lack standard-ized cr iter ia regarding surgical complications and comparison to a group of patients who underwent RP without the use of neoadjuvant therapy. The aim of this study is to describe and compare the perioperative complication rates. Materials and Methods: This was a prospective, single-center phase II trial in patients with high-risk prostate cancer (HRPCa). The control group included HRPCa patients who underwent RP outside the clinical trial during the same study recruit-ment period. The interventional group was randomized (1:1) to receive neoadjuvant androgen deprivation therapy plus abiraterone with or without apalutamide followed by RP. Complications observed up to 30 days of surgery were classi-fied based on the Clavien-Dindo classification. Uni-and multivariate analyses were carried out to assess predictive factors associated with perioperative complications. Results: In total, 124 patients with HRPCa were underwent to RP between May 27, 2019 and August 6, 2021, including 61 patients in the intervention group and 63 patients in the control group. The general and major complications in the intervention group reached 29.6% and 6.6%, respectively, and 39.7% and 7.9% in the control group, respectively. There was no significant difference between groups. We observed 4.9% of thromboembolic event in the neoadjuvant group. Conclusions: There was no significant increase in morbidity rate in RP after intense neoadjuvant therapy. The association of intense androgen deprivation neoadjuvant therapy with RP and extended pelvic lymphadenectomy may increase the risk of a perioperative thromboembolic events.