SERGIO SILVEIRA JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
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- Combined liver and multivisceral resections: A comparative analysis of short and long-term outcomes(2020) JUNIOR, Sergio S.; COELHO, Fabricio F.; TUSTUMI, Francisco; CASSENOTE, Alex J. F.; JEISMANN, Vagner B.; FONSECA, Gilton M.; KRUGER, Jaime A. P.; ERNANI, Lucas; CECCONELLO, Ivan; HERMAN, PauloBackground En bloc liver and adjacent organs resections are technically demanding procedures. Few case series and nonmatched comparative studies reported the outcomes of multivisceral liver resections (MLRs). Objectives To compare the short and long-term outcomes of patients submitted MLRs with those submitted to isolated hepatectomies. Methods From a prospective database, a case-matched 1:2 study was performed comparing MLRs and isolated hepatectomy. Additionally, a risk analysis was performed to evaluate the association between MLRs and perioperative morbidity, mortality, and long-term survival. Results Fifty-three MLRs were compared with 106 matched controls. Patients undergoing MLRs had longer operative time (430 [320-525] vs 360 [270-440] minutes,P = .005); higher estimated blood loss (600 [400-800] vs 400 [100-600] mL;P = .011); longer hospital stay (8 [6-14] vs 7 [5-9] days;P = .003); and higher postoperative mortality (9.4% vs 1.9%,P = .042). Number of resected organs was not an independent prognostic factor for perioperative major complications (odds ratio [OR], 1 organ = 1.8 [0.54-6.05]; OR >= 2, organs = 4.0 [0.35-13.84]) or perioperative mortality (OR, 1, organ = 5.2 [0.91-29.51]; OR >= 2, organs = 6.5 [0.52-79.60]). No differences in overall (P = .771) and disease-free survival (P = .28) were observed. Conclusion MLRs are feasible with acceptable morbidity but relatively high perioperative mortality. MLRs did not negatively affect long-term outcomes.
- The impact of multivisceral liver resection on short- and long-term outcomes of patients with colorectal liver metastasis: A systematic review and meta-analysis(2022) SILVEIRA JUNIOR, Sergio; TUSTUMI, Francisco; MAGALHAES, Daniel de Paiva; JEISMANN, Vagner Birk; FONSECA, Gilton Marques; KRUGER, Jaime Arthur Pirola; COELHO, Fabricio Ferreira; HERMAN, PauloThe impact of Multivisceral Liver Resection (MLR) on the outcome of patients with Colorectal Liver Metastasis (CRLM) is unclear. The present systematic review aimed to compare patients with CRLM who underwent MLR versus standard hepatectomy regarding short-and long-term outcomes. MLR is a feasible procedure but has a higher risk of major complications. MLR did not negatively affect long-term survival, suggesting that an extended resection is an option for potentially curative treatment for selected patients with CRLM.
- The impact of venous resection in pancreatoduodectomy A systematic review and meta-analysis(2021) PINHEIRO FILHO, Joao Emilio Lemos; TUSTUMI, Francisco; COELHO, Fabricio Ferreira; SILVEIRA JUNIOR, Sergio; HONORIO, Fernanda Cavalcanti Cabral; HENRIQUES, Alexandre Cruz; DIAS, Andre Roncon; WAISBERG, JaquesBackground: Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial. Objective: This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD). Methods: A systematic review and meta-analysis of studies comparing VRPD and PD were performed. Results: VRPD was associated with a higher risk for postoperative mortality (risk difference: -0.01; 95% confidence interval [CI] -0.02 to -0.00) and complications (risk difference: -0.05; 95% CI -0.09 to -0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: -0.65; 95% CI -2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: -69.09; 95% CI -88.4 to -49.78), with a higher blood loss rate (MD: -314.04; 95% CI -423.86 to -195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03-1.23). Conclusion: VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.
- Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials(2021) TUSTUMI, Francisco; MIRANDA NETO, Antonio Afonso de; SILVEIRA JUNIOR, Sergio; FERNANDES, Felipe Alexandre; SILVA, Miller Barreto de Brito e; ERNANI, Lucas; NACIF, Lucas Souto; COELHO, Fabricio Ferreira; ANDRAUS, Wellington; BERNARDO, Wanderley Marques; HERMAN, Paulo; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoA combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p=0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen.
- Treatment of hepatocellular carcinoma with macroscopic vascular invasion: A systematic review and network meta-analysis(2023) TUSTUMI, Francisco; COELHO, Fabricio Ferreira; MAGALHAES, Daniel de Paiva; SILVEIRA JUNIOR, Sergio; JEISMANN, Vagner Birk; FONSECA, Gilton Marques; KRUGER, Jaime Arthur Pirola; D'ALBUQUERQUE, Luiz Augusto Carneiro; HERMAN, PauloBackground: This study aimed to evaluate the outcomes of different treatments for patients with hepatocellular carcinoma (HCC) and macroscopic vascular invasion.Methods: A systematic review and meta-analysis of comparative studies was performed to evaluate various treatment modalities for HCC with macroscopic vascular invasion, including liver resection (LR), liver trans-plantation (LT), transarterial chemoembolization (TACE), transarterial radioembolization (TARE), radiotherapy (RT), radiofrequency ablation (RFA), and antineoplastic systemic therapy (AnST).Results: After applying the selection criteria, 31 studies were included. The surgical resection (SR) group (including LR and LT) had a similar mortality rate to the non-surgical resection (NS) group (RD =-0.01; 95% CI-0.05 to 0.03). The SR group had a higher rate of complications (RD = 0.06; 95% CI 0.00 to 0.12) but a higher 3-year overall survival (OS) rate than the NS group (RD = 0.12; 95% CI 0.05 to 0.20). The network analysis revealed that the overall survival was lower in the AnST group. LT and LR had similar survival benefits. The meta-regression suggested that SR has a greater impact on the survival of patients with impaired liver function.Discussion: Most likely, LT has a significant impact on long-term survival and consequently would be a better option for HCC with macroscopic vascular invasion in patients with impaired liver function. LT and LR offer a higher chance of long-term survival than NS alternatives, although LR and LR are associated with a higher risk of procedure-related complications.
article 0 Citação(ões) na Scopus Rectal gist resection following neoadjuvant therapy. Reporting two cases from a single institute [Resección del gist rectal tras la terapia neo-adyuvante. Relato de dos casos de un único instituto](2020) PANDINI, R.V.; JúNIOR, S.S.; PINTO, R.A.; NAHAS, C.S.R.; TUSTUMI, F.; PINHEIRO, R.B.B.; JúNIOR, U.R.; NAHAS, S.C.; CECCONELLO, I.Gastrointestinal stromal tumours (GIST) are the most common neoplasms arising from the mesenchymal cells of the gastrointestinal tract. Although GIST can arise in any gastrointestinal site, the most common are stomach and small bowel. Less than 5% of all GIST are located in rectum. Surgery is the main treatment option for resectable GIST. Current-ly, local excision has been increasingly employed thanks to neoadjuvant therapy. This paper reports two cases of rectal GIST treated with Imatinib neoadjuvant therapy followed by trans anal local resection. © 2020, Sociedad Argentina de Gastroenterologia. All rights reserved.- Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis(2018) TUSTUMI, Francisco; ERNANI, Lucas; COELHO, Fabricio F.; BERNARDO, Wanderley M.; JUNIOR, Sergio S.; KRUGER, Jaime A. P.; FONSECA, Gilton M.; JEISMANN, Vagner B.; CECCONELLO, Ivan; HERMAN, PauloBackground: Preoperative strategies to increase the future liver remnant are useful methods to improve resectability rates for patients with hepatocellular carcinoma (HCC). The aim of this study was to perform a systematic review and meta-analysis of the main strategies used for this purpose. Methods: A systematic review was performed in PubMed, EMBASE, Cochrane and Scielo/LILACS. The procedures included for analysis were portal vein embolization or ligation (PVE/PVL), sequential trans-arterial embolization and PVE (TACE + PVE), radioembolization (RE) and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS). Perioperative morbidity and mortality, post-hepatectomy liver failure (PHLF), and survival rates were evaluated. Results: A total of 46 studies were included in the systematic review (1284 patients). Resection rate was higher in TACE + PVE (90%; N = 315) when compared to PVE/PVL (75%; N = 254; P = < 0.001) and similar to ALPPS (84%; N = 43; P = 0.374) and RE (100%; N = 28; P = 0.14). ALPPS was associated with higher PHLF and perioperative mortality rates when compared to PVE/PVL and TACE + PVE. ALPPS and RE showed higher risk of major complications than PVE/PVL and TACE + PVE. Conclusion: Preoperative strategies to increase liver volume are effective in achieving resectability of HCC. TACE + PVE is as safe as PVL/PVE providing higher OS. ALPPS is associated with a higher risk of PHLF, major complications, and mortality. RE despite the small experience seems to present similar resection rate and OS as TACE + PVE with higher rate of major complications.
- Analysis of laboratory tests results of patients submitted to a clinical screening program(2016) ZAPELINI, Raphaela M.; KOCH, Kaiser S.; ALTHOFF, Geraldo César C.; DUARTE, Camila S.; JOÃO, Eloysa M.; SILVEIRA JR., SérgioABSTRACT Introduction: There are not studies demonstrating the major changes in biochemical tests performed in screening programs. Objective: Identify the results found in laboratory tests of patients submitted to medical check-up program, showing the main abnormal tests and correlating it with the age groups in which they were performed. Method: A cross-sectional study carried out with patients undergoing a screening service, from January to July 2015. Results: The study evaluated 738 patients. Form these, 53.3% were men and 46.7% were women. Body mass index (BMI) > 25 kg/m2 was present in 43.4% of patients aged 18-39 years; 46% aged 40-59 years and 10.5% aged ≥ 60 years. Levels of fasting plasma glucose between 100-125 mg/dl were found in 10.2%. Decreased levels of high-density lipoprotein cholesterol (HDL-c) were observed in 14% and high triglyceride values in 12.7%. Changes in blood count were found in 12.6%, 7.7% of which with anemia. Among the patients, 39% of had an qualitative urine testing (QUT). Of which, 21.2% presented microscopic hematuria. Glutamic-pyruvic transaminase (GPT) was decreased in 22.5%. Urea was increased in 11%. Vitamin D insufficiency and deficiency was present in 41.2% and 19.4%, respectively. Conclusion: The main biochemical tests that showed changes, in sequence, were: vitamin D; qualitative urine testing; GPT; HDL-c; triglycerides; blood count; fasting glycemia and urea. The only tests that had the most abnormal rates in young adults, aged 18-39 years, were: parasitological examination of stool; decreased serum levels of urea and glutamic-oxaloacetic transaminase (GOT) and increased values of GPT.
conferenceObject Pancreatoduodenectomy With and Without Venous Resection for Pancreatic Cancer: A Systematic Review and Meta-analysis(2021) LEMOS FILHO, P. Joao Emilio; CABRAL, Fernanda C.; TUSTUMI, Francisco; DIAS, Andre R.; HENRIQUES, Alexandre C.; FUHRO, Felipe E.; WAISBERG, Jaques; JUNIOR, Sergio S.conferenceObject TREATMENT OF HEPATOCELLULAR CARCINOMA WITH MACROSCOPIC VASCULAR INVASION: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS(2023) TUSTUMI, Francisco; COELHO, Fabricio F.; MAGALHAES, Daniel D.; SILVEIRA, Sergio; JEISMANN, Vagner B.; FONSECA, Gilton M.; KRUGER, Jaime Arthur Pirola; D'ALBUQUERQUE, Luiz C.; HERMAN, Paulo