BRUNO DA COSTA MARTINS
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Long-term results of an endoscopic screening program for superficial esophageal cancer in patients with head and neck squamous cell carcinoma(2022) MOURA, Renata Nobre; KUBOKI, Yeda; BABA, Elisa Ryoka; SAFATLE-RIBEIRO, Adriana; MARTINS, Bruno; PAULO, Gustavo Andrade de; TOLENTINO, Luciano Lenz; LIMA, Marcelo Simas de; KULCSAR, Marco Aurelio; SALLUM, Rubens Antonio Aissar; JR, Ulysses Ribeiro; MALUF-FILHO, FauzeBackground and study aims Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of a second primary tumor in the gastrointestinal tract, most commonly in the esophagus. Screening these patients for esophageal carcinoma may help detect asymptomatic dysplasia and early cancer, thus allowing curative treatment and more prolonged survival, but the impact of endoscopic screening remains uncertain. Here we aimed to describe the long-term results of an esophageal SCC screening program in patients with head and neck cancer in terms of prevalence, associated risk factors, and survival. Patients and methods We performed an observational study of a prospectively collected database including patients with HNSCC who had undergone high-definition endoscopy with chromoscopy between 2010 and 2018 at a Brazilian tertiary academic center. Results The study included 1,888 patients. The esophageal SCC prevalence was 7.9 %, with the majority (77.8 %) being superficial lesions. Significant risk factors for esophageal high-grade dysplasia (HGD) and invasive cancer included tumors of the oral cavity and oropharynx and the presence of low-grade dysplasia (LGD). Overall survival (OS) was significantly shorter among patients in whom esophageal cancer was diagnosed at an advanced stage (P < .001). OS did not significantly differ between patients with HGD and early esophageal cancer versus those without esophageal cancer (P = .210) Conclusions Endoscopic screening for superficial esophageal neoplasia in patients with HNSCC improves esophageal cancer detection. Screening could potentially benefit patients with primary cancer located at the oropharynx or oral cavity. In addition, the detection of esophageal LGD indicates a need for endoscopic surveillance.
- Two-step ESD: an option for en-bloc resection of extensive colorectal laterally spreading tumors(2019) KAWAGUTI, Fabio S.; OKAZAKI, Ossamu; MIYAJIMA, Nelson T.; SEGATELI, Vanderlei; MARQUES, Carlos F. S.; NAHAS, Caio S. R.; MARTINS, Bruno C.; NAHAS, Sergio C.; JUNIOR, Ulysses R.; FILHO, Fauze M.Background and study aims Endoscopic submucosal dissection (ESD) is considered feasible and safe for treatment of colorectal laterally spreading tumors (LST), However it remains a challenge in case of extensive lesions even for experts. This study aimed to describe a new method to facilitate ESD of extensive colorectal LSTs. Between July 2010 and January 2018, 140 patients underwent ESD for colorectal LSTs. Four of them were submitted to two-step ESD and were included in this retrospective study. The submucosal dissection of lesions larger than 12 cm started and continued until the medical team decided to pause the procedure and continue it in a second step. The second procedure was performed 2 days after to finish the en-bloc resection.Three patients were male, with mean age of 67.2y (+/- 2.2). All lesions were located in the rectum, with a mean size of 153.7 mm (+/- 33.8). En-bloc and curative resection were successfully achieved in all cases. Mean duration of the first step of the procedure was 255 minutes (+/- 61.8), and mean duration of the second step was 205 minutes (+/- 205). Overall mean duration of both steps was 460 minutes (+/- 168). Mean dissected area in the first step of the procedure was approximately 55 % of the lesion. No adverse events were observed. In conclusion, our results suggest that performing ESD in two steps could be a feasible and safe option for exceptional cases in which is not possible to finish the procedure in one step, avoiding the morbidity of surgical treatment.
- Impact of coronavirus pandemic crisis in endoscopic clinical practice: Results from a national survey in Brazil(2020) ARANTES, Vitor Nunes; MARTINS, Bruno Costa; SEQATTO, Raphael; MILHOMEN-CARDOSO, Daniela Medeiros; FRANZINI, Tomazo Prince; ZUCCARO, Anna Maria; ALVES, Jairo Silva; MALUF-FILHO, FauzeBackground and study aims In March 2020, the World Health Organization declared coronavirus disease of 2019 (COVID-19) as a pandemic, mobilizing all countries to contain the disease spread. Activity in endoscopy centers globally was severely affected. We conducted a national survey aiming to assess the impact of the COVID-19 outbreak on endoscopic clinical practice in Brazil. Methods In April 2020, 3,719 associate members of SOBED (Brazilian Society of Digestive Endoscopy) were invited to respond to an electronic survey. An Internet link was established to provide access to the online questionnaire with 40 questions regarding personal profile, endoscopy unit logistics and schedule, availability and use of personal protective equipment (PPE), financial impact, and exposure to COVID-19. Results A total of 2,131 individuals (67 %) accessed the questionnaire and 1155 responses were received. After review, 980 responses were considered valid. According to almost 90 % of respondents, endoscopy activity was restricted to urgent procedures, in both public and private hospitals. All respondents increased PPE use after the outbreak, however, institutions provided adequate PPE to only 278 responders (28.7 %). Significant income loss was universally reported. A total of 10 practitioners (1 %) reported COVID-19 infection and attributed the contamination to endoscopic procedures. Conclusions Based on this nationwide survey with almost 1,000 respondents, the COVID-19 pandemic substantially reduced the activity of endoscopy units in private and public settings. The pandemic increased awareness of PPE use, but its availability was not universal and 1 % of the respondents became infected with COVID-19, allegedly due to exposure during endoscopic procedures.
- Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis(2018) RIBEIRO, Igor Braga; BERNARDO, Wanderley Marques; MARTINS, Bruno da Costa; MOURA, Diogo Turiani Hourneaux de; BABA, Elisa Ryoka; JOSINO, Iatagan Rocha; MIYAJIMA, Nelson Tomio; CORDERO, Martin Andres Coronel; VISCONTI, Thiago Arantes de Carvalho; IDE, Edson; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer death worldwide. Malignant colonic obstruction (MCO) due to CRC occurs in 8% to 29% of patients. The aim of this study was to perform a systematic review and meta-analysis of RCTs comparing colonic SEMS versus emergency surgery (ES) for MCO in palliative patients. This was the first systematic review that included only randomized controlled trials in the palliative setting. Methods A literature search was performed according to the PRISMA method using online databases with no restriction regarding idiom or year of publication. Data were extracted by two authors according to a predefined data extraction form. Primary outcomes were: mean survival, 30-day adverse events, 30-day mortality and length of hospital stay. Stoma formation, length of stay on intensive care unit (ICU), technical success and clinical success were recorded for secondary outcomes. Technical success (TS) was defined as successful stent placement across the stricture and its deployment. Clinical success (CS) was defined as adequate bowel decompression within 48 h of stent insertion without need for re-intervention. Results We analyzed data from four RCT studies totaling 125 patients. The 30-day mortality was 6.3% for SEMS-treated patients and 6.4% for ES-treated patients, with no difference between groups (RD: -0.00, 95% CI [-0.10, 0.10], I-2: 0 %). Mean survival was 279 days for SEMS and 244 days for ES, with no significant difference between groups (RD: 20.14, 95% CI: [-42.92, 83.21], I-2: 44%). Clinical success was 96% in the ES group and 86.1% in the SEMS group (RD: -0.13, 95% CI [-0.23, -0.02], I-2: 51%). Permanent stoma rate was 84% in the ES group and 14.3% in the SEMS group (RR: 0.19, 95% CI: [0.11, 0.33], I-2: 28%). Length of hospital stay was shorter in SEMS group (RD: -5.16, 95% CI: [-6.71, -3.61], I-2: 56%). There was no significant difference between groups regarding adverse events (RD 0.18, 95% CI: [-0.19, 0.54;]) neither regarding ICU stay. (RD: -0.01, 95% CI: [-0.08, 0.05], I-2: 7%). The most common stent-related complication was perforation (42.8% of all AE). Conclusion Mortality, mean survival, length of stay in the ICU and early complications of both methods were similar. SEMS may be an alternative to surgery with the advantage of early hospital discharge and lower risk of permanent stoma.
- TC-325 hemostatic powder in the management of upper gastrointestinal malignant bleeding: a randomized controlled trial(2022) MARTINS, Bruno Costa; MACHADO, Andressa Abnader; SCOMPARIN, Rodrigo Corsato; PAULO, Gustavo Andrade; SAFATLE-RIBEIRO, Adriana; GEIGER, Sebastian Naschold; LENZ, Luciano; LIMA, Marcelo Simas; PENNACCHI, Caterina; RIBEIRO, Ulysses; BARKUN, Alan N.; MALUF-FILHO, FauzeBackground and study aims Upper gastrointestinal bleeding (UGIB) from malignancy is associated with high rebleeding and mortality rates. Recently, TC-325 powder has shown promising results in the treatment of UGIB, including malignant bleeding. The aim of this study was to compare the efficacy of TC-325 versus best clinical management. Patients and methods From August 2016 to February 2020, all patients with evidence of UGIB from malignancy were randomized to receive TC-325 therapy or control group, in which endoscopic treatment was not mandatory. Exclusion criteria were hemoglobin drop without overt bleeding and UGIB from non-tumor origin. The primary outcome was 30-day mortality. Secondary outcomes were 30-day rebleeding, blood transfusion and length of hospital stay. Results Sixty-two patients were randomized, three were excluded and 59 were included in the final analysis (TC-325 group = 28; control = 31). Groups were similar at baseline. Active bleeding was observed in 22 patients in the TC-325 group and 19 in the control group (P=0.15). Successful initial hemostasis with TC-325 was achieved in all cases. Additional therapy (radiotherapy, surgery or arterial embolization) was equally performed in both groups (42.9% vs 58.1 %; P=0.243). There were no differences in 30-day mortality (28.6% vs. 19.4%, P=0.406) or 30-day rebleeding rates (32.1 % vs. 19.4%, P=0.26). Logistic regression identified no significant predictors of rebleeding. Age, Eastern Cooperative Oncology Group (ECOG) score 3 to 4 and AIMS65 score > 1 predicted greater mortality. Conclusions TC-325 was effective in achieving immediate hemostasis in malignant gastrointestinal bleeding but did not reduce 30-day mortality, 30-day rebleeding, blood transfusion or length of hospital stay. Age, ECOG 3-4, and AIMS65 > 1 were predictive factors of mortality.