DANIEL TAVARES DE REZENDE
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Unidades Organizacionais
5 resultados
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- Magnifying chromoendoscopy is a reliable method in the selection of rectal neoplasms for local excision(2023) KIMURA, C. M. S.; KAWAGUTI, F. S.; HORVAT, N.; NAHAS, C. S. R.; MARQUES, C. F. S.; PINTO, R. A.; REZENDE, D. T. de; SEGATELLI, V.; SAFATLE-RIBEIRO, A. V.; JUNIOR, U. R.; MALUF-FILHO, F.; NAHAS, S. C.Purpose Adequate staging of early rectal neoplasms is essential for organ-preserving treatments, but magnetic resonance imaging (MRI) frequently overestimates the stage of those lesions. We aimed to compare the ability of magnifying chromoendoscopy and MRI to select patients with early rectal neoplasms for local excision. Methods This retrospective study in a tertiary Western cancer center included consecutive patients evaluated by magnifying chromoendoscopy and MRI who underwent en bloc resection of nonpedunculated sessile polyps larger than 20 mm, laterally spreading tumors (LSTs) >= 20 mm, or depressed-type lesions of any size (Paris 0-IIc). Sensitivity, specificity, accuracy, and positive and negative predictive values of magnifying chromoendoscopy and MRI to determine which lesions were amenable to local excision (i.e., <= T1sm1) were calculated. Results Specificity of magnifying chromoendoscopy was 97.3% (95% CI 92.2-99.4), and accuracy was 92.7% (95% CI 86.7-96.6) for predicting invasion deeper than T1sm1 (not amenable to local excision). MRI had lower specificity (60.5%, 95% CI 43.4-76.0) and lower accuracy (58.3%, 95% CI 43.2-72.4). Magnifying chromoendoscopy incorrectly predicted invasion depth in 10.7% of the cases in which the MRI was correct, while magnifying chromoendoscopy provided a correct diagnosis in 90% of the cases in which the MRI was incorrect (p = 0.001). Overstaging occurred in 33.3% of the cases in which magnifying chromoendoscopy was incorrect and 75% of the cases in which MRI was incorrect. Conclusion Magnifying chromoendoscopy is reliable for predicting invasion depth in early rectal neoplasms and selecting patients for local excision.
conferenceObject RISK FACTORS FOR STENOSIS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION OF LARGE LESIONS OF THE RECTUM(2021) REZENDE, Daniel T.; KAWAGUTI, Fabio S.; MARTINS, Bruno; SAFATLE-RIBEIRO, Adriana V.; NAHAS, Caio Sergio R.; MARQUES, Carlos F.; POMBO, Amanda A.; SANTOS, Alisson L.; BRAGHIROLI, Oddone F.; RIBEIRO, Ulysses; NAHAS, Sergio C.; MALUF-FILHO, Fauze- 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.
- Underwater endoscopic resection of an ileal neuroendocrine tumor(2021) REZENDE, Daniel T.; KAWAGUTI, Fabio S.; SAFATLE-RIBEIRO, Adriana V.; TOLENTINO, Luciano H. L.; RIBEIRO JUNIOR, Ulysses; MALUF-FILHO, Fauze
- Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil(2021) POMBO, Amanda A. M.; LENZ, Luciano; PAULO, Gustavo A.; SANTOS, Monica A.; TAMAE, Patricia K.; SANTOS, Alisson L. D. R.; REZENDE, Daniel T.; MARTINS, Bruno; KAWAGUTI, Fabio S.; PENNACHI, Caterina M. P. S.; GUSMON-OLIVEIRA, Carla C.; UEMURA, Ricardo S.; GEIGER, Sebastian; LIMA, Marcelo S.; BABA, Elisa R.; FIGUEIREDO, Viviane R.; SAFATLE-RIBEIRO, Adriana; MALUF-FILHO, Fauze; RIBEIRO-JUNIOR, UlyssesOBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of Sao Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.