ANDRE LUIS MONTAGNINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- The interaction between N-category and N-ratio as a new tool to improve lymph node metastasis staging in gastric cancer: Results of a single cancer center in Brazil(2011) COIMBRA, F. J. F.; COSTA JR., W. L.; MONTAGNINI, A. L.; DINIZ, A. L.; RIBEIRO, H. S. C.; SILVA, M. J. B.; BEGNAMI, M. F. S.Background: Depth of tumor invasion (T-category) and the number of metastatic lymph nodes (N-category) are the most important prognostic factors in patients with gastric cancer. Recently, the ratio between metastatic and dissected lymph nodes (N-ratio) has been established as one. The aim of this study is to evaluate the impact of N-ratio and its interaction with N-category as a prognostic factor in gastric cancer. Methods: This was a retrospective study in which we reviewed clinical and pathological data of 165 patients who had undergone curative surgery at our institution through a 9-year period. The exclusion criteria included metastases, gastric stump tumors and gastrectomy with less than 15 lymph nodes dissected. Results: The median age of the patients was 63 years and most of them were male. Total gastrectomy was the most common procedure and 92.1% of the patients had a D2-lymphadenectomy. Their 5-year overall survival was 57.7%. T-category, N-category, extended gastrectomy, and N-ratio were prognostic factors in overall and disease-free survival in accordance with univariate analysis. In accordance with TNM staging, N1 patients who have had NR1 had 5-year survival in 75.5% whereas in the NR2 group only 33% of the cases had 5-year survival. In the multivariate analysis, the interaction between N-category and N-ratio was an independent prognostic factor. Conclusion: Our findings confirmed the role of N-ratio as prognostic factor of survival in patients with gastric cancer surgically treated with at least 15 lymph nodes dissected. The relationship between N-category and N-ratio is a better predictor than lymph node metastasis staging.
- Worldwide survey on opinions and use of minimally invasive pancreatic resection(2017) HILST, Jony van; ROOIJ, Thijs de; HILAL, Mohammed Abu; ASBUN, Horacio J.; BARKUN, Jeffrey; BOGGI, Uggo; BUSCH, Olivier R.; CONLON, Kevin C. P.; DIJKGRAAF, Marcel G.; HAN, Ho-Seong; HANSEN, Paul D.; KENDRICK, Michael L.; MONTAGNINI, Andre L.; PALANIVELU, Chinnusamy; ROSOK, Bard I.; SHRIKHANDE, Shailesh V.; WAKABAYASHI, Go; ZEH, Herbert J.; VOLLMER, Charles M.; KOOBY, David A.; BESSELINK, Marc G. H.Background: The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow. The worldwide utilization of MIPR and attitude towards future perspectives of MIPR remains unknown. Methods: An anonymous survey on MIPR was sent to the members of six international associations of Hepato-Pancreato-Biliary (HPB) surgery. Results: The survey was completed by 435 surgeons from 50 countries, with each surgeon performing a median of 22 (IQR 12-40) pancreatic resections annually. Minimally invasive distal pancreatectomy (MIDP) was performed by 345 (79%) surgeons and minimally invasive pancreatoduodenectomy (MIPD) by 124 (29%). The median total personal experience was 20 (IQR 10-50) MIDPs and 12 (IQR 4-40) MIPDs. Current superiority for MIDP was claimed by 304 (70%) and for MIPD by 44 (10%) surgeons. The most frequently mentioned reason for not performing MIDP (54/90 (60%)) and MIPD (193/311 (62%)) was lack of specific training. Most surgeons (394/435 (90%)) would consider participating in an international registry on MIPR. Discussion: This worldwide survey showed that most participating HPB surgeons value MIPR as a useful development, especially for MIDP, but the role and implementation of MIPD requires further assessment. Most HPB surgeons would welcome specific training in MIPR and the establishment of an international registry.
- Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury(2015) PERINI, Marcos V.; HERMAN, Paulo; MONTAGNINI, Andre L.; JUKEMURA, Jose; COELHO, Fabricio F.; KRUGER, Jaime A.; BACCHELLA, Telesforo; CECCONELLO, IvanAIM: To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular injury. METHODS: From a prospective database of patients treated for benign biliary strictures at our hospital, cases that underwent liver resections were reviewed. All cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy (open or laparoscopic). Liver resection was indicated in patients with Strasberg E3/E4 (hilar stricture) bile duct lesions associated with vascular damage (arterial and/or portal), ipsilateral liver atrophy/abscess, recurrent attacks of cholangitis, and failure of previous hepaticojejunostomy. RESULTS: Of 148 patients treated for benign biliary strictures, nine (6.1%) underwent liver resection; eight women and one man with a mean age of 38.6 years. Six patients had previously been submitted to open cholecystectomy and three to laparoscopic surgery. The mean number of surgical procedures before definitive treatment was 2.4. All patients had Strasberg E3/E4 injuries, and vascular injury was present in all cases. Eight patients underwent right hepatectomy and one underwent left lateral sectionectomy without mortality. Mean time of follow up was 69.1 mo and after long-term follow up, eight patients are asymptomatic. CONCLUSION: Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed.
- COMPARING THE ENZYME REPLACEMENT THERAPY COST IN POST PANCREATECTOMY PATIENTS DUE TO PANCREATIC TUMOR AND CHRONIC PANCREATITIS(2016) FRAGOSO, Anna Victoria; PEDROSO, Martha Regina; HERMAN, Paulo; MONTAGNINI, André LuisABSTRACT Background - Among late postoperative complications of pancreatectomy are the exocrine and endocrine pancreatic insufficiencies. The presence of exocrine pancreatic insufficiency imposes, as standard treatment, pancreatic enzyme replacement. Patients with chronic pancreatitis, with intractable pain or any complications with surgical treatment, are likely to present exocrine pancreatic insufficiency or have this condition worsened requiring adequate dose of pancreatic enzymes. Objective - The aim of this study is to compare the required dose of pancreatic enzyme and the enzyme replacement cost in post pancreatectomy patients with and without chronic pancreatitis. Methods - Observational cross-sectional study. In the first half of 2015 patients treated at the clinic of the Department of Gastrointestinal Surgery at Hospital das Clínicas, Universidade de São Paulo, Brazil, who underwent pancreatectomy for at least 6 months and in use of enzyme replacement therapy were included in this series. The study was approved by the Research Ethics Committee. The patients were divided into two groups according to the presence or absence of chronic pancreatitis prior to pancreatic surgery. For this study, P<0.05 was considered statistically significant. Results - The annual cost of the treatment was R$ 2150.5 ± 729.39; R$ 2118.18 ± 731.02 in patients without pancreatitis and R$ 2217.74 ± 736.30 in patients with pancreatitis. Conclusion - There was no statistically significant difference in the cost of treatment of enzyme replacement post pancreatectomy in patients with or without chronic pancreatitis prior to surgical indication.
bookPart Tumores de pâncreas(2013) FREITAS, Daniela de; MONTAGNINI, André LuisbookPart Videolaparoscopia diagnóstica em oncologia(2013) PERINI, Marcos Vinicius; MONTAGNINI, André Luís- 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
- Biliary tract schwannoma: A rare cause of obstructive jaundice in a young patient(2012) FONSECA, Gilton Marques; MONTAGNINI, Andre Luis; ROCHA, Manoel de Souza; PATZINA, Rosely Antunes; BERNARDES, Mario Vinicius Angelete Alvarez; CECCONELLO, Ivan; JUKEMURA, JoseSchwannoma is a tumor derived from Schwann cells which usually arises in the upper extremities, trunk, head and neck, retroperitoneum, mediastinum, pelvis, and peritoneum. However, it can arise in the gastrointestinal tract, including biliary tract. We present a 24-year-old male patient with obstructive jaundice, whose investigation with computed tomography abdomen showed focal wall thickening in the common hepatic duct, difficult to differentiate with hilar adenocarcinoma. He was diagnosed intraoperatively schwannoma of common bile duct and treated with local resection. The patient recovered well without signs of recurrence of the lesion after 12 mo. We also reviewed the common bile duct schwannoma related in the literature and evaluated the difficulty in pre and intraoperative differential diagnosis with adenocarcinoma hilar. Resection is the treatment of choice for such cases and the tumor did not recur in any of the resected cases.
- Standardizing terminology for minimally invasive pancreatic resection(2017) MONTAGNINI, Andre L.; ROSOK, Bard I.; ASBUN, Horacio J.; BARKUN, Jeffrey; BESSELINK, Marc G.; BOGGI, Ugo; CONLON, Kevin C. P.; FINGERHUT, Abe; HAN, Ho-Seong; HANSEN, Paul D.; HOGG, Melissa E.; KENDRICK, Michael L.; PALANIVELU, Chinnusamy; SHRIKHANDE, Shailesh V.; WAKABAYASHI, Go; ZEH, Herbert; VOLLMER, Charles M.; KOOBY, David A.Background: There is a growing body of literature pertaining to minimally invasive pancreatic resection (MIPR). Heterogeneity in MIPR terminology, leads to confusion and inconsistency. The Organizing Committee of the State of the Art Conference on MIPR collaborated to standardize MIPR terminology. Methods: After formal literature review for ""minimally invasive pancreatic surgery"" term, key terminology elements were identified. A questionnaire was created assessing the type of resection, the approach, completion, and conversion. Delphi process was used to identify the level of agreement among the experts. Results: A systematic terminology template was developed based on combining the approach and resection taking into account the completion. For a solitary approach the term should combine ""approach + resection"" (e.g. ""laparoscopic pancreatoduodenectomy""); for combined approaches the term must combine ""first approach + resection"" with ""second approach + reconstruction"" (e.g. ""laparoscopic central pancreatectomy"" with ""open pancreaticojejunostomy"") and where conversion has resulted the recommended term is "" first approach"" + ""converted to"" + ""second approach"" + ""resection"" (e.g. ""robot-assisted"" "" converted to open"" ""pancreatoduodenectomy"") Conclusions: The guidelines presented are geared towards standardizing terminology for MIPR, establishing a basis for comparative analyses and registries and allow incorporating future surgical and technological advances in MIPR.
- BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA(2020) COIMBRA, Felipe Jose F.; TORRES, Orlando Jorge M.; ALIKHANOV, Ruslan; AGARWAL, Anil; PESSAUX, Patrick; FERNANDES, Eduardo de Souza M.; QUIREZE-JUNIOR, Claudemiro; ARAUJO, Raphael Leonardo C.; GODOY, Andre Luis; WAECHTER, Fabio Luis; RESENDE, Alexandre Prado de; BOFF, Marcio Fernando; COELHO, Gustavo Rego; REZENDE, Marcelo Bruno de; LINHARES, Marcelo Moura; BELOTTO, Marcos; MORAES-JUNIOR, Jose Maria A.; AMARAL, Paulo Cezar G.; PINTO, Rinaldo Danesi; GENZINI, Tercio; LIMA, Agnaldo Soares; RIBEIRO, Heber Salvador C.; RAMOS, Eduardo Jose; ANGHINONI, Marciano; PEREIRA, Lucio Lucas; ENNE, Marcelo; SAMPAIO, Adriano; MONTAGNINI, Andre Luis; DINIZ, Alessandro; JESUS, Victor Hugo Fonseca de; SIROHI, Bhawna; V, Shailesh Shrikhande; PEIXOTO, Renata D. Alpino; KALIL, Antonio Nocchi; JARUFE, Nicolas; SMITH, Martin; HERMAN, PauloBackground: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.