JAIME ARTHUR PIROLA KRUGER
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies(2023) COELHO, Fabricio Ferreira; HERMAN, Paulo; KRUGER, Jaime A. P.; WU, Andrew G. R.; CHIN, Ken-Min; HASEGAWA, Kiyoshi; ZHANG, Wanguang; ALZOUBI, Mohammad; AGHAYAN, Davit L.; SIOW, Tiing-Foong; SCATTON, Olivier; KINGHAM, T. Peter; V, Marco Marino; MAZZAFERRO, Vincenzo; CHIOW, Adrian K. H.; SUCANDY, Iswanto; IVANECZ, Arpad; CHOI, Sung Hoon; LEE, Jae Hoon; GASTACA, Mikel; VIVARELLI, Marco; GIULIANTE, Felice; RUZZENENTE, Andrea; YONG, Chee-Chien; DOKMAK, Safi; FONDEVILA, Constantino; EFANOV, Mikhail; MORISE, Zenichi; BENEDETTO, Fabrizio Di; BRUSTIA, Raffaele; VALLE, Raffaele Dalla; BOGGI, Ugo; GELLER, David; BELLI, Andrea; MEMEO, Riccardo; GRUTTADAURIA, Salvatore; MEJIA, Alejandro; PARK, James O.; ROTELLAR, Fernando; CHOI, Gi Hong; ROBLES-CAMPOS, Ricardo; WANG, Xiaoying; SUTCLIFFE, Robert P.; PRATSCHKE, Johann; LAI, Eric C. H.; CHONG, Charing C. N.; D'HONDT, Mathieu; MONDEN, Kazuteru; LOPEZ-BEN, Santiago; LIU, Rong; FERRERO, Alessandro; ETTORRE, Giuseppe Maria; CIPRIANI, Federica; CHERQUI, Daniel; LIANG, Xiao; SOUBRANE, Olivier; WAKABAYASHI, Go; TROISI, Roberto I.; YIN, Mengqiu; CHEUNG, Tan-To; SUGIOKA, Atsushi; HAN, Ho-Seong; LONG, Tran Cong Duy; FUKS, David; HILAL, Mohammad Abu; CHEN, Kuo-Hsin; ALDRIGHETTI, Luca; EDWIN, Bjorn; GOH, Brian K. P.Background: The impact of cirrhosis and portal hypertension on perioperative outcomes of minimally invasive left lateral sectionectomies remains unclear. We aimed to compare the perioperative outcomes between patients with preserved and compromised liver function (noncirrhotics versus Child-Pugh A) when undergoing minimally invasive left lateral sectionectomies. In addition, we aimed to determine if the extent of cirrhosis (Child-Pugh A versus B) and the presence of portal hypertension had a significant impact on perioperative outcomes. Methods: This was an international multicenter retrospective analysis of 1,526 patients who underwent minimally invasive left lateral sectionectomies for primary liver malignancies at 60 centers worldwide between 2004 and 2021. In the study, 1,370 patients met the inclusion criteria and formed the final study group. Baseline clinicopathological characteristics and perioperative outcomes of these patients were compared. To minimize confounding factors, 1:1 propensity score matching and coarsened exact matching were performed. Results: The study group comprised 559, 753, and 58 patients who did not have cirrhosis, Child-Pugh A, and Child-Pugh B cirrhosis, respectively. Six-hundred and thirty patients with cirrhosis had portal hy-pertension, and 170 did not.After propensity score matching and coarsened exact matching, Child-Pugh A patients with cirrhosis undergoing minimally invasive left lateral sectionectomies had longer operative time, higher intraoperative blood loss, higher transfusion rate, and longer hospital stay than patients without cirrhosis. The extent of cirrhosis did not significantly impact perioperative outcomes except for a longer duration of hospital stay. Conclusion: Liver cirrhosis adversely affected the intraoperative technical difficulty and perioperative outcomes of minimally invasive left lateral sectionectomies. & COPY; 2023 Elsevier Inc. All rights reserved.
- Long-term oncological outcomes for HALS/Hybrid vs pure laparoscopic approach in colorectal liver metastases: a propensity score matched analysis(2023) LOPEZ-LOPEZ, Victor; KRURGER, Jaime Arthur Pirola; KUEMMERLI, Christopher; TOHME, Samer; GOMEZ-GAVARA, Concepcion; INIESTA, Maria; LOPEZ-CONESA, Asuncion; DOGEAS, Epameinondas; DALMAU, Mar; BRUSADIN, Roberto; SANCHEZ-ESQUER, Ignacio; GELLER, David A.; HERMAN, Paulo; ROBLES-CAMPOS, RicardoBackgroundStudies comparing hand-assisted laparoscopic (HALS)/Hybrid and pure laparoscopic (PLS) resection for colorectal cancer liver metastasis have focused on short-term results, while long-term oncological outcomes remain understudied.MethodsWe established a multi-institutional retrospective cohort study from four centers with experience in minimally invasive surgery between 2004 and 2020. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Other endpoints analyzed were intraoperative and postoperative outcomes. Propensity score matching (PSM) was used to minimize baseline differences.ResultsA total of 219 HALS/Hybrid (57.8%) and 160 PLS (42.2%) patients were included. After PSM, 155 patients remained in each group. Operative time (182 vs. 248 min, p = 0.012), use of intraoperative ablation (12.3 vs. 4.5%, p = 0.024), positive resection margin (4.5 vs 13.2%, p = 0.012), and pringle time (21 vs. 37 min, p = 0.001) were higher in PLS group. DFS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 65.4%, 39.3%, 37.5%, and 36.3% vs. 64.9%, 38.0%, 33.1%, and 33.1%, respectively (p = 0.84). OS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 94.5%, 71.4%, 54.3%, and 46.0% vs. 96.0%, 68.5%, 51.2%, and 41.2%, respectively (p = 0.73).ConclusionOur study suggests no differences in long-term oncologic outcomes between the two techniques. We discovered that longer total operative, pringle time, higher rates of intraoperative ablation, and positive resection margins were associated with PLS. These differences in favor of HALS/Hybrid could be due to a shorter learning curve and a greater ability to control hemorrhage.
- HEPATOSPLENIC SCHISTOSOMIASIS-ASSOCIATED CHRONIC PORTAL VEIN THROMBOSIS: RISK FACTOR FOR HEPATOCELLULAR CARCINOMA?(2023) DARCE, George Felipe Bezerra; MAKDISSI, Fabio Ferrari; ANDO, Sabrina de Mello; FONSECA, Gilton Marques; KRUGER, Jaime Arthur Pirola; COELHO, Fabricio Ferreira; ROCHA, Manoel de Souza; HERMAN, PauloBACKGROUND: Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis. AIMS: To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up. METHODS: A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021. RESULTS: A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5-31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before. CONCLUSIONS: The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients.
- 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.
- Liver resection for hepatolithiasis: A multicenter experience in Latin America(2023) GARCIA, Daniel; MARINO, Carlo; COELHO, Fabricio Ferreira; REBOLLEDO, Patricia; ACHURRA, Pablo; FONSECA, Gilton Marques; KRUGER, Jaime A. P.; VINUELA, Eduardo; BRICENO, Eduardo; D'ALBUQUERQUE, Luiz Carneiro; JARUFE, Nicolas; MARTINEZ, Jorge A.; HERMAN, Paulo; DIB, Martin J.Background: Hepatolithiasis is a prevalent disease in Asia but rare in Western countries. An increasing number of cases have been reported in Latin America. Liver resection has been proposed as a definitive treatment for complete stone clearance. The aim of this study was to evaluate the postoperative out-comes of liver resection for the treatment of hepatolithiasis in 2 large hepatobiliary reference centers from South America.Methods: We conducted a retrospective descriptive analysis from patients with hepatolithiasis who underwent liver resection between November 1986 and December 2018, in 2 Latin-American centers in Chile and Brazil.Results: One hundred forty-nine patients underwent liver resection for hepatolithiasis (72 in Chile, 77 in Brazil). The mean age was 49 years and most patients were female (62.4%). Hepatolithiasis was localized in the left lobe (61.7%), right lobe (24.2%), and bilateral lobe (14.1%). Bilateral lithiasis was associated with higher incidence of preoperative and postoperative cholangitis (81% vs 46.9% and 28.6% vs 6.1%) and need for hepaticojejunostomy (52.4%). In total, 38.9% of patients underwent major hepatectomy and 14.1% were laparoscopic. The postoperative stone clearance was 100%. The 30-day morbidity and mortality rates were 30.9% and 0.7%, respectively. Cholangiocarcinoma was seen in 2 specimens, and no post-operative malignancy were seen after a median follow-up of 38 months. Fourteen patients (9.4%) had intrahepatic stones recurrence.Conclusions: Liver resection is an effective and definitive treatment for patients with hepatolithiasis. Bilateral hepatolithiasis was associated with perioperative cholangitis, the need for hepaticojejunostomy, and recurrent disease. Resection presents a high rate of biliary tree stone clearance and excellent long-term results, with low recurrence rates and low risk of malignancy.(c) 2022 Elsevier Inc. All rights reserved.
- Multiple colorectal liver metastases resection can offer long-term survival: The concept of a chronic neoplastic disease(2023) DUMARCO, Rodrigo Blanco; FONSECA, Gilton Marques; COELHO, Fabricio Ferreira; JEISMANN, Vagner Birk; MAKDISSI, Fabio Ferrari; KRUGER, Jaime Arthur Pirolla; NAHAS, Sergio Carlos; HERMAN, PauloBackground: Resection for colorectal liver metastases has evolved significantly and, currently, there are no limits to the number of resected nodules. This study aimed to evaluate the outcomes and prognostic factors after liver resection for patients with >= 4 colorectal liver metastases, emphasizing long-term survival. Methods: The study population consisted of 137 patients with >= 4 colorectal liver metastases out of a total of 597 patients with colorectal liver metastases who underwent curative intent liver resection from January 2010 to July 2019 in a single hepatobiliary center. Results: The probability of overall and disease-free survival at 1, 3, and 5 years was 90.8%, 64.5%, 40.6%, and 37.7%, 19.3%, 18.1%, respectively. In a multivariate analysis for overall survival, the size of the largest metastatic nodule was the only unfavorable factor (P =.001). For disease-free survival, complete pathological response was a favorable factor (P =.04), and the following were negative factors: number of nodules >= 7 (P =.034), radiofrequency ablation during surgery (P =.04), positive primary tumor lymph nodes (P =.034), R1 resection (P =.011), and preoperative carcinoembryonic antigen >20 ng/mL (P =.015). After the first and second years of follow-up, 59 patients (45.3%) and 45 patients (34.6%), respectively, were not receiving chemotherapy. After 5 years of follow-up, 21 (16.1%) multimetastatic patients were chemotherapy-free. Conclusion: A significant number of patients with multiple colorectal liver metastases will present long-term survival and should not be denied surgery. The long-term survival rates, even in the presence of recurrence, characterize a chronic neoplastic disease.
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, PauloconferenceObject HEPATIC ANGIOMYOLIPOMAS: CLINICAL AND IMAGING FINDINGS(2023) SILVEIRA, Sergio; TUSTUMI, Francisco; DARCE, George F.; JEISMANN, Vagner B.; FONSECA, Gilton M.; KRUGER, Jaime Arthur Pirola; MAKDISSI, Fabio Ferrari; OLIVEIRA, Irai Santana de; ROCHA, Manoel de Souza; COELHO, Fabricio F.; HERMAN, Paulo- Brazilian Landscape of Hepatocellular Carcinoma(2023) FONSECA, Leonardo G.; CHEN, Andre T. C.; OLIVEIRA, Irai S. de; CHAGAS, Aline L.; KRUGER, Jaime A. P.; CARRILHO, Flair J.The incidence of hepatocellular carcinoma (HCC) is expected to increase in the coming years, and strategies to mitigate the burden of this disease are needed in different regions. Geographic variations in epidemiology and risk factors, such as viral hepatitis and metabolic disease, pose challenges in adopting programs for early detection programs and management of patients with HCC. Brazil, like other countries, has high economic and social inequality, with heterogeneous access to health care. Viral hepatitis is themain risk factor but there is growing awareness of fatty liver disease. Risk factor monitoring and screening programs are unmet priorities because patients are often diagnosed at later stages. Advances in the management of patients with HCC have been made in recent years, including new tools for selecting patients for liver transplantation, sophisticated surgical techniques, and new systemic agents. High-volume academic centers often achieve favorable results through the adoption and application of established treatments, but this is not a reality in most regions of Brazil, because of disparities in wealth and resources. As HCC management requires a coordinated and multidisciplinary team, the role of local referral centers in decentralizing access to treatments and promoting health education in different regions should be encouraged and supported.