RODRIGO OLIVA PEREZ
Índice h a partir de 2011
25
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- Baseline T Classification Predicts Early Tumor Regrowth After Nonoperative Management in Distal Rectal Cancer After Extended Neoadjuvant Chemoradiation and Initial Complete Clinical Response(2017) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; GAMA-RODRIGUES, Joaquim; VAILATI, Bruna Borba; ORTEGA, Cinthia; FERNANDEZ, Laura Melina; ARAUJO, Sergio Eduardo Alonso; PEREZ, Rodrigo OlivaBACKGROUND: Selected patients with rectal cancer and complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively with acceptable outcomes. However, approximate to 20% of these patients will develop early tumor regrowth. Identification of these patients could select candidates for more intensive follow-up. OBJECTIVE: The purpose of this study was to investigate the influence of baseline radiological T classification on recurrences after a complete clinical response managed nonoperatively after chemoradiation. DESIGN: This was a retrospective review of a prospective collected database. SETTINGS: The study was conducted at a single center. PATIENTS: Patients with distal rectal cancer (cT2-4N0-2M0) undergoing extended chemoradiation (54 Gy + 5-fluorouracil-based chemotherapy) were eligible. Patients were reassessed for tumor response at 10 weeks after radiation completion. Patients with complete clinical response (clinical, radiological, and endoscopic) were managed nonoperatively and strictly followed. MAIN OUTCOMES MEASURES: Complete clinical response rates, early tumor regrowth rates (<12 mo), local recurrence-free survival, and distant metastases-free survival were measured. RESULTS: A total of 91 consecutive patients with rectal cancer underwent extended chemoradiation. Sixty-one patients developed initial complete clinical response (67%). cT2 patients developed similar initial complete clinical response rates compared with cT3/T4 (72% vs 63%; p = 0.403). Early tumor regrowths were more frequent among baseline cT3/4 when compared with cT2 patients (30% vs 3%; p = 0.007). There were no differences in late local recurrences (p = 0.593) or systemic recurrences (p = 0.387). Local recurrence-free survival was significantly better for cT2 patients at 1 year (96% vs 69%; p = 0.009). After Cox regression analysis, baseline T stage was an independent predictor of improved local recurrence-free survival at 1 year (p = 0.03; OR = 0.09 (95% CI, 0.01-0.81)). LIMITATIONS: This study was limited by its small sample size, retrospective nature, and short follow-up. CONCLUSIONS: cT2 patients who develop complete clinical response after extended chemoradiation managed nonoperatively are less likely to develop early tumor regrowths when compared with cT3/4 patients. cT3/4 patients should undergo more intensive follow-up after a complete clinical response to allow for early detection of early regrowths.
- Transanal Endoscopic Microsurgery (TEM) Following Neoadjuvant Chemoradiation for Rectal Cancer: Outcomes of Salvage Resection for Local Recurrence(2016) PEREZ, Rodrigo Oliva; HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; PROSCURSHIM, Igor; FERNANDEZ, Laura Melina; AZEVEDO, Rafael Ulysses de; VAILATI, Bruna B.; FERNANDES, Felipe Alexandre; GAMA-RODRIGUES, JoaquimTransanal endoscopic microsurgery (TEM) has been considered an alternative for selected patients with rectal cancer following neoadjuvant chemoradiation (CRT). Immediate total mesorectal completion for all patients with unfavorable pathological features would result in unnecessary protectomies in a significant proportion of patients. Instead, salvage total mesorectal excision (TME) could be restricted for patients developing local recurrence. The aim of the present study is to determine oncological outcomes of salvage resection for local recurrences following CRT and TEM. Consecutive patients undergoing TEM following neoadjuvant CRT for rectal cancer were reviewed. Patients with ""near"" complete response to CRT (a parts per thousand currency sign3 cm; ycT1-2N0) were offered TEM. Salvage surgery was attempted in the event of a local recurrence. A total of 53 patients were managed by CRT followed by TEM. Unfavorable pathological features were present in 36 patients (68 %). None of the patients underwent immediate completion TME. There were 12 patients who developed local recurrence resulting in a 2-year local recurrence-free survival of 77 % (95 % CI, 53-100 %). Of these patients, 9 developed exclusively local recurrences, and all had at least 1 unfavorable pathological feature in the specimen after TEM (100 %). Eight patients (8 of 9) underwent salvage resection (abdominoperineal resection [APR] in 87 %) with CRM+ in 7 of 8 patients (87 %). Four patients developed local re-recurrence after a median 36 months of follow-up. The 2-year local re-recurrence free survival was 60 %. Salvage resection for local recurrence following CRT and TEM is associated with high rates of R1 resection (CRM+) and local re-recurrence. Immediate completion of TME should be considered for patients with unfavorable pathological features after TEM.
- Transanal Endoscopic Microsurgery for Residual Rectal Cancer (ypT0-2) Following Neoadjuvant Chemoradiation Therapy: Another Word of Caution(2013) PEREZ, Rodrigo Oliva; HABR-GAMA, Angelita; LYNN, Patricio Bernardo; JULIAO, Guilherme Pagin Sao; BIANCHI, Romina; PROSCURSHIM, Igor; GAMA-RODRIGUES, JoaquimBACKGROUND: Significant tumor downstaging among patients with rectal cancer following neoadjuvant chemoradiation has raised the issue of offering patients with small residual cancers restricted to the bowel wall an alternative treatment strategy to total mesorectal excision. Transanal endoscopic microsurgery may allow proper primary tumor resection with promising oncological outcomes, less postoperative morbidity, and minimal long-term sexual, urinary, and fecal continence disorders in comparison with radical resection. OBJECTIVE: The aim of this study was to determine the oncological outcomes of patients with residual rectal cancers restricted to the rectal wall (ypT0-2) following neoadjuvant chemoradiation and transanal endoscopic microsurgery. DESIGN: This study considered a prospective cohort of patients with residual rectal cancers following neoadjuvant chemoradiation treated by transanal endoscopic microsurgery and no additional systemic therapy. SETTINGS: This study was a single-institution experience. PATIENTS: Patients with adenocarcinoma of the rectum located no more than 7 cm from the anal verge and endorectal ultrasound-or magnetic resonance-staged cT2-4N0-2M0 treated by neoadjuvant chemoradiation (50.4-54 Gy and 5-fluorouracil-based chemotherapy) were eligible for the study. Patients with small residual tumors (<= 3 cm) radiologically staged ycT0-2N0 were treated by transanal endoscopic microsurgery. INTERVENTIONS: Transanal endoscopic microsurgery was performed. MAIN OUTCOME MEASURES: The primary outcome measured was local recurrence. RESULTS: Of the 27 patients treated by transanal endoscopic microsurgery, 3 had ypT0, 6 had ypT1, and 18 had ypT2 cancers. All patients underwent R0 transanal endoscopic microsurgery excision. Local recurrence was observed in 4 (15%) patients after a median follow-up of 15 months. Only lymphovascular invasion was an independent predictive factor for local failure (p = 0.04). Tumor size, ypT status, T-status downstaging, lateral/radial margins, and tumor regression grade were not predictors of local failure. LIMITATIONS: This study was limited by the small sample size and limited follow-up. CONCLUSIONS: A local failure rate of 15% after transanal endoscopic microsurgery for patients with residual rectal cancers restricted to the bowel wall (ypT0-2) may limit the indication of this procedure to highly selected patients as an alternative to standard radical total mesorectal excision.
- Time to rethink transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation for highly selected patients(2017) PEREZ, Rodrigo Oliva; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba
- Inferior Survival Rates After Chemoradiation for Rectal Cancer Without Surgery(2017) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; PEREZ, Rodrigo O.
- Contact X-Ray Brachytherapy in Organ Preservation for Rectal Cancer(2018) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; PEREZ, Rodrigo O.
- Organ Preservation in cT2N0 Rectal Cancer After Neoadjuvant Chemoradiation Therapy The Impact of Radiation Therapy Dose-escalation and Consolidation Chemotherapy(2019) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; VAILATI, Bruna Borba; SABBAGA, Jorge; AGUILAR, Patricia Bailao; FERNANDEZ, Laura Melina; ARAUJO, Sergio Eduardo Alonso; PEREZ, Rodrigo OlivaObjective: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. Background: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients. Methods: Patients with distal and nonmetastatic cT2N0 rectal cancer managed by neoadjuvant CRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5-FU-based chemotherapy) were compared with those undergoing extended CRT (54 Gy and 6 cycles of 5-FUbased chemotherapy). Patients were assessed for tumor response at 8 to 10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (""Watch and Wait""). Patients were referred to salvage surgery in the event of local recurrence during follow-up. Results: Thirty-five patients underwent standard and 46 patients extended CRT. Patients undergoing extended CRT were more likely to undergo organ preservation and avoid definitive surgical resection at 5years (67% vs 30%; P = 0.001). After development of a cCR, surgery-free survival is similar between extended and standard CRT groups at 5 years (78% vs 56%; P = 0.12). Conclusions: Dose-escalation and consolidation chemotherapy leads to increased long-term organ-preservation rates among cT2N0 rectal cancer. After achievement of a cCR, the risk for local recurrence and need for salvage surgery is similar, irrespective of the CRT regimen.
- Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation Long-Term Results of a Prospective Trial (National Clinical Trial 00254683)(2012) PEREZ, Rodrigo Oliva; HABR-GAMA, Angelita; GAMA-RODRIGUES, Joaquim; PROSCURSHIM, Igor; JULIAO, Guilherme Pagin Sao; LYNN, Patricio; ONO, Carla Rachel; CAMPOS, Fabio Guilherme; SOUSA JR., Afonso Henrique Silva e; IMPERIALE, Antonio Rocco; NAHAS, Sergio Carlos; BUCHPIGUEL, Carlos AlbertoBACKGROUND: Neoadjuvant chemoradiation (CRT) therapy may result in significant tumor regression in patients with rectal cancer. Patients who develop complete tumor regression have been managed by treatment strategies that are alternatives to standard total mesorectal excision. Therefore, assessment of tumor response with positron emission tomography/computed tomography (PET/CT) after neoadjuvant treatment may offer relevant information for the selection of patients to receive alternative treatment strategies. METHODS: Patients with clinical T2 (cT2) through cT4NxM0 rectal adenocarcinoma were included prospectively. Neoadjuvant therapy consisted of 54 grays of radiation and 5-fluorouracil-based chemotherapy. Baseline PET/CT studies were obtained before CRT followed by PET/CT studies at 6 weeks and 12 weeks after the completion of CRT. Clinical assessment was performed at 12 weeks after CRT completion. PET/CT results were compared with clinical and pathologic data. RESULTS: In total, 99 patients were included in the study. Twenty-three patients were complete responders (16 had a complete clinical response, and 7 had a complete pathologic response). The PET/CT response evaluation at 12 weeks indicated that 18 patients had a complete response, and 81 patients had an incomplete response. There were 5 false-negative and 10 false-positive PET/CT results. PET/CT for the detection of residual cancer had 93% sensitivity, 53% specificity, a 73% negative predictive value, an 87% positive predictive value, and 85% accuracy. Clinical assessment alone resulted in an accuracy of 91%. PET/CT information may have detected misdiagnoses made by clinical assessment alone, improving overall accuracy to 96%. CONCLUSIONS: Assessment of tumor response at 12 weeks after CRT completion with PET/CT imaging may provide a useful additional tool with good overall accuracy for the selection of patients who may avoid unnecessary radical resection after achieving a complete clinical response. Cancer 2012;35013511. (C) 2011 American Cancer Society.
article 2 Citação(ões) na Scopus Anal cancer: leading the way(2017) HABR-GAMA, Angelita; JULIAO, Guilherme Pagin Sao; PEREZ, Rodrigo Oliva- Carbon Dioxide Embolism Associated With Transanal Total Mesorectal Excision Surgery: A Report From the International Registries(2019) DICKSON, Edward A.; PENNA, Marta; CUNNINGHAM, Chris; RATCLIFFE, Fiona M.; CHANTLER, Jonathan; CRABTREE, Nicholas A.; TUYNMAN, Jurriaan B.; ALBERT, Matthew R.; MONSON, John R. T.; HOMPES, Roel; ABDELMOATY, Walaa; ADAMINA, Michel; AIGNER, Felix; ALAVI, Karim; ALBERS, Benjamin; ALBERT, Matthew; FURAJII, Hazar al; -ALLISON, Andrew; ARAUJO, Sergio Eduardo Alonso; APOSTOLIDES, George Y.; AREZZO, Alberto; ARNOLD, Steven J.; ARYAL, Kamal; ASHAMALLA, Shady; ASHRAF, Shazad; ATTALURI, Vikram; AUSTIN, Ralph; BARUGOLA, Giuliano; BEGGS, Andrew; BELGERS, H. J.; BELL, Stephen; BEMELMAN, Willem; BERTI, Stefano; BIEBL, Matthias; BLONDEEL, Joris; BINKY, Balazs; BALOYIANNIS, Ioannis; BANDYOPADHYAY, Dibyendu; BONI, Luigi; BORDEIANOU, Liliana; BOX, Benjamin; BOYCE, Stephen; BROKELMAN, Walter; BROWN, Carl J.; BRUEGGER, Lukas; BUCHLI, Christian; BUCHS, Nicolas Christian; BULUT, Orhan; BURT, Caroline; BURSICS, Attila; CAHILL, Ronan A.; CAMPANA, Juan Pablo; CARICATO, Marco; CARO-TARRAGO, Aleidis; CASANS, Fida; CASSINOTTI, Elisa; CAYCEDO-MARULANDA, Antonio; CHADI, Sami A.; CHANDRASINGHE, Pramodh; CHAUDHRI, Sanjay; CHAUMONT, Nicole; CHITSABESAN, Praminthra; COGET, Julien; COLLERA, Pablo; COLEMAN, Mark; COURTNEY, Edward D.; DAGBERT, Francois; DALTON, Stephen J.; DANIEL, Geissmann; CLARK, David A.; DEDRYE, Lieven; TORRE, Javier de la; DAPRI, Giovanni; DAYAL, Sanjeev P.; CHAISEMARTIN, Cecile de; LACY, F. Borja de; DELGADO, Olga Blasco; CANDIDO, Francesca Di; GOBBO, Gabriel Diaz del; GRAAF, E. J. R. de; DELRIO, Paolo; POOTER, Karl De; D'HOOGE, Pieter; DOORNEBOSCH, Pascal; DUFF, Sarah; JARDIN, Philippe Du; DZHUMABAEV, Khasan E.; EDWARDS, Mon Tom; EGENVALL, Ika; ESPIN, Eloy; EUGENIO, Morandi; EGENVALL, Monika; ERIKSEN, Jens Ravn; FAERDEN, Arne E.; FAES, Seraina; FERNANDEZ, Vicente Simo; FICHERA, Alessandro; FIERENS, Johan; FIERENS, Kjell; FORGAN, Timothy; FRANCIS, Nader; FRANCOMBE, James; FRANCONE, Elisa; FRANCONE, Todd; GAMAGE, Bawantha; GARCIA, Jose Alberto Perez; GECIM, I. Ethem; GELUWE, Bart Van; GINGERT, Christian; GEORGE, Virgilio; GLOECKLER, Markus; GOGENUR, Ismail; GOULART, Andre; GROLICH, Tomas; HAAS, Eric; HAMEED, Usmaan; HAHNLOSER, Dieter; HARIKRISHNAN, Athur; HARRIS, Guy; HAUNOLD, Ingrid; HENDRICKSE, Charles; HENDRICKX, Tom; HEYNS, Michael; HORWOOD, James; HUERGA, Daniel; ITO, Masaaki; JARIMBA, Aldo; JOENG, Henry K. M.; JONES, Oliver; JUTTEN, Guido; KALA, Zdenek; KITA, Yoshiaki; KNOL, Joep; KOCHUPAPY, Rajesh Thengugal; KNEIST, Werner; KOK, Amy S. Y.; KUSTERS, Miranda; LACY, Antonio M.; LAKATOS, Miklos; LAL, Roshan; LAKKIS, Zaher; LEAO, Pedro; LAMBRECHTS, Anton; LEE, Lawrence; LELONG, Bernard; LEUNG, Edmund; LEZOCHE, Emanuele; LIBERMAN, Alexander Sender; LIDDER, Paul; LIMA, Meyline Andrade; LOGANATHAN, Arun; LOMBANA, Luis J.; LORENZON, Laura; LORIZ, Haug; LUKAS, Marti; LUTRIN, Dean; MACKEY, Paul; MAMEDLI, Zaman Z.; MANSFIELD, Steve; MARCELLO, Peter; MARCOEN, Steven; MARCOS, Juan M. Romero; MARCY, Tobias; MARECIK, Slawomir; MARKS, John; MARSANIC, Patrizia; MATTACHEO, Adrian; MAUN, Dipen; MAY, Denzil; MAYKEL, Justin A.; MCARTHUR, David; MCCALLUM, Iain; MCCARTHY, Kathryn; MCLEMORE, Elisabeth C.; MENDES, Carlos Ramon Silviera; MESSARIS, Evangelos; MICHALOPOULOS, Antonios; MIKALAUSKAS, Saulius; MILES, Anthony; MILLAN, Monica; MILLS, Sarah; MISKOVIC, Danilo; MONSON, John R. T.; MONTRONI, Isacco; MOORE, Etienne; MOORE, Tim; MORI, Shinichiro; MORINO, Mario; MURATORE, Andrea; MUTAFCHIYSKI, Ventzislav; MYERS, Alistair; NIEUWENHOVE, Yves van; NISHIZAWA, Yuji; NG, Paul; NOLAN, Gregory John; OBIAS, Vincent; OCHSNER, Alex; OH, Jae Hwan; ONGHENA, Thierry; OOMMEN, Samuel; ORKIN, Bruce A.; OSMAN, Khalid; OURO, Susana; PANIS, Yves; PAPAVRAMIDIS, Theodosios; PAPEN, Michael von; PAPP, Geza; PAQUETTE, Ian; PARAOAN, Marius T.; PAREDES, Jesus P.; PASTOR, Carlos; PATTYN, Paul R. L.; PERDAWOOD, Sharaf Karim; PEI, Cherylin Fu Wan; PIEHSLINGER, Jakob; PENCHEV, Dimitar; PEREZ, Rodrigo Oliva; PERSIANI, Roberto; PFEFFER, Frank; PHANG, P. Terry; POKELA, Vesa; PICCHETTO, Andrea; POSKUS, Eligijus; PRIETO, Daniel; QUERESHY, Fayez A.; RAMCHARAN, Sean; RAUCH, Stephanie; REGA, Daniela; REYES, Juan C.; RIS, Frederic; RIVILLA, Salvadora Delgado; ROCKALL, Timothy Alexander; ROQUETE, Paulo; ROSSI, Gustavo; RUFFO, Giacomo; SAKAI, Yoshiharu; SANDS, Dana; JULIAO, Guilherme Pagin Sao; SCALA, Andrea; SCALA, Dario; SCHWARZ, Lope Estevez; SEID, Victor Edmond; SEITINGER, Gerald; SHAIKH, Irshad A.; SHARMA, Abhiram; SIETSES, Colin; SINGH, Baljit; SJO, Ole Helmer; SOHN, Dae Kyung; SORAVIA, Claudio; SOSEF, M. N.; SPINELLI, Antonino; SPEAKMAN, Chris; STEELE, Scott; STEPHAN, Vorburger; STEVENSON, Andrew R. L.; STOTLAND, Peter; STUDER, Peter; STRYPSTEIN, S.; SYLLA, Patricia; SZYSZKOWITZ, Alexander; TALWAR, Anjay; TANIS, Peter; TEJEDOR, Patricia; TESO, Enrique Pastor; TOGNELLI, Joaquin; TORKINGTON, Jared; TSCHANN, Peter; TUECH, Jean-Jacques; TUERLER, Andreas; TZOVARAS, George; UGOLINI, Giampaolo; VALLRIBERA, Francesc; VANSTEENKISTE, Franky; VANGENECHTEN, Eva; VERDAASDONK, Emiel G. G.; VILELA, Nuno; WALTER, Brunner; WARREN, Oliver J.; VISSER, T.; WARRIER, Satish; WARNER, Mike; WARUSAVITARNE, Janindra; WHITEFORD, Mark H.; WIK, Tom Andreas; WITZIG, Jacques-Alain; WOLFF, Torsten; WOLTHUIS, Albert M.; WYNN, GregBACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be approximate to 0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30 degrees and 45 degrees. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links.lww.com/DCR/A961.