RODRIGO OLIVA PEREZ

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  • article 33 Citação(ões) na Scopus
    Conditional Survival in Patients With Rectal Cancer and Complete Clinical Response Managed by Watch and Wait After Chemoradiation Recurrence Risk Over Time
    (2020) JULIAO, Guilherme P. Sao; KARAGKOUNIS, Georgios; FERNANDEZ, Laura M.; HABR-GAMA, Angelita; VAILATI, Bruna B.; DATTANI, Mit; KALADY, Matthew F.; PEREZ, Rodrigo O.
    Objective: Analyze conditional recurrence-free survival (cRFS) for rectal cancer patients with complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT) managed nonoperatively after each year without recurrence. Summary Background Data: Select patients with cCR after nCRT have been managed nonoperatively. Risk factors for local recurrence, the need for prolonged follow-up, and the risk of recurrence over time are not well defined. Methods: Retrospective review of patients with rectal cancer cT2-4N0-2M0 treated with nCRT. Mean follow-up was 64 months. Patients who achieved cCR were managed nonoperatively. cRFS was used to investigate the evolution of recurrence-odds, as patients remain recurrence-free after completion of nCRT. Three-year cRFS was estimated at ""x"" years after completion of nCRT based on the formula cRFS(3) = RFS(x+3)/RFS(x). Results: One hundred ninety-seven patients with cCR after nCRT were included. Overall survival and recurrence-free survival (RFS) at 5 years were 81.9% (95% CI 74.0%-87.6%) and 60.4% (95% CI 52.5%-67.4%) respectively. Using cRFS estimates, the probability of remaining disease-free for an additional 3 years if the patient survived without disease at 1, 3, and 5 years, was 77.4% (95% CI 68.8%-83.8%), 91.0% (95% CI 81.9%-95.7%), and 94.3% (95% CI 82.9%-98.2%), respectively. In contrast, actuarial RFS rates for similar intervals were 79.1% (95% CI 72.5%-84.2%), 64.2% (95% CI 56.5%-70.8%), and 60.4% (95% CI 52.5%-67.4%). After 2 years disease-free, 3 year cRFS became similar for T2 and T3 cancers. In contrast, patients undergoing extended nCRT became less likely to develop recurrences only after initial 2 years of successful organ-preservation. Conclusions: Conditional survival suggests that patients have significantly lower risks (<= 10%) of developing recurrences after 2 years of achieving cCR following nCRT.
  • article 36 Citação(ões) na Scopus
    Local Excision Techniques for Rectal Cancer After Neoadjuvant Chemoradiotherapy: What Are We Doing?
    (2017) SMITH, Fraser McLean; AHAD, Abdul; PEREZ, Rodrigo Oliva; MARKS, John; BUJKO, Krzysztof; HEALD, Richard J.
    BACKGROUND: Recent evidence shows that the majority of rectal cancers demonstrate occult tumor scatter after neoadjuvant chemoradiotherapy that can extend for several centimeters under adjacent normal-appearing mucosa beside the residual mucosal abnormality or scar. OBJECTIVE: This systematic review aimed to determine all of the published selection criteria and technical descriptions for local excision to date with regard to this phenomenon. DATA SOURCES: PubMed, MEDLINE, and Embase were searched using the following key words: rectal cancer, local excision, radiotherapy, and neoadjuvant. STUDY SELECTION: Studies that assessed local excision of rectal cancer after neoadjuvant chemoradiotherapy were included. Duplicate series were excluded from final analysis. INTERVENTION: All of the data points were tabulated and analyzed using Microsoft Excel. MAIN OUTCOME MEASURES: Criteria for patient selection, surgical technique, clinical restaging, pathologic assessment, and indications for completion surgery were analyzed. RESULTS: After exclusions, data from 25 studies that in total evaluated local excision in 1001 patients were included. Compared with the single accepted technique of total mesorectal excision, described techniques for local excision after neoadjuvant therapy demonstrate significant variability in many critical technical issues, such as marking/tattooing original tumor margins before neoadjuvant therapy, using pretreatment tumor size/stage as exclusion criteria, and specifically stating lateral excision margins. Where detailed, the majority of local recurrences occurred in patients with clear pathological margins, yet significant variation existed for pathological assessment and reporting, with few studies detailing R status and some not reporting margin status at all. Significant variability also existed for adverse tumor features that mandated completion surgery, and, importantly, many series describe patients refusing completion surgery where indicated. LIMITATIONS: We were unable to perform metaanalysis because studies lacked sufficient methodologic homogeneity to synthesize. CONCLUSIONS: The observations from this study prompt additional study, standardization of technique, and cautious use of local excision of rectal cancer in the setting of neoadjuvant chemoradiotherapy.
  • article 56 Citação(ões) na Scopus
    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, Greg
    BACKGROUND: 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.
  • article 94 Citação(ões) na Scopus
    Definition of the Rectum An International, Expert-based Delphi Consensus
    (2019) D'SOUZA, Nigel; BABBERICH, Michael P. M. de Neree Tot; D'HOORE, Andre; TIRET, Emmanuel; XYNOS, Evaghelos; BEETS-TAN, Regina G. H.; NAGTEGAAL, Iris D.; BLOMQVIST, Lennart; HOLM, Torbjorn; GLIMELIUS, Bengt; LACY, Antonio; CERVANTES, Andres; GLYNNE-JONES, Robert; WEST, Nicholas P.; PEREZ, Rodrigo O.; QUADROS, Claudio; LEE, Kil Yeon; MADIBA, Thandinkosi E.; WEXNER, Steven D.; GARCIA-AGUILAR, Julio; SAHANI, Dushyant; MORAN, Brendan; TEKKIS, Paris; RUTTEN, Harm J.; TANIS, Pieter J.; WIGGERS, Theo; BROWN, Gina
    Background: The wide global variation in the definition of the rectum has led to significant inconsistencies in trial recruitment, clinical management, and outcomes. Surgical technique and use of preoperative treatment for a cancer of the rectum and sigmoid colon are radically different and dependent on the local definitions employed by the clinical team. A consensus definition of the rectum is needed to standardise treatment. Methods: The consensus was conducted using the Delphi technique with multidisciplinary colorectal experts from October, 2017 to April, 2018. Results: Eleven different definitions for the rectum were used by participants in the consensus. Magnetic resonance imaging (MRI) was the most frequent modality used to define the rectum (67%), and the preferred modality for 72% of participants. The most agreed consensus landmark (56%) was ""the sigmoid take-off,'' an anatomic, image-based definition of the junction of the mesorectum and mesocolon. In the second round, 81% of participants agreed that the sigmoid take-off as seen on computed tomography or MRI achieved consensus, and that it could be implemented in their institution. Also, 87% were satisfied with the sigmoid take-off as the consensus landmark. Conclusion: An international consensus definition for the rectumis the point of the sigmoid take-off as visualized on imaging. The sigmoid take-off can be identified as the mesocolon elongates as the ventral and horizontal course of the sigmoid on axial and sagittal views respectively on cross-sectional imaging. Routine application of this landmark during multidisciplinary team discussion for all patients will enable greater consistency in tumour localisation.
  • article 85 Citação(ões) na Scopus
    Shifting concepts in rectal cancer management A Review of Contemporary Primary Rectal Cancer Treatment Strategies
    (2012) KOSINSKI, Lauren; HABR-GAMA, Angelita; LUDWIG, Kirk; PEREZ, Rodrigo
    The management of rectal cancer has transformed over the last 3 decades and continues to evolve. Some of these changes parallel progress made with other cancers: refinement of surgical technique to improve organ preservation, selective use of neoadjuvant (and adjuvant) therapy, and emergence of criteria suggesting a role for individually tailored therapy. Other changes are driven by fairly unique issues including functional considerations, rectal anatomic features, and surgical technical issues. Further complexity is due to the variety of staging modalities (each with its own limitations), neoadjuvant treatment alternatives, and competing strategies for sequencing multimodal treatment even for nonmetastatic disease. Importantly, observations of tumor response made in the era of neoadjuvant therapy are reshaping some traditionally held concepts about tumor behavior. Frameworks for prioritizing and integrating complex data can help to formulate treatment plans for patients. CA Cancer J Clin 2012;. (C) 2012 American Cancer Society.
  • article 0 Citação(ões) na Scopus
    SSAT State-of-the-Art Conference: Advances in the Management of Rectal Cancer
    (2019) CARCHMAN, Evie; CHU, Daniel I.; KENNEDY, Gregory D.; MORRIS, Melanie; DAKERMANDJI, Marc; MONSON, John R. T.; FERNANDEZ, Laura Melina; PEREZ, Rodrigo Oliva; FICHERA, Alessandro; ALLAIX, Marco E.; LISKA, David
  • article 7 Citação(ões) na Scopus
    The Future of Rectal Cancer Surgery: A Narrative Review of an International Symposium
    (2018) LACY, F. Borja de; CHADI, Sami A.; BERHO, Mariana; HEALD, Richard J.; KHAN, Jim; MORAN, Brendan; PANIS, Yves; PEREZ, Rodrigo; TEKKIS, Paris; MORTENSEN, Neil J.; LACY, Antonio M.; WEXNER, Steven D.; CHAND, Manish
    Surgery remains the mainstay of curative treatment for primary rectal cancer. For mid and low rectal tumors, optimal oncologic surgery requires total mesorectal excision (TME) to ensure the tumor and locoregional lymph nodes are removed. Adequacy of surgery is directly linked to survival outcomes and, in particular, local recurrence. From a technical perspective, the more distal the tumor, the more challenging the surgery and consequently, the risk for oncologically incomplete surgery is higher. TME can be performed by an open, laparoscopic, robotic or transanal approach. There is a lack of consensus on the gold standard approach with each of these options offering specific advantages. The International Symposium on the Future of Rectal Cancer Surgery was convened to discuss the current challenges and future pathways of the 4 approaches for TME. This article reviews the findings and discussion from an expert, international panel.