RODRIGO OLIVA PEREZ

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  • article 95 Citação(ões) na Scopus
    Achieving a Complete Clinical Response After Neoadjuvant Chemoradiation That Does Not Require Surgical Resection: It May Take Longer Than You Think!
    (2019) HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; FERNANDEZ, Laura M.; VAILATI, Bruna B.; ANDRADE, Andres; ARAUJO, Sergio E. A.; GAMA-RODRIGUES, Joaquim; PEREZ, Rodrigo O.
    BACKGROUND: Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed by organ-preserving strategies and acceptable long-term outcomes. Controversy still exists regarding optimal timing for the assessment of tumor response after neoadjuvant chemoradiation. OBJECTIVE: The purpose of this study was to estimate the time interval for achieving complete clinical response using strict endoscopic and clinical criteria after a single neoadjuvant chemoradiation regimen. DESIGN: This was a retrospective review of consecutive patients managed by 54-Gy and consolidation 5-fluorouracil-based chemotherapy. Assessment of response was performed at 10 weeks after radiation. Patients with suspected complete clinical response were offered watch-and-wait strategy and reassessment every 6 to 8 weeks until achievement of strict criteria of complete clinical response or overt residual cancer. SETTINGS: This study was conducted at a single tertiary care center. PATIENTS: Patients with complete clinical response who underwent a successful watch-and-wait strategy until last follow-up were eligible. Dates of radiation completion and achievement of strict endoscopic and clinical criteria (mucosal whitening, teleangiectasia, and no ulceration or irregularity) were recorded. Patients with incomplete response or with initial complete clinical response followed by local recurrence or regrowth were excluded. MAIN OUTCOMES MEASURES: The distribution of time intervals between completion of radiation and achievement of strict complete clinical response was measured. Patients who achieved early complete clinical response (<= 16 wk) were compared with late complete clinical response (>16 wk). RESULTS: A total of 49 patients achieved complete clinical response and were successfully managed nonoperatively. A median interval of 18.7 weeks was observed for achieving strict complete clinical response. Only 38% of patients achieved complete clinical response between 10 and 16 weeks from radiation completion. Patients with earlier cT status (cT2/T3a) achieved a complete clinical response significantly earlier when compared with those patients with more advanced disease (T3b-d/4; 19 vs 26 wk; p = 0.03). LIMITATIONS: This was a retrospective study with a small sample size. CONCLUSIONS: Assessment at 10 to 16 weeks may detect a minority of patients who achieve complete clinical response without additional recurrence after neoadjuvant chemoradiation. Patients suspected for a complete clinical response should be considered for reassessment beyond 16 weeks before definitive management when considered for a watch and wait strategy. See Video Abstract at http://links.lww.com/DCR/A901.
  • article 1 Citação(ões) na Scopus
  • article 0 Citação(ões) na Scopus
    Real-World Situation of Lateral Lymph Node Dissection for Rectal Cancer in Japan Reply
    (2019) PEREZ, Rodrigo Oliva; KONISHI, Tsuyoshi; JULIAO, Guilherme P. Sao; VAILATI, Bruna Borba; FERNANDEZ, Laura Melina; MATTACHEO, Adrian
  • article 101 Citação(ões) na Scopus
    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 Oliva
    Objective: 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.
  • article 13 Citação(ões) na Scopus
    Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study
    (2019) AREZZO, A.; SECCO, G. Lo; PASSERA, R.; ESPOSITO, L.; GUERRIERI, M.; ORTENZI, M.; BUJKO, K.; PEREZ, R. O.; HABR-GAMA, A.; STIPA, F.; PICCHIO, M.; RESTIVO, A.; ZORCOLO, L.; COCO, C.; RIZZO, G.; MISTRANGELO, M.; MORINO, M.
    Background An organ-preserving strategy may be a valid alternative in the treatment of selected patients with rectal cancer after neoadjuvant radiotherapy. Preoperative assessment of the risk for tumor recurrence is a key component of surgical planning. The aim of the present study was to increase the current knowledge on the risk factors for tumor recurrence. Methods The present study included individual participant data of published studies on rectal cancer surgery. The literature was reviewed according to according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data checklist (PRISMA-IPD) guidelines. Series of patients, whose data were collected prospectively, having neoadjuvant radiotherapy followed by transanal local excision for rectal cancer were reviewed. Three independent series of univariate/multivariate binary logistic regression models were estimated for the risk of local, systemic and overall recurrence, respectively. Results We identified 15 studies, and 7 centers provided individual data on 517 patients. The multivariate analysis showed higher local and overall recurrences for ypT3 stage (OR 4.79; 95% CI 2.25-10.16 and OR 6.43 95% CI 3.33-12.42), tumor size after radiotherapy > 10 mm (OR 5.86 95% CI 2.33-14.74 and OR 3.14 95% CI 1.68-5.87), and lack of combined chemotherapy (OR 3.68 95% CI 1.78-7.62 and OR 2.09 95% CI 1.10-3.97), while ypT3 was the only factor correlated with systemic recurrence (OR 5.93). The analysis of survival curves shows that the overall survival is associated with ypT and not with cT. Conclusions Local excision should be offered with caution after neoadjuvant chemoradiotherapy to selected patients with rectal cancers, who achieved a good response to 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 12 Citação(ões) na Scopus
    Role of magnetic resonance imaging in organ-preserving strategies for the management of patients with rectal cancer
    (2019) ORTEGA, Cinthia D.; PEREZ, Rodrigo O.
    Total mesorectal excision has been the most effective treatment strategy adopted to reduce local recurrence rates among patients with rectal cancer. The morbidity associated with this radical surgical procedure led surgeons to challenge the standard therapy particularly when dealing with superficial lesions or good responders after neoadjuvant radiotherapy, to which radical surgery may be considered overtreatment. In this subset of patients, less invasive procedures in an organ-preserving strategy may result in good oncological and functional outcomes. In order to tailor the most appropriate treatment option, accurate baseline staging and reassessment of tumor response are relevant. MRI is the most robust tool for the precise selection of patients that are candidates for organ preservation; therefore, radiologists must be familiar with the criteria used to guide the management of these patients. The purpose of this article is to review the relevant features that radiologists should know in order to provide valuable information during the multidisciplinary discussion and ultimate management decision.
  • 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 2 Citação(ões) na Scopus
    Response to Comment on ""Organ Preservation for cT2N0 Distal Rectal Cancer-Are There Any Better Surgical Alternatives Without Chemoradiation?''
    (2019) HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; VAILATI, Bruna B.; FERNANDEZ, Laura M.; ARAUJO, Sergio E. A.; SABBAGA, Jorge; AGUILAR, Patricia B.; PEREZ, Rodrigo O.