FLAVIO ROBERTO TAKEDA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- PROGNOSTIC FACTORS AND SURVIVAL ANALYSIS IN ESOPHAGEAL CARCINOMA(2016) TUSTUMI, Francisco; KIMURA, Cintia Mayumi Sakurai; TAKEDA, Flavio Roberto; UEMA, Rodrigo Hideki; SALUM, Rubens Antonio Aissar; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Despite recent advances in diagnosis and treatment, esophageal cancer still has high mortality. Prognostic factors associated with patient and with disease itself are multiple and poorly explored. Aim: Assess prognostic variables in esophageal cancer patients. Methods: Retrospective review of all patients with esophageal cancer in an oncology referral center. They were divided according to histological diagnosis (444 squamous cell carcinoma patients and 105 adenocarcinoma), and their demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival. Results: No difference was noted between squamous cell carcinoma and esophageal adenocarcinoma overall survival curves. Squamous cell carcinoma presented 22.8% survival after five years against 20.2% for adenocarcinoma. When considering only patients treated with curative intent resection, after five years squamous cell carcinoma survival rate was 56.6 and adenocarcinoma, 58%. In patients with squamous cell carcinoma, poor differentiation histology and tumor size were associated with worse oncology stage, but this was not evidenced in adenocarcinoma. Conclusion: Weight loss (kg), BMI variation (kg/m(2)) and percentage of weight loss are factors that predict worse stage at diagnosis in the squamous cell carcinoma. In adenocarcinoma, these findings were not statistically significant.
- Predictive factors of recurrence in adenocarcinoma of the esophagogastric junction in the multimodal era(2021) TAKEDA, Flavio Roberto; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; MUNIZ, Renan Rosetti; TUSTUMI, Francisco; CASTRIA, Tiago Biachi de; SALLUM, Rubens Antonio Aissar; ZILBERSTEIN, Bruno; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanIntroduction: Adenocarcinoma of the esophagogastric junction (AEGJ) represents a poor prognostic tumor. We evaluated the recurrence pattern and risk factors associated with recurrence in patients undergoing surgical resection by AEJG. Methods: Recurrences were categorized as locoregional, peritoneal, or distant. These three recurrence groups and a non-recurrence group were compared, and overall survival (OS) and disease-free survival (DFS) for each one was obtained. Results: We analyzed 188 patients with curative surgical treatment. Recurrence was observed in 72 (38.3%) patients. Locoregional recurrence was observed in 17 (23.6%); 20 (27.8%) peritoneal recurrence and 35 (48.6%) distant metastasis. DFS was 9, 5, and 8 months, and OS was 21.8, 13.2, and 20.8, respectively. Tumors larger than 5 cm are risk factors for peritoneal recurrence (OR:2.88, p = 0.012). Positive lymph nodes were related to distant metastasis (OR:9.15, p = 0.040), and lymphatic invasion for locoregional recurrence (OR:3.81, p = 0.028). Conclusion: AEGJ is associated with high rates of early recurrence.
- Prognostic value of F-18-fluorodeoxyglucose PET/computed tomography metabolic parameters measured in the primary tumor and suspicious lymph nodes before neoadjuvant therapy in patients with esophageal carcinoma(2021) TUSTUMI, Francisco; DUARTE, Paulo Schiavom; ALBENDA, David Gutierrez; TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; BUCHPIGUEL, Carlos Alberto; CECCONELLO, IvanBackground F-18-fluorodeoxyglucose PET/computed tomography (F-18-FDG PET/CT) metabolic parameters are prognostic indicators in several neoplasms. This study aimed to evaluate the prognostic value of the maximum and average standardized uptake value (SUVmax and SUVavg), metabolic tumor value (MTV), and total lesion glycolysis (TLG) measured in the primary tumor and suspicious lymph nodes preneoadjuvant therapy in patients submitted to surgical resection for esophageal cancer. Methods A cohort of 113 patients with esophageal cancer who performed F-18-FDG PET/CT preneoadjuvant therapy was assessed. The association of the SUV, MTV, and TLG measured in the primary tumor and in the suspicious lymph nodes with the overall survival was assessed. It was also analyzed other potentially confounding variables such as age, sex, clinical stage, and histologic subtype. The analyses were performed using Kaplan-Meier curve, log-rank test, and Cox regression. Results The univariate analyses showed that the MTV and TLG in the primary tumor, the SUV in the suspicious lymph nodes, the age, the histologic subtype, and the clinical stage were associated with survival after surgery (P <= 0.05). In the Cox regression multivariate analyses, all variables identified in the univariate analyses but the clinical stage were associated with survival after surgery (P <= 0.05). Conclusion In esophageal cancer patients, some of the F-18-FDG PET/CT metabolic parameters measured in the primary tumor and in the suspicious lymph nodes before the neoadjuvant therapy are independent indicators of overall survival and appear to be more important than the clinical stage in the prognostic definition of this group of patients.
- LYMPHOCYTE COUNT AND PLATELET VOLUME PREDICTS POSTOPERATIVE COMPLICATIONS IN ESOPHAGECTOMY FOR CANCER: A COHORT STUDY(2019) TUSTUMI, Francisco; TAKEDA, Flávio Roberto; BRANDÃO, Antonio Adolfo Guerra Soares; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanABSTRACT BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer.
- Diaphragmatic Hernia Repair After Esophagectomy: Technical Report and Lessons After a Series of Cases(2020) TAKEDA, Flavio R.; TUSTUMI, Francisco; FILHO, Marco A. S.; SILVA, Matheus O.; JUNIOR, Ulysses R.; SALLUM, Rubens A. A.; CECCONELLO, IvanIntroduction: Diaphragmatic hernia (DH) repair after esophagectomy is infrequent and technically challenging. Such hernias are mostly asymptomatic and have an estimated incidence of around 2.5%. Controversy continues over suture versus mesh cruroplasty. This article reports a series of cases and a description of the technique, showing this type of procedure being performed in the medical literature and its results. Methods: A DH was diagnosed, and repair was performed in eight out of 328 esophagectomies. All of them were performed through the following steps: (1) Pulling the hernia content down properly without handling the intestinal segment directly to not promote serosal lesions; (2) Lysis of adhesions-this should be done close to the diaphragmatic pillar, with precaution toward the vessels running in the epiplon and near the greater gastric curvature; and (3) Closure of the diaphragmatic hiatus achieved with anterior and posterior sutures. Mesh repair was performed across the DH defects that measured more than 5.5 cm. Results: The patients constituted five men (62.5%) with a mean age of 61.6 years. The main DH-related symptom was abdominal pain, reported by four patients (50%). The other symptoms mentioned were dyspnea (37.5%), thoracic pain (25%), and dysphagia (25%). The mean hospitalization period was 17.5 days and was related to the restoration of the respiratory function. Most of the DH repairs were performed by adopting a laparoscopic approach. Conclusions: DH is a rare complication following esophagectomy with most of the symptomatic manifestations. However, its repair is feasible and safe, with low morbidity (only respiratory complications) and no mortality.
- TRANSHIATAL ESOPHAGECTOMY IS NOT ASSOCIATED WITH POOR QUALITY LYMPHADENECTOMY(2019) TAKEDA, Flavio Roberto; TUSTUMI, Francisco; NIGRO, Bruna de Camargo; SALLUM, Rubens Antonio Aissar; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Esophageal cancer neoadjuvant therapy followed by surgery increases the likelihood of treatment success. Aim: To evaluate variables that can influence the number of retrieved lymph nodes, the number of retrieved metastatic lymph nodes and lymphnodal recurrence in esophagectomy after neoadjuvant chemoradiotherapy. Methods: Patients of a single institute were evaluated after completion of trimodal therapy. Univariate and multivariate analyses were performed to evaluate variables that can influence in the number of retrieved lymph nodes and retrieved metastatic lymph nodes. Results: One hundred and forty-nine patients were included. Thoracoscopy access was considered an independent factor for the number of lymph nodes retrieved, but was neither related to the number of positive lymph nodes retrieved nor to lymphnodal recurrence. Pathological complete response on the primary tumor and male were independent variables associated with the number of positive lymph node retrieved. Pathological complete response on the primary tumor site did not statistically influence the likelihood of a lower number of lymph nodes retrieved. Conclusion: Patients submitted to esophagectomy after neoadjuvant chemoradiotherapy, thoracoscopic access is more accurate for pathological staging, even in a complete pathological response. With a proper patient selection, transhiatal surgery may preserve the quality of lymphadenectomy of the positive lymph nodes.
- ESOPHAGEAL CARCINOMA: IS SQUAMOUS CELL CARCINOMA DIFFERENT DISEASE COMPARED TO ADENOCARCINOMA? A transversal study in a quaternary high volume hospital in Brazil(2016) TUSTUMI, Francisco; TAKEDA, Flavio Roberto; KIMURA, Cintia Mayumi Sakurai; SALLUM, Rubens Antônio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanABSTRACT Background Esophageal cancer is one of the leading causes of mortality among the neoplasms that affect the gastrointestinal tract. There are several factors that contribute for development of an epidemiological esophageal cancer profile in a population. Objective This study aims to describe both clinically and epidemiologically the population of patients with diagnosis of esophageal cancer treated in a quaternary attention institute for cancer from January, 2009 to December, 2011, in Sao Paulo, Brazil. Methods The charts of all patients diagnosed with esophageal cancer from January, 2009, to December, 2011, in a Sao Paulo (Brazil) quaternary oncology institute were retrospectively reviewed. Results Squamous cell cancer made up to 80% of the cases of esophageal cancer. Average age at diagnosis was 60.66 years old for esophageal adenocarcinoma and 62 for squamous cell cancer, average time from the beginning of symptoms to the diagnosis was 3.52 months for esophageal adenocarcinoma and 4.2 months for squamous cell cancer. Average time for initiating treatment when esophageal cancer is diagnosed was 4 months for esophageal adenocarcinoma and 4.42 months for squamous cell cancer. There was a clear association between squamous cell cancer and head and neck cancers, as well as certain habits, such as smoking and alcoholism, while adenocarcinoma cancer showed more association with gastric cancer and gastroesophageal reflux disease. Tumoral bleeding and pneumonia were the main causes of death. No difference in survival rate was noted between the two groups. Conclusion Adenocarcinoma and squamous cell carcinoma are different diseases, but both are diagnosed in advanced stages in Brazil, compromising the patients' possibilities of cure.
- Prognostic Value of Tumor Regression Grade Based on Ryan Score in Squamous Cell Carcinoma and Adenocarcinoma of Esophagus(2020) TAKEDA, Flavio Roberto; TUSTUMI, Francisco; OBREGON, Carlos de Almeida; YOGOLARE, Gustavo Goncalves; NAVARRO, Yasmin Peres; SEGATELLI, Vanderlei; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanPurposes Tumor regression grade (TRG) of the primary tumor after neoadjuvant therapy is one of the most sensitive prognostic factors among patients with locally advanced esophageal cancer, although no TRG system is fully accepted. The Ryan score was proposed in 2005 to evaluate TRG in rectal cancer and could be adaptable for pathological evaluation of esophageal cancer. The objective of this study is to evaluate the prognostic value of the Ryan score for esophageal cancer in the setting of trimodal therapy. Methods We performed a retrospective cohort study in which patients with locally advanced esophageal cancer, submitted to neoadjuvant therapy followed by surgical resection, were selected. One hundred thirty-four patients were selected. All tissue specimens were assessed as per the TRG system proposed by Ryan et al. Survival curves were assessed by the Kaplan-Meier method and log-rank test. Chi-square test or likelihood-ratio test was used for absolute and relative variables. Kruskal-Wallis and analysis of variance tests were used to assess significant differences on a continuous dependent variable by a categorical independent variable. Results Of the 134 included patients, 94 (70.1%) had squamous cell carcinoma, and 40 (29.9%) adenocarcinoma. Ryan score was correlated with histological type (p < 0.001), and clinical (p = 0.044) and pathological (p < 0.001) staging. Mean follow-up was 31.1 months. Multivariate analysis showed that Ryan score can safely predict survival, and systemic and lymphatic recurrence (p < 0.05). Conclusions Ryan score is an effective system to evaluate TRG and can predict risk for lymph node or distant metastasis, overall survival, and disease-free survival.
- Anatomical topography of the tumor is related to prognostic survival in adenocarcinoma of esophagogastric junction?: Multivariable analysis.(2019) TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; RIBEIRO, Ulysses; CASTRIA, Tiago Bianchi de; TUSTUMI, Francisco; ROCHA, Julio Rafael Mariano; CECCONELLO, Ivan
- ASO Author Reflections: Evaluation of Tumor Regression After Neoadjuvant Chemoradiotherapy in Esophageal Carcinoma-How to Do It?(2020) TAKEDA, Flavio Roberto; TUSTUMI, Francisco; CECCONELLO, Ivan