FRANCISCO TUSTUMI

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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

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  • article 2 Citação(ões) na Scopus
    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, Ivan
    Introduction: 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.
  • article 8 Citação(ões) na Scopus
    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, Ivan
    Background 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.
  • article 14 Citação(ões) na Scopus
    Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial)
    (2021) PAJECKI, Denis; DANTAS, Anna Carolina Batista; TUSTUMI, Francisco; KANAJI, Ana Lumi; CLEVA, Roberto de; SANTO, Marco Aurelio
    Purpose Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes. Objectives This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older. Methods Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions. Results The median age (67 x 67 years; p=0.67) and initial body mass index (BMI) (46.3 x 51.3 kg/m(2); p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 x 47.6 kg/m(2); p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 x 68%; p=0.04; 24.9 x 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (-1.1 x -0.5%; p<0.01) as well as LDL control (-27.5 x +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality. Conclusion Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.
  • article 0 Citação(ões) na Scopus
    Post-fundoplication dysphagia: Laparoscopic intervention or endoscopic dilation?
    (2021) TUSTUMI, F.; DATRINO, L. Nogueira; SERAFIM, M. C. Andrade; ORLANDINI, M. F.; MORRELL, A. L. Gioia
  • article
    An evaluation of the reporting quality in clinical practice guidelines for hepatocellular carcinoma using the RIGHT checklist
    (2021) CHEN, Haiyang; TAO, Meng; LI, Ding; HAN, Jing; CHENG, Cheng; MA, Yanfang; WU, Yingxi; SHELAT, Vishal G.; TUSTUMI, Francisco; SATAPATHY, Sanjaya K.; KANG, Koo Jeong; WANG, Qiming
    Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Clinical practice guidelines (CPGs) on the prevention, surveillance, diagnosis and management of HCC are essential to guide clinical practice. The objective of this study was to evaluate the reporting quality of the most recent CPGs for HCC published worldwide. Methods: We systematically searched literature databases and websites of guideline development organizations and medical associations to extract CPGs on HCC published between January 2018 and December 2020. We evaluated the reporting quality using the Reporting Items for practice Guidelines in Healthcare (RIGHT) statement. We assessed for each of the 35 RIGHT checklist items whether the guidelines reported the corresponding information. We calculated the mean (+/- standard error of the mean, SEM) percentages of the guidelines' compliance with the items (reporting rate), both overall and for each of the seven domains of the RIGHT checklist. Results: We identified 22 guidelines, of which three (14%) were written in Chinese and 19 (86%) in English. The mean +/- SEM overall reporting rate in the twenty-two guidelines was 56%+/- 4%. The reporting rates of the seven domains were the following: basic information 81%+/- 3%, background 58%+/- 6%, evidence 58%+/- 6%, recommendations 59%+/- 5%, review and quality assurance 34%+/- 10%, funding and declaration and management of interests 39%+/- 4%, and other information 23%+/- 6%. Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Clinical practice guidelines (CPGs) on the prevention, surveillance, diagnosis and management of HCC are essential to guide clinical practice. The objective of this study was to evaluate the reporting quality of the most recent CPGs for HCC published worldwide. Methods: We systematically searched literature databases and websites of guideline development organizations and medical associations to extract CPGs on HCC published between January 2018 and December 2020. We evaluated the reporting quality using the Reporting Items for practice Guidelines in Healthcare (RIGHT) statement. We assessed for each of the 35 RIGHT checklist items whether the guidelines reported the corresponding information. We calculated the mean (+/- standard error of the mean, SEM) percentages of the guidelines' compliance with the items (reporting rate), both overall and for each of the seven domains of the RIGHT checklist. Results: We identified 22 guidelines, of which three (14%) were written in Chinese and 19 (86%) in English. The mean +/- SEM overall reporting rate in the twenty-two guidelines was 56%+/- 4%. The reporting rates of the seven domains were the following: basic information 81%+/- 3%, background 58%+/- 6%, evidence 58%+/- 6%, recommendations 59%+/- 5%, review and quality assurance 34%+/- 10%, funding and declaration and management of interests 39%+/- 4%, and other information 23%+/- 6%. Conclusions: The reporting quality of the recently published guidelines for HCC was suboptimal. While there is no doubt about the great value of the CPGs' recommendations in clinical practice, the reporting in CPGs for HCC still needs improvement.
  • article 5 Citação(ões) na Scopus
    OBESITY AND SEVERE STEATOSIS: THE IMPORTANCE OF BIOCHEMICAL EXAMS AND SCORES
    (2021) SILVA, Miller Barreto de Brito e; TUSTUMI, Francisco; DANTAS, Anna Carolina Batista; MIRANDA, Barbara Cristina Jardim; PAJECKI, Denis; DE-CLEVA, Roberto; SANTO, Marco Aurelio; NAHAS, Sergio Carlos
    INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients. OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population. METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery. RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m(2) (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%. CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.
  • article 7 Citação(ões) na Scopus
    The impact of venous resection in pancreatoduodectomy A systematic review and meta-analysis
    (2021) PINHEIRO FILHO, Joao Emilio Lemos; TUSTUMI, Francisco; COELHO, Fabricio Ferreira; SILVEIRA JUNIOR, Sergio; HONORIO, Fernanda Cavalcanti Cabral; HENRIQUES, Alexandre Cruz; DIAS, Andre Roncon; WAISBERG, Jaques
    Background: Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial. Objective: This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD). Methods: A systematic review and meta-analysis of studies comparing VRPD and PD were performed. Results: VRPD was associated with a higher risk for postoperative mortality (risk difference: -0.01; 95% confidence interval [CI] -0.02 to -0.00) and complications (risk difference: -0.05; 95% CI -0.09 to -0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: -0.65; 95% CI -2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: -69.09; 95% CI -88.4 to -49.78), with a higher blood loss rate (MD: -314.04; 95% CI -423.86 to -195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03-1.23). Conclusion: VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.
  • article 3 Citação(ões) na Scopus
    Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials
    (2021) TUSTUMI, Francisco; MIRANDA NETO, Antonio Afonso de; SILVEIRA JUNIOR, Sergio; FERNANDES, Felipe Alexandre; SILVA, Miller Barreto de Brito e; ERNANI, Lucas; NACIF, Lucas Souto; COELHO, Fabricio Ferreira; ANDRAUS, Wellington; BERNARDO, Wanderley Marques; HERMAN, Paulo; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto
    A combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p=0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen.
  • article 2 Citação(ões) na Scopus
    Electrical nerve stimulation therapy in refractory primary monosymtomatic enuresis - A sistematic review
    (2021) SOUZA, T. M. P.; LIMA, G. S. de; PASQUALINI, L. B.; MELLEIRO, V.; GLINA, F. P. A.; SERRA, M. J. R.; BACCAGLINI, W.; TUSTUMI, F.; BERNARDO, W. M.; GLINA, S.
    Objective To analyze the effect of electrical nerve stimulation on urinary symptoms in pediatric patients with monosymptomatic primary enuresis refractory to conventional treatment. Methods: Three databases (Medline, Embase, and Cochrane) were searched and 160 studies were identified by July 15, 2020. After establishing and applying the inclusion and exclusion criteria, a step-by-step analysis was performed using the title, abstract and full text. The Cochrane Collaboration Tool was then used to analyze the biases of the selected studies. Results: Of the 160 articles found, 03 were selected for this systematic review. In 02 studies there was a significant reduction in the number of wet nights/week after electrical nerve stimulation. Urodynamic pattern was evaluated in 01 study, with improvement of maximum cystometric capacity in the intervention group. About maximum voided volume, there was no improvement in 01 study, but in other, there was increase in the intervention group. Conclusion: Electrical nerve stimulation might promote improvement in partial and total response scores over the number of dry nights, with no improvement in urodynamic parameters, and could be considered as an feasible option in the management of refractory monosymptomatic primary enuresis. However, it is worth emphasizing the need to conduct more RCTs with a larger sample for better evaluation of the role of neurostimulation.
  • article 3 Citação(ões) na Scopus
    Myotomy in sigmoid megaesophagus: is it applicable? A systematic review and meta-analysis
    (2021) ORLANDINI, Marina Feliciano; SERAFIM, Maria Carolina Andrade; DATRINO, Leticia Nogueira; TAVARES, Guilherme; TRISTAO, Luca Schiliro; SANTOS, Clara Lucato dos; BERNARDO, Wanderley Marques; TUSTUMI, Francisco
    Introduction: Achalasia may evolve to sigmoid megaesophagus in 10-15% of patients and is usually treated with esophagectomy, which has high morbi-mortality. Many surgeons debate the applicability of the Heller myotomy for treating sigmoid megaesophagus. This study intents to analyze the effectiveness of myotomy for treating patients with sigmoid megaesophagus. Methods: A systematic review and meta-analysis was conducted in PubMed, Cochrane, Lilacs and Embase alongside manual search of references. The inclusion criteria were clinical trials, cohort, case-series; patients with sigmoid megaesophagus and esophageal diameter >= 6 cm; and patients undergoing primary myotomy. The exclusion criteria were reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; previous surgical treatment for achalasia; and pediatric or animal model studies. No restrictions on language and date of publication, and no filters were applied. Subgroups analyses were performed to assess the laparoscopic myotomy perioperative outcomes. Besides, subgroup analyses were performed to assess the long-term outcomes of the studies with a follow-up time > 24 months. To verify heterogeneity, the 12 test was used. The random effects were applied, and the fixed model was evaluated as sensitivity analysis. To assess risk of bias and certainty of evidence, the tools ROBINS-I and GRADE were used, respectively. Registration number: CRD42020199667. Results: Sixteen articles were selected, encompassing 350 patients. The mean age ranged from 36 to 61 years old, and the mean follow-up ranged from 16 to 109 months. Complications rate was 0.08 (CI: 0.040-0.153; P = 0.01). Need for retreatment rate was 0.128 (CI: 0.031-0.409; P = 0.01). The probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.703-0.812; P < 0.01). Postoperative mortality rate was 0.008 (CI: 0.004-0.015; P < 0.01). Conclusion: Surgical myotomy is an option for avoiding esophagectomy in achalasia, with a low morbi-mortality rate and good results. It is effective for most patients and only a minority will demand retreatment.