FRANCISCO TUSTUMI
Projetos de Pesquisa
Unidades Organizacionais
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
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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- MANAGEMENT OF SYMPTOMS RECURRENCE AFTER MYOTOMY FOR ACHALASIA. A PRACTICAL APPROACH(2023) TUSTUMI, Francisco; SZACHNOWICZ, Sergio; ANDREOLLO, Nelson Adami; SEGURO, Francisco Carlos Bernal da Costa; BIANCHI, Edno Tales; DUARTE, Andre Fonseca; NASI, Ary; SALLUM, Rubens Antonio AissarBACKGROUND: Achalasia is an esophageal motility disorder, and myotomy is one of the most used treatment techniques. However, symptom persistence or recurrence occurs in 9 to 20% of cases. AIMS: This study aims to provide a practical approach for managing the recurrence or persistence of achalasia symptoms after myotomy. METHODS: A critical review was performed to gather evidence for a rational approach for managing the recurrence or persistence of achalasia symptoms after myotomy. RESULTS: To properly manage an achalasia patient with significant symptoms after myotomy, such as dysphagia, regurgitation, thoracic pain, and weight loss, it is necessary to classify symptoms, stratify severity, perform appropriate tests, and define a treatment strategy. A systematic differential diagnosis workup is essential to cover the main etiologies of symptoms recurrence or persistence after myotomy. Upper digestive endoscopy and dynamic digital radiography are the main tests that can be applied for investigation. The treatment options include endoscopic dilation, peroral endoscopic myotomy, redo surgery, and esophagectomy, and the decision should be based on the patient's individual characteristics. CONCLUSIONS: A good clinical evaluation and the use of proper tests jointly with a rational assessment, are essential for the management of symptoms recurrence or persistence after achalasia myotomy.
- 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.
article THE INDISPENSABLE HUMAN PARTICIPATION IN ARTIFICIAL INTELLIGENCE GENERATED DATA(2023) TUSTUMI, Francisco; ANDREOLLO, Nelson Adami; AGUILAR-NASCIMENTO, Jose Eduardo de- ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: DIFFERENCES IN DIRECT COSTS FROM A BRAZILIAN PUBLIC INSTITUTE PERSPECTIVE(2022) COSTA, Thiago Nogueira; TUSTUMI, Francisco; FERROS, Lucas Sousa Maia; COLONNO, Barbara Buccelli; ABDALLA, Ricardo Zugaib; JR, Ulysses Ribeiro; CECCONELLO, IvanBackground: Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias.Aims: This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution.Methods: This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$).Results: A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91 +/- 644.79; LVIHR: 1,989.67 +/- 763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57 +/- 211.51; LVIHR: 84.55 +/- 252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43 +/- 894.97; LVIHR: 2,120.16 +/- 663.78; p<0.001), material resources (RVIHR: 3,204.32 +/- 351.55; LVIHR: 736.51 +/- 972.32; p<0.001), and medications (RVIHR: 823.40 +/- 175.47; LVIHR: 288.50 +/- 352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24 +/- 3,520.82; LVIHR: 10,295.95 +/- 3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes.Conclusion: Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.
- 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.
- 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 CarlosINTRODUCTION: 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.
- AVALIAÇÃO DA DISSEMINAÇÃO LINFONODAL, METÁSTASES À DISTÂNCIA E INVASÃO LOCAL DO CARCINOMA ESOFÁGICO(2016) TUSTUMI, Francisco; KIMURA, Cintia Mayumi Sakurai; TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Knowing esophageal tumors behavior in relationship to lymph node involvement, distant metastases and local tumor invasion is of paramount importance for the best esophageal tumors management. Aim: To describe lymph node involvement, distant metastases, and local tumor invasion in esophageal carcinoma, according to tumor topography and histology. Methods: A total of 444 patients with esophageal squamous cell carcinoma and 105 adenocarcinoma were retrospectively analyzed. They were divided into four groups: adenocarcinoma and squamous cell carcinoma in the three esophageal segments: cervical, middle, and distal. They were compared based on their CT scans at the time of the diagnosis. Results: Nodal metastasis showed great relationship with of primary tumor site. Lymph nodes of hepatogastric, perigastric and peripancreatic ligaments were mainly affected in distal tumors. Periaortic, interaortocaval and portocaval nodes were more commonly found in distal squamous carcinoma; subcarinal, paratracheal and subaortic nodes in middle; neck chains were more affected in cervical squamous carcinoma. Adenocarcinoma had a higher frequency of peritoneal involvement (11.8%) and liver (24.5%) than squamous cell carcinoma. Considering the local tumor invasion, the more cranial neoplasia, more common squamous invasion of airways, reaching 64.7% in the incidence of cervical tumors. Middle esophageal tumors invade more often aorta (27.6%) and distal esophageal tumors, the pericardium and the right atrium (10.4%). Conclusion: Esophageal adenocarcinoma and squamous cell carcinoma in different topographies present peculiarities in lymph node involvement, distant metastasis and local tumor invasion. These differences must be taken into account in esophageal cancer patients' care.
- THE BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY COMPLETES 35 YEARS AND A NEW CYCLE BEGINS(2021) ANDREOLLO, Nelson Adami; TUSTUMI, Franisco; AGUILAR-NASCIMENTO, Jose Eduardo de
- FUTURE OF THE LANGUAGE MODELS IN HEALTHCARE: THE ROLE OF CHATGPT(2023) TUSTUMI, Francisco; ANDREOLLO, Nelson Adami; AGUILAR-NASCIMENTO, Jose Eduardo deThe field of medicine has always been at the forefront of technological innovation, Fabricio Ferreira COELHO3 , Paulo HERMAN3 constantly seeking new strategies to diagnose, treat, and prevent diseases. Guidelines for clinical practice to orientate medical teams regarding diagnosis, treatment, and prevention measures have increased over the years. The purpose is to gather the most medical knowledge to construct an orientation for practice. Evidence-based guidelines follow several main characteristics of a systematic RESUMO -Racmonal: O tratamento de escolha para pacientes com ipertensao portal review, including systematic and unbiased search, selection, and extraction of the source of evidence. esquistossomotica com sangramento de varizes e a desconexao azigo-portal mais In recent years, the rapid advancement of artificial intelligence has provided clinicians and patients esplenetomia (DAPE) associad a terapa endoscoica. Porem, estuds mostram aumento with access to personalized, data-driven insights, suport and new opportunities for healthcare do calibre das varizes em alguns pacientes durante o seguimento em longo prazo. Objetmvo: professionals to improve patient outcomes, increase efficiency, and reduce costs. One of the most Avaliar o impacto da DAPE e tratamento endoscopico pos-operatorio no comportamento exciting developments in Artificial Intelligence has been the emergence of chatbots. A chatbot is a computer program used to simulate conversations with human users. Recently, OpenAI, a research das varizes esofagicas e recidiva hemorragica, de pacientes esquistossomoticos. Metodos: organization focused on machine learning, developed ChatGPT, a large language model that Foram estudados 36 pacientes com eguimento superior a cinco anos, distribuidos em generates human-like text. ChatGPT uses a type of AI known as a deep learning model. ChatGPT dois grupos: qued a prssao portal abaixo de 30% e acima de 30% compaados com o can quickly search a nd select pieces of evidence through numerous databases to provide answers calibre das varizes esofagicas no pos-operatorio precoce e tardio alem do indice de recidiva to complex questions, reducing the time and effort required to research a particular topic manually. hemorragica. Resultados Consequently, language models can accelerate the creation of clinical practice guidelines. While there is no doubt that ChatGPT has the potential to revolutionize the way healthcare is delivered, esofagicas que, durante o seguimento aumentaram de calibre e foram controladas com it is essential to note that it should not be used as a substitute for human healthcare professionals. Instead, ChatGPT should be considered a tool that can be used to augment and support the work of o comportamento do calibre das varizes no pos-opeatorio precoce nem tardio nem os healthcare professionals, helping them to provide better care to their patients.