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
35 resultados
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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.
- Esophageal achalasia: a risk factor for carcinoma. A systematic review and meta-analysis(2017) TUSTUMI, F.; BERNARDO, W. M.; ROCHA, J. R. M. da; SZACHNOWICZ, S.; SEGURO, F. C.; BIANCHI, E. T.; SALLUM, R. A. A.; CECCONELLO, I.Achalasia of the cardia is associated with an increased risk of esophageal carcinoma. The real burden of achalasia at the malignancy genesis is still a controversial issue. Therefore, there are no generally accepted recommendations on follow-up evaluation for achalasia patients. This study aims to estimate the risk of esophageal adenocarcinoma and squamous cell carcinoma in achalasia patients. We searched for association between carcinoma and esophageal achalasia in databases up to January 2017 to perform a systematic review and meta-analysis. A total of 1,046 studies were identified from search strategy, of which 40 were selected for meta-analysis. A cumulative number of 11,978 esophageal achalasia patients were evaluated. The incidence of squamous cell carcinoma was 312.4 (StDev 429.16) cases per 100,000 patient-years at risk. The incidence of adenocarcinoma was 21.23 (StDev 31.6) cases per 100,000 patient-years at risk. The prevalence for esophageal carcinoma was 28 carcinoma cases in 1,000 esophageal achalasia patients (CI 95% 2, 39). The prevalence for squamous cell carcinoma was 26 cases in 1,000 achalasia patients (CI 95% 18, 39) and for adenocarcinoma was 4 cases in 1,000 achalasia patients (CI 95% 3, 6). The absolute risk increase for squamous cell carcinoma was 308.1 and for adenocarcinoma was 18.03 cases per 100,000 patients per year. To the best of our knowledge, this is the first meta-analysis estimating the burden of achalasia as an esophageal cancer risk factor. The high increased risk rate for cancer in achalasia patients points to a strict endoscopic surveillance for these patients. Also, the increased risk for developing adenocarcinoma in achalasia patients suggests fundoplication after myotomy, to avoid esophageal reflux and Barret esophagus, a known risk factor for adenocarcinoma.
article THE INDISPENSABLE HUMAN PARTICIPATION IN ARTIFICIAL INTELLIGENCE GENERATED DATA(2023) TUSTUMI, Francisco; ANDREOLLO, Nelson Adami; AGUILAR-NASCIMENTO, Jose Eduardo de- 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
- 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.
- 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.
conferenceObject THE IMPACT OF INSTITUTIONAL VOLUME OF TOTAL GASTRECTOMY FOR PATIENTS WITH GASTRIC CANCER ON SHORT-TERM OUTCOMES AND COSTS IN BRAZILIAN PUBLIC HEALTH SYSTEM(2023) SZOR, Daniel J.; TUSTUMI, Francisco; SILVA, Thaysa Venturini da; ARVATE, Gabriela Gerote; SANTOS, Maria Eduarda Carvalhal; GOUVEA, Fabiana Pereira Riviello; OLIVEIRA, Julia Politano de; MIHICH, Juliana Salem; WOLOSKER, Nelson- Prognostic factors for ESD of early gastric cancers: a systematic review and meta-analysis(2020) MARCO, Michele Oliveira De; TUSTUMI, Francisco; BRUNALDI, Vitor Ottoboni; RESENDE, Ricardo Hannum; MATSUBAYASHI, Carolina Ogawa; BABA, Elisa Ryoka; CHAVES, Dalton Marques; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims Gastric neoplasms are one of the leading types of cancer in the world and early detection is essential to improve prognosis. Endoscopy is the gold-standard diagnostic procedure and allows adequate treatment in selected cases. Endoscopic submucosal dissection (ESD) has been reported to safely address most early gastric cancers (EGCs), with high curability rates. However, data on prognostic factors related to ESDs of EGCs are conflicting. Therefore, we aimed to systematically review the available literature and to perform a meta-analysis to identify the relevant prognostic factors in this context. Methods We performed this study according to PRISMA guidelines. Comparative studies assessing the relationship between curative resection or long-term curability rates and relevant prognostic factors were selected. Prognostic factors were demographic data, lesion features (location, morphology of the lesion, size, and depth of invasion), histological findings,Helycobacter pylori(HP) infection, presence of gastric a atrophy and body mass index (BMI). Finally, we also evaluated risk factors related to metachronous gastric neoplasm. Results The initial search retrieved 2829 records among which 46 studies were included for systematic review and meta-analysis. The total sample comprised 28366 patients and 29282 lesions. Regarding curative resection, pooled data showed no significant influence of sex [odds ratio (OR): 1.15 (0,97, 1.36)P = 0.10 I-2 = 47 %] , age [OR: 1.00 (0.61, 1.64)P = 1.00 I-2 = 58 %], posterior vs non-posterior location [OR: 1.35 (0.81, 2.27)P = 0.25 I-2 = 84 %], depressed vs von-depressed macroscopic type[OR: 1.21 (0.99, 1.49)P = 0.07 I-2 = 0 %], non-upper vs upper location [OR: 1.41 (0.93, 2.14)P = 0.10 I-2 = 77 %] and BMI [OR: 0.84 (0.57; 1.26)P = 0.41 I-2 = 0 %]. Differentiated neoplasms presented greater chance of cure compare to undifferentiated [OR: 0.10 (0.07, 0.15)P < 0.00001 I-2 = 0 %]. Ulcerated lesions had lower curative rates compared to non-ulcerated [OR: 3.92 (2.81, 5.47)P < 0.00001 I-2 = 44 %]. Lesions smaller than 20 mm had greater chance of curative resection [OR: 3.94 (3.25, 4.78)P < 0.00001 I-2 = 38 %]. Bleeding during procedure had lower curative rates compared to non-bleeding [OR: 2.13 (1.56, 2.93)P < 0.0001 I-2 = 0 %]. Concerning long-term cure, female gender [OR 1.62 (1.33, 1.97)P < 0.00001 I-2 = 0 %] and the mucosal over SM1 cancers were protective factors [OR: 0.08 (0.02, 0.39)P = 0.002 I-2 = 86 %]. Gastric atrophy [OR: 0.60 (0.45, 0.81)P = 0.0006 I-2 = 42 %] and the pepsinogen I/pepsinogen II ratio [OR 2.29 (1.47, 3.57)P = 0.0002 I-2 = 0 %] were risk factors to metachronous gastric neoplasm. Conclusions Ulcerated lesions, histology, bleeding and size > 20 mm are prognostic factors concerning curative resection. Regarding long-term cure, female gender and mucosal over SM1 cancer are predictive factors.
- 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.