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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- O uso potencial do Balão de Oclusão Endovascular da Aorta para Ressuscitação em um hospital brasileiro.(2020) SOUSA, Jorge Henrique Bento; EDELMUTH, Rodrigo Camargo Leão; TUSTUMI, Francisco; KHALIL, Douglas da Cunha; SOUSA, Gabriel Mayo Vieira de; FONSECA, Eduardo Leite; STEINMAN, MiltonABSTRACT Aim: To evaluate the potential use of REBOA in a Brazilian hospital. Methods: We performed a retrospective analysis of all requests for emergency surgical evaluation for patients with suspected massive hemorrhage, hospitalized in a private Brazilian general hospital, from April 1, 2017 to March 31, 2018. Inclusion criteria for REBOA eligibility were: suspected abdominal and/or pelvic bleeding, hemorrhagic shock and older than 18 years of age. Exclusion criteria were: older than 70 years of age, and pre-existing terminal disease or significant comorbidities. Results: 90 evaluations were requested during the study period. However, according to our inclusion/exclusion criteria, only on 14 occasions (15.6%) there was a recommendation for the use of REBOA. Gynecological/obstetric conditions were the indication in 11 cases (78.6%) and elective oncologic surgery in three cases (21.4%). Conclusions: The use of REBOA is not common in our country, but it can be an essential tool, and perhaps the last resource in extremely severe conditions until the definitive surgical, endovascular or endoscopic treatment is performed.
- 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.
- 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 AurelioPurpose 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.
- Efficacy and Safety of Endoscopic Sleeve Gastroplasty at Mid Term in the Management of Overweight and Obese Patients: a Systematic Review and Meta-Analysis(2020) MIRANDA NETO, Antonio Afonso de; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; KHAN, Ahmad; SINGH, Shailendra; PONTE NETO, Alberto Machado da; MADRUGA NETO, Antonio Coutinho; MONTE JUNIOR, Epifanio Silvino do; TUSTUMI, Francisco; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. Methods This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. Results Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78 kg/m(2). Pooled mean %TWL observed at 6, 12, and 18 months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18 months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. Conclusion ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.
- 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.
- Combined liver and multivisceral resections: A comparative analysis of short and long-term outcomes(2020) JUNIOR, Sergio S.; COELHO, Fabricio F.; TUSTUMI, Francisco; CASSENOTE, Alex J. F.; JEISMANN, Vagner B.; FONSECA, Gilton M.; KRUGER, Jaime A. P.; ERNANI, Lucas; CECCONELLO, Ivan; HERMAN, PauloBackground En bloc liver and adjacent organs resections are technically demanding procedures. Few case series and nonmatched comparative studies reported the outcomes of multivisceral liver resections (MLRs). Objectives To compare the short and long-term outcomes of patients submitted MLRs with those submitted to isolated hepatectomies. Methods From a prospective database, a case-matched 1:2 study was performed comparing MLRs and isolated hepatectomy. Additionally, a risk analysis was performed to evaluate the association between MLRs and perioperative morbidity, mortality, and long-term survival. Results Fifty-three MLRs were compared with 106 matched controls. Patients undergoing MLRs had longer operative time (430 [320-525] vs 360 [270-440] minutes,P = .005); higher estimated blood loss (600 [400-800] vs 400 [100-600] mL;P = .011); longer hospital stay (8 [6-14] vs 7 [5-9] days;P = .003); and higher postoperative mortality (9.4% vs 1.9%,P = .042). Number of resected organs was not an independent prognostic factor for perioperative major complications (odds ratio [OR], 1 organ = 1.8 [0.54-6.05]; OR >= 2, organs = 4.0 [0.35-13.84]) or perioperative mortality (OR, 1, organ = 5.2 [0.91-29.51]; OR >= 2, organs = 6.5 [0.52-79.60]). No differences in overall (P = .771) and disease-free survival (P = .28) were observed. Conclusion MLRs are feasible with acceptable morbidity but relatively high perioperative mortality. MLRs did not negatively affect long-term outcomes.
- Cholecystectomy in Patients Submitted to Bariatric Procedure: A Systematic Review and Meta-analysis(2018) TUSTUMI, Francisco; BERNARDO, Wanderley M.; SANTO, Marco A.; CECCONELLO, IvanWeight loss following bariatric surgery increases risk for biliary stones. This study performed a meta-analysis evaluating cholecystectomy risks in bariatric patients. A systematic review and meta-analysis were performed. We evaluated the incidence rate for biliary complications in patients followed after bariatric surgery. We compared the risks for mortality, complications, and in hospital stay among patient submitted to cholecystectomy before, concomitantly with or after bariatric surgery, as well as patients submitted to bariatric surgery and cholecystectomy, and patients submitted only to bariatric surgery in order to evaluate when to perform cholecystectomy in morbidly obese patients. The incidence rate of biliary complications was 5.54 cases/1000 patient year. The addition of cholecystectomy to bariatric surgery resulted in an increased risk for complications (RD = 0.02). The risk for complications (RD = - 0.09) and reoperation (RD = - 0.02) was lower when performed concomitantly with bariatric surgery compared to post-bariatric procedure. Prophylactic cholecystectomy may be avoided. Patients submitted to bariatric surgery have low incidence rate of biliary complications, and concomitant cholecystectomy increases the risk for postoperative complications and operative time. If cholecystectomy is not indicated, patients should be carefully followed with attention for biliary complications, once cholecystectomy performed post-bariatric surgery is at higher risk for complications and reoperations.
- Esophagojejunostomy after total gastrectomy: A systematic review and meta-analysis comparing hand-sewn and stapled anastomosis(2022) HONORIO, Fernanda Cavalcanti Cabral; TUSTUMI, Francisco; PINHEIRO FILHO, Joao Emilio Lemos; MARQUES, Stefanie Sophie Buuck; GLINA, Felipe Placco Araujo; HENRIQUES, Alexandre Cruz; DIAS, Andre Roncon; WAISBERG, JaquesThis review aims to evaluate the surgical outcomes of hand-sewn esophageal anastomosis compared to mechanical anastomosis to reconstruct total gastrectomy. A systematic review and meta-analysis of comparative studies evaluating hand-sewn and stapled anastomosis were performed. A total of 12 studies were selected, comprising 1761 individuals. The results indicate that the hand-sewn and stapled esophageal anastomosis have similar surgical outcomes. Stapled anastomosis has a shorter operation time.
- The impact of sarcopenia on esophagectomy for cancer: a systematic review and meta-analysis(2023) PARK, Amanda; ORLANDINI, Marina Feliciano; SZOR, Daniel Jose; RIBEIRO, Ulysses; TUSTUMI, FranciscoBackgroundEsophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in cancer patients. The exact burden of sarcopenia in esophagectomy outcomes remains unclear. Therefore, this systematic review and meta-analysis were performed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer.MethodsWe performed a systematic review and meta-analysis comparing sarcopenic with non-sarcopenic patients before esophagectomy for cancer (Registration number: CRD42021270332). An electronic search was conducted on Embase, PubMed, Cochrane, and LILACS, alongside a manual search of the references. The inclusion criteria were cohorts, case series, and clinical trials; adult patients; studies evaluating patients with sarcopenia undergoing esophagectomy or gastroesophagectomy for cancer; and studies that analyze relevant outcomes. The exclusion criteria were letters, editorials, congress abstracts, case reports, reviews, cross-sectional studies, patients undergoing surgery for benign conditions, and animal studies. The meta-analysis was synthesized with forest plots.ResultsThe meta-analysis included 40 studies. Sarcopenia was significantly associated with increased postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14), severe complications (RD: 0.11; 95% CI: 0.04 to 0.19), and pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18). Patients with sarcopenia had a lower probability of survival at a 3-year follow-up (RD: -0.16; 95% CI: -0.23 to -0.10).ConclusionPreoperative sarcopenia imposes a higher risk for overall complications and severe complications. Besides, patients with sarcopenia had a lower chance of long-term survival.
- Long Term Follow-up Results of Surgical Management of Chronic Pancreatitis(2019) TUSTUMI, Francisco; COSTA, Thiago Nogueira; PENTEADO, Sonia; BACCHELLA, Telesforo; CECCONELLO, IvanBackground: Chronic pancreatitis is a progressive loss of exocrine and endocrine pancreatic function. Surgical procedures are required in cases of intractable pain, biliary obstruction or intestinal obstruction, complications from pseudocysts, or pancreatic fistulae. Objective. To assess the outcomes after surgical management of chronic pancreatitis, in a long-term follow-up. Methods: Patients that underwent surgical management of chronic pancreatitis,from 2006 to 2017, were reviewed. Demographics and complications of the procedures were recorded. Visual analogue pain scale was used for pain control evaluation. The 12-Item Short-Form Health Survey questionnaire was used for quality of life assessment. Results: Sixty-five patients were included in the study. Mean follow-up was 60.26 months. Twenty patients underwent lateral pancreatojejunostomy, 22 to Roux-en-Y cystojejunostomy, 7 to transgastric cyst-gastrostomy,1 to Frey procedure, 4 to hepaticojejunostomy, 1 to Frey procedure and hepaticojejunostomy, 1 to lateral pancreatojejunostomy and cyst-gastrostomy, 7 to lateral pancreatojejunostomy and hepaticojejunostomy and 2 to cystojejunostomy and hepaticojejunostomy. No cases of perioperative deaths were recorded. A Pancreatic fistula was found in 5 cases, and all of them followed non-operative management. Of the 65 patients included in the study, 39 answered the questionnaires. Mean scores on SF-12, physical and mental scales were respectively 42.72 +/- 10.76 and 49.84 +/- 11.75. Conclusion: Surgical management of chronic pancreatitis is safe, with low mortality and morbidity rates. These procedures are effective in assuaging pain and in providing good quality of life.