EDUARDO HIROSHI AKAISHI
Projetos de Pesquisa
Unidades Organizacionais
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer?(2015) TEIXEIRA, Frederico; AKAISHI, Eduardo Hiroshi; USHINOHAMA, Adriano Zuardi; DUTRA, Tiago Cypriano; COUTO NETTO, Sergio Dias do; UTIYAMA, Edivaldo Massazo; BERNINI, Celso Oliveira; RASSLAN, SamirPatients with colorectal cancer admitted to the emergency room are generally at more advanced stage of the disease and are usually submitted to a resection with curative intent in a smaller scale. In such scenario, one of the aspects to be considered is whether the principles of oncologic resection are observed when those patients diagnosed with colon cancer are treated with surgery. We selected 87 patients with adenocarcinoma of colon and/or upper rectum submitted to an emergency surgical resection. The major variables reviewed retrospectively were: the extent of resection performed, the number of dissected regional lymph nodes and the overall survival rate. Intestinal obstruction was observed in 67 patients (77%) while perforation was found in 20 patients (23%). Seven (8%) specimens had circumferential compromised margins, all found in patients with T4 tumors combine with poor clinical status. The number of dissected regional lymph nodes was greater than, or equal to, 12 in 71% of patients. While the average days of stay in the ICU was 5.7 days, the median was 3 days. The morbidity and peri-operative mortality stood at 33.6% and 20%, respectively. The outcome of an emergency surgery of colorectal cancer observed in this study was similar to those found in the literature. The principles of oncologic resection were respected when considering and analyzing the extent of the resection, the surgical margins and the number of dissected lymph nodes.
- Popliteal lymph node dissection for metastases of cutaneous malignant melanoma(2014) TEIXEIRA, Frederico; MOUTINHO JR., Vitor; AKAISHI, Eduardo; MENDES, Gabriella; PERINA, Andre; LIMA, Tiberio; LALLEE, Margareth; COUTO, Sergio; UTIYAMA, Edivaldo; RASSLAN, SamirPopliteal lymph node dissection is performed when grossly metastatic nodal disease is encountered in the popliteal fossa or after microscopic metastasis is found in interval sentinel nodes during clinical staging of cutaneous malignant melanoma. Initially, an S-shaped incision is made to gain access to the popliteal fossa. A careful en bloc removal of fat tissue and lymph nodes is made to preserve and avoid the injury of peroneal and tibial nerves as well as popliteal vessels, following the previous recommendations. This rare surgical procedure was successfully employed in a patient with cutaneous malignant melanoma and nodal metastases at the popliteal fossa. The technique described by Karakousis was reproduced in a step-by-step fashion to allow anatomical identification of the neurovascular structures and radical resection with no post-operative morbidity and prompt recovery. Popliteal lymph node dissection is a rarely performed operative procedure. Following a lymphoscintigraphic examination of the popliteal nodal station, surgeons can be asked to explore the popliteal fossa. Detailed familiarity of the operative procedure is necessary, however, to avoid complications.
conferenceObject 0.75mm Breslow Index as Standard Cut-off in Sentinel Lymph Node Biopsy for Melanoma(2012) MOUTINHO, V.; AKAISHI, E.; UTIYAMA, E.; MENDES, G.; TEIXEIRA, F.; FERREIRA, F.; PERINA, A.; RASSLAN, S.Introduction: Breslow index is the most important risk factor for melanoma progression. Breslow index cutoff to perform sentinel node biopsy is not consensual among institutions worldwide. Our study aims to discuss if 0.75mm is an adequate cut-off for sentinel node biopsy for melanoma. Methods: Retro- spective charts from initial 115 patient files from May/2008 to June/2011 were analyzed. Sentinel lymph node biopsy was routinely carried out in patients with Breslow >0.75mm and in high risk patients with Breslow < or =0.75mm (pres-ence of ulceration, regression, mitoses and Clark levels IV/V). Two groups were defined based on Breslow: (A) < or =1.00mm - major group with 17 patients; (B) 0.76-1.00mm - subgroup of 5 patients at threshold for sentinel biopsy. Both groups were compared with Breslow > 1.00 patients as Control Group, using Fischer’s test. High risk of recurrence characteristics were reviewed in patients with Breslow <0.76mm and expressed as percentages. Results: Sen- tinel lymph node biopsies were positive in 40,5% (15/37) of melanomas with Breslow >1.00mm. In patients with Breslow < or =1.00mm (A) there was 5.8% (1/17) sentinel node positivity. In the subgroup of patients with Breslow 0.76- 1.00mm (B) sentinel nodes were positive in 20% (1/5). When testing statisti- cally, Group A (< or =1.00mm) was different from Control group patients (> 1.00mm) regarding sentinel node positivity (p=0.008), while Group B (0.75- 1.00 mm) was similar to Control group patients (p=0.35). In patients with Bres- low <0.76 mm with high risk characteristics on pathologic report, ulceration was not present in any patient, 16,7% were Clark levels IV/V, mitoses were present in 70% of patients, lesions were in vertical phase of growth in 40% and regression was present in 36%. Conclusions: 1. Sentinel node biopsy in melanomas with Breslow 0.76-1.00mm should be routinely indicated due to a high positivity rate (20% in our sample) in this range. 2. Node positivity in patients with Breslow <0.76mm (5.8%) was statistically different from node positivity in Breslow >1.00mm group (40%; p=0.008) rising the question that indication of sentinel node biopsy in Breslow <0.76mm is controversial.