EDUARDO HIROSHI AKAISHI
Projetos de Pesquisa
Unidades Organizacionais
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature(2017) TEIXEIRA JR., Frederico Jose Ribeiro; COUTO NETTO, Sergio Dias do; AKAISHI, Eduardo Hiroshi; UTIYAMA, Edivaldo Massazo; MENEGOZZO, Carlos Augusto Metidieri; ROCHA, Marcelo CristianoIntroduction: Acute appendicitis is significantly common. Despite the increased use of computed tomography, the number of perforated cases has been stable in the past three decades. Between 2% and 6% of patients with acute appendicitis present appendiceal mass, often described as inflammatory phlegmon or abscess. Malignant tumors are confirmed by pathological analysis in 0.9-1.4% of all appendectomies performed to treat acute appendicitis. However, recent series demonstrate an elevated incidence of malignancies, ranging from 5.9 to 12%, in patients with inflammatory appendiceal mass. Methods: The analysis was based on a systematic review of the literature. The articles were searched in PubMed for the period from 1987 to 2016. Articles presenting the incidence of the hidden malignancy among patients with appendiceal inflammatory mass were selected. Variables as age, interval appendectomy rate, the incidence of neoplasm, time to surgery, minimally invasive assessment, histology, right colectomy rate and morbidity were analyzed. Results: A total of 13.244 patients were described as presenting acute appendicitis. Appendiceal tumor is present in approximately 1% of the appendectomies, while the rate of neoplasm varies from 10 to 29% in patients presenting appendiceal inflammatory mass. Interval appendectomies, despite been the minority of the procedures, disregard the higher morbidity associated with right sided colectomies. The review of literature also describes oncologic, histologic and clinical aspects of patients presenting appendiceal neoplasm, describing the most frequent histologic subtypes of this illness. Conclusion: Hidden appendiceal neoplasm in acute appendicitis are rare, fortunately. However, its incidence is much higher in patients presenting appendiceal inflammatory mass. Hence, interval appendectomy should be considered in this subgroup of patients.
- Multivisceral resection for retroperitoneal liposarcoma-is it worth it? A 20-year single-center experience(2023) JR, Frederico Ribeiro Teixeira; ARAKAKI, Mariana Sousa; LIMA, Helber Vidal Gadelha; FERREIRA, Fabio de Oliveira; MENEGOZZO, Carlos Augusto Metidieri; SILVA, Eduardo Rissi; MONTERO, Edna Frasson de Souza; OYA, Toshiko; LIMA, Luiz Calima; AKAISHI, Eduardo Hiroshi; UTIYAMA, Edivaldo MassazoPurposeSoft tissue sarcomas are rare malignant tumors. Liposarcoma constitutes the most frequent histological subtype of retroperitoneal sarcoma. The prognosis of soft tissue sarcomas depends on clinical and histologic characteristics.ObjectiveEvaluate variables that may be related to the overall and local recurrence-free survival in patients with retroperitoneal liposarcoma and discuss the need for visceral resection en-bloc for tumors.MethodsA retrospective analysis was conducted of the medical records of 60 patients seen between 1997 and 2017 who underwent surgical resection of retroperitoneal liposarcoma.ResultsThe overall survival rate at 5 years of follow-up was 75.22% (95% confidence interval [CI] 0.58-0.86). The probability of a local recurrence-free survival at 5 years of follow-up was 26.04% (95% CI 0.11-0.44). The multivariate analysis showed that dedifferentiated or pleomorphic tumors and R2/fragmented resection were associated with a shorter time to recurrence. No other characteristics markedly influenced the overall survival (P > 0.05).ConclusionPatients with dedifferentiated or pleomorphic tumors and incomplete resection were associated with higher local recurrence rates than others. This study reinforces the need for complete and en-bloc resection with organs when there is clear involvement or technical surgical difficulty to maintain the tumor integrity.
- 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.
- Abdominal wall reconstruction after desmoid type fibromatosis radical resection: Case series from a single institution and review of the literature(2017) NETO, S. D. Couto; TEIXEIRA JR., F.; MENEGOZZO, C. A. M.; ALBERTINI, A.; AKAISHI, E. H.; UTIYAMA, E. M.BACKGROUND: Abdominal wall desmoid type fibromatosis management has been changing over recent years, from an aggressive approach towards a more conservative one. When radical resection is indicated, the surgical team faces the challenge of abdominal wall reconstruction, for which optimal technique is still debated. The present study reports the experience from a single center with abdominal closures after desmoid type fibromatosis resection. MATERIAL AND METHODS: Retrospective analysis of patients who underwent abdominal wall closure after sporadic abdominal desmoid type fibromatosis radical resection from 1982 to 2013. RESULTS: Twenty-seven patients were included, mean tumor diameter was 10 + 5.3 cm, and the main choice of abdominal wall reconstruction was midline closure with anterior rectus sheath relaxing incisions and polypropylene onlay mesh (74% of the cases). Only 7% of the cases required more complex procedures for skin closure. Mean follow-up was 5 years and 89% remained disease-free. No grade 4 or 5 complications were observed. CONCLUSION: High midline fascial closure rate can be achieved after resection of abdominal wall desmoid tumor using relaxing incisions and mesh, with low complication rate. (C) 2017 The Author(s).
- Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of gastric cancer(2020) PEIXOTO, Renata D'Alpino; ROCHA-FILHO, Duilio R.; WESCHENFELDER, Rui F.; REGO, Juliana F. M.; RIECHELMANN, Rachel; COUTINHO, Anelisa K.; FERNANDES, Gustavo S.; JACOME, Alexandre A.; ANDRADE, Aline C.; MURAD, Andre M.; MELLO, Celso A. L.; MIGUEL, Diego S. C. G.; GOMES, Diogo B. D.; RACY, Douglas J.; MORAES, Eduardo D.; AKAISHI, Eduardo H.; CARVALHO, Elisangela S.; MELLO, Evandro S.; MALUF FILHO, Fauze; COIMBRA, Felipe J. F.; CAPARELI, Fernanda C.; ARRUDA, Fernando F.; VIEIRA, Fernando M. A. C.; TAKEDA, Flavio R.; COTTI, Guilherme C. C.; PEREIRA, Guilherme L. S.; PAULO, Gustavo A.; RIBEIRO, Heber S. C.; LOURENCO, Laercio G.; CROSARA, Marcela; TONETO, Marcelo G.; OLIVEIRA, Marcos B.; OLIVEIRA, Maria de Lourdes; BEGNAMI, Maria Dirlei; FORONES, Nora M.; YAGI, Osmar; ASHTON-PROLLA, Patricia; AGUILLAR, Patricia B.; AMARAL, Paulo C. G.; HOFF, Paulo M.; ARAUJO, Raphael L. C.; PAULA FILHO, Raphael P. Di; GANSL, Rene C.; GIL, Roberto A.; PFIFFER, Tulio E. F.; SOUZA, Tulio; JR, Ulysses Ribeiro; JESUS, Victor Hugo F.; JR, Wilson L. Costa; PROLLA, GabrielGastric cancer is among the ten most common types of cancer worldwide. Most cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of gastric carcinomas. The Brazilian Group of Gastrointestinal Tumors (GTG) invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy and follow-up, which was followed by presentation, discussion, and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of gastric carcinomas in several scenarios and clinical settings.
- Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of oesophageal cancer(2021) ROCHA-FILHO, Duilio R.; PEIXOTO, Renata D'Alpino; WESCHENFELDER, Rui F.; REGO, Juliana F. M.; RIECHELMANN, Rachel; COUTINHO, Anelisa K.; FERNANDES, Gustavo S.; JACOME, Alexandre A.; ANDRADE, Aline C.; MURAD, Andre M.; MELLO, Celso A. L.; MIGUEL, Diego S. C. G.; GOMES, Diogo B. D.; RACY, Douglas J.; MORAES, Eduardo D.; AKAISHI, Eduardo H.; CARVALHO, Elisangela S.; MELLO, Evandro S.; MALUF FILHO, Fauze; COIMBRA, Felipe J. F.; CAPARELI, Fernanda C.; ARRUDA, Fernando F.; VIEIRA, Fernando M. A. C.; TAKEDA, Flavio R.; COTTI, Guilherme C. C.; PEREIRA, Guilherme L. S.; PAULO, Gustavo A.; RIBEIRO, Heber S. C.; LOURENCO, Laercio G.; CROSARA, Marcela; TONETO, Marcelo G.; OLIVEIRA, Marcos B.; OLIVEIRA, Maria de Lourdes; BEGNAMI, Maria Dirlei; FORONES, Nora M.; YAGI, Osmar; ASHTON-PROLLA, Patricia; AGUILLAR, Patricia B.; AMARAL, Paulo C. G.; HOFF, Paulo M.; ARAUJO, Raphael L. C.; PAULA FILHO, Raphael P. Di; GANSL, Rene C.; GIL, Roberto A.; PFIFFER, Tulio E. F.; SOUZA, Tulio; JR, Ulysses Ribeiro; JESUS, Victor Hugo F.; JR, Wilson L. Costa; PROLLA, GabrielOesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.
- Pancreaticoduodenectomy in patients with type 1 Neurofibromatosis: Report of two cases and literature review(2016) TEIXEIRA, Frederic; MENEGOZZO, Carlos Augusto Metidieri; COUTO NETTO, Sergio Dias do; SCAPINI, Gustavo; AKAISHI, Eduardo Hiroshi; VASCONCELOS, Marcela Pereira Silva; UTIYAMA, Edivaldo MassazoINTRODUCTION: Type 1 Neurofibromatosis (NF1) is one of the most common autosomal dominantly inherited multisystem disorders. It is associated with an increased risk of developing neurologic and gastrointestinal (GI) malignant neoplasms. The incidence of GI involvement is reported in 10-25% of patients. Less than 5% of NF1 patients with GI neoplasms manifest symptoms. The presence of synchronic gastrointestinal stromal and neuroendocrine tumors is rare in these patients. PRESENTATION OF CASES: The first case is a 37 year-old male patient with a history of abdominal pain for a few months. Imaging study showed a periampullary mass and a solid lesion at the third duodenal portion. He was submitted to a pancreatoduodenectomy and histological anaylisis showed two low-grade neuroendocrine tumors and a gastrointestinal stromal tumor. The second case is a 47 year-old female patient with a routine computed tomography scan showing a duodenal and a jejunal lesion. Duodenopancreatectomy was performed and histological analysis showed a neuroendocrine adenocarcinoma of the duodenum and two jejunal lesions compatible with GI tumors. DISCUSSION: GI symptoms such as jaundice, pain and bleeding in NF1 patients should prompt urgent admission Occasionally, associated gastrointestinal tumors may be incidentally found in asymptomatic NF1 patients. The presence of a periampullary or duodenal neoplasia such as neuroendocrine tumors should be evaluated. CONCLUSION: Although rare, the synchronic presentation of gastrointestinal tumors in patients with NF1 should be ruled out since it can lead to higher morbidity and mortality rates. Single-stage surgical management is feasable and yields satisfactory results. (C) 2016 The Authors.
- Leiomyosarcoma of the inferior vena cava: Survival rate following radical resection(2017) TEIXEIRA JR., Frederico Jose Ribeiro; COUTO NETTO, Sergio Dias do; PERINA, Andre Luis De Freitas; TORRICELLI, Fabio C. M.; TEIXEIRA, Luciana Ragazzo; ZERATI, Antonio Eduardo; FERREIRA, Fabio de Oliveira; AKAISHI, Eduardo Hiroshi; NAHAS, William Carlos; UTIYAMA, Edivaldo MassazoLeiomyosarcoma (LMS) of inferior vena cava (IVC) is a rare neoplasm affecting approximately 1/100,000 people. The prognosis is poor and potential curative intent occurs through challenging operations, such as vena cava resection, occasionally multivisceral when required, and vascular reconstruction. There are few retrospective series regarding this retroperitoneal neoplasm, and the aim of the present study was to discuss the experience at the Sao Paulo Cancer Institute and Clinics Hospital of University of Sao Paulo Medical School, Sao Paulo, Brazil. The current study is a retrospective review of 7 patients treated in the two tertiary hospitals between 2005 and 2013. Oncological and operative aspects were discussed, primarily regarding surgical aspects highlighting en bloc resection, vascular reconstruction, and the overall survival and recurrence rates. All the patients were treated with radical intent, 4 of whom underwent multivisceral resection, with the kidney being the most resected organ. The location of the IVC tumor was described using Kulaylat's description and the median tumor size was 10 cm. Vascular reconstruction was necessary in 4 patients. The overall survival rate at 3 and 5 years was 100, and 25%, respectively. The disease-free survival rate at 3 and 5 years was 57 and 20%, respectively. In conclusion, IVC LMS is a rare and severe retroperitoneal neoplasm, with multivisceral resections remaining a surgical challenge. The treatment requires numerous experienced surgeons and the impact of microscopic free margins remains unclear. Vascular reconstruction depends on several aspects regarding primarily the topography of the tumor.