LEANDRO CARDOSO BARCHI
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- Robotic digestive tract reconstruction after total gastrectomy for gastric cancer: a simple way to do it(2016) BARCHI, Leandro Cardoso; JACOB, Carlos Eduardo; FRANCISS, Maurice Youssef; KAPPAZ, Guilherme Tommasi; RODRIGUES FILHO, Edison Dias; ZILBERSTEIN, BrunoBackground Intracorporeal digestive tract reconstruction after minimally invasive total gastrectomy may be challenging, even when using the da Vinci (R) Surgical System. This may be due to intrinsic difficulties during oesophagojejunal anastomosis (EJA). The aim of this study was to describe a simple way to perform digestive tract reconstruction after robotic total gastrectomy (RTG) for gastric cancer and the results of its application in a small series of cases. Methods In the last 2 years, six patients with gastric adenocarcinoma have been treated by RTG, four male and two female, with mean age of 59.8 (range 48-74) years. The tumour was located in the gastric body in three patients, the gastric antrum in two patients and the fundus in one patient with no need of splenectomy. In all cases, D2 lymphadenectomy was completed. A modified robotic reconstruction technique proposed by the authors was used in these operations, which consists in a latero-lateral EJA using a linear stapler. An entero-enterostomy is also performed in the upper abdomen. Results The mean operative time was 408 (range 340-481) min. The mean time for digestive tract reconstruction was 57 (range 47-68) min. There were no conversions to open or laparoscopic surgery. The number of lymph nodes removed varied in the range 28-52 (average 40). There was no mortality. Postoperative staging showed three T1N0M0s, one T2N0M0, one T3N0M0 and one T3N2M0. Conclusion This series, which despite being small, demonstrates that this robotic reconstruction technique is safe, with no major complications, demands a relatively short time for its accomplishment, even when dealing with initial experience.
- GASTRIC NEUROENDOCRINE TUMOR: REVIEW AND UPDATE(2017) DIAS, Andre Roncon; AZEVEDO, Beatriz Camargo; ALBAN, Luciana Bastos Valente; YAGI, Osmar Kenji; RAMOS, Marcus Fernando Kodama Pertille; JACOB, Carlos Eduardo; BARCHI, Leandro Cardoso; CECCONELLO, Ivan; RIBEIRO-JR, Ulysses; ZILBERSTEIN, BrunoABSTRACT Introduction: The frequency of gastric neuroendocrine tumors is increasing. Reasons are the popularization of endoscopy and its technical refinements. Despite this, they are still poorly understood and have complex management. Aim: Update the knowledge on gastric neuroendocrine tumor and expose the future perspectives on the diagnosis and treatment of this disease. Method: Literature review using the following databases: Medline/PubMed, Cochrane Library and SciELO. Search terms were: gastric carcinoid, gastric neuroendocrine tumor, treatment. From the selected articles, 38 were included in this review. Results: Gastric neuroendocrine tumors are classified in four clinical types. Correct identification of the clinical type and histological grade is fundamental, since treatment varies accordingly and defines survival. Conclusion: Gastric neuroendocrine tumors comprise different subtypes with distinct management and prognosis. Correct identification allows for a tailored therapy. Further studies will clarify the diseases biology and improve its treatment.
conferenceObject OUTCOME OF GASTRIC CANCER PATIENTS SUBMITTED TO D1 LYMPH NODE DISSECTION DUE TO UNFAVORABLE MEDICAL CONDITIONS(2017) RAMOS, Marcus Kodama; PEREIRA, Marina; DIAS, Andre R.; YAGI, Osmar K.; BARCHI, Leandro C.; JACOB, Carlos E.; MUCERINO, Donato R.; LOPASSO, Fabio; MESTER, Marcelo; BRESCIANI, Claudio C.; CHARRUF, Amir Z.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO, Ulyssesarticle Surgical outcome of Gastric Cancer in patients older than 80 years(2016) OLIVEIRA, Rodrigo José de; CHARRUF, Amir Zeide; JACOB, Carlos Eduardo; RAMOS, Marcus Kodama P.; DIAS, André Roncon; YAGI, Osmar K.; MUCERINO, Donato R.; BARCHI, Leandro; MESTER, Marcelo; BRESCIANI, Cláudio J. C.; LOPASSO, Fábio P.; ZILBERSTEIN, Bruno; CECCONELLO, Ivanarticle Morbimortality of extended local resection for advanced gastric cancer(2016) OLIVEIRA, Rodrigo José de; CHARRUF, Amir Zeide; JACOB, Carlos Eduardo; RAMOS, Marcus Kodama P.; DIAS, André Roncon; YAGI, Osmar K.; MUCERINO, Donato R.; BARCHI, Leandro; MESTER, Marcelo; BRESCIANI, Cláudio J. C.; LOPASSO, Fábio P.; ZILBERSTEIN, Bruno; CECCONELLO, Ivan- Simplified technique for reconstruction of the digestive tract after total and subtotal gastrectomy for gastric cancer(2014) ZILBERSTEIN, Bruno; JACOB, Carlos Eduardo; BARCHI, Leandro Cardoso; YAGI, Osmar Kenji; RIBEIRO-JR, Ulysses; COIMBRA, Brian Guilherme Monteiro Marta; CECCONELLO, IvanBACKGROUND: Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. AIM - To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. METHODS - In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. RESULTS - The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. CONCLUSION - The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method.
- Minimally invasive surgery for gastric cancer in Brazil: current status and perspectives-a report from the Brazilian Laparoscopic Oncologic Gastrectomy Group (BLOGG)(2017) KASSAB, Paulo; COSTA JR., Wilson Luiz da; JACOB, Carlos Eduardo; CORDTS, Roberto de Moraes; CASTRO, Osvaldo Antonio Prado; BARCHI, Leandro Cardoso; CECCONELLO, Ivan; CHARRUF, Amir Zeide; COIMBRA, Felipe Jose Fernandez; CURY, Antonio Moris; DINIZ, Alessandro Landskron; FARIAS, Igor Correia de; FREITAS JR., Wilson Rodrigues de; GODOY, Andre Luis de; ILIAS, Elias Jirjoss; MALHEIROS, Carlos Alberto; RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO, Heber Salvador de Castro; DIAS, Andre Roncon; THULER, Fabio Rodrigues; YAGI, Osmar Kenji; LOURENCO, Laercio Gomes; ZILBERSTEIN, BrunoThe minimally invasive surgery for gastric cancer in Brazil has begun about two years after the first laparoscopic gastrectomy (LG) performed by Kitano in Japan, in 1991. Although the report of first surgeries shows the year of 1993, there was no dissemination of the technique until the years 2010. At that time with the improvement of optical devices, laparoscopic instruments and with the publications coming from Asia, several Brazilian surgeons felt encouraged to go to Korea and Japan to learn the standardization of the LG. After that there was a significant increase in that type of surgery, especially after the IRCAD opened a branch in Brazil. The growing interest for the subject led some services to begin their own experience with the LG and, since the beginning, the results were similar with those found in the open surgery. Nevertheless, there were some differences with the papers published initially in Japan and Korea. In those countries, the surgeries were laparoscopic assisted, meaning that, in the majority of cases, the anastomoses were done through a mini-incision in the end of the procedure. In Brazil since the beginning it was performed completely through laparoscopic approach due to the skills acquired by Brazilian surgeons in bariatric surgeries. Another difference was the stage. While in the east the majority of cases were done in T1 patients, in Brazil, probably due to the lack of early cases, the surgeries were done also in advanced cases. The initial experience of Zilberstein et al. revealed low rates of morbidity without mortality. Comparing laparoscopic and open surgery, the group from Barretos/IRCAD showed shorter surgical time (216x255 minutes), earlier oral or enteral feeding and earlier hospital discharge, with a smaller number of harvested lymph nodes (28 in laparoscopic against 33 in open surgery). There was no significant difference regarding morbidity, mortality and reoperation rate. In the first efforts to publish a multicentric study the Brazilian Gastric Cancer Association (BGCA) collected data from three institutions analyzing 148 patients operated from 2006 to 2016. There were 98 subtotal, 48 total and 2 proximal gastrectomies. The anastomoses were totally laparoscopic in 105, laparoscopic assisted in 21, cervical in 2, and 20 open (after conversion). The reconstruction methods were: 142 Roux-en-Y, two Billroth I, and three other types. The conversion rate was 13.5% (20/148). The D2 dissection was performed in 139 patients. The mean number of harvested lymph nodes was 34.4. If we take only the D2 cases the mean number was 39.5. The morbidity rate was 22.3%. The mortality was 2.7%. The stages were: IA-59, IB-14, IIA-11, IIB-15, IIIA-9, IIIB-19, IIIC-11 and stage IV-three cases. Four patients died from the disease and 10 are alive with disease. The participating services have already begun the robotic gastrectomy with satisfactory results. The intention of this group is to begin now a prospective multicentric study to confirm the data already obtained with the retrospective studies.
- MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM(2016) BARCHI, Leandro Cardoso; JACOB, Carlos Eduardos; BRESCIANI, Cláudio José Caldas; YAGI, Osmar Kenji; MUCERINO, Donato Roberto; LOPASSO, Fábio Pinatel; MESTER, Marcelo; RIBEIRO-JÚNIOR, Ulysses; DIAS, André Roncon; RAMOS, Marcus Fernando Kodama Pertille; CECCONELLO, Ivan; ZILBERSTEIN, BrunoABSTRACT Introduction: Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. Objective: To evaluate and summarize the current status of minimally invasive resection of gastric cancer. Methods: A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. Results: 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Conclusion: Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale.
- Laparoscopic D2 Gastrectomy for Gastric Cancer: Mid-Term Results and Current Evidence(2019) DIAS, Andre Roncon; JACOB, Carlos Eduardo; RAMOS, Marcus Fernando Kodama Pertille; PEREIRA, Marina Alessandra; SZOR, Daniel Jose; YAGI, Osmar Kenji; BARCHI, Leandro Cardoso; RIBEIRO JR., Ulysses; ZILBERSTEIN, Bruno; CECCONELLO, IvanIntroduction: Although the first laparoscopic gastrectomy was performed in 1991, there was a long delay until it was incorporated into the regular practice of western surgeons. In Brazil, there are only few case series reported and data on its safety and efficacy along with mid- and long-term results are desired. Objective: Present the mid-term results of laparoscopic gastrectomy with curative intent in the treatment of gastric adenocarcinoma and review the current evidence on the therapy of this neoplasia with the laparoscopic access. Methods: Patients who underwent D2 laparoscopic gastrectomy for gastric adenocarcinoma were retrospectively reviewed. Results: Sixty-nine patients met the inclusion criteria. The mean age was 59.2 years and the mean body mass index was 24.2 kg/m(2). Subtotal gastrectomy was performed in 73.9%. The mean number of harvested lymph nodes was 36.7, increased lymph node count and shorter operative time were observed in the last 34 cases. Median hospital stay was 8 days. Postoperative complications occurred in 22 (31.9%) cases. Surgical mortality was 4.3%. Conclusion: Laparoscopic gastrectomy can be performed safely with excellent short- and mid-term results. As experience increases, surgical duration is reduced and lymph node count rises.
- Favorable minimal invasive surgery in the treatment of superior mesenteric artery syndrome: Case report(2016) BARCHI, Leandro Cardoso; ALVES, Aline Marcilio; JACOB, Carlos Eduardo; BRESCIANI, Claudio Jose Caldas; YAGI, Osmar Kenji; NOGUEIRA, Tarsila Gasparotto; CECCONELLO, Ivan; ZILBERSTEIN, BrunoINTRODUCTION: The Superior Mesenteric Artery Syndrome (SMAS) is a rare form of intestinal obstruction. The diagnosis is based on findings from imaging studies, including vascular compression of the duodenum by the SMA and can be associated with duodenal dilatation. PRESENTATION OF CASE: We report a case of a patient with SMAS and recurrent episodes of intestinal obstruction, which was successfully treated by laparoscopic duodenojejunostomy. DISCUSSION: The initial treatment is usually conservative for patient's clinical improvement. Surgery is indicated when conservative treatment fails as well for patients with recurrent symptoms. Minimal invasive surgery might be a good approach, specially in patients who suffers from this disease and currently are in depleted health conditions. CONCLUSION: The procedure herein demonstrated may be considered safe and resolutive, with good visualization of structures, relative short surgical time and fast post-operative recovery. (C) 2016 The Authors.