RUBENS ANTONIO AISSAR SALLUM
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- 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.
- Prognostic value of F-18-fluorodeoxyglucose PET/computed tomography metabolic parameters measured in the primary tumor and suspicious lymph nodes before neoadjuvant therapy in patients with esophageal carcinoma(2021) TUSTUMI, Francisco; DUARTE, Paulo Schiavom; ALBENDA, David Gutierrez; TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; BUCHPIGUEL, Carlos Alberto; CECCONELLO, IvanBackground F-18-fluorodeoxyglucose PET/computed tomography (F-18-FDG PET/CT) metabolic parameters are prognostic indicators in several neoplasms. This study aimed to evaluate the prognostic value of the maximum and average standardized uptake value (SUVmax and SUVavg), metabolic tumor value (MTV), and total lesion glycolysis (TLG) measured in the primary tumor and suspicious lymph nodes preneoadjuvant therapy in patients submitted to surgical resection for esophageal cancer. Methods A cohort of 113 patients with esophageal cancer who performed F-18-FDG PET/CT preneoadjuvant therapy was assessed. The association of the SUV, MTV, and TLG measured in the primary tumor and in the suspicious lymph nodes with the overall survival was assessed. It was also analyzed other potentially confounding variables such as age, sex, clinical stage, and histologic subtype. The analyses were performed using Kaplan-Meier curve, log-rank test, and Cox regression. Results The univariate analyses showed that the MTV and TLG in the primary tumor, the SUV in the suspicious lymph nodes, the age, the histologic subtype, and the clinical stage were associated with survival after surgery (P <= 0.05). In the Cox regression multivariate analyses, all variables identified in the univariate analyses but the clinical stage were associated with survival after surgery (P <= 0.05). Conclusion In esophageal cancer patients, some of the F-18-FDG PET/CT metabolic parameters measured in the primary tumor and in the suspicious lymph nodes before the neoadjuvant therapy are independent indicators of overall survival and appear to be more important than the clinical stage in the prognostic definition of this group of patients.
- Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors(2021) TAKEDA, Flavio Roberto; OBREGON, Carlos de Almeida; NAVARRO, Yasmin Peres; MOURA, Diogo Turiani Hourneaux; JR, Ulysses Ribeiro; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanBACKGROUND & nbsp; Thoracoscopic esophagectomy is related to an extended lymphadenectomy, and a high number of retrieved lymph nodes, compared to the transhiatal approach; however, its association with an improvement in overall survival (OS) is debatable. & nbsp; AIM & nbsp; To compare thoracoscopic esophagectomy with transhiatal esophagectomy in patients with adenocarcinoma of the esophagogastric junction (AEGJ) in terms of survival, number of lymph nodes, and complications. & nbsp; METHODS & nbsp; In total, 147 patients with AEGJ were selected retrospectively from 2002 to 2019, and divided into Group A for thoracoscopic esophagectomy, and group B for transhiatal esophagectomy. OS, disease-free survival, postoperative complications, and number of nodes, were similarly evaluated. & nbsp; RESULTS & nbsp; One hundred and thirty (88%) were male; the mean age was 64 years. Group A had a mean age of 61.1 years and group B 65.7 years (P = 0.009). Concerning the extent of lymphadenectomy, group A showed a higher number of retrieved lymph nodes (mean of 31.89 +/- 8.2 vs 20.73 +/- 7; P < 0.001), with more perioperative complications, such as hoarseness, surgical site infections, and respiratory complications. Although both groups had similar OS rates, subgroup analysis showed better survival of transthoracic esophagectomy in patients with earlier diseases. & nbsp; CONCLUSION & nbsp; Both methods are safe, having similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a more extensive resection of the lymph nodes and may have better oncological outcomes during earlier stages of the disease. Prospective studies are warranted to better evaluate these findings.
- Management of Respiratory Failure Caused by COVID-19 after Thoracoscopic Esophagectomy(2021) TAKEDA, Flavio Roberto; OBREGON, Carlos de Almeida; NAVARRO, Yasmin Peres; SANTO FILHO, Marco Aurelio; RIBEIRO JUNIOR, Ulysses; SALLUM, Rubens Antonio Aissar; CECCONELLO, Ivan
- Supercharged cervical anastomosis for esophagectomy and gastric pull-up(2021) TAKEDA, Flavio Roberto; TUTIHASHI, Rafael; TUSTUMI, Francisco; SALLUM, Rubens Antonio Aissar; BUSNARDO, Fabio de Freitas; RIBEIRO JR., Ulysses; CECCONELLO, IvanObjective: Esophagectomy has high rates of morbidity and mortality. Anastomotic leakage is the most frequent complication and is likely caused by diminished anastomotic perfusion. Supercharged microvascular anastomosis has previously been performed in select patients to supplement the blood supply to the graft and anastomosis after esophagectomy. This study aimed to evaluate complications that may arise after performing the supercharged cervical anastomosis for esophagectomy procedure. Methods: This prospective comparative study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were divided into group 1, in which conventional cervical anastomosis was performed, and group 2, in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas in group 2 patients were evaluated using indocyanine and the SPY device (Novadaq Technologies, Inc, Toronto, Ontario, Canada) before and after supercharged cervical anastomosis for esophagectomy. Postesophagectomy complications were also recorded. Results: The study enrolled 80 patients, which included 62 (77.5%) men, mean age 64.3 years. Groups 1 and 2 comprised 55 patients and 25 patients, respectively. Leakage occurred in 10.5% and 0% of patients in groups 1 and 2, respectively (P = .169), whereas the corresponding anastomotic stricture rates were 14.5% and 4%, respectively (P = .260). Perfusion analyses showed a 26.5% improvement in the anastomotic area after venous anastomosis and a 34.6% improvement after arterial and venous anastomosis. Conclusions: The supercharged cervical anastomosis for esophagectomy procedure may reduce the occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.
- Surgical management of esophageal stenosis due to ingestion of corrosive substances(2021) TUSTUMI, Francisco; SEGURO, Francisco Carlos Bernal da Costa; SZACHNOWICZ, Sergio; BIANCHI, Edno Tales; MORRELL, Andre Luiz Gioia; SILVA, Matheus Oliveira da; DUARTE, Andre Fonseca; SOUSA, Jorge Henrique Bento de; LAUREANO, Gabriela Gomes; ROCHA, Julio Rafael Mariano da; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanBackground: Corrosive ingestion is a significant challenge for healthcare systems. Limited data are available regarding the best treatments, and there remains a lack of consensus about the optimal surgical approach and its outcomes. This study aims to review the current literature and show a single institution's experience regarding the surgical treatment of esophageal stenosis due to corrosive substance ingestion. Methods: A retrospective review that accounted for demographics, psychiatric profiles, surgical procedures, and outcomes was performed. A systematic review of the literature was performed using PubMed. Results: In total, 27 surgical procedures for esophageal stenosis due to corrosive substance ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. Esophagectomies and esophageal bypasses were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. Conclusion: Surgical intervention either by esophagectomy or esophageal bypass results in durable relief from dysphagia. However, successful clinical outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.
- CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS FISTULA FOLLOWING ESOPHAGECTOMY: A PROBLEM WITH NO SOLUTION?(2021) TAKEDA, Flavio Roberto; SALLUM, Rubens Aissar; CECCONELLO, Ivan; NAHAS, Sergio Carlos
- Postoperative outcomes in oesophagectomy with trainee involvement(2021) EVANS, R. P. T.; HODSON, J.; KAMARAJAH, S. K.; GRIFFITHS, E. A.; SINGH, P.; ALDERSON, D.; BUNDRED, J.; GOSSAGE, J.; JEFFERIES, B.; MCKAY, S.; MOHAMED, I; LOI, K.; FISHER, O. M.; WARD, S.; READ, M.; JOHNSON, M.; BASSARI, R.; BUI, H.; CECCONELLO, I; SALLUM, R. A. A.; TAKEDA, F. R.; FREIRE, J.; ROCHA, J. R. M. da; LOPES, L. R.; TERCIOTI JR., V.; COELHO, J. D. S.; FERRER, J. A. P.; BUDUHAN, G.; TAN, L.; SRINATHAN, S.; SHEA, P.; YEUNG, J.; CASACA, R.; KIDANE, B.; ALLISON, F.; CARROLL, P.; VARGAS-BARATO, F.; GONZALEZ, F.; ORTEGA, J.; NINO-TORRES, L.; BELTRAN-GARCIA, T. C.; CASTILLA, L.; PINEDA, M.; COSTA, R. C. T.; BASTIDAS, A.; CASTRO, R. Guevara; GOMEZ-MAYORGA, J.; CORTES, N.; CETARES, C.; CACERES, S.; DUARTE, S.; PAZDRO, A.; SNAJDAUF, M.; FALTOVA, H.; SCURTU, R. R.; SEVCIKOVA, M.; MORTENSEN, P. B.; HARUSTIAK, T.; KATBALLE, N.; INGEMANN, T.; MORTEN, B.; KRUHLIKAVA, I; AINSWORT, A. P.; STILLING, N. M.; ECKARDT, J.; MOGOANTA, S. S.; HOLM, J.; THORSTEINSSON, M.; SIEMSEN, M.; BEKELE, A.; BRANDT, B.; NEGA, B.; TEFERRA, E.; TIZAZU, A.; KAUPPILA, J. S.; KOIVUKANGAS, V; BOLCA, C.; MERILAINEN, S.; GRUETZMANN, R.; KRAUTZ, C.; WEBER, G.; KECHAGIAS, A.; GOLCHER, H.; EMONS, G.; AZIZIAN, A.; EBELING, M.; NIEBISCH, S.; CONSTANTINOIU, S.; KREUSER, N.; ALBANESE, G.; HESSE, J.; VOLOVNIK, L.; BOECHER, U.; GOCKEL, I; REEH, M.; TRIANTAFYLLOU, S.; SCHIZAS, D.; MICHALINOS, A.; SEKHNIAIDZE, D.; BAILI, E.; MPOURA, M.; CHARALABOPOULOS, A.; MANATAKIS, D. K.; BALALIS, D.; BOLGER, J.; KENNEDY, A.; BABAN, C.; MASTROSIMONE, A.; MCANENA, O.; SO, J. B. Y.; QUINN, A.; SUILLEABHAIN, C. B. O.; HENNESSY, M. M.; IVANOVSKI, I.; KHIZER, H.; RAVI, N.; DONLON, N.; ROIT, A. Da; CERVELLERA, M.; VACCARI, S.; GACVSKI, G.; BIANCHINI, S.; SARTARELLI, L.; ASTI, E.; BERNARDI, D.; MERIGLIANO, S.; PROVENZANO, L.; SCARPA, M.; SAADEH, L.; BAGAJEVAS, A.; SALMASO, B.; NEPOGODIEV, D.; MANZONI, G. De; GIACOPUZZI, S.; MENDOLA, R. La; PASQUAL, C. A. De; TSUBOSA, Y.; NIIHARA, M.; IRINO, T.; MAKUUCHI, R.; ISHII, K.; AZAGRA, J. S.; LOUREIRO, C.; MWACHIRO, M.; FEKADU, A.; ODERA, A.; MWACHIRO, E.; ALSHEHAB, D.; AHMED, H. A.; SHEBANI, A. O.; ELHADI, A.; ELNAGAR, F. A.; ELNAGAR, H. F.; PERA, M.; MAHENDRAN, H. A.; MAKKAI-POPA, S. T.; WONG, L. F.; YUNRONG, T.; THANNINALAI, S.; AIK, H. C.; SOON, P. W.; HUEI, T. J.; BASAVE, H. N. L.; CORTES-GONZALEZ, R.; BIANCHI, A.; LAGARDE, S. M.; MEJIA-FERNANDEZ, L.; LANSCHOT, J. J. B. van; CORDS, C.; JANSEN, W. A.; MARTIJNSE, I; MATTHIJSEN, R.; BOUWENSE, S.; KLARENBEEK, B.; VERSTEGEN, M.; GIJON, M. Moreno; WORKUM, F. van; RUURDA, J. P.; WIJNHOVEN, B. P. L.; VEEN, A. van der; BERG, J. W. van den; EVENETT, N.; JOHNSTON, P.; PATEL, R.; MACCORMICK, A.; YOUNG, M.; FERNANDEZ, J. Martin; SMITH, B.; EKWUNIFE, C.; MEMON, A. H.; KAFSI, J. El; SHAIKH, K.; WAJID, A.; KHALIL, N.; HARIS, M.; MIRZA, Z. U.; QUDUS, S. B. A.; CARRERA, M. S. Trugeda; SARWAR, M. Z.; SHEHZADI, A.; RAZA, A.; JHANZAIB, M. H.; SAYYED, R. H.; FARMANALI, J.; ZAKIR, Z.; SHAKEEL, O.; NASIR, I; KHATTAK, S.; VALLVE-BERNAL, M.; BAIG, M.; NOOR, M. A.; AHMED, H. H.; NAEEM, A.; PINHO, A. C.; SOUSA, M.; SILVA, R. da; BERNARDES, A.; CAMPOS, J. C.; MATOS, H.; PASCUAL, M. A. Citores; BRAGA, T.; MONTEIRO, C.; RAMOS, P.; CABRAL, F.; GOMES, M. P.; MARTINS, P. C.; SAMPAIO, A. S.; CORREIA, A. M.; VIDEIRA, J. F.; CIUCE, C.; ELMAHI, S.; DRASOVEAN, R.; APOSTU, R.; PAITICI, S.; RACU, A. E.; V, C. Obleaga; BEURAN, M.; STOICA, B.; NEGOI, I; CIUBOTARU, C.; NEGOITA, V; HALLDESTAM, I; CORDOS, I; BIRLA, R. D.; PREDESCU, D.; HOARA, P. A.; TOMSA, R.; SHNEIDER, V; AGASIEV, M.; GANJARA, I; BLANCO, R.; GUNJIC, D.; SIAW-ACHEAMPONG, K.; VESELINOVIC, M.; BABIC, T.; CHIN, T. S.; SHABBIR, A.; KIM, G.; CRNJAC, A.; SAMO, H.; VAL, I. Diez del; LETURIO, S.; WALLNER, B.; HEDBERG, J.; RAMON, J. M.; CERO, M. Dal; RIFA, S.; RICO, M.; POMAR, A. Pagan; CORCOLES, J. A. Martinez; MIRAVALLES, J. L. Rodicio; PAIS, S. A.; TURIENZO, S. A.; ALVAREZ, L. S.; MONIG, S.; SCHNEIDER, P. M.; V, P. Campos; RENDO, A. G.; GARCIA, S. S.; SANTOS, E. P. G.; MARTINEZ, E. T.; DIAZ, M. J. Fernandez; ALVAREZ, C. Magadan; MARTIN, V. Concepcion; LOPEZ, C. Diaz; GUTKNECHT, S.; RODRIGO, A. Rosat; HSU, P. K.; SANCHEZ, L. E. Perez; CUADRADO, M. Bailon; CARRASCO, C. Tinoco; BHOJWANI, E. Choolani; SANCHEZ, D. P.; AHMED, M. E.; DZHENDOV, T.; LINDBERG, F.; TEZ, M.; RUTEGARD, M.; SUNDBOM, M.; ISIK, A.; MICKAEL, C.; COLUCCI, N.; SCHNIDER, A.; ER, S.; KURNAZ, E.; TURKYILMAZ, S.; TURKYILMAZ, A.; GUNER, A.; YILDIRIM, R.; BAKI, B. E.; AKKAPULU, N.; GANANADHA, S.; KARAHAN, O.; DAMBURACI, N.; HARDWICK, R.; SAFRANEK, P.; SUJENDRAN, V; BENNETT, J.; TIRNAKSIZ, T. B.; AFZAL, Z.; SHROTRI, M.; CHAN, B.; EXARCHOU, K.; WILLS, V; GILBERT, T.; AMALESH, T.; MUKHERJEE, D.; MUKHERJEE, S.; WIGGINS, T. H.; COLAK, E.; KENNEDY, R.; MCCAIN, S.; HARRIS, A.; DOBSON, G.; DAVIES, N.; DEVADAS, M.; WILSON, I; MAYO, D.; BENNETT, D.; YOUNG, R.; SEVINC, B.; MANBY, P.; BLENCOWE, N.; SCHILLER, M.; BYRNE, B.; MITTON, D.; WONG, V; DUONG, C.; ELSHAER, A.; COWEN, M.; MENON, V; HINDMARSH, A.; TAN, L. C.; MCLAUGHLIN, E.; KOSHY, R.; SHARP, C.; BREWER, H.; DAS, N.; COX, M.; TALBOT, M.; KHYATT, W. Al; WORKU, D.; KHAN, I; IQBAL, R.; WALLS, L.; MCGREGOR, R.; FULLARTON, G.; MACDONALD, A.; MACKAY, C.; CRAIG, C.; DWERRYHOUSE, S.; HII, M. W.; HORNBY, S.; HILLEGERSBERG, R. van; JAUNOO, S.; WADLEY, M.; BAKER, C.; SAAD, M.; KELLY, M.; DAVIES, A.; MAGGIO, F. Di; MISTRY, P.; SINGHAL, R.; JACOBS, R.; KHOO, D.; TUCKER, O.; KAPOULAS, S.; POWELL-BRETT, S.; DAVIS, P.; BROMLEY, G.; WATSON, L.; VERMA, R.; WARD, J.; SHETTY, V; BALL, C.; BYROM, R.; ANDREOLLO, N. A.; PURSNANI, K.; SARELA, A.; LING, H. Sue; MEHTA, S.; HAYDEN, J.; TO, N.; PALSER, T.; HUNTER, D.; SUPRAMANIAM, K.; GOKHALE, J.; BUTT, Z.; JOHNSTON, B.; AHMED, A.; KUMAR, S.; CHAUDRY, A.; MOUSSA, O.; KORDZADEH, A.; PATIL, P.; NOAMAN, I; WILLEM, J.; WILKERSON, P.; BOURAS, G.; EVANS, R.; DARLING, G.; SINGH, M.; WARRILOW, H.; AHMAD, A.; TEWARI, N.; YANNI, F.; COUCH, J.; THEOPHILIDOU, E.; JAIN, P.; REILLY, J. J.; BOXEL, G. van; AKBARI, K.; ISAZA-RESTREPO, A.; ZANOTTI, D.; SGROMO, B.; SANDERS, G.; WHEATLEY, T.; ARIYARATHENAM, A.; REECE-SMITH, A.; CHAN, D.; HUMPHREYS, L.; CHOH, C.; CARTER, N.; KNIGHT, B.; ROSERO, G.; PUCHER, P.; ATHANASIOU, A.; TAN, B.; ABDULRAHMAN, M.; VICKERS, J.; ROBERTSON, K.; AKHTAR, K.; CHAPARALA, R.; BROWN, R.; ALASMAR, M. M. A.; ACKROYD, R.; ARIAS-AMEZQUITA, F.; PATEL, K.; TAMHANKAR, A.; WYMAN, A.; WALKER, R.; IFTIKHAR, S.; GRACE, B.; ABBASSI, N.; SLIM, N.; IOANNIDI, L.; BLACKSHAW, G.; HAVARD, T.; RAPTIS, D.; ESCOFET, X.; POWELL, A.; OWERA, A.; SKIPWORTH, R.; RASHID, F.; JAMBULINGAM, P.; PADICKAKUDI, J.; BEN-YOUNES, H.; MCCORMACK, K.; MAKEY, I. A.; KARUSH, M. K.; GAEDCKE, J.; SEDER, C. W.; LIPTAY, M. J.; FORSHAW, M.; CHMIELEWSKI, G.; ROSATO, E. L.; BERGER, A. C.; ZHENG, R.; OKOLO, E.; SINGH, A.; SCOTT, C. D.; WEYANT, M. J.; REIM, D.; MITCHELL, J. D.; VOHRA, R.; IZBICKI, J.; EGBERTS, J. H.; DIKINIS, S.; KJAER, D. W.; LARSEN, M. H.; ACHIAM, M. P.; SAARNIO, J.; THEODOROU, D.; LIAKAKOS, T.; KORKOLIS, D. P.; HIGGS, S.; ROBB, W. B.; COLLINS, C.; MURPHY, T.; REYNOLDS, J.; TONINI, V; MIGLIORE, M.; BONAVINA, L.; VALMASONI, M.; BARDINI, R.; WEINDELMAYER, J.; NIJJAR, R.; TERASHIMA, M.; WHITE, R. E.; ALGHUNAIM, E.; ELHADI, M.; LEON-TAKAHASHI, A. M.; MEDINA-FRANCO, H.; LAU, P. C.; OKONTA, K. E.; HEISTERKAMP, J.; ROSMAN, C.; VISWANATH, Y. K. S.; BEBAN, G.; BABOR, R.; GORDON, A.; I, J. Rossaak; I, K. M. Pal; QURESHI, A. U.; NAQI, S. A.; SYED, A. A.; BARBOSA, J.; VICENTE, C. S.; TURNER, P.; LEITE, J.; DEXTER, S.; BODDY, A.; ALLUM, W. H.; OGLESBY, S.; CHEONG, E.; BEARDSMORE, D.; WANIGASOORIYA, K.; MAYNARD, N.; BERRISFORD, R.; MERCER, S.; PUIG, S.; MELHADO, R.; KELTY, C.; UNDERWOOD, T.; DAWAS, K.; LEWIS, W.; AL-BAHRANI, A.; WHITEHOUSE, T.; BRYCE, G.; THOMAS, M.; ARNDT, A. T.; PALAZZO, F.; MEGUID, R. A.; FERGUSSON, J.; BEENEN, E.; MOSSE, C.; SALIM, J.; CHEAH, S.; GJATA, A.; WRIGHT, T.; CERDEIRA, M. P.; MCQUILLAN, P.; RICHARDSON, M.; LIEM, H.; SPILLANE, J.; YACOB, M.; ALBADAWI, F.; THORPE, T.; DINGLE, A.; I, J. Moreno; CABALAG, C.Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on perioperative outcomes in the international multicentre Oesophago-Gastric Anastomosis Audit (OGAA). Analysis of 2232 oesophagectomies has shown that trainee involvement did not negatively impact perioperative outcomes.
- Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy(2021) TAKEDA, Flavio Roberto; SALLUM, Rubens Antonio Aissar; FERNANDES, Felipe Alexandre; CECCONELLO, IvanEsophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.
- Anti-reflux surgery for controlling respiratory symptoms of gastro- esophageal reflux disease: A systematic review and meta-analysis(2021) TUSTUMI, Francisco; BERNARDO, Wanderley Marques; ROCHA, Julio Rafael Mariano da; SZACHNOWICZ, Sergio; SEGURO, Francisco Carlos Bernal da Costa; BIANCHI, Edno Tales; TAKEDA, Flavio Roberto; MIRANDA NETO, Antonio Afonso de; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanGastro-esophageal reflux disease (GERD) patients have a higher prevalence of airway symptoms, such as chronic cough, wheezing, and hoarseness. The therapeutic management of patients with these symptoms is controversial. Therefore, this study aims to perform a systematic review and meta-analysis evaluating the efficacy of anti-reflux surgery for controlling respiratory symptoms related to GERD. A systematic review and meta-analysis was performed. Extraction of the data concerning proportions of participants who were not free of respiratory symptoms related to GERD (cough, wheezing, hoarseness) or not substantially improved at follow-ups (failure to cure) was performed. Of the 3,424 initially screened articles, 68 studies were included for systematic review and 61 were included for meta analysis, with a cumulative sample size of 3,869 patients. Of all the included patients, after anti-reflux surgery, the general symptoms improvement was 80% (95% CI 75.2-84%). The numbers needed to harm (NNH) and the numbers needed to treat (NNT) were 15.21 and 1.23, respectively. Of the included patients, 83.4% (95% CI 78.3-87.5%) patients reported improvement in cough symptoms after surgery. For the wheezing symptom, 71.5% (95% CI 62.9-78.8%) reported improvement after surgery. Moreover, surgery presented better results in improving respiratory symptoms than medical therapy (risk difference:-0.46; 95% CI-0.77,-0.16). Physicians should strongly consider surgical anti-reflux procedures for controlling respiratory symptoms in GERD patients after proper patient selection. Anti-reflux surgery has shown high efficacy in improving respiratory symptoms related to GERD, even when compared to medical therapy. (C) 2020 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.