RUBENS ANTONIO AISSAR SALLUM
Projetos de Pesquisa
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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- Robot-assisted cervical esophagectomy: first clinical experiences and review of the literature(2020) CHIU, Philip Wai-Yan; GROOT, Eline Marieke de; YIP, Hon-Chi; EGBERTS, Jan-Hendrik; GRIMMINGER, Peter; SETO, Yasuyuki; UYAMA, Ichiro; SLUIS, Pieter Christiaan van der; STEIN, Hubert; SALLUM, Rubens; RUURDA, Jelle P.; HILLEGERSBERG, Richard vanPulmonary complications, and especially pneumonia, remain one of the most common complications after esophagectomy for esophageal cancer. These complications are reduced by minimally invasive techniques or by avoiding thoracic access through a transhiatal approach. However, a transhiatal approach does not allow for a full mediastinal lymphadenectomy. A transcervical mediastinal esophagectomy avoids thoracic access, which may contribute to a decrease in pulmonary complications after esophagectomy. In addition, this technique allows for a full mediastinal lymphadenectomy. A number of pioneering studies have been published on this topic. Here, the initial experience is presented as well as a review of the current literature concerning transcervical esophagectomy, with a focus on the robot-assisted cervical esophagectomy procedure.
- Induction Chemotherapy for Locally Advanced Esophageal Cancer(2020) HARADA, Guilherme; BONADIO, Renata Rodrigues da Cunha Colombo; ARAUJO, Frederico Cantarino Cordeiro de; VICTOR, Carolina Ribeiro; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; CECCONELLO, Ivan; TAKEDA, Flavio Roberto; CASTRIA, Tiago Biachi deBackground Concurrent chemoradiotherapy followed by surgery is the standard treatment for locally advanced esophageal cancer (EC), and the role of induction chemotherapy (IC) remains unclear. We aimed to study if the addition of IC to standard treatment increases the rate of pathologic complete response (pCR). Methods We assembled a retrospective analysis of patients (pts) diagnosed with locally advanced EC and treated with preoperative chemoradiotherapy followed by esophagectomy (CRT+S), preceded or not by IC, between 2009 and 2017. Patients' characteristics, tumor variables, and treatment outcomes were evaluated. The Kaplan-Meier method was used to estimate overall survival and the Cox proportional hazard model to evaluate prognostic factors. Results One hundred and three patients were studied, with a median age of 62 years (range 37-84). Seventy-five patients (73%) were male, 67 (65%) had squamous cell carcinoma, and 31 (30%) had adenocarcinoma. Forty-three patients (41.7%) received IC followed by CRT+S (IC+CRT+S). The most frequent IC consisted of paclitaxel and platinum chemotherapy (90%), and the median number of cycles was 2. All patients received CRT+S. Concurrent chemotherapy was a combination of paclitaxel and platinum in 94 patients (91%). There was no statistically significant difference in pCR between the IC group and the standard CRT+S group. The pCR was 41.9% and 46.7% in the IC+CRT+S and CRT+S groups (p = 0.628), respectively. In the multivariate analysis, pCR was an independent prognostic factor for time to treatment failure (TTF) (HR 0.35, p = 0.021), but not for overall survival (OS) (p = 0.863). The factor that significantly affected OS in the multivariate analysis was positive lymph node (HR 5.9, 95%, p = 0.026). Conclusions Our data suggest that the addition of IC to standard CRT + S does not increase the pCR rate in locally advanced EC. No difference in OS was observed between pts. that received or not IC. Regardless of the treatment received, pts. achieving a pCR presented improved TTF.
- 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.
conferenceObject Robotic-assisted (RAMIE) x thoracoscopic esophagectomy (MIE): Comparison on safety and lymph nodal dissection in 181 cases.(2018) SALLUM, Rubens Antonio Aissar; TAKEDA, Flavio Roberto; SANTO, Marco Aurelio; CECCONELLO, Ivan- Esophageal achalasia: a risk factor for carcinoma. A systematic review and meta-analysis(2017) TUSTUMI, F.; BERNARDO, W. M.; ROCHA, J. R. M. da; SZACHNOWICZ, S.; SEGURO, F. C.; BIANCHI, E. T.; SALLUM, R. A. A.; CECCONELLO, I.Achalasia of the cardia is associated with an increased risk of esophageal carcinoma. The real burden of achalasia at the malignancy genesis is still a controversial issue. Therefore, there are no generally accepted recommendations on follow-up evaluation for achalasia patients. This study aims to estimate the risk of esophageal adenocarcinoma and squamous cell carcinoma in achalasia patients. We searched for association between carcinoma and esophageal achalasia in databases up to January 2017 to perform a systematic review and meta-analysis. A total of 1,046 studies were identified from search strategy, of which 40 were selected for meta-analysis. A cumulative number of 11,978 esophageal achalasia patients were evaluated. The incidence of squamous cell carcinoma was 312.4 (StDev 429.16) cases per 100,000 patient-years at risk. The incidence of adenocarcinoma was 21.23 (StDev 31.6) cases per 100,000 patient-years at risk. The prevalence for esophageal carcinoma was 28 carcinoma cases in 1,000 esophageal achalasia patients (CI 95% 2, 39). The prevalence for squamous cell carcinoma was 26 cases in 1,000 achalasia patients (CI 95% 18, 39) and for adenocarcinoma was 4 cases in 1,000 achalasia patients (CI 95% 3, 6). The absolute risk increase for squamous cell carcinoma was 308.1 and for adenocarcinoma was 18.03 cases per 100,000 patients per year. To the best of our knowledge, this is the first meta-analysis estimating the burden of achalasia as an esophageal cancer risk factor. The high increased risk rate for cancer in achalasia patients points to a strict endoscopic surveillance for these patients. Also, the increased risk for developing adenocarcinoma in achalasia patients suggests fundoplication after myotomy, to avoid esophageal reflux and Barret esophagus, a known risk factor for adenocarcinoma.
- 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.
- Long-term results of an endoscopic screening program for superficial esophageal cancer in patients with head and neck squamous cell carcinoma(2022) MOURA, Renata Nobre; KUBOKI, Yeda; BABA, Elisa Ryoka; SAFATLE-RIBEIRO, Adriana; MARTINS, Bruno; PAULO, Gustavo Andrade de; TOLENTINO, Luciano Lenz; LIMA, Marcelo Simas de; KULCSAR, Marco Aurelio; SALLUM, Rubens Antonio Aissar; JR, Ulysses Ribeiro; MALUF-FILHO, FauzeBackground and study aims Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of a second primary tumor in the gastrointestinal tract, most commonly in the esophagus. Screening these patients for esophageal carcinoma may help detect asymptomatic dysplasia and early cancer, thus allowing curative treatment and more prolonged survival, but the impact of endoscopic screening remains uncertain. Here we aimed to describe the long-term results of an esophageal SCC screening program in patients with head and neck cancer in terms of prevalence, associated risk factors, and survival. Patients and methods We performed an observational study of a prospectively collected database including patients with HNSCC who had undergone high-definition endoscopy with chromoscopy between 2010 and 2018 at a Brazilian tertiary academic center. Results The study included 1,888 patients. The esophageal SCC prevalence was 7.9 %, with the majority (77.8 %) being superficial lesions. Significant risk factors for esophageal high-grade dysplasia (HGD) and invasive cancer included tumors of the oral cavity and oropharynx and the presence of low-grade dysplasia (LGD). Overall survival (OS) was significantly shorter among patients in whom esophageal cancer was diagnosed at an advanced stage (P < .001). OS did not significantly differ between patients with HGD and early esophageal cancer versus those without esophageal cancer (P = .210) Conclusions Endoscopic screening for superficial esophageal neoplasia in patients with HNSCC improves esophageal cancer detection. Screening could potentially benefit patients with primary cancer located at the oropharynx or oral cavity. In addition, the detection of esophageal LGD indicates a need for endoscopic surveillance.
conferenceObject Can an Effective Nissen Fundoplication Improve the Weak Motility of Barrett's Esophagus?(2013) FALCAO, Angela; SZACHNOWICZ, Sergio; SALLUM, Rubens A.; SEGURO, Francisco C.; NASI, Ary; ROCHA, Julio R.; CECCONELLO, IvanbookPart Doença do Refluxo Gastroesofágico(2013) NASI, Ary; SALLUM, Rubens Antônio Aissar; SANTO, Marco Aurelio; CECCONELLO, Ivan- 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.