IVAN CECCONELLO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
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- PROGNOSTIC FACTORS AND SURVIVAL ANALYSIS IN ESOPHAGEAL CARCINOMA(2016) TUSTUMI, Francisco; KIMURA, Cintia Mayumi Sakurai; TAKEDA, Flavio Roberto; UEMA, Rodrigo Hideki; SALUM, Rubens Antonio Aissar; RIBEIRO-JUNIOR, Ulysses; CECCONELLO, IvanBackground: Despite recent advances in diagnosis and treatment, esophageal cancer still has high mortality. Prognostic factors associated with patient and with disease itself are multiple and poorly explored. Aim: Assess prognostic variables in esophageal cancer patients. Methods: Retrospective review of all patients with esophageal cancer in an oncology referral center. They were divided according to histological diagnosis (444 squamous cell carcinoma patients and 105 adenocarcinoma), and their demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival. Results: No difference was noted between squamous cell carcinoma and esophageal adenocarcinoma overall survival curves. Squamous cell carcinoma presented 22.8% survival after five years against 20.2% for adenocarcinoma. When considering only patients treated with curative intent resection, after five years squamous cell carcinoma survival rate was 56.6 and adenocarcinoma, 58%. In patients with squamous cell carcinoma, poor differentiation histology and tumor size were associated with worse oncology stage, but this was not evidenced in adenocarcinoma. Conclusion: Weight loss (kg), BMI variation (kg/m(2)) and percentage of weight loss are factors that predict worse stage at diagnosis in the squamous cell carcinoma. In adenocarcinoma, these findings were not statistically significant.
- Worldwide Esophageal Cancer Collaboration: neoadjuvant pathologic staging data(2016) RICE, T. W.; LERUT, T. E. M. R.; ORRINGER, M. B.; CHEN, L. -Q.; HOFSTETTER, W. L.; SMITHERS, B. M.; RUSCH, V. W.; LANSCHOT, J. van; CHEN, K. N.; DAVIES, A. R.; D'JOURNO, X. B.; KESLER, K. A.; LUKETICH, J. D.; FERGUSON, M. K.; RASANEN, J. V.; HILLEGERSBERG, R. van; FANG, W.; DURAND, L.; ALLUM, W. H.; CECCONELLO, I.; CERFOLIO, R. J.; PERA, M.; GRIFFIN, S. M.; BURGER, R.; LIU, J. -F.; ALLEN, M. S.; LAW, S.; WATSON, T. J.; DARLING, G. E.; SCOTT, W. J.; DURANCEAU, A.; DENLINGER, C. E.; SCHIPPER, P. H.; ISHWARAN, H.; APPERSON-HANSEN, C.; DIPAOLA, L. M.; SEMPLE, M. E.; BLACKSTONE, E. H.To address uncertainty of whether pathologic stage groupings after neoadjuvant therapy (ypTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report datasimple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survivalfor pathologically staged cancers after neoadjuvant therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 7,773 pathologically staged neoadjuvant patients, 2,045 had squamous cell carcinoma, 5,686 adenocarcinoma, 31 adenosquamous carcinoma, and 11 undifferentiated carcinoma. Patients were older (61 years) men (83%) with normal (40%) or overweight (35%) body mass index, 0-1 Eastern Cooperative Oncology Group performance status (96%), and a history of smoking (69%). Cancers were ypT0 (20%), ypT1 (13%), ypT2 (18%), ypT3 (44%), ypN0 (55%), ypM0 (94%), and G2-G3 (72%); most involved the distal esophagus (80%). Non-risk-adjusted survival for yp categories was unequally depressed, more for earlier categories than later, compared with equivalent categories from prior WECC data for esophagectomy-alone patients. Thus, survival of patients with ypT0-2N0M0 cancers was intermediate and similar regardless of ypT; survival for ypN+ cancers was poor. Because prognoses for ypTNM and pTNM categories are dissimilar, prognostication should be based on separate ypTNM categories and groupings. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics and should direct 9th edition data collection.
article 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 Clinicopathologic features and surgical outcome of Gastric Stump Cancer(2016) OLIVEIRA, Rodrigo José de; CHARRUF, Amir Zeide; JACOB, Carlos Eduardo; DANTAS, Anna Carolina B.; RAMOS, Marcus Kodama P.; DIAS, André Roncon; YAGI, Osmar; MUCERINO, Donato; MESTER, Marcelo; BRESCIANI, Cláudio; LOPASSO, Fábio; ZILBERSTEIN, Bruno; CECONELLO, 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, IvanconferenceObject OUTCOMES OF NONSURGICAL TREATMENT IN PATIENTS WITH CLINICAL COMPLETE RESPONSE AFTER NEOADJUVANT THERAPY FOR RECTAL CANCER.(2016) COTTI, G.; NAHAS, C.; MARQUES, C.; IMPERIALE, A.; RIBEIRO JUNIOR, U.; NAHAS, S.; CECCONELLO, I.; HOFF, P.- The life of John Cedric Goligher (1912-1998) revisited(2016) CAMPOS, Fabio Guilherme; NAHAS, Sergio Carlos; CECCONELLO, IvanJohn Cedric Goligher was one of the great figures in British surgery. Although he practised general surgery as well, the medical community around the world elected him the pre-eminent colon and rectal surgeon of his time. Technically he was considered a master surgeon with enormous personal experience that was expressed in many papers and books written throughout his life. As the Chairman of the University Department of Surgery at the General Infirmary at Leeds, he developed many prospective controlled studies that granted him a national and international reputation. This paper aims to render him posthumous credit by remembering his career, literature contributions and the importance of his legacy to the surgical community.
- Carnoy's solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial(2016) DIAS, Andre Roncon; PEREIRA, Marina Alessandra; MELLO, Evandro Sobroza; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; RIBEIRO JUNIOR, UlyssesPathological examination of a minimum of 16 lymph nodes is recommended following surgery for gastric adenocarcinoma, despite this a longer survival is expected when 30 or more lymph nodes are examined. Small lymph nodes are difficult to identify, and fat-clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit. Fifty D2 subtotal gastrectomy specimens were randomized for fixation in Carnoy's solution (CS) or 10 % neutral buffered formalin (NBF), with subsequent fat dissection. After dissection, the residual fat from the NBF group, instead of being discarded, was immersed in CS and dissected again. Data from 25 D2 subtotal gastrectomies performed before the study were also analyzed. The mean number of examined lymph nodes was 50.4 and 34.8 for CS and NBF, respectively (p < 0.001). Missing lymph nodes were found in all cases from the residual fat group (mean of 16.9), and in eight of them (32 %) metastatic lymph nodes were present; this allowed the upstaging of two patients. Lymph nodes in the CS group were smaller than those in the NBF group (p = 0.01). The number of retrieved lymph nodes was similar among the NBF and Retrospective groups (p = 0.802). Compared with NBF, CS increases lymph node detection following gastrectomy and allows a more accurate pathological staging. No influence of the research protocol on the number of examined lymph nodes was observed.
- Transabdominal midline reconstruction by minimally invasive surgery: technique and results(2016) COSTA, T. N.; ABDALLA, R. Z.; SANTO, M. A.; TAVARES, R. R. F. M.; ABDALLA, B. M. Z.; CECCONELLO, I.The introduction of the minimally invasive approach changed the way abdominal surgery was carried out. Open suture and mesh reinforcement in ventral hernia repair used to be the surgeon's choice of procedure. Although the laparoscopic approach, with defect bridging and mesh fixation, has been described since 1993, the procedure remains largely unchanged. Evidence shows that defect closure and retro-muscular mesh positioning have the best outcomes and are the best surgical practice. We therefore aimed to develop and demonstrate a procedure which combined the good results of open surgery using the Rives-Stoppa principles, particularly in terms of recurrence, with all the benefits of minimally invasive surgery. Between October 2012 and February 2014, 15 post-bariatric surgery patients underwent laparoscopic midline incisional hernia repair. The peritoneal cavity was accessed through a 5-mm optical view cannula at the superior left quadrant. A suprapubic and two right and left lower quadrant cannulas were inserted for inferior access and dissection. The defect adhesions were released. The whole midline was closed with an endoscopic linear stapler, including the defect, from the lower abdomen, 4 cm below the umbilicus, until the epigastric region, including posterior sheath mechanical suturing and cutting in the same movement. A retrorectus space was created in which a retro-muscular mesh was deployed. Fixation was done using a hernia stapler against the posterior sheath from the peritoneal cavity to the abdominal wall muscles. Selection was based on xifo-umbilical incisional midline hernias post open bariatric surgery. Pregnant women, cancer patients, or patients with clinical contraindications were excluded. The patients mean age was 51.2 years (range 39-67). Four patients were men and eleven women. Two had well-compensated fibromyalgia, four had diabetes, and five had hypertension. The mean BMI was 29.5 kg/m(2) (range 23-31.6). Surgery was performed successfully in all cases through four ports; the number of incisional hernias was 3 +/- A 2, with a mean maximum width of 3.75 cm (range 2.1-9) and maximum length of 14 cm (7.5-20.5). The mean surgical time was 114.3 min (range 85-170), and the median hospital stay was 1.4 days. No intra-operative or immediate post-operative complication or death occurred. One patient had a seroma treated conservatively 1 week after surgery and another had a retro-muscular infection treated with percutaneous drainage. CT-Scans made before and after the procedure, showed total closure of the defect. QOL questionnaire showed satisfaction, acceptance, and no complaints. Although the study involved a small number of patients, it has proved the technique to be feasible, easy to perform, and have the combined benefits of laparoscopic and open surgery. The results, shown by CT-scan, peri-operative, and QOL findings, were good.
conferenceObject Prognostic Factors for Recurrence of Sporadic Pancreatic Neuroendocrine Tumors after Surgical Resection(2016) FIGUEIRA, E. R. R.; BACCHELLA, T.; JUREIDINI, R.; CUNHA, J. E. M.; NAMUR, G. N.; RIBEIRO, T. C.; OKUBO, J.; V, A. G. Fernandes; CECCONELLO, I