AFONSO HENRIQUE DA SILVA E SOUSA JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Laparoscopic Total Mesorectal Excision for Rectal Cancer after Neoadjuvant Treatment: Targeting Sphincter-Preserving Surgery(2011) ARAUJO, Sergio Eduardo Alonso; SEID, Victor Edmond; BERTONCINI, Alexandre; CAMPOS, Fabio Guilherme; SOUSA JUNIOR, Afonso; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground/Aims: Laparoscopic total mesorectal excision for rectal cancer is under scrutiny. This study aimed at analyzing feasibility, adequacy of resection, impact on early outcomes after neoadjuvant chemoradiation therapy, and to investigate trend towards indication of laparoscopy for sphincter-preservation in a single university medical center. Methodology: Patients with distal rectal cancer submitted to neoadjuvant treatment followed by laparoscopic total mesorectal excision were prospectively enrolled. The studied parameters were: demographics, previous surgery, BMI, type of operation, rate of sphincter-preserving surgery, duration of surgery, conversion, specimen retrieval, lymphadenectomy, distal and radial margins, intra and postoperative morbidity, reoperations, hospital stay, and mortality. Results: From January 2000 to July 2010, 68 patients were enrolled. Mean age was 60 (30-87) years. There were 27 anterior and 41 abdominoperineal resections. Six patients underwent a totally laparoscopic resection and coloanal anastomosis. There was a trend (p=0.003) towards more sphincter-preserving surgery. Conversion was 4.5%. Intraoperative complication was 7.4%. Postoperative complications occurred in 15%. Mortality was 3%. Lymph-node harvest was 11 (0-33). Mean distal margin was 2.5cm (1-4). Radial margins were positive in 3 (10%) cases. Conclusions: Laparoscopic total mesorectal excision after neoadjuvant treatment is feasible and safe. Sphincter-preserving laparoscopic oncologic rectal surgery has been accomplished more frequently.
- The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment(2021) SOBRADO, Carlos Walter; OBREGON, Carlos de Almeida; SOBRADO, Lucas Faraco; BASSI, Lucas Morales; HORA, Jose Americo Bacchi; SOUSA JUNIOR, Afonso Henrique Silva e; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground: The classification for HD was developed by Goligher in 1980 and does not contemplate important aspects of this disease, which limits its use in guiding treatment. The aim of this study if to apply in clinical practice the new classification for hemorrhoids named BPRST (bleeding, prolapse, reduction, skin tags, thrombosis), to compare it with the original classification proposed by Goligher and to propose an algorithm for treatment. Materials and methods: This is a prospective study conducted at the University of Sao Paulo's teaching hospital and Hospital 9 de Julho. Patients with HD treated from March 2011 to July 2013 were included. Patients were classified according to BPRST and Goligher classifications and treated according to personal experience and most updated guidelines. The association between both classifications and the treatment adopted was compared and an algorithm for treatment was developed. Results: 229 patients were included in this study and 28 patients were lost due to follow-up. According to Goligher, 29, 61, 85 and 26 were classified as grades I, II, III and IV, respectively. According to the BPRST, 23 were classified as stage I, 95 as stage II and 83 as stage III. Six patients classified as Goligher I were reclassified as BPRST stage III and required conventional hemorrhoidectomy, either due to thrombosis (n = 4) or intolerable skin tags (n = 2). The BPRST classification was more closely associated with the type of treatment employed and had few outliers than Goligher (p < 0.001). Conclusion: There are limitations to the use of Goligher's classification in clinical practice. The novel BPRST classification includes important aspects of HD that should be considered when deciding the best treatment option. Our algorithm for treatment contemplates the most commonly used techniques and can help to guide the treatment of this complex disease.
- Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation Long-Term Results of a Prospective Trial (National Clinical Trial 00254683)(2012) PEREZ, Rodrigo Oliva; HABR-GAMA, Angelita; GAMA-RODRIGUES, Joaquim; PROSCURSHIM, Igor; JULIAO, Guilherme Pagin Sao; LYNN, Patricio; ONO, Carla Rachel; CAMPOS, Fabio Guilherme; SOUSA JR., Afonso Henrique Silva e; IMPERIALE, Antonio Rocco; NAHAS, Sergio Carlos; BUCHPIGUEL, Carlos AlbertoBACKGROUND: Neoadjuvant chemoradiation (CRT) therapy may result in significant tumor regression in patients with rectal cancer. Patients who develop complete tumor regression have been managed by treatment strategies that are alternatives to standard total mesorectal excision. Therefore, assessment of tumor response with positron emission tomography/computed tomography (PET/CT) after neoadjuvant treatment may offer relevant information for the selection of patients to receive alternative treatment strategies. METHODS: Patients with clinical T2 (cT2) through cT4NxM0 rectal adenocarcinoma were included prospectively. Neoadjuvant therapy consisted of 54 grays of radiation and 5-fluorouracil-based chemotherapy. Baseline PET/CT studies were obtained before CRT followed by PET/CT studies at 6 weeks and 12 weeks after the completion of CRT. Clinical assessment was performed at 12 weeks after CRT completion. PET/CT results were compared with clinical and pathologic data. RESULTS: In total, 99 patients were included in the study. Twenty-three patients were complete responders (16 had a complete clinical response, and 7 had a complete pathologic response). The PET/CT response evaluation at 12 weeks indicated that 18 patients had a complete response, and 81 patients had an incomplete response. There were 5 false-negative and 10 false-positive PET/CT results. PET/CT for the detection of residual cancer had 93% sensitivity, 53% specificity, a 73% negative predictive value, an 87% positive predictive value, and 85% accuracy. Clinical assessment alone resulted in an accuracy of 91%. PET/CT information may have detected misdiagnoses made by clinical assessment alone, improving overall accuracy to 96%. CONCLUSIONS: Assessment of tumor response at 12 weeks after CRT completion with PET/CT imaging may provide a useful additional tool with good overall accuracy for the selection of patients who may avoid unnecessary radical resection after achieving a complete clinical response. Cancer 2012;35013511. (C) 2011 American Cancer Society.
- A New Classification for Hemorrhoidal Disease: The Creation of the ""BPRST"" Staging and Its Application in Clinical Practice(2020) SOBRADO JUNIOR, Carlos Walter; OBREGON, Carlos de Almeida; SOUSA JUNIOR, Afonso Henrique da Silva e; SOBRADO, Lucas Faraco; NAHAS, Sergio Carlos; CECCONELLO, IvanPurpose: Present an updated classification for symptomatic hemorrhoids, which not only guides the treatment of internal hemorrhoids but also the treatment of external components. In addition, this new classification includes new treatment alternatives created over the last few years. Methods: Throughout the past 7 years, the authors developed a method to classify patients with symptomatic hemorrhoids. This study, besides presenting this classification proposal, also retrospectively analyzed 149 consecutive patients treated between March 2011 and November 2013 and aimed to evaluate the association between the management adopted with Goligher classification and our proposed BPRST classification. Results: Both classifications had a statistically significant association with the adopted management strategies. However, the BPRST classification tended to have fewer management discrepancies when each stage of disease was individually analyzed. Conclusion: Although there is much disagreement about how the classification of hemorrhoidal disease should be updated, it is accepted that some kind of revision is needed. The BPRST method showed a strong association with the management that should be adopted for each stage of the disease. Further studies are needed for its validation, but the current results are encouraging.
- Optimal Timing for Assessment of Tumor Response to Neoadjuvant Chemoradiation in Patients With Rectal Cancer: Do All Patients Benefit From Waiting Longer Than 6 Weeks?(2012) PEREZ, Rodrigo O.; HABR-GAMA, Angelita; JULIAO, Guilherme P. Sao; GAMA-RODRIGUES, Joaquim; SOUSA JR., Afonso H. S.; CAMPOS, Fabio Guilherme; IMPERIALE, Antonio R.; LYNN, Patricio B.; PROSCURSHIM, Igor; NAHAS, Sergio Carlos; ONO, Carla Rachel; BUCHPIGUEL, Carlos AlbertoPurpose: To estimate the metabolic activity of rectal cancers at 6 and 12 weeks after completion of chemoradiation therapy (CRT) by 2-[fluorine-18] fluoro-2-deoxy-D-glucose-labeled positron emission tomography/computed tomography ([18 FDG] PET/CT) imaging and correlate with response to CRT. Methods and Materials: Patients with cT2-4N0-2M0 distal rectal adenocarcinoma treated with long-course neoadjuvant CRT (54 Gy, 5-fluouracil-based) were prospectively studied (ClinicalTrials. org identifier NCT00254683). All patients underwent 3 PET/CT studies (at baseline and 6 and 12 weeks fromCRT completion). Clinical assessment was at 12 weeks. Maximal standard uptakevalue (SUVmax) of the primary tumor wasmeasured and recorded at eachPET/CTstudy after 1 h (early) and3 h (late) from 18 FDGinjection. Patientswith an increase in early SUVmax between 6 and 12 weeks were considered "" bad"" responders and the others as ""good"" responders. Results: Ninety-one patients were included; 46 patients (51%) were ""bad"" responders, whereas 45 (49%) patients were "" good"" responders. "" Bad"" responders were less likely to develop complete clinical response (6.5% vs. 37.8%, respectively; PZ. 001), less likely to develop significant histological tumor regression (complete or near-complete pathological response; 16% vs. 45%, respectively; PZ. 008) and exhibited greater final tumor dimension (4.3cmvs. 3.3cm; PZ. 03). Decrease between early (1 h) and late (3 h) SUVmax at 6-week PET/CTwas a significant predictor of "" good"" response (accuracy of 67%). Conclusions: Patients who developed an increase in SUVmax after 6 weeks were less likely to develop significant tumor downstaging. Early-late SUVmax variation at 6-week PET/CT may help identify these patients and allow tailored selection of CRT-surgery intervals for individual patients. (C) 2012 Elsevier Inc.
bookPart Pólipos colorretais(2014) NAHAS, Sergio Carlos; CASTRO, Vinicius Leite de; JúNIOR, Afonso Henrique da Silva e Sousa; ALVES, Paulo Roberto Arruda; NOVAES, André Luiz de OliveiraconferenceObject Colonoscopic Findings in Patients With Positive Fecal Immunochemical Test During a Pilot Study of Colorectal Cancer Screening in a Western Country: Partial Results(2017) SORBELLO, Mauricio P.; RIBEIRO JR., Ulysses; BASTOS, Victor Rossi Bastos; PFUETZENREITER, Vinicius; SOUSA JR., Afonso Henrique; COHEN, Diane; ALVES, Venancio Avancini; HASHIMOTO, Claudio; NAHAS, Sergio; CECCONELLO, Ivan; NETO, Jose Eluf; SAFATLE-RIBEIRO, Adriana Vaz