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RESUMO Racional: Carcinoma incidental da vesícula biliar é definido como uma neoplasia descoberta por exame histológico após colecistectomia videolaparoscópica. É potencialmente uma doença curável. Entretanto algumas questões relacionadas ao seu manuseio permanecem controversas e uma estratégia definida está associada com melhor prognóstico. Objetivo: Desenvolver o primeiro consenso baseado em evidências para o manuseio de pacientes com carcinoma incidental da vesícula biliar no Brasil. Métodos: Dezesseis questões foram selecionadas e para responder as questões e 36 membros das sociedades brasileiras e internacionais foram incluídos. As recomendações foram baseadas em evidências da literatura atual. Um relatório final foi enviado para os membros do painel para avaliação de concordância. Resultados: Avaliação intraoperatória da peça cirúrgica, uso de bolsas para retirar a peça cirúrgica e exame histopatológico de rotina, foram recomendados. Avaliação pré-operatória completa é necessária e deve ser realizada assim que o estadiamento final esteja disponível. Avaliação da margem do ducto cístico e biópsia de rotina do linfonodo 16b1 são recomendadas. Quimioterapia deve ser considerada e quimioradioterapia indicada se a margem cirúrgica microscópica seja positiva. Os portais devem ser ressecados excepcionalmente. O estadiamento laparoscópico antes da operação é recomendado, mas o tratamento radical por abordagem minimamente invasiva deve ser realizado apenas em centros especializados em cirurgia hepatopancreatobiliar minimamente invasiva. A extensão da ressecção hepática é aceitável até que seja alcançada a ressecção R0. A linfadenectomia padrão é indicada para tumores iguais ou superiores a T2, mas a ressecção da via biliar não é recomendada de rotina. Conclusões: Recomendações seguras foram preparadas para carcinoma incidental da vesícula biliar, destacando os mais frequentes tópicos do trabalho diário do cirurgião do aparelho digestivo e hepatopancreatobiliar.

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

https://doi.org/10.1590/0102-672020190001e1496 2194 downloads

LIVER RESECTION FOR NON-ORIENTAL HEPATOLITHIASIS
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TORRES, Orlando Jorge Martins

; LINHARES, Marcelo Moura

; RAMOS, Eduardo José B

; AMARAL, Paulo Cezar G

; BELOTTO, Marcos

; LUCCHESE, Angelica Maria

; NEIVA, Romerito Fonseca

; FREITAS, Theago Medeiros

; SANTANA, Rodolfo

; VIEIRA, Josiel Paiva

; FREIRE, Jaldo Santos

; TORRES, Camila Cristina S

; KALIL, Antonio Nocchi

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2019, Volume 32 N. 4 elocation e1463

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: Litíase intra-hepática primária é definida quando os cálculos são formados dentro do fígado, podendo estar associada à dilatação local e estenosa da via biliar. A ressecção hepática é considerada o procedimento ideal. Objetivo: Avaliar os resultados da ressecção hepática no tratamento da litíase intra-hepática não oriental. Métodos: Cinquenta e um pacientes com hepatolitíase benigna não oriental sintomática foram submetidos à ressecção hepática em seis instituições no Brazil. Os dados demográficos, sintomas clínicos, classificação, diagnóstico, tratamento e evolução pós-operatória foram analisados. Resultados: Dos 51 pacientes havia 28 homens (54,9%), e a idade média era de 49,3 anos. História de colangite foi observada em 15 pacientes (29,4%). Os tipos de litíase observados foram tipo I em 39 (76,5%) e tipo IIb em 12 (23,5%), com o tipo adicional Ea em seis pacientes (11,8%). Os testes de função hepática estavam normais em 42 (82,4%) e atrofia segmentar foi observada em 12 (23,5%). O tratamento incluiu setorectomia lateral esquerda em 24 (47,1%), hepatectomia esquerda em 14 (27,5%) e hepatectomia direita em oito pacientes (15,7%). A hepaticojejunostomia esteve associada ao procedimento inicial em quatro (7,8%). Hepatectomia por videolaparoscopia foi realizada em oito (15,7%). Complicações pós-operatórias foram observadas em 20 pacientes (39,2%) e não houve mortalidade. Conclusão: Ressecção hepática na hepatolitíase é o procedimento ideal, pois remove os cálculos, a estenose, o parênquima atrofiado e minimiza os riscos para colangiocarcinoma.

ABSTRACT Background: Primary intrahepatic lithiasis is defined when the stones are formed in the liver and associated with local dilatation and biliary stricture. Liver resection is the ideal procedure. Aim: To evaluate the results of liver resection in the treatment of non-oriental intrahepatic lithiasis. Methods: Fifty-one patients with symptomatic benign non-oriental hepatolithiasis underwent surgical resection in six institutions in Brazil. Demography data, clinical symptoms, classification, diagnosis, management and postoperative course were analyzed. Results: Of the 51 patients, 28 were male (54.9%), with a mean age of 49.3 years. History of cholangitis was observed in 15 (29.4%). The types of intrahepatic lithiasis were type I in 39 (76.5%) and type IIb in 12 (23.5%), with additional type Ea in six (11.8%). Liver function test were normal in 42 patients (82.4%). Segmental atrophy was observed in 12 (23.5%). Treatments included left lateral sectionectomy in 24 (47.1%), left hepatectomy in 14 (27.5%) and right hepatectomy in eight (15.7%), with associated hepaticojejunostomy in four (7.8%). Laparoscopic liver resection was performed in eight (15.7%). Postoperative complications were observed in 20 (39.2%) with no mortality. Conclusion: Liver resection in patients with hepatolithiasis is the ideal procedure as it removes stones, stricture, atrophic parenchyma, and minimizes the risk of cholangiocarcinoma.

https://doi.org/10.1590/0102-672020190001e1463 2245 downloads

Quimioterapia Aerossolizada e Pressurizada Intraperitoneal (PIPAC) por monoportal: aplicação alternativa no controle das metástases peritoneais.
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Seitenfus, Rafael

; Kalil, Antonio Nocchi

; de-Barros, Eduardo Dipp

; Fedrizzi, Guilherme

Revista do Colégio Brasileiro de Cirurgiões

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2018, Volume 45 N. 4 elocation e1909

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A carcinomatose peritoneal é a evolução natural das neoplasias gastrointestinais, ginecológicas e primárias do peritônio. Nos últimos anos, a carcinomatose passou a ser considerada uma doença confinada ao peritônio, e não mais uma doença disseminada. Desta forma, a associação de citorredução cirúrgica associada à quimioterapia intraperitoneal se tornou o ponto chave no controle das metástases peritoneais. Tradicionalmente, a quimioterapia intraperitoneal é aplicada utilizando soluções líquidas. Uma nova modalidade de infusão da quimioterapia na cavidade abdominal surge como uma alternativa ao método tradicional. A chamada PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) transforma a solução terapêutica líquida em um spray aerossolizado, potencializando a distribuição e penetração da quimioterapia intraperitoneal. Este relato tem por objetivo descrever essa nova técnica cirúrgica inovadora, realizada pela primeira vez por um monoportal no Brasil, alterando a forma descrita originalmente para a aplicação da PIPAC.

ABSTRACT Peritoneal carcinomatosis is the natural course of gastrointestinal, gynecologic, and primary peritoneal neoplasms. In recent years, our understanding of carcinomatosis has changed; it is no longer considered a disseminated condition, but rather a disease confined to the peritoneum. Thus, the combination of cytoreductive surgery and intraperitoneal chemotherapy has become the cornerstone of control of peritoneal metastases. Traditionally, intraperitoneal chemotherapy is delivered in the form of liquid solutions. However, a new mode of chemotherapy delivery to the abdominal cavity has arisen as an alternative to the conventional method. In Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), the liquid solution is aerosolized into a spray, potentiating the distribution and penetration of the chemotherapeutic agent intraperitoneally. The present study aims to describe a novel form of this innovative surgical technique performed for the first time in Brazil, in a modification of the technique originally described for PIPAC: delivery through a single-port device.

https://doi.org/10.1590/0100-6991e-20181909 6413 downloads

A prototype single-port device for pressurized intraperitoneal aerosol chemotherapy. Technical feasibility and local drug distribution
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Seitenfus, Rafael

; Ferreira, Paulo Roberto Walter

; Santos, Gabriel Oliveira dos

; Alves, Rafael José Vargas

; Kalil, Antonio Nocchi

; Barros, Eduardo Dipp de

; Glehen, Olivier

; Casagrande, Thaís Andrade Costa

; Bonin, Eduardo Aimoré

; Silva Junior, Edison Martins da

Acta Cirúrgica Brasileira

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dec 2017, Volume 32 N. 12 Pages 1056 - 1063

Abstract: En | Text: En | PDF: En

Abstract Purpose: To evaluate the technical feasibility and homogeneity of drug distribution of pressurized intraperitoneal aerosol chemotherapy (PIPAC) based on a novel process of intraperitoneal drug application (multidirectional aerosolization). Methods: This was an in vivo experimental study in pigs. A single-port device was manufactured at the smallest diameter possible for multidirectional aerosolization of the chemotherapeutic drug under positive intraperitoneal pressure. Four domestic pigs were used in the study, one control animal that received multidirectional microjets of 9 mL/sec for 30 min and three animals that received multidirectional aerosolization (pig 02: 9 mL/sec for 30 min; pigs 03 and 04: 3 mL/sec for 15 min). Aerosolized silver nitrate solution was applied for anatomopathological evaluation of intraperitoneal drug distribution. Results: Injection time was able to maintain the pneumoperitoneum pressure below 20 mmHg. The rate of moderate silver nitrate staining was 45.4% for pig 01, 36.3% for pig 02, 36.3% for pig 03, and 72.7% for pig 04. Conclusions: Intra-abdominal drug distribution had a broad pattern, especially in animals exposed to the drug for 30 min. Our sample of only four animals was not large enough to demonstrate an association between aerosolization and a higher silver nitrate concentration in the stained abdominal regions.

https://doi.org/10.1590/s0102-865020170120000007 1040 downloads

Repercussões emocionais da exenteração pélvica feminina: revisão da literatura (2003-2013)
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Haas, Sílvia Abduch

; Levandowski, Daniela Centenaro

; Kalil, Antônio Nocchi

Psicologia, Saúde & Doenças

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aug 2017, Volume 18 N. 2 Pages 614 - 624

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A exenteração pélvica (EP) é uma técnica cirúrgica radical, indicada para tumores avançados de colo de útero e reto, dentre outros. Nesse estudo realizou-se uma revisão sistemática da literatura, com foco em artigos científicos publicados na última década (2003-2013) sobre as repercussões emocionais da EP para a população feminina. Foram localizados 59 artigos nas bases PsycINFO, PubMed, LILACS e SciELO, usando como descritores “exenteração pélvica”, “fatores emocionais”, “sexualidade”, “depressão” e “ansiedade”. Destes, seis artigos (cinco empíricos e um de revisão de literatura) foram considerados para análise, baseada no tema, objetivos do estudo, metodologia e principais resultados e conclusões. Predominou o delineamento quantitativo, com o emprego de instrumentos estruturados em pacientes alemãs, norte-americanas, egípcias e dinamarquesas. Quanto ao tema, destacou-se a qualidade de vida. Os principais achados e conclusões referem-se ao abalo emocional vivido por essas mulheres devido às alterações da imagem corporal após a cirurgia, principalmente pelo uso das ostomias.

Pelvic exenteration (PE) is a radical surgery mostly indicated for advanced cancers of uterus, cervix, and rectum, among others. In this study, a systematic review of the literature was carried out, focusing on scientific papers published in the past decade (2003-2013) about emotional repercussions of PE for female population. A total of 59 articles were found on PubMed, LILACS, SciELO and PsycInfo databases, using the following descriptors: “pelvic exenteration”, “emotional factors”, “sexuality”, “depression” and “anxiety”. Six articles (five empirical and one literature review) were considered for analysis, based on the theme, objectives, methodology, main results, and conclusions. A quantitative research design was predominant; data were collected using structured instruments with German, American, Egyptian and Danish patients. Emphasis was given to quality of life. Main findings and conclusions refer to emotional impact experienced by these women because of changes in their body image after surgery, which included the use of ostomies.

https://doi.org/10.15309/17psd180227 1628 downloads

Oxidative Stress in Human Aorta of Patients with Advanced Aortoiliac Occlusive Disease
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Lucas, Márcio Luís

; Carraro, Cristina Campos

; Belló-Klein, Adriane

; Kalil, Antonio Nocchi

; Aerts, Newton

Brazilian Journal of Cardiovascular Surgery

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dec 2016, Volume 31 N. 6 Pages 428 - 433

Abstract: En | Text: En | PDF: En

Abstract Introduction: Oxidative stress seems to be a role in the atherosclerosis process, but research in human beings is scarce. Objective: To evaluate the role of oxidative stress on human aortas of patients submitted to surgical treatment for advanced aortoiliac occlusive disease. Methods: Twenty-six patients were divided into three groups: control group (n=10) formed by cadaveric organ donors; severe aortoiliac stenosis group (patients with severe aortoiliac stenosis; n=9); and total aortoiliac occlusion group (patients with chronic total aortoiliac occlusion; n=7). We evaluated the reactive oxygen species concentration, nicotinamide adenine dinucleotide phosphate-oxidase, superoxide dismutase and catalase activities as well as nitrite levels in samples of aortas harvested during aortofemoral bypass for treatment of advanced aortoiliac occlusive disease. Results: We observed a higher level of reactive oxygen species in total aortoiliac occlusion group (48.3±9.56 pmol/mg protein) when compared to severe aortoiliac stenosis (33.5±7.4 pmol/mg protein) and control (4.91±0.8 pmol/mg protein) groups (P<0.05). Nicotinamide adenine dinucleotide phosphate oxidase activity was also higher in total aortoiliac occlusion group when compared to the control group (3.81±1.7 versus 1.05±0.31 µmol/min.mg protein; P<0.05). Furthermore, superoxide dismutase and catalase activities were significantly higher in the severe aortoiliac stenosis and total aortoiliac occlusion groups when compared to the control cases (P<0.05). Nitrite concentration was smaller in the severe aortoiliac stenosis group in comparing to the other groups. Conclusion: Our results indicated an increase of reactive oxygen species levels and nicotinamide adenine dinucleotide phosphate-oxidase activity in human aortic samples of patients with advanced aortoiliac occlusive disease. The increase of antioxidant enzymes activities may be due to a compensative phenomenon to reactive oxygen species production mediated by nicotinamide adenine dinucleotide phosphate oxidase. This preliminary study offers us a more comprehensive knowledge about the role of oxidative stress in advanced aortoiliac occlusive disease in human beings.

https://doi.org/10.5935/1678-9741.20160086 694 downloads

BRAZILIAN CONSENSUS FOR MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 3: CONTROVERSIES AND UNRESECTABLE METASTASES
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TORRES, Orlando Jorge Martins

; MARQUES, Márcio Carmona

; SANTOS, Fabio Nasser

; FARIAS, Igor Correia de

; COUTINHO, Anelisa Kruschewsky

; OLIVEIRA, Cássio Virgílio Cavalcante de

; KALIL, Antonio Nocchi

; MELLO, Celso Abdon Lopes de

; KRUGER, Jaime Arthur Pirola

; FERNANDES, Gustavo dos Santos

; QUIREZE JR, Claudemiro

; MURAD, André M.

; SILVA, Milton José de BARROS E

; ZURSTRASSEN, Charles Edouard

; FREITAS, Helano Carioca

; CRUZ, Marcelo Rocha

; WESCHENFELDER, Rui

; LINHARES, Marcelo Moura

; CASTRO, Leonaldson dos Santos

; VOLLMER, Charles

; DIXON, Elijah

; RIBEIRO, Héber Salvador de Castro

; COIMBRA, Felipe José Fernandez

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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sep 2016, Volume 29 N. 3 Pages 173 - 179

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Neste último módulo do consenso, abordou-se alguns temas controversos. O primeiro tópico discutido foi o manejo da doença após progressão na primeira linha de quimioterapia, com foco em se ainda haveria indicação cirúrgica neste cenário. A seguir, o painel debruçou-se sobre as situações de ressecção da doença hepática na presença de doença extra-hepática, assim como, qual a melhor sequência de tratamento. O tratamento de conversão para doença inicialmente irressecável também foi abordado neste módulo, incluindo as importantes definições de quando se pode esperar que a doença se torne ressecável e quais esquemas terapêuticos seriam mais efetivos à luz dos conhecimentos atuais sobre a biologia tumoral e taxas de resposta objetiva. Por último, o tratamento da doença não passível de ressecção foi discutida, focando-se nos melhores esquemas a serem empregados e seu sequenciamento, bem como o papel da quimioembolização no manejo destes pacientes.

ABSTRACT In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization.

https://doi.org/10.1590/0102-6720201600030011 5210 downloads

Oxidative stress in carotid arteries of patients submitted to carotid endarterectomy. The role of aging process
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Lucas, Márcio Luís

; Carraro, Cristina Campos

; Belló-Klein, Adriane

; Kalil, Antônio Nocchi

; Aerts, Newton

Acta Cirúrgica Brasileira

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aug 2016, Volume 31 N. 8 Pages 564 - 568

Abstract: En | Text: En | PDF: En

ABSTRACT PURPOSE: To evaluated the role of oxidative stress on aging process in patients submitted to carotid endarterectomy. METHODS: Twenty patients were divided into two groups: older group (≥ 70 years old); and the younger group (< 70 years old). We evaluated the reactive oxygen species (ROS) concentration, nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase, superoxide dismutase (SOD) and catalase (CAT) activities as so as nitrite levels in fragments of carotid arteries harvested during carotid endarterectomy for treatment of high grade carotid stenosis. RESULTS: We observed a higher levels of ROS and NADPH oxidase activity in the older group (p<0.05). Furthermore, the nitrite concentration was lower in the older group (14.55 ± 5.61 x 10-3 versus 26.42 ± 8.14 x 10-3 µM; p=0.0123). However, the activities of antioxidant enzymes (CAT and SOD) were similar in both the groups. CONCLUSIONS : Arterial aging is associated with increased concentrations of oxygen species and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity as so as nitrite reduction in human carotid artery specimens. Maybe therapies that block NADPH oxidase activity and enhance nitrite stores would be a good strategy to reduce the effect of oxidative stress in arterial aging.

https://doi.org/10.1590/S0102-865020160080000010 1080 downloads

I BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 2: APPROACH TO RESECTABLE METASTASES
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RIBEIRO, Héber Salvador de Castro

; TORRES, Orlando Jorge Martins

; MARQUES, Márcio Carmona

; HERMAN, Paulo

; KALIL, Antonio Nocchi

; FERNANDES, Eduardo de Souza Martins

; OLIVEIRA, Fábio Ferreira de

; CASTRO, Leonaldson dos Santos

; HANRIOT, Rodrigo

; OLIVEIRA, Suilane Coelho Ribeiro

; BOFF, Marcio Fernando

; COSTA Jr, Wilson Luiz da

; GIL, Roberto de Almeida

; PFIFFER, Tulio Eduardo Flesch

; MAKDISSI, Fabio Ferrari

; ROCHA, Manoel de Souza

; AMARAL, Paulo Cezar Galvão do

; COSTA, Leonardo Atem Gonçalves de Araújo

; ALOIA, Tomas A.

; D'ALBUQUERQUE, Luiz Augusto Carneiro

; COIMBRA, Felipe José Fernandez

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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mar 2016, Volume 29 N. 1 Pages 9 - 13

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Racional: As metástases hepáticas de câncer colorretal são evento frequente e potencialmente fatal na evolução dos pacientes. Objetivo : No segundo módulo desse consenso, foi discutido o manejo de metástases hepáticas ressecáveis. Método : Foi definido o conceito de metástases síncrônicas e metacrônicas, e ambos os cenários foram discutidos separadamente de acordo com as suas peculiaridades prognósticas e terapêuticas. Resultados : Foi dada especial atenção às missing metástases em resposta ao tratamento pré-operatório sistêmico, com ênfase em estratégias para evitar sua recorrência e como gerenciar as lesões desaparecidas. Conclusão : Foram apresentadas e validadas estratégias de ressecção em várias circunstâncias, para serem aplicadas na prática clínica.

Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients. Aim : In the second module of this consensus, management of resectable liver metastases was discussed. Method : Concept of synchronous and metachronous metastases was determined, and both scenarius were discussed separately according its prognostic and therapeutic peculiarities. Results : Special attention was given to the missing metastases due to systemic preoperative treatment response, with emphasis in strategies to avoid its reccurrence and how to manage disappeared lesions. Conclusion : Were presented validated ressectional strategies, to be taken into account in clinical practice.

https://doi.org/10.1590/0102-6720201600010003 4172 downloads

10.

FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION
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COIMBRA, Felipe José Fernandez

; RIBEIRO, Heber Salvador de Castro

; MARQUES, Márcio Carmona

; HERMAN, Paulo

; CHOJNIAK, Rubens

; KALIL, Antonio Nocchi

; WIERMANN, Evanius Garcia

; CAVALLERO, Sandro Roberto de Araújo

; COELHO, Fabricio Ferreira

; FERNANDES, Paulo Henrique de Souza

; SILVESTRINI, Anderson Arantes

; ALMEIDA, Maria Fernanda Arruda

; ARAÚJO, Antônio Luis Eiras de

; PITOMBO, Marcos

; TEIXEIRA, Heberton Medeiros

; WAECHTER, Fábio Luiz

; FERREIRA, Fábio Gonçalves

; DINIZ, Alessandro Landskron

; D'IPPOLITO, Giuseppe

; BEGNAMI, Maria Dirlei F. de Sousa

; PROLLA, Gabriel

; BALZAN, Silvio Márcio Pegoraro

; OLIVEIRA, Thiago Bueno de

; SZULTAN, Luís Arnaldo

; LENDOIRE, Javier

; TORRES, Orlando Jorge Martins

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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dec 2015, Volume 28 N. 4 Pages 222 - 230

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Racional : As metástases hepáticas de câncer colorretal são evento frequente e potencialmente fatal na evolução de pacientes com estas neoplasias. Objetivo : Neste módulo procurou-se contextualizar esta situação clínica, bem como parametrizar dados epidemiológicos e de resultados das diversas modalidades de tratamento estabelecidas. Método : Foi realizada discussão sobre como detectar e estadiar o câncer colorretal metastático, bem como o emprego dos métodos de imagem na avaliação de resposta ao tratamento sistêmico instituído. Resultado : Fundamentou na definição de quais pacientes teriam suas metástases consideradas ressecáveis e de como se poderia ampliar a gama de pacientes submetidos às modalidades de tratamento ditas de intuito curativo. Conclusão : Foram apresentados os fatores prognósticos clínicos, patológicos e moleculares com validação para serem levados em consideração na prática clínica.

Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. Results : The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.

https://doi.org/10.1590/s0102-6720201500040002 5011 downloads

11.

The association between preoperative chemotherapy and the prevalence of hepatic steatosis in hepatectomy for metastatic colorectal cancer
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KALIL, Antonio Nocchi

; CORAL, Gabriela Perdomo

; SANTOS, Félix Antônio Insaurriaga dos

; GONZALEZ, Maria Cristina

; NEUTZLING, Cristiane Becker

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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jun 2014, Volume 27 N. 2 Pages 120 - 125

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RACIONAL: Alguns estudos sugerem que a quimioterapia pré-operatória para metástases hepáticas do câncer colorretal pode causar dano celular e aumentar morbidade e mortalidade. OBJETIVO: Analisar a prevalência de esteatose hepática em fígados de pacientes expostos à quimioterapia pré-operatória por metástase de câncer colorretal. MÉTODOS: O delineamento do estudo foi observacional de coorte retrospectivo, no qual 166 pacientes foram submetidos a 185 hepactectomias por metástase de câncer colorretal, com e sem quimioterapia pré-operatória, no período de 2004 a 2011. Os dados foram extraídos da revisão dos prontuários e da análise do laudo anatomopatológico da parte não tumoral da peça cirúrgica. A amostra foi dividida em grupo exposto e não-exposto à quimioterapia. Os dados foram analisados por programa estatístico Stata 11.2, e aplicado o teste exato de Fischer para análise bivariada, e a regressão de Poisson, para análise multivariada; valores p< 0,05 foram considerados como significativos. RESULTADOS: Das hepatectomias, 136 casos (73,5%) receberam quimioterapia pré-operatória, e o regime mais utilizado (62,5%) foi 5-fluorouracila+leucovorin. No grupo exposto, a lesão hepatocelular esteve presente em 62% dos casos e correspondeu a risco de 40% em relação ao grupo não-exposto. O padrão histológico da lesão hepatocelular predominante foi a esteatose, em 51% de casos do grupo exposto. A exposição à quimioterapia aumentou em 2,2 vezes a possibilidade de esteatose. Entretanto, quando foram controlados os fatores de risco, somente a hepatopatia prévia esteve associada à presença de esteatose após quimioterapia com risco relativo de 4 (2,7-5,9). CONCLUSÕES: Pacientes expostos à quimioterapia têm risco 2,2 maior de desenvolver esteatose, e sua prevalência está associada à presença de fatores predisponentes, como risco de hepatopatia prévia.

BACKGROUND: Some studies have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury and increase perioperative morbidity and mortality. AIM: To evaluate the prevalence of hepatic steatosis in patients undergoing preoperative chemotherapy for metastatic colorectal cancer. METHODS: Observational retrospective cohort study in which 166 patients underwent 185 hepatectomies for metastatic colorectal cancer with or without associated preoperative chemotherapy from 2004 to 2011. The data were obtained from a review of the medical records and an analysis of the anatomopathological report on the non-tumor portion of the surgical specimen. The study sample was divided into two groups: those who were exposed and those who were unexposed to chemotherapy. RESULTS: From the hepatectomies, 136 cases (73.5%) underwent preoperative chemotherapy, with most (62.5%) using a regimen of 5-fluorouracil + leucovorin. A 40% greater risk of cell damage was detected in 62% of the exposed group. The predominant histological pattern of the cell damage was steatosis, which was detected in 51% of the exposed cases. Exposure to chemotherapy increased the risk of steatosis by 2.2 fold. However, when the risk factors were controlled, only the presence of risk of hepatopathy was associated with steatosis, with a relative risk of 4 (2.7-5.9). CONCLUSION: Patients exposed to chemotherapy have 2.2 times the risk of developing hepatic steatosis, and its occurrence is associated with the presence of predisposing factors such as diabetes mellitus and hepatopathy.

https://doi.org/10.1590/S0102-67202014000200008 3023 downloads

12.

Hepatectomia em pacientes idosos
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Laporte, Gustavo Andreazza

; Kalil, Antônio Nocchi

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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jun 2013, Volume 26 N. 2 Pages 136 - 139

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A expectativa de vida da população tem aumentado nos últimos anos, como também houve progressão da incidência de neoplasias primárias e secundárias do fígado. A medicina vem acompanhando esse processo, mas ainda há receios quanto ao uso de tratamentos cirúrgicos agressivos em pacientes idosos, especialmente no que tange à cirurgia do fígado. OBJETIVO: Analisar a influência da idade na morbimortalidade de pacientes submetidos à ressecção hepática. MÉTODOS: Revisão bilbliográfica através dos sites do PubMed, Scielo e Bireme, com os descritores "elderly", "hepatectomy", "hepatic resection", "postoperative complications", "morbidity", "mortality". Foram selecionados os trabalhos que compararam os resultados de hepatectomia entre grupos de pacientes jovens e idosos. CONCLUSÃO: A idade não é fator predisponente à piora dos resultados na ressecção hepática.

INTRODUCTION: Life expectancy of the population has increased in recent years as a result of human development, leading to an increase in the incidence of primary and secondary neoplasms of the liver. Medicine has been following this process, but there is still fear of aggressive surgical treatment in elderly patients, especially concerning to liver surgery. AIM: To analyze the influence of age on the morbidity and mortality of patients undergoing liver resection. METHOD: Literature review of scientific articles available in PubMed, Scielo and Bireme database with "elderly", "hepatectomy," "hepatic resection," "postoperative complications", "morbidity", "mortality". It was selected studies that compared the results of hepatectomy between groups of young and elderly patients. CONCLUSION: Age is not a predisposing factor for the worsening of results in liver resection.

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13.

Paraganglioma de pâncreas: relato de caso e revisão da literatura
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Kalil, Antônio Nocchi

; Laporte, Gustavo Andreazza

; Barra, Marinez Bizarro

; Remonti, Tiago Auatt Paes

; Cunha, Felipe Rodrigues

; Seitenfus, Rafael

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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dec 2010, Volume 23 N. 4 Pages 289 - 290

Abstract: Pt | Text: Pt | PDF: Pt

3395 downloads

14.

Leiomioma hepático em paciente imunocompetente
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Kalil, Antonio Nocchi

; Ferreira, Marcelo Tonding

; Ressler, Fernando

; Zettler, Cláudio

Revista do Colégio Brasileiro de Cirurgiões

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aug 2009, Volume 36 N. 4 Pages 362 - 363

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Diagnosis and treatment of hepatic tumors are a challenge for the surgeon in some situations. There are many histologic types of these neoplasms, and their diagnoses are increasing. Leyomioma of the liver is a rare pathology that is presented in this article in a 44 years old woman without immunosuppression. A review about its clinical aspects, image diagnosis and surgical therapy is discussed, based on the world medical literature.

1685 downloads

15.

Hepatectomia para metástases hepáticas de câncer de mama
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Kalil, Antonio Nocchi

; Severa, Camila

Revista do Colégio Brasileiro de Cirurgiões

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oct 2005, Volume 32 N. 5 Pages 285 - 286

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Patients with metastatic breast cancer, whereas liver is the only site of dissemination, may benefit from hepatectomy. Literature suggests that surgical treatment of these metastases may offer a longer survival rate than systemic chemotherapy and/or isolated homonal therapy. We report two cases of hepatic resection for liver metastases from breast cancer, with survival of 11 and 16 months without recurrence. One patient had a single metastases and the other two. No post-operative complications were observed.

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