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Histologyassessmentofbipolarcoagulationandargonplasmacoagulationon digestivetract

World Journal of Gastrointestinal Endoscopy 2014年第7期6卷 304-311页

作者： Garrido T Baba ER Wodak S Sakai P cecconello i Maluf-Filho F Teresa Garrido Elisa R Baba Stephanie Wodak Paulo Sakai Ivan Cecconello Fauze Maluf-Filho Endoscopy Division and Gastrointestinal Surgery Division Hospital das Clinicas of the University of S?o Paulo S?o Paulo SP 05403-000 Brazil

AiM: To analyze the effect of bipolar electrocoagula-tion and argon plasma coagulation on fresh specimens of gastrointestinal tract. METHODS: An experimental evaluation was performed at Hospital das Clinicas of the University of So Paulo, on 31 fresh surgical specimens using argon plasma coagulation and bipolar electrocoagulation at different time intervals. The depth of tissue damage was his-topathologically analyzed by single senior pathologist unaware of the coagulation method and power setting applied. To analyze the results, the mucosa was divided in superficial mucosa (epithelial layer of the esophagus and superficial portion of the glandular layer of the stomach and colon) intermediate mucosa (until thelamina propria of the esophagus and until the bottom of the glandular layer of the stomach and colon) and muscularis mucosa. Necrosis involvement of the layers was compared in several combinations of power and time interval. RESULTS: involvement of the intermediate mucosa of the stomach and of the muscularis mucosa of the three organs was more frequent when higher amounts of en-ergy were used with argon plasma. in the esophagus and in the colon, injury of the intermediate mucosa was frequent, even when small amounts of energy were used. The use of bipolar electrocoagulation resulted in more frequent involvement of the intermediate mucosa and of the muscularis mucosa of the esophagus and of the colon when higher amounts of energy were used. in the stomach, these involvements were rare. The risk of injury of the muscularis propria was significant only in the colon when argon plasma coagulation was ***: Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depend on the amount of energy used.

关键词： Argon plasma coagulation Electrocoagula-tion Gastrointestinal endoscopy Surgical procedures Endoscopic gastrointestinal Mucous membrane/injuries

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influence of obesity and bariatric surgery on gastric cancer

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Cancer Biology & Medicine 2016年第2期13卷 269-276页

作者： Anna Carolina Batista Dantas Marco Aurelio Santo Roberto de Cleva Rubens Antonio Aissar Sallum ivan cecconello Department of Digestive Surgery University of Sao Paulo School of Medicine Sao Paulo-SP 05403-000 Brazil

Esophageal and gastric cancer(GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.

关键词： Obesity bariatric surgery stomach neoplasms esophageal neoplasms

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Repeat hepatectomy for recurrent colorectal liver metastases:A comparative analysis of short-and long-term results

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Hepatobiliary & Pancreatic Diseases international 2022年第2期21卷 162-167页

作者： Paulo Figueiredo Costa Fabricio Ferreira Coelho Vagner Birk Jeismann Jaime Arthur Pirola Kruger Gilton Marques Fonseca ivan cecconello Paulo Herman Digestive Surgery Brazilian College of Digestive Surgery(Colégio Brasileiro de Cirurgia Digestiva-CBCD) São PauloBrazil Digestive Surgery Division Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil instituto do Câncer do Estado de São Paulo(iCESP) São PauloBrazil

Background: Liver recurrence after resection of colorectal liver metastases(CRLM) is frequent. Repeat hepatectomy has been shown to have satisfactory perioperative results. However, the long-term outcomes and the benefts for patients with early recurrence have not been clarifed. The aim of this study was to compare the short-and long-term outcomes of patients undergoing single hepatectomy and repeat hepatectomy for CRLM. Additionally, the oncological outcomes of patients with early( ≤ 6 months) and late recurrence who underwent repeat hepatectomy were compared. Methods: Consecutive adult patients undergoing hepatectomy for CRLM between June 20 0 0 and February 2020 were included and divided into two groups: single hepatectomy and repeat hepatectomy. Results: A total of 709 patients were included: 649 in the single hepatectomy group and 60 in the repeat hepatectomy group. Patients in the repeat hepatectomy group underwent more cycles of preoperative chemotherapy [4(3-6) vs. 3(2-4), P = 0.003]. Patients in the single hepatectomy group more frequently underwent major hepatectomies(34.5% vs. 16.7%, P = 0.004) and had a greater number of lesions resected(2.9 ± 3.6 vs. 1.9 ± 1.8, P = 0.011). There was no increase in operative time, estimated blood loss, length of hospital stay, complications, or mortality in the repeat hepatectomy group. There were no differences in overall survival( P = 0.626) and disease-free survival( P = 0.579) between the two groups. Similarly, for patients underwent repeat hepatectomy, no difference was observed between the early and late recurrence groups in terms of overall survival( P = 0.771) or disease-free survival( P = 0.350). Conclusions: Repeat hepatectomy is feasible and safe, with similar short-and long-term outcomes when compared to single hepatectomy. Surgical treatment of early liver recurrence offers similar oncological outcomes to those obtained for late recurrence.

关键词： Colorectal cancer Metastasis Hepatectomy Postoperative complications Survival analysis

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Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury

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World Journal of Gastroenterology 2015年第7期21卷 2102-2107页

作者： Marcos V Perini Paulo Herman Andre L Montagnini Jose Jukemura Fabricio F Coelho Jaime A Kruger Telesforo Bacchella ivan cecconello Digestive Surgery Division Depar-tment of Gastroenterology University of Sao Paulo Medical School

AiM:To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular ***:From a prospective database of patients treated for benign biliary strictures at our hospital,cases that underwent liver resections were *** cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy(open or laparoscopic).Liver resection was indicated in patients with Strasberg E3/E4(hilar stricture)bile duct lesions associated with vascular damage(arterial and/or portal),ipsilateral liver atrophy/abscess,recurrent attacks of cholangitis,and failure of previous ***:Of 148 patients treated for benign biliary strictures,nine(6.1%)underwent liver resection;eight women and one man with a mean age of 38.6 *** patients had previously been submitted to open cholecystectomy and three to laparoscopic *** mean number of surgical procedures before definitive treatment was *** patients had Strasberg E3/E4injuries,and vascular injury was present in all *** patients underwent right hepatectomy and one underwent left lateral sectionectomy without *** time of follow up was 69.1 mo and after longterm follow up,eight patients are ***:Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed.

关键词： Abscess Atrophy Benign Bile ducts Cholecystectomy

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Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?

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World Journal of Gastroenterology 2010年第27期16卷 3423-3426页

作者： Paulo Herman Marcos V Perini Vincenzo Pugliese Julio Cesar Pereira Marcel Autran C Machado William A Saad Luiz AC D'Albuquerque ivan cecconello Department of Gastroenterology Hospital Das Clínicas-University of So Paulo Medical SchoolSo Paulo-SP-CEP 05403-000BrazilPaulo HermanPraa Santos Coimbra10So Paulo-SP-CEP 05614-050Brazil

AiM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic *** factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were ***:Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver *** was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of the extrahepatic biliary duct(>2 cm).Late results and risk factors for recurrence of symptoms or stones were ***:There was no operative *** a mean follow-up of 50.3 mo,good late results were observed in 82.9% of patients;all patients submitted to liver resection alone and 58.8% of those submitted to liver resection and hepaticojejunostomy were free of symptoms(P=0.0006).Patients with unilateral and bilateral disease showed good late results in 94.1% and 28.6%,respectively(PiON:Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal *** studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct.

关键词： Biliary lithiasis Bilioenteric anastomosis Cholangitis intrahepatic lithiasis Liver resection

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A novel sampling method for the investigation of gut microbiota

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World Journal of Gastroenterology 2007年第29期13卷 3990-3995页

作者： Alina Guimares Quintanilha Bruno Zilberstein Manoel A A Santos Denis Pajecki Eduardo Guimares Hourneaux Moura Paulo Roberto Arruda Alves Fauze Maluf-Filho ivan cecconello Digestive Surgery Division Department of Gastroenterology and Institute of Biomedical Sciences Department of Microbiology So Paulo University Medical School So Paulo SP Brazil

AiM： in order to characterize the qualitative and quantitative microorganisms in different sites of the lower digestive tract （LDT） in healthy volunteers, a specific technique was developed for collecting mucous of the distal ileum, colon and rectum. METHODS： A polyethylene tube was designed to go through the colonoscope channel with a No. 8 French tube. in order to avoid internal contamination, the distal extremity was protected with a membrane of microfilm after being sterilized in ethilene oxid. To facilitate the aspiration of a precise volume, its interior was coated with silicone. One hundred rnicrolliter （0.1 mL） sample of mucous was collected and transferred into an Eppenddorff tube containing nine hundred rnicrolliter （0.9mL） of VMGA-3 （viable medium of Goteborg）. This procedure was repeated at each site of the LDT with a new sterilized catheter. RESULTS： All sites revealed the ＂non pathogenic＂ anaerobic bacteria Veillonella sp （average 10s colony forming units/mL-CFU/mL）, allowing to conclude an environment of low oxidation-reduction potential （redox） in the LDT. it was also characterized the presence of Klebisiella sp with significant statistical predominance （SSP） in the ileum. Enterobacter sp was found with SSP in the sigrnoid colon, Bacteroides sp non-pigmented （npg） and Ecoli with SSP in the sigrnoid colon and rectum, Enterococcus sp and Lactobacillus sp with SSP in the rectum, all in a mean concentration of 10s CFU/mL CONCLUSiON： This procedure is feasible and efficient and can point out a similar distribution of the aerobic and anaerobic bacteria with the presence of biological markers of normal microbiota in the LDT.

关键词： Colony count Microbial Fungi Aerobic bacteria Anaerobic bacteria Gastrointestinal endoscopy Large intestine Bacterial translocation Microbiology Catheterization

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Expression profiles of gastric cancer molecular subtypes in remnant tumors

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World Journal of Gastrointestinal Oncology 2021年第4期13卷 265-278页

作者： Marcus Fernando Kodama Pertille Ramos Marina Alessandra Pereira Leonardo Cardili Evandro Sobroza de Mello Ulysses Ribeiro Jr Bruno Zilberstein ivan cecconello Department of Gastroenterology Instituto do CancerHospital das ClinicasHCFMUSPFaculdade de MedicinaUniversidade de São PauloSão Paulo 01249000São PauloBrazil Department of Pathology Instituto do CancerHospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de São PauloSão Paulo 01249000São PauloBrazil

BACKGROUND Remnant gastric cancer(RGC)is a carcinoma arising in the stomach remnant after previous gastric *** is frequently reported as a tumor with a poor prognosis and distinct biological features from primary gastric cancer(PGC).However,as it is less frequent,its profile regarding the current molecular classifications of gastric cancer has not been *** To evaluate a cohort of RGC according to molecular subtypes of GC using a panel of immunohistochemistry and in situ hybridization to determine whether the expression profile is different between PGC and *** Consecutive RGC patients who underwent gastrectomy between 2009 and 2019 were assessed using seven GC panels:Epstein-Barr virus in situ hybridization,immunohistochemistry for mismatch repair proteins(MutL homolog 1,MutS homolog 2,MutS homolog 6,and PMS1 homolog 2),p53 protein,and E-cadherin *** characteristics and survival of these patients were compared to 284 PGC *** A total of 40 RGC patients were enrolled in this *** to PGC,older age(Pindex(P=0.010),and lower hemoglobin level(Piated with RGC *** difference was observed regarding Lauren’s type and pathologic Tumor Node Metastasis stage between the *** the profiles evaluated,EBV-positive tumors were higher in RGC compared to PGC(P=0.039).The frequency of microsatellite instability,aberrant p53 immunostaining,and loss of E-cadherin expression were similar between RGC and *** rates of simultaneous alterations in two or more profiles were observed in RGC compared to PGC(Ping to the molecular classification,the subtypes were defined as EBV in nine(22.5%)cases,microsatellite instability in nine(22.5%)cases,genomically stable in one(2.5%)case,and chromosomal instability in 21(52.5%)*** was no significant difference in survival between molecular subtypes in RGC *** RGC w

关键词： Stomach neoplasms Gastric remnant Gastric remnant cancer Adenocarcinoma immunohistochemistry

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Biliary tract schwannoma:A rare cause of obstructive jaundice in a young patient

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World Journal of Gastroenterology 2012年第37期18卷 5305-5308页

作者： Gilton Marques Fonseca André Luis Montagnini Manoel de Souza Rocha Rosely Antunes Patzina Mário Vinícius Angelete Alvarez Bernardes ivan cecconello José Jukemura Digestive Surgery Division Department of GastroenterologySchool of MedicineUniversity of So Paulo

Schwannoma is a tumor derived from Schwann cells which usually arises in the upper extremities, trunk, head and neck, retroperitoneum, mediastinum, pelvis, and peritoneum. However, it can arise in the gastro-intestinal tract, including biliary tract. We present a 24-year-old male patient with obstructive jaundice, whose investigation with computed tomography abdomen showed focal wall thickening in the common hepatic duct, difficult to differentiate with hilar adenocarcinoma. He was diagnosed intraoperatively schwannoma of common bile duct and treated with local resection. The patient recovered well without signs of recurrence of the lesion after 12 mo. We also reviewed the common bile duct schwannoma related in the literature and evaluated the difficulty in pre and intraoperative differential diagnosis with adenocarcinoma hilar. Resection is the treatment of choice for such cases and the tumordid not recur in any of the resected cases.

关键词： Schwannoma Neurilemoma Biliary tract Hilar adenocarcinoma Computadorized tomography

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Hepatic ischemic preconditioning increases portal vein flow in experimental liver ischemia reperfusion injury

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Hepatobiliary & Pancreatic Diseases international 2014年第1期13卷 40-47页

作者： Estela RR Figueira Joel A Rocha-Filho Mauro Nakatani Marcelo FS Buto Eduardo R Tatebe Vitor O Andre ivan cecconello Luiz AC D'Albuquerque Department of Gastroenterology Laboratory of Medical Investigations LIM37 Discipline of Liver and Gastrointestinal Transplantation Hospital das ClinicasUniversity of So Paulo Brazil Discipline of Anesthesiology Hospital das ClinicasUniversity of So Paulo Brazil School of Medicine Medical Student and Scientific Research in Medicine FAPESP Hospital das Clinicas University of So Paulo Brazil

BACKGROUND: ischemic preconditioning(iPC) has been shown to decrease liver injury and to increase hepatic microvascular perfusion after liver ischemia reperfusion. This study aimed to evaluate the effects of iPC on hemodynamics of the portal venous system. METHODS: Thirty-two rats were randomized into two groups: iPC group and control group. The rats of the iPC group underwent iPC by 10 minutes of liver ischemia followed by 10 minutes of reperfusion before liver ischemia, and the rats of the control group were subjected to 60 minutes of partial liver ischemia. Non-ischemic lobes were resected immediately after reperfusion. The animals were studied at 4 hours and 12 hours after reperfusion. Mean arterial pressure, heart rate, portal vein flow and pressure were analyzed. Blood was collected for the determination of the levels of aspartate aminotransferase, alanine aminotransferase, calcium, lactate, pH, bicarbonate, and base excess. RESULTS: iPC increased the mean portal vein flow at 4 hours and 12 hours after reperfusion. iPC recovered 78% of the meanportal vein flow at 12 hours after reperfusion. iPC decreased the levels of aspartate aminotransferase, alanine aminotransferase and lactate, and increased the levels of ionized calcium, bicarbonate and base excess at 12 hours after reperfusion. CONCLUSiONS: This study demonstrated that iPC increases portal vein flow and enhances hepatoprotective effects in liver ischemia reperfusion. The better recovery of portal vein flow after iPC may be correlated with the lower levels of transaminases and with the better metabolic profile.

关键词： ischemic preconditioning portal vein flow liver ischemia

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Surgical treatment of fibrolamellar hepatocellular carcinoma:an underestimated malignant tumor?

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Hepatobiliary & Pancreatic Diseases international 2014年第6期13卷 618-621页

作者： Paulo Herman Aline Lopes Chagas Marcos Vinicius Perini Fabricio Ferreira Coelho Gilton Marques Fonseca Venancio Avancini Ferreira Alves Flair José Carrilho ivan cecconello Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil Department of Pathology University of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil

BACKGROUND： Fibrolamellar hepatocellular carcinoma （FLHCC） is a rare disease with an indolent behavior. its prognosis is better than that of patients with hepatocellular carcinoma. The authors present their experience with resection of FLHCC. METHODS： Twenty-one patients with FLHCC were treated at our institution between 1990 and 2012. Of these patients, 14 were subjected to resection of the tumor. Patient demographics, medical history, results of imaging studies and laboratory tests, surgical data, and pathologic findings were evaluated. RESULTS： The median age of the patients at the diagnosis of the tumor was 20 years and 14 patients were female. None of the patients had tumor-associated chronic liver disease or cirrhosis. The mean tumor size was 12.8 cm （range 6-19） and 18 patients had a single liver nodule. Fourteen patients were subjected to hepatectomy and six of them had lymph node metastases resected. Pathologic evaluation revealed that 5 （35.7%） patients had major vascular invasion. Tumor recurrence was seen in 8 patients （66.7%）, during a follow-up. The median survival time for patients who were subjected to resection was 36 months. The 5-year overall survival rate and disease free survival rate were 28.0% and 8.5%, respectively. Univariate analysis showed that vascular invasion was the only variable associated with the disease free survival ***： Despite an aggressive treatment, patients with FLHCC presented unexpected low survival rates. it seems that an underestimated malignant behavior is attributed to this disease, and that the forms of adjuvant treatment should be urgently evaluated.

关键词： fibrolamellar hepatocellular carcinoma hepatectomy hepatocellular carcinoma lymph node excision survival

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