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| 1 | Laparoscopic liver resection:Experience based guidelines显示文摘Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation. | fabricio ferreira coelho jaime arthur pirola kruger gilton marques fonseca raphael leonardo cunha araújo vagner birk jeismann marcos vinícius perini renato micelli lupinacci ivan cecconello paulo herman | 2016 | World Journal of Gastrointestinal Surgery2016，8，1： | 22 |
| 2 | Biliary tract schwannoma:A rare cause of obstructive jaundice in a young patient显示文摘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. | Gilton Marques Fonseca André Luis Montagnini Manoel de Souza Rocha Rosely Antunes Patzina Mário Vinícius Angelete Alvarez Bernardes Ivan Cecconello José Jukemura | 2012 | World Journal of Gastroenterology2012，18，37： | 10 |
| 3 | Hepatic ischemic preconditioning increases portal vein flow in experimental liver ischemia reperfusion injury显示文摘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. | Estela RR Figueira Joel A Rocha-Filho Mauro Nakatani Marcelo FS Buto Eduardo R Tatebe Vitor O Andre Ivan Cecconello Luiz AC D'Albuquerque | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，1： | 6 |
| 4 | Gastric partitioning for the treatment of malignant gastric outlet obstruction显示文摘BACKGROUND Gastric outlet obstruction(GOO)is one of the main complications in stage IV gastric cancer patients.This condition is usually managed by gastrojejunostomy(GJ).However,gastric partitioning(GP)has been described as an alternative to overcoming possible drawbacks of GJ,such as delayed gastric emptying and tumor bleeding.AIM To compare the outcomes of patients who underwent GP and GJ for malignant GOO.METHODS We retrospectively analyzed 60 patients who underwent palliative gastric bypass for unresectable distal gastric cancer with GOO from 2009 to 2018.Baseline clinicopathological characteristics including age,nutritional status,body mass index,and performance status were evaluated.Obstructive symptoms were graded according to GOO score(GOOS).Surgical outcomes evaluated included duration of the procedure,surgical complications,mortality,and length of hospital stay.Acceptance of oral diet after the procedure,weight gain,and overall survival were the long-term outcomes evaluated.RESULTS GP was performed in 30 patients and conventional GJ in the other 30 patients.The mean follow-up was 9.2 mo.Forty-nine(81.6%)patients died during that period.All variables were similar between groups,with the exception of worse performance status in GP patients.The mean operative time was higher in the GP group(161.2 vs 85.2 min,P<0.001).There were no differences in postoperative complications and surgical mortality between groups.The median overall survival was 7 and 8.4 mo for the GP and GJ groups,respectively(P=0.610).The oral acceptance of soft solids(GOOS 2)and low residue or full diet(GOOS 3)were reached by 28(93.3%)GP patients and 22(75.9%)GJ patients(P=0.080).Multivariate analysis demonstrated that GOOS 2 and GOOS 3 were the main prognostic factors for survival(hazard ratio:8.90,95%confidence interval:3.38-23.43,P<0.001).CONCLUSION GP is a safe and effective procedure to treat GOO.Compared to GJ,it provides similar surgical outcomes with a trend to better solid diet acceptance by patients. | Marcus Fernando Kodama Pertille Ramos Leandro Cardoso Barchi Rodrigo Jose de Oliveira Marina Alessandra Pereira Donato Roberto Mucerino Ulysses Ribeiro Jr Bruno Zilberstein Ivan Cecconello | 2019 | World Journal of Gastrointestinal Oncology2019，11，12： | 2 |
| 5 | Short-term outcomes after laparoscopic colorectal surgery in patients with previous abdominal surgery: A systematic review显示文摘AIM: To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS: A broad literature search was performed with the terms 'colorectal', 'colectomy', 'PAOS', 'previous surgery' and 'PAOS'. Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS, whether descriptive or comparative. Endpoints of interest were conversion rates, inadvertent enterotomy and morbidity. Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.RESULTS: From a total of 394 citations, 13 full-texts achieved selection criteria to be included in the study. Twelve of them compared patients with and without PAOS. All studies were retrospective and comparative and two were case-matched. The selected studies comprised a total of 5005 patients, 1865 with PAOS. Among the later, only 294(16%) had history of a midline incision for previous gastrointestinal surgery. Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopywas more prevalent in 3 of 5 studies that disclosed this event. Morbidity was similar in the majority of studies. A quantitative analysis(meta-analysis) could not be performed due to heterogeneity of the studies. CONCLUSION: Conversion rates were slightly higher in PAOS groups, although not statistical significant in most studies. History of PAOS did not implicate in higher morbidity rates. | Marleny Novaes Figueiredo Fabio Guilherme Campos Luiz Augusto D'Albuquerque Sergio Carlos Nahas Ivan Cecconello Yves Panis | 2016 | World Journal of Gastrointestinal Surgery2016，8，7： | 2 |
| 6 | Absence of Lymph Nodes in the Resected Specimen After Radical Surgery for Distal Rectal Cancer and Neoadjuvant Chemoradiation Therapy: What does it Mean?显示文摘 | Angelita Habr-Gama M.D. Ph.D. Rodrigo O. Perez M.D. Ph.D. Igor Proscurshim M.S. Viviane Rawet M.D. Ph.D. Diego D. Pereira M.S. Afonso H. S. Sousa M.D. Ph.D. Desiderio Kiss M.D. Ph.D. Ivan Cecconello M.D. Ph.D | 2008 | Diseases of the Colon & Rectum2008，，3： | 2 |
| 7 | Repeat hepatectomy for recurrent colorectal liver metastases:A comparative analysis of short-and long-term results显示文摘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. | Paulo Figueiredo Costa Fabricio Ferreira Coelho Vagner Birk Jeismann Jaime Arthur Pirola Kruger Gilton Marques Fonseca Ivan Cecconello Paulo Herman | 2022 | Hepatobiliary & Pancreatic Diseases International2022，21，2： | 2 |
| 8 | Transanal endoscopic microsurgery: indications, results and controversies显示文摘 | Andre Roncon Dias Caio Sergio Rizkallah Nahas Carlos Frederico Sparapan Marques Sergio Carlos Nahas Ivan Cecconello | 2009 | Techniques in Coloproctology2009，，2： | 1 |
| 9 | Endoscopic Detection of Early Esophageal Squamous Cell Carcinoma in Patients with Achalasia: Narrow-Band Imaging versus Lugol’s Staining显示文摘 | Edson Ide Fred Olavo Arag?o Andrade Carneiro Mariana Souza Varella Fraz?o Dalton Marques Chaves Rubens Ant?nio Aissar Sallum Eduardo Guimar?es Hourneaux de Moura Paulo Sakai Ivan Cecconello Fauze Maluf-Filho Everson L. A. Artifon | 2013 | Journal of Oncology2013，，： | 1 |
| 10 | Endoscopic Sphincterotomy Before Deployment of Covered Metal Stent is Associated With Greater Complication Rate: A Prospective Randomized Control Trial显示文摘 | Everson L. A. Artifon Paulo Sakai Shinichi Ishioka Sérgio B. Marques André S. Lino José E. M. Cunha José Jukemura Ivan Cecconello Flair J. Carrilho Eduardo Opitz Atul Kumar | 2008 | Journal of Clinical Gastroenterology2008，，7： | 1 |
| 11 | Refractory and new-onset diabetes more than 5?years after gastric bypass for morbid obesity显示文摘 | Camila Yamaguchi Joel Faintuch Silvia Hayashi Jacob Faintuch Ivan Cecconello | 2012 | Surgical Endoscopy2012，，10： | 1 |
| 12 | The prognostic value of CD147/EMMPRIN is associated with monocarboxylate transporter 1 co-expression in gastric cancer显示文摘 | Céline Pinheiro Adhemar Longatto-Filho Kleber Sim?es Carlos Eduardo Jacob Cláudio José Caldas Bresciani Bruno Zilberstein Ivan Cecconello Venancio Avancini Ferreira Alves Fernando Schmitt Fátima Baltazar | 2009 | European Journal of Cancer2009，，13： | 1 |
| 13 | A novel sampling method for the investigation of gut microbiota显示文摘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 microlliter (0.1 mL) sample of mucous was collected and transferred into an Eppenddorff tube containing nine hundred microlliter (0.9 mL) 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 105 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 sigmoid colon, Bacteroides sp non-pigmented (npg) and E.coli with SSP in the sigmoid colon and rectum, Enterococcus sp and Lactobacillus sp with SSP in the rectum, all in a mean concentration of 105 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. | Alina Guimares Quintanilha Bruno Zilberstein Manoel A A Santos Denis Pajecki Eduardo Guimares Hourneaux Moura Paulo Roberto Arruda Alves Fauze Maluf-Filho Ivan Cecconello | 2007 | World Journal of Gastroenterology2007，13，29： | 1 |
| 14 | Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury显示文摘AIM:To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular injury.METHODS:From a prospective database of patients treated for benign biliary strictures at our hospital,cases that underwent liver resections were reviewed.All 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 hepaticojejunostomy.RESULTS: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 years.Six patients had previously been submitted to open cholecystectomy and three to laparoscopic surgery.The mean number of surgical procedures before definitive treatment was 2.4.All patients had Strasberg E3/E4injuries,and vascular injury was present in all cases.Eight patients underwent right hepatectomy and one underwent left lateral sectionectomy without mortality.Mean time of follow up was 69.1 mo and after longterm follow up,eight patients are asymptomatic.CONCLUSION: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. | Marcos V Perini Paulo Herman Andre L Montagnini Jose Jukemura Fabricio F Coelho Jaime A Kruger Telesforo Bacchella Ivan Cecconello | 2015 | World Journal of Gastroenterology2015，21，7： | 1 |
| 15 | Influence of obesity and bariatric surgery on gastric cancer显示文摘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. | Anna Carolina Batista Dantas Marco Aurelio Santo Roberto de Cleva Rubens Antonio Aissar Sallum Ivan Cecconello | 2016 | Cancer Biology & Medicine2016，13，2： | 1 |
| 16 | Laparoscopic Duodenal-Jejunal Bypass for the Treatment of Duodenal Obstruction Caused by Annular Pancreas: Description of a Surgical Technique显示文摘 | Bruno Zilberstein Mauricio P. Sorbello Ivan R.B. Orso Ivan Cecconello | 2011 | Surgical Laparoscopy, Endoscopy & Percutaneous Techniques2011，，： | 1 |
| 17 | Megaesophagus microbiota: A qualitative and quantitative analysis显示文摘 | Denis Pajecki M.D. Bruno Zilberstein M.D. Ph.D. F.A.C.S. Manoel Armando Azevedo dos Santos M.D. Ph.D. Joao Ari Ubriaco D.D. Alina Guimar?es Quintanilha M.D. Ivan Cecconello M.D. Ph.D. Joaquim Gama-Rodrigues M.D. Ph.D | 2002 | Journal of Gastrointestinal Surgery2002，，5： | 1 |
| 18 | Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?显示文摘AIM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis.Prognostic factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.METHODS:Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection.Resection 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 evaluated.RESULTS:There was no operative mortality.After 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(P<0.001).CONCLUSION:Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal solution.Further studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct. | Paulo Herman Marcos V Perini Vincenzo Pugliese Julio Cesar Pereira Marcel Autran C Machado William A Saad Luiz AC D'Albuquerque Ivan Cecconello | 2010 | World Journal of Gastroenterology2010，16，27： | 0 |
| 19 | Surgical treatment of fibrolamellar hepatocellular carcinoma:an underestimated malignant tumor?显示文摘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 rate.CONCLUSIONS: 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. | Paulo Herman Aline Lopes Chagas Marcos Vinicius Perini Fabricio Ferreira Coelho Gilton Marques Fonseca Venancio Avancini Ferreira Alves Flair José Carrilho Ivan Cecconello | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，6： | 0 |
| 20 | Expression profiles of gastric cancer molecular subtypes in remnant tumors显示文摘BACKGROUND Remnant gastric cancer(RGC)is a carcinoma arising in the stomach remnant after previous gastric resection.It 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 evaluated.AIM 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 RGC.METHODS 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 expression.Clinicopathological characteristics and survival of these patients were compared to 284 PGC patients.RESULTS A total of 40 RGC patients were enrolled in this study.Compared to PGC,older age(P<0.001),male(P<0.001),lower body mass index(P=0.010),and lower hemoglobin level(P<0.001)were associated with RGC patients.No difference was observed regarding Lauren’s type and pathologic Tumor Node Metastasis stage between the groups.Regarding 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 PGC.Higher rates of simultaneous alterations in two or more profiles were observed in RGC compared to PGC(P<0.001).According 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%)cases.There was no significant difference in survival between molecular subtypes in RGC patients.CONCLUSION RGC was associated with EBV positivity and higher rates of co-altered expression profiles compared to PGC.According to the molecular classification,there was no significant difference in survival between the subtypes of RGC. | Marcus Fernando Kodama Pertille Ramos Marina Alessandra Pereira Leonardo Cardili Evandro Sobroza de Mello Ulysses Ribeiro Jr Bruno Zilberstein Ivan Cecconello | 2021 | World Journal of Gastrointestinal Oncology2021，13，4： | 0 |
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