LENINE GARCIA BRANDAO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review(2016) GUIMARAES, Andre Vicente; AIRES, Felipe Toyama; DEDIVITIS, Rogerio Aparecido; KULCSAR, Marco Aurelio Vamondes; RAMOS, Daniel Marin; CERNEA, Claudio Roberto; BRANDAO, Lenine GarciaBackground. The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The purpose of this study was to evaluate the impact of PMMF in reducing pharyngocutaneous fistula rates after total laryngectomy. Methods. The analyzed intervention was the use of a PMMF after total laryngectomy. Results. Pharyngocutaneous fistula occurred in 230 cases (global incidence, 30.9%). In the group of patients who underwent PMMFs, there were 49 cases of pharyngocutaneous fistula, compared with 181 cases in the control group. There was a 22% decreased risk of pharyngocutaneous fistula incidence in the PMMF group (p < .001). Patients who underwent a PMMF had lower risk of pharyngocutaneous fistula compared with the control group (p = .008). There were no changes when only patients who underwent total laryngectomy (p < .001) and those who underwent total pharyngolaryngectomy (p = .007) were separately assessed. Conclusion. Prophylactic use of PMMF decreases the incidence of pharyngocutaneous fistula after salvage total laryngectomy. (C) 2015 Wiley Periodicals, Inc.
- Pharyngocutaneous fistula following total laryngectomy(2012) AIRES, Felipe Toyama; DEDIVITIS, Rogerio Aparecido; CASTRO, Mario Augusto Ferrari de; RIBEIRO, Daniel Araki; CERNEA, Claudio Roberto; BRANDAO, Lenine GarciaPharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy. Objectives: To establish the incidence of this complication and to analyze the predisposing factors. Method: This is a cross-sectional study of a historical cohort including 94 patients who underwent total laryngectomy. The following aspects were correlated to the occurrence of PCF: gender, age, tumor site, TNM staging, type of neck dissection, previous radiation therapy, previous tracheotomy, and use of stapler for pharyngeal closure. The following were considered in PCF cases: the day into postoperative care when the fistula was diagnosed, duration of occurrence, and proposed treatment. Results: Twenty (21.3%) patients had PCF. The incidence of PCF was statistically higher in T4 tumors when compared to T2 and T3 neoplasms (p = 0.03). The other analyzed correlations were not statistically significant. However, 40.9% of the patients submitted to tracheostomy previously had fistulae, against 21.1% of the patients not submitted to this procedure. Conclusion: Advanced primary tumor staging is correlated with higher incidences of PCF.
- Micro-Raman spectroscopic study of thyroid tissues(2017) MEDEIROS NETO, Lazaro Pinto; CARVALHO, Luis Felipe das Chagas e Silva de; SANTOS, Laurita dos; SOTO, Claudio Alberto Tellez; CANEVARI, Renata de Azevedo; SANTOS, Andre Bandiera de Oliveira; MELLO, Evandro Sobroza; PEREIRA, Marina Aparecida; CERNEA, Claudio Roberto; BRANDAO, Lenine Garcia; MARTIN, Airton AbrahaoThyroid carcinomas are the most common endocrine malignancy. Inconclusive results for the analysis of malignancies are an issue in the diagnosis of thyroid carcinomas; 20% of thyroid cancer diagnoses are indeterminate or suspicious, resulting in a surgical procedure without immediate need. The use of Raman spectroscopy may help improve the diagnosis of thyroid carcinoma. In this study, 30 thyroid samples, including normal thyroid, goiter and thyroid cancer, were analyzed by confocal Raman spectroscopy. Principal component analysis (PCA), linear discriminant analysis (LDA) with cross validation and binary logistic regression (BLR) analysis were applied to discriminate among tissues. Significant discrimination was observed, with a consistent rate of concordant pairs of 89.2% for normal thyroid versus cancer, 85.7% for goiter versus cancer and 80.6% for normal thyroid versus goiter using just the amide III region. Raman spectroscopy was thus proven to be an important and fast tool for the diagnosis of thyroid tissues. The spectral region of 1200-1400 cm(-1) discriminated normal versus goiter tissues despite the great similarity of these tissues.
- Risk factors for salvage surgery failure in oral cavity squamous cell carcinoma(2018) MATSUURA, Danielli; VALIM, Tiago Dias; KULCSAR, Marco Aurelio Vamondes; PINTO, Fabio Roberto; BRANDAO, Lenine Garcia; CERNEA, Claudio Roberto; MATOS, Leandro LuongoObjectives/HypothesisLocoregional recurrences of oral cavity squamous cell carcinoma (SCC) may be diagnosed during follow-up of surgically treated patients. Nevertheless, few studies have investigated factors that impact salvage surgery failure and the mortality rates of these patients. The objectives were to identify predictive factors of salvage surgery failure and mortality in patients who undergo surgical treatment for recurrent oral cavity SCC and to compare the overall survival rates of these patients with those of patients who undergo only one surgical treatment. Study DesignRetrospective cohort study. MethodsForty-six patients submitted to salvage surgery for local or locoregional recurrence. ResultsThe presence of lymph node metastasis and positive surgical margins at the salvage surgery time were the only independent factors associated with both recurrence rates (hazard ratio [HR]: 5.04 and 2.82, respectively) and mortality (HR: 3.51 and 3.24, respectively). When the overall survival rates of the 199 patients who only underwent one surgical treatment were compared to those of the 46 patients subjected to salvage surgery, a similarity was evident when patients who underwent salvage surgery did not have a new disease recurrence (70.7% vs. 54.7%, respectively; P = .158). Likewise, patients with new recurrences after salvage surgery and patients who received palliative treatment for relapsed disease had similar overall survival rates (0.6% vs. 0.0%, respectively; P = .475). ConclusionsThe presence of lymph node metastasis at the time of recurrence and positive surgical margins after the salvage surgery were associated with a worse overall survival rate in patients with oral cavity SCC relapse.
- CLASSIFICATION OF PAPILLARY THYROID MICROCARCINOMA ACCORDING TO SIZE AND FINE-NEEDLE ASPIRATION CYTOLOGY: BEHAVIOR AND THERAPEUTIC IMPLICATIONS(2011) FRIGUGLIETTI, Celso Ubirajara Moretto; DUTENHEFNER, Simone Elisa; BRANDAO, Lenine Garcia; KULCSAR, Marco Aurelio VamondesBackground. The purpose of this study was to assess and classify cases of papillary microcarcinoma according to size (up to 0.5 cm and between 0.6 and 1.0 cm) and fine-needle aspiration cytology (FNAC). These results were then correlated with clinical and histopathologic factors of worse prognosis. Methods. A total of 448 cases of papillary thyroid carcinoma were studied retrospectively. Results. Of the 448 patients, 173 presented with carcinomas of <= 0.5 cm and 275 patients presented with carcinomas sized between 0.6 and 1.0 cm (> 0.5 cm). Lymph node metastasis was diagnosed in 6% of the carcinoma cases of <= 0.5 cm and in 16% of the cases with tumors of > 0.5 cm. A total of 281 cases tested positive for papillary carcinoma by FNAC, and in 113 cases, the carcinoma was diagnosed during the histopathologic examination. A positive FNAC for carcinoma was correlated with a higher incidence of lymph node metastasis (16% vs 5%). Conclusion. The diagnosis of papillary carcinoma using the preoperative biopsy enables a more precise oncological procedure with greater chance of biological cure. (C) 2010 Wiley Periodicals, Inc. Head Neck 33: 696-701, 2011
- Pharyngocutaneous fistula after total laryngectomy: Systematic review of risk factors(2015) DEDIVITIS, Rogerio Aparecido; AIRES, Felipe Toyama; CERNEA, Claudio Roberto; BRANDAO, Lenine GarciaBackground. Pharyngocutaneous fistula (PCF) is the most common surgical complication after total laryngectomy. Controversy still remains regarding the multiple risk factors implicated. The purpose of this study was to evaluate the potential risk factors for PCF. Methods. The strategy for our literature survey included research in MEDLINE up to December 2013. The risk factors analyzed were age, sex, smoking habit, alcohol use, comorbidity, preoperative hemoglobin level, blood transfusion, preoperative tracheotomy, previous radiotherapy and chemoradiotherapy, primary tumor site, T classification, cartilage invasion, tumor grade, surgical margins, suture material, second layer of suture, reconstruction, tracheoesophageal prosthesis, and neck dissection. Results. The electronic search resulted in 311 studies from which 63 met the inclusion criteria. Conclusion. Chronic obstructive pulmonary disease (COPD), previous hemoglobin <12.5g/dL, blood transfusion, previous radiotherapy or chemoradiotherapy, advanced primary tumors, supraglottic subsite, hypopharyngeal tumor site, positive surgical margins, and the performance of neck dissection were risk factors for PCF. (C) 2014 Wiley Periodicals, Inc.
- Tumor volume as an independent predictive factor of worse survival in patients with oral cavity squamous cell carcinoma(2017) LIN, Chin Shien; SANTOS, Andre Bandiera de Oliveira; SILVA, Evandro Lima e; MATOS, Leandro Luongo de; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio Vamondes; PINTO, Fabio Roberto; BRANDAO, Lenine Garcia; CERNEA, Claudio RobertoBackgroundThe purpose of the present study was to investigate the role of tumor volume in the prognosis of patients with oral cavity squamous cell carcinoma (SCC). MethodsOne hundred twenty-three patients with T4a oral cavity SCCs underwent surgical treatment. The volumes of the primary cancer were calculated by the multiplication of 3 macroscopic dimensions of the surgical specimen and related to recurrence and death. ResultsThere were 54 recurrences (43.9%) and 75 deaths (60.9%). The mean tumor volume among the patients living without disease during the follow-up period was 28.2 cc, compared to 88.2 cc for patients living with disease, and to 78.9 cc for patients who died of the disease (p < .001). Multivariate analyses showed that volume and perineural invasion were independent factors for recurrence, whereas volume and lymph node metastasis were independent factors for death. ConclusionAmong patients who already have advanced cancers, tumor volume can significantly impact their prognoses. (c) 2017 Wiley Periodicals, Inc. Head Neck 39: 960-964, 2017
- Early oral feeding after total laryngectomy: A systematic review(2015) AIRES, Felipe Toyama; DEDIVITIS, Rogerio Aparecido; PETRAROLHA, Silvia Migueis Picado; BERNARDO, Wanderley Marques; CERNEA, Claudio Roberto; BRANDAO, Lenine GarciaBackground. Early oral feeding for patients who underwent total laryngectomy is still controversial. The purpose of this study was to evaluate the safety of initiating early oral feeding after total laryngectomy regarding pharyngocutaneous fistula. The survey included research in MEDLINE, EMBASE, and LILACS. Methods. The intervention analyzed was early oral feeding (<5 days), whereas the control group received late oral feeding (>7 days) after total laryngectomy. Results. From 304 studies, 4 randomized clinical trials with 180 patients were selected. In the early oral feeding group, the incidence was 6.7%, whereas in the late oral feeding group it was 10%, with no statistically significant difference (IC95% -0.11 to 0.05; p=.42; I-2=0%). Four cohort studies with 490 patients were also selected. In the early oral feeding group, the incidence was 12.2%, whereas in the other group, it was 10.1%, with no statistically significant difference (IC95% -0.05 to 0.08; p=.67; I-2=0%). Conclusion. There is no increase in pharyngocutaneous fistula rates in patients who receive early oral feeding after total laryngectomy. (C) 2014 Wiley Periodicals, Inc.
- Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer(2017) CALVAS, Oscar Israel Jaramillo; RAMOS, Daniel Marin; MATOS, Leandro Luongo; KULCSAR, Marco Aurélio Vamondes; DEDIVITIS, Rogério Aparecido; BRANDÃO, Lenine Garcia; CERNEA, Claudio RobertoSummary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).
- Prognostic significance of the number of lymph nodes in elective neck dissection for tongue and mouth floor cancers(2012) AMAR, Ali; CHEDID, Helma Maria; RAPOPORT, Abrao; CERNEA, Claudio Roberto; DEDIVITIS, Rogerio Aparecido; CURIONI, Otavio Alberto; BRANDAO, Lenine GarciaThe presence of metastatic lymph nodes is a relevant aspect in the treatment of head and neck cancer, bringing about a 50% reduction in survival. Objective: To assess the number of lymph nodes removed in the neck dissection and their relationship with the prognosis. Methods: A retrospective study involving 143 patients with tongue and mouth floor epidermoid carcinoma, which histological exam showed no lymph node metastases. Among those, 119 were males and 24 females, with mean age of 54 years. As to the primary tumor site, 65 were in the tongue and 78 in the mouth floor. T stage distribution was of four T1, 84 T2, 36 T3 and 19 T4. We carried out 176 neck dissections, unilateral in 110 cases and bilateral in 33. Of these, 78 were radical and 98 selective. The patients were broken down into three groups, according to the 33 and 66 percentiles of the number of lymph nodes resected. Results: The mean number of resected lymph nodes was 27; 24 in selective dissections and 31 in the complete ones. We did not have statistically significant differences when associated to the T and N stages. Conclusions: The larger number of lymph nodes dissected in the neck dissection identifies the group of better prognoses among pN0 cases.