MARCO AURELIO VAMONDES KULCSAR

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: LENINE GARCIA BRANDAO ×

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  • article 33 Citação(ões) na Scopus
    Tumor thickness as a predictive factor of lymph node metastasis and disease recurrence in T1N0 and T2N0 squamous cell carcinoma of the oral tongue
    (2014) MATOS, Leandro Luongo de; MANFRO, Gabriel; SANTOS, Ricardo Vieira dos; STABENOW, Elaine; MELLO, Evandro Sobroza de; ALVES, Venancio Avancini F.; PINTO, Fabio Roberto; KULCSAR, Marco Aurelio Vamondes; BRANDAO, Lenine Garcia; CERNEA, Claudio Roberto
    Objective. The aim of the study was to compare the thickness of primary tumors with the frequency of nodal metastases and survival in patients surgically treated for T1/T2N0 oral tongue squamous cell carcinoma. Study Design. This is a retrospective longitudinal study with 74 patients. Results. None of the patients with a tumor thickness (TT) <= 7 mm presented with nodal metastasis, whereas 25 of the patients with a TT > 7 mm (51.0%) developed metastases (P < .0001). Multivariate analysis showed that TT > 7 mm was a risk factor for occult nodal metastasis (odds ratio = 8.7; P = .002) with 81.9% accuracy. TT > 10 mm was also a predictive factor of worse disease-free survival in these patients (hazard ratio = 12.2; P = .003). Conclusions. Tumor thickness of greater than 7 mm is predictive of a higher incidence of lymph node metastasis, and a TT > 10 mm is predictive of worse disease-free survival in squamous cell carcinoma of the oral tongue.
  • article
    Practical tips to reduce complication rate in thyroidectomy
    (2017) CERNEA, Claudio; BRANDAO, Lenine G.; HOJAIJ, Flavio C.; CARLUCCI, Dorival De; VANDERLEI, Felipe; GOTODA, Renato; LEITE, Ana K.; KULCSAR, Marco A. V.; MATOS, Leandro L.; DEDIVITIS, Rogerio A.; ARAUJO-FILHO, Vergilius J. F.; TAVARES, Marcos R.
    Introduction: Thyroid cancer is the most frequent endocrine neoplasm, and its incidence has been consistently rising during the last decades. Surgical treatment is the choice, but the complications can be truly devastating. Methods: The objective of this article is to present some practical tips to reduce the complication rate in thyroid surgery. Results: The more frequent complications during a thyroidectomy are mentioned, as well as practical tips to try to prevent them: acute airway compression, nerve injuries (both inferior laryngeal and external branch of the superior laryngeal nerves), and hypoparathyroidism. Conclusion: The prevention of complications during a thyroidectomy is imperative. The only way that the surgeon can assure the safety is to strictly adhere to technical principles, with diligent hemostasis, thorough anatomical knowledge, and gentle handling of the anatomic structures adjacent to the thyroid gland.
  • article 26 Citação(ões) na Scopus
    Pectoralis major myocutaneous flap for head and neck reconstruction: risk factors for fistula formation
    (2014) LEITE, A. K. N.; MATOS, L. L. De; BELLI, M.; KULCSAR, M. A. V.; CERNEA, C. R.; BRANDAO, L. Garcia; PINTO, F. R.
    The pectoralis major myocutaneous flap (PMMF) is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro- or pharyngocutaneous fistula. Herein, we attempt to establish risk factors for fistula formation in reconstructions of mucosal defects in the head and neck using PMMF through retrospective analysis of PMMF performed during 3 years at a single institution, with a total of 84 procedures. There were 69 men and 15 women, with a mean age of 59.5 years. There were 15 cases of partial flap loss, two total flap losses and 31 fistulas. The independent risk factors for fistula formation were preoperative serum hemoglobin <13 g/dl, preoperative serum albumin <3.4 g/dl and hypopharynx reconstruction. The PMMF is still a very useful flap and this is the first multivariate analysis analysing risk factors for fistula formation. These findings are helpful in selecting patients with elevated risk of fistula formation, and therefore preventive measures can be undertaken to avoid potentially serious complications.
  • article 23 Citação(ões) na Scopus
    Videoendoscopic Evaluation of Swallowing After Thyroidectomy: 7 and 60 Days
    (2015) ARAKAWA-SUGUENO, Lica; FERRAZ, Alberto Rosseti; MORANDI, Janaina; CAPOBIANCO, Dirce Maria; CERNEA, Claudio Roberto; SAMPAIO, Maury Antonio; KULCSAR, Marco Aurelio Vamondes; SIMOES, Cesar Augusto; BRANDAO, Lenine Garcia
    Deglutition complaints are frequent after thyroidectomy. The purpose of this study was to follow-up on patients with thyroidectomy indication to compare the videoendoscopic evaluation of swallowing on the seventh day (early postoperative, EPO) and on the 60th day after thyroidectomy, (late postoperative, LPO) and to compare patients that evolved with normal laryngeal mobility (NLM) and abnormal laryngeal mobility (ALM). Nasofibroscopic evaluation was performed preoperatively (PRE), on the EPO and LPO. Two groups were compared: ALM and NLM. The majority of people were women, age bracket 46-65, who underwent total thyroidectomy and with high frequency of carcinoma. 30 out of the 54 patients in the study had change in swallowing (55 %). Dysphagia occurred in 87 % (13/15) of patients with ALM in the EPO and remained in 67 % of them in the LPO. In the NLM group, dysphagia occurred in 44 % (17/39) in EPO and 25 % in LPO. There was a statistical difference between PRE and EPO, and PRE and LPO (P < 0,001). In the ALM group, liquid penetration and aspiration were identified in 33 % of the cases during EPO (P = 0,014); retention of food occurred in 87 % in EPO and in 60 % in LPO (P < 0,001). Dysphagia occurs in patients after thyroid surgery (regardless of larynx mobility alteration) and characterized by stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.
  • article 57 Citação(ões) na Scopus
    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 Garcia
    Background. 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.
  • article 32 Citação(ões) na Scopus
    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 Luongo
    Objectives/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.
  • article 20 Citação(ões) na Scopus
    Prevalence of human papillomavirus types and variants and p16(INK4a) expression in head and neck squamous cells carcinomas in Sao Paulo, Brazil
    (2016) BETIOL, Julio C.; SICHERO, Laura; COSTA, Henrique O. de Olival; MATOS, Leandro L. de; ANDREOLI, Maria A.; FERREIRA, Silvaneide; FARAJ, Sheila F.; MELLO, Evandro S. de; SOBRINHO, Joao S.; BRANDAO, Lenine G.; CERNEA, Claudio R.; KULCSAR, Marco A.; PINTO, Fabio R.; GONCALVES, Antonio J.; MENEZES, Marcelo B.; SILVA, Leonardo; ROSSI, Lia M.; NUNES, Rafaella A. Lima; TERMINI, Lara; VILLA, Luisa L.
    Background: Human papillomavirus (HPV) prevalence in head and neck squamous cell carcinomas (HNSCC) diverges geographically. The reliability of using p16(INK4a) expression as a marker of viral infection is controversial in HNSCC. We evaluated HPV types and HPV-16 variants prevalence, and p16(INK4a) expression in HNSCC specimens provided by two different Institutions in Sao Paulo. Methods: HPV DNA from formalin-fixed specimens was accessed by Inno-LiPA, HPV-16 variants by PCR-sequencing, and p16(INK4a) protein levels by immunohistochemistry. Results: Overall, HPV DNA was detected among 19.4 % of the specimens (36/186). Viral prevalence was higher in the oral cavity (25.0 %, 23/92) then in other anatomical sites (oropharynx 14,3 %, larynx 13.7 %) when samples from both Institutions were analyzed together. HPV prevalence was also higher in the oral cavity when samples from both Institutions were analyzed separately. HPV-16 was the most prevalent type identified in 69.5 % of the HPV positive smaples and specimens were assigned into Asian-American (57.2 %) or European (42.8 %) phylogenetic branches. High expression of p16(INK4a) was more common among HPV positive tumors. Conclusion: Our results support a role for HPV-16 in a subset of HNSCC.
  • article 19 Citação(ões) na Scopus
    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 Vamondes
    Background. 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
  • article 14 Citação(ões) na Scopus
    Deaths related to differentiated thyroid cancer: a rare but real event
    (2017) LEITE, Ana Kober N.; CAVALHEIRO, Beatriz G.; KULCSAR, Marco Aurélio; HOFF, Ana de Oliveira; BRANDÃO, Lenine G.; CERNEA, Claudio Roberto; MATOS, Leandro L.
    ABSTRACT Objective The present study describes the clinical and tumor characteristics of patients that died from differentiated thyroid cancer and reports on the cause and circumstances of death in these cases. Subjects and methods Retrospective analysis of all the differentiated thyroid cancer (DTC) related deaths at a single institution over a 5-year period, with a total of 33 patients. Results Most of the patients were female (63.6%), with a mean age at diagnosis of 58.2 years. The most common histologic type was papillary (66.7%) and 30.3% were follicular. The distribution according to the TNM classification was: 15.4% of T1; 7.7% T2; 38.4% T3; 19.2% of T4a and 19.2% of T4b. Forty-four percent of cases were N0; 20% N1a and 36.6% of N1b. Twelve patients were considered non-responsive to radioiodine. Only one of the patients did not have distant metastases. The most common metastatic site was the lung in 69.7%. The majority of deaths were due to pulmonary complications related to lung metastases (17 patients, 51.5%), followed by post-operative complications in 5 cases, neurological disease progression in 3 cases, local invasion and airway obstruction in one patient. Median survival between diagnosis and death was reached in 49 months while between disease progression and death it was at 22 months. Conclusion Mortality from DTC is extremely rare but persists, and the main causes of death derive from distant metastasis, especially respiratory failure due to lung metastasis. Once disease progression is established, median survival was only 22 months.
  • article 23 Citação(ões) na Scopus
    Oral cavity squamous cell carcinoma: factors related to occult lymph node metastasis
    (2015) D'ALESSANDRO, Andre Fernandes; PINTO, Fabio Roberto; LIN, Chin Shien; KULCSAR, Marco Aurelio Vamondes; CERNEA, Claudio Roberto; BRANDAO, Lenine Garcia; MATOS, Leandro Luongo de
    Introduction: Elective neck dissection is recommended in cases of oral cavity squamous cell carcinoma without lymph node metastasis because of the risk of occult metastasis. Objective: The present study aimed to evaluate predictive factors for occult lymph node metastasis in patients with oral cavity squamous cell carcinoma treated with elective neck dissection and their impact on overall and disease-free survival. Methods: Forty surgically treated patients were retrospectively included. Results: Ten cases (25%) had lymphatic metastasis. Of the studied variables, perineural and angiolymphatic invasion in addition to tumor thickness were statistically associated with lymph node metastasis. Only angiolymphatic invasion was identified as an independent risk factor for occult metastasis in the logistic regression (OR=39.3; p=0.002). There was no association between overall and disease-free survival with the presence of occult lymph node metastasis. Conclusion: Metastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor (C) 2015 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.