JOSE ROBERTO FILASSI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
16 resultados
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- Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques(2011) MUNHOZ, Alexandre Mendonca; ALDRIGHI, Claudia Maria; MONTAG, Eduardo; ARRUDA, Eduardo; BRASIL, Jose Augusto; FILASSI, Jose Roberto; ALDRIGHI, Jose Mendes; GEMPERLI, Rolf; FERREIRA, Marcus CastroBackground: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.
- Reply to: Mastectomy skin flap thickness(2018) MARTA, Gustavo Nader; POORTMANS, Philip; BARROS, Alfredo C. de; FILASSI, Jose Roberto; FREITAS-JUNIOR, Ruffo; AUDISIO, Riccardo A.; MANO, Max Senna; METERISSIAN, Sarkis; DESNYDER, Sarah M.; BUCHHOLZ, Thomas A.; HIJAL, Tarek
- Occult Carcinoma in 866 Reduction Mammaplasties: Preserving the Choice of Lumpectomy(2011) MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; FILASSI, Jose Roberto
- Superficial inferior epigastric artery (SIEA) free flap using perforator vessels as a recipient site: clinical implications in autologous breast reconstruction(2011) MUNHOZ, Alexandre Mendonca; PELLARIN, Leandro; MONTAG, Eduardo; FILASSI, Jose Roberto; TACHIBANA, Adriano; GEBRIM, Heloisa; GEMPERLI, Rolf; FERREIRA, Marcus CastroBACKGROUND: Breast reconstruction with autogenous tissue is a well-established technique, but there are some limitations related to donor-site morbidity. Among available techniques, the superficial inferior epigastric artery (SIEA) flap is the least invasive procedure because it does not require harvesting or incision of the rectus muscle or the abdominal fascia. Besides adequate flap choice, the proper selection of the recipient vessels is an important factor. Thus, the internal mammary perforator branches (IMPBs) have been an attractive option regarding recipient pedicle morbidity. METHODS: The investigators reported the use of the free SIEA flap with the IMPBs as a recipient site to reconstruct radical mastectomy. RESULTS: Five patients with invasive ductal carcinoma underwent modified radical mastectomy and reconstruction. The IMPBs were selected as the recipient site and a free SIEA flap was used. The donor defect was closed directly without synthetic mesh. Satisfactory breast shape was achieved, and no complications were observed. CONCLUSIONS: For selected patients, the SIEA flap and IMPBs may constitute a new alternative for immediate breast reconstruction, because of the possibility of large tissue transfer with minimal donor and recipient area morbidity. The SIEA pedicle size and the quality of IMPB vessels should be carefully evaluated.
- What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery(2018) FREITAS, Thiago Brasileiro de; LIMA, Kennya Medeiros Lopes de Barros; CARVALHO, Heloisa de Andrade; MARQUES, Patricia de Azevedo; MATTOS, Fabio Teixeira Belfort; FONSECA, Alexandre Siqueira Franco; MUNHOZ, Alexandre Mendonca; FILASSI, Jose Roberto; STUART, Silvia R.; MARTA, Gustavo NaderPurpose/objective(s): To evaluate the role of surgical clips placement in the definition of boost treatment volume. Materials/methods: Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by cry Boost minus CTV Quadrant. Results: A total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52 cc, CTV Boost:36.59 cc, CTV Quadrant:285.07 cc, Cry NT:210.1 cc and CTV MISS:13.57 cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the Cry Quadrant and in 473% (117), partially inside. Among patients with any CFV MISS, 803% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CFV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue. Conclusion: Surgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.
- Cancer During Pregnancy: The Oncologist Overview(2019) HEPNER, Adriana; NEGRINI, Daniel; HASE, Eliane Azeka; EXMAN, Pedro; TESTA, Laura; TRINCONI, Angela F.; FILASSI, Jose Roberto; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo; O'CONNOR, Tracey L.; MARTIN, Michael GaryAlthough a rare and challenging condition, cancer during pregnancy should promptly be identified and treated. Not only standards of care guidelines for the underlying disease are taken into account, but also fetal safety might be weighted for clinical decisions. Frequent lack of experience and knowledge about this condition could lead to late diagnosis, imprecise management, suboptimal treatment and fetal and maternal harm. Therefore, this review aims to summarize the current evidence regarding the epidemiology, clinical presentation, diagnostic workup, staging and treatment, including novel treatment modalities for patients diagnosed with cancer during pregnancy.
- Reply: Chest Wall Reconstruction for Locally Advanced Breast Cancer with the V-Y Thoracoabdominal Perforator Flap(2012) MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; FILASSI, Jose Roberto
- Comment on: Use of tumescent mastectomy technique as a risk factor for native breast skin flap necrosis after immediate breast reconstruction(2012) MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; FILASSI, Jose Roberto
- Immediate Locally Advanced Breast Cancer and Chest Wall Reconstruction: Surgical Planning and Reconstruction Strategies with Extended V-Y Latissimus Dorsi Myocutaneous Flap(2011) MUNHOZ, Alexandre Mendonca; MONTAG, Eduardo; ARRUDA, Eduardo; OKADA, Alberto; BRASIL, Jose Augusto; GEMPERLI, Rolf; FILASSI, Jose Roberto; FERREIRA, Marcus CastroBackground: Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. Methods: In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds. Results: Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care. Conclusions: The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management. (Plast. Reconstr. Surg. 127: 2186, 2011.)
- SPECT-CT-Guided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients With Breast Cancer A Pilot Study(2016) PIATO, Jose Roberto Morales; FILASSI, Jose Roberto; VEGA, Alberto Jorge Monteiro Dela; COURA-FILHO, George Barberio; AGUIAR, Fernando Nalesso; PORCIUNCULA, Ligia Maria Teixeira Pereira; DORIA, Maira Teixeira; SOARES JR., Jose Maria; BARACAT, Edmund ChadaObjective: The objective of this study was to determine the impact of the use of single-photon emission computed tomography fused with computed tomography (SPECT-CT) on thoracoscopic biopsy of sentinel lymph nodes (SLNs) in the internal mammary chain in patients with breast cancer by evaluating resultant changes in staging and their clinical implications. Methods: Between September 2010 and January 2014, we performed lymphoscintigraphy-assisted thoracoscopic biopsy of the internal mammary chain SLN in 20 patients with breast cancer. Single-photon emission computed tomography fused with computed tomography was also used in 13 of these patients. The sentinel nodes were surgically identified with the aid of a gamma probe. Results: Sentinel lymph nodes were identified surgically in 19 of 20 patients. In the 13 patients in whom SPECT-CT was used, it readily identified SLNs, especially when they were located over an intercostal space. Change of staging occurred in three patients (15%), two of whom accordingly received adjuvant radiotherapy to the internal thoracic chain. Conclusions: Compared with lymphoscintigraphy alone, the use of SPECT-CT improves localization of the SLN in the internal mammary chain, allowing more accurate planning of each individual's treatment.