Departamento de Cirurgia - FM/MCG

URI Permanente desta comunidade

O Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo (FMUSP) compromete-se com o ensino, pesquisa e extensão nas áreas de Anestesiologia, Cirurgia Plástica, Cirurgia de Cabeça e Pescoço, Cirurgia Geral e do Trauma, Topografia Estrutural Humana, Cirurgia Pediátrica, Cirurgia Vascular, Disciplina de Transplante e Cirurgia do Fígado, Urologia, Disciplina de Técnica Cirúrgica e Cirurgia Experimental.

Também oferece, àqueles que pretendem iniciar a pós graduação na área da Clínica Cirúrgica, um programa de pós-graduação stricto sensu destinado a profissionais da área médica e das demais áreas que estejam interessados em desenvolver projetos de pesquisa compatíveis com os desenvolvidos no Departamento.

Site oficial: http://www2.fm.usp.br/cirurgia/

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article 0 Citação(ões) na Scopus
Total laryngectomy vs. non-surgical organ preservation in advanced laryngeal cancer: a metanalysis
(2024) JR, Elio Gilberto Pfuetzenreiter; FERRERON, Gabriela Feltrini; SADKA, Julia Zumerkorn; SOUZA, Ana Beatriz Padua de; MATOS, Leandro Luongo; KOWALSKI, Luiz Paulo; DEDIVITIS, Rogerio Aparecido
Objective: To compare the oncological results and the functional outcomes of patients undergoing Total Laryngectomy (TL) with the non-surgical treatment (organ preservation protocol) in the treatment of advanced laryngeal carcinomas through systematic review and meta-analysis. Methods: A literature survey strategy was employed in order to perform a systematic review of the available evidence. Success rate and functional outomes after oncological treatment of patients with advanced laryngeal carcinomas was evaluated through systematic review and metanalysis, comparing TL and organ preservation protocol. Results: The surgical treatment was associated with better survival outcomes. When stratifying by T stage, while patients with T4 staging have less risk of mortality with TL, there is no difference between the different treatments for patients with T3 tumors. Surgery is related to a lower chance of recurrence, late dysphagia and feeding tube dependence.
article 0 Citação(ões) na Scopus
HOXA1 3′UTR Methylation Is a Potential Prognostic Biomarker in Oral Squamous cell Carcinoma
(2024) SORROCHE, Bruna Pereira; MIRANDA, Keila Cristina; BELTRAMI, Caroline Moraes; ARANTES, Lidia Maria Rebolho Batista; KOWALSKI, Luiz Paulo; MARCHI, Fabio Albuquerque; ROGATTO, Silvia Regina; ALMEIDA, Janete Dias
Simple Summary: Head and neck cancer with increased expression levels of HOXA1 tends to have a worse outcome. This gene is regulated by DNA methylation. Herein, we studied the methylation pattern of HOXA1 in oral cavity tumors. We found that methyl groups gather more often in a specific region of HOXA1, named 3 ' UTR, in tumor cells compared to healthy tissues. Interestingly, patients with increased methylation levels were preferentially detected in heavier smokers and patients with a longer survival. Our findings suggest that the analysis of the DNA methylation located in the 3 ' UTR of HOXA1 could help predict the patient's prognosis. Our findings could potentially guide treatment decisions and improve patient care in the future. Background: HOXA1 is a prognostic marker and a potential predictive biomarker for radioresistance in head and neck tumors. Its overexpression has been associated with promoter methylation and a worse prognosis in oral squamous cell carcinoma (OSCC) patients. However, opposite outcomes are also described. The effect of the methylation of this gene on different gene regions, other than the promoter, remains uncertain. We investigated the methylation profile at different genomic regions of HOXA1 in OSCC and correlated differentially methylated CpG sites with clinicopathological data. Methods: The HOXA1 DNA methylation status was evaluated by analyzing data from The Cancer Genome Atlas and three Gene Expression Omnibus datasets. Significant differentially methylated CpG sites were considered with a |triangle beta| >= 0.10 and a Bonferroni-corrected p-value < 0.01. Differentially methylated CpGs were validated by pyrosequencing using two independent cohorts of 15 and 47 OSCC patients, respectively. Results: Compared to normal tissues, we found significantly higher DNA methylation levels in the 3 ' UTR region of HOXA1 in OSCC. Higher methylation levels in tumor samples were positively correlated with smoking habits and patients' overall survival. Conclusions: Our findings suggest that HOXA1 gene body methylation is a promising prognostic biomarker for OSCC with potential clinical applications in patient monitoring.
article 1 Citação(ões) na Scopus
Markers of Tissue Perfusion as Predictors of Adverse Outcomes in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery
(2024) YAMAGUTI, Thiana; AULER JUNIOR, Jose Otavio Costa; DALLAN, Luis Alberto Oliveira; GALAS, Filomena Regina Barbosa Gomes; CUNHA, Ligia Cristina Camara; PICCIONI, Marilde de Albuquerque
Background: Cardiac surgery patients may be exposed to tissue hypoperfusion and anaerobic metabolism. Objective: To verify whether the biomarkers of tissue hypoperfusion have predictive value for prolonged intensive care unit (ICU) stay in patients with left ventricular dysfunction who underwent coronary artery bypass surgery. Methods: After approval by the institution's Ethics Committee and the signing of informed consent, 87 patients with left ventricular dysfunction (ejection fraction < 50%) undergoing coronary artery bypass surgery were enrolled. Hemodynamic and metabolic biomarkers were collected at five time points: after anesthesia, at the end of the surgery, at ICU admission, and at six and twelve hours after. An analysis of variance for repeated measures followed by a Bonferroni post hoc test was used for repeated, continuous variables (hemodynamic and metabolic variables) to determine differences between the two groups over the course of the study period. The level of statistical significance adopted was 5%. Results: Thirty-eight patients (43.7%) who presented adverse outcomes were older, higher Euro score (p<0.001), and elevated increment Delta pCO(2) as analyzed 12 hours after ICU admission (p<0.01), while increased arterial lactate concentration at 6 hours postoperatively was found to be a negative predictive factor (p<0.01). Conclusions: Euro SCORE, six-hour postoperative arterial lactate, 12-hour postoperative increment Delta PCO2, and eRQ are independent predictors of adverse outcomes in patients with left ventricular dysfunction after cardiac surgery.
article 1 Citação(ões) na Scopus
Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis
(2024) TALIZIN, Thalita Bento; DANILOVIC, Alexandre; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni S.; VICENTINI, Fabio C.; BATAGELLO, Carlos; NAHAS, William Carlos; MAZZUCCHI, Eduardo
Purpose: The aim of this study is to perform a high -quality meta -analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random -effects model was employed, and the alpha risk was defined as < 0.05. Results: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). Conclusion: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.
article 0 Citação(ões) na Scopus
The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction
(2024) CHOI, Esther Mihwa Oh; RIBEIRO, Renan Diego Americo; MONTAG, Eduardo; UEDA, Thiago; OKADA, Alberto Yoshikazu; MUNHOZ, Alexandre Mendonca; BUSNARDO, Fabio de Freitas; GEMPERLI, Rolf
Background Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival.Methods This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed.Results Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group ( p = 0.005), as was the rate of flap loss ( p = 0.006) and reoperation due to venous thrombosis ( p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group ( p = 0.01).Conclusion Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis.
article 0 Citação(ões) na Scopus
Upregulation of shelterin and CST genes and longer telomeres are associated with unfavorable prognostic characteristics in prostate cancer
(2024) SANTOS, Gabriel Arantes dos; I, Nayara Viana; PIMENTA, Ruan; CAMARGO, Juliana Alves de; GUIMARAES, Vanessa R.; ROMA, Poliana; CANDIDO, Patricia; SANTOS, Vinicius Genuino dos; REIS, Sabrina; LEITE, Katia Ramos Moreira; SROUGI, Miguel
Introduction: Search for new clinical biomarkers targets in prostate cancer (PC) is urgent. Telomeres might be one of these targets. Telomeres are the extremities of linear chromosomes, essential for genome stability and control of cell divisions. Telomere homeostasis relies on the proper functioning of shelterin and CST complexes. Telomeric dysfunction and abnormal expression of its components are reported in most cancers and are associated with PC. Despite this, there are only a few studies about the expression of the main telomere complexes and their relationship with PC progression. We aimed to evaluate the role of shelterin (POT1, TRF2, TPP1, TIN2, and RAP1) and CST (CTC1, STN1, and TEN1) genes and telomere length in the progression of PC. Methods: We evaluated genetic alterations of shelterin and CST by bioinformatics in samples of localized (n = 499) and metastatic castration-resistant PC (n = 444). We also analyzed the expression of the genes using TCGA (localized PC n = 497 and control n = 152) and experimental approaches, with surgical specimens (localized PC n = 81 and BPH n = 10) and metastatic cell lines (LNCaP, DU145, PC3 and PNT2 as control) by real-time PCR. Real-time PCR also determined the telomere length in the same experimental samples. All acquired data were associated with clinical parameters. Results: Genetic alterations are uncommon in PC, but POT1, TIN2, and TEN1 showed significantly more amplifications in the metastatic cancer. Except for CTC1 and TEN1, which are differentially expressed in localized PC samples, we did not detect an expression pattern relative to control and cell lines. Nevertheless, except for TEN1, the upregulation of all genes is associated with a worse prognosis in localized PC. We also found that increased telomere length is associated with disease aggressiveness in localized PC. Conclusion: The upregulation of shelterin and CST genes creates an environment that favors telomere elongation, giving selective advantages for localized PC cells to progress to more aggressive stages of the disease.
article 0 Citação(ões) na Scopus
Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases
(2024) ALVARENGA, Bruno Henrique; RIOS, Izabel Cristina; SILVA, Francisco de Salles Collet e; UTIYAMA, Edivaldo Massazo
Objective: To evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. Methods: During a period of two years, all General Surgery resident doctors at the Hospital das Cl & iacute;nicas of the Faculty of Medicine of the University of Sao Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. Results: There was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. Conclusion: The impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.
article 0 Citação(ões) na Scopus
The prognostic role of single cell invasion and nuclear diameter in early oral tongue squamous cell carcinoma
(2024) ALMANGUSH, Alhadi; HAGSTROM, Jaana; HAGLUND, Caj; KOWALSKI, Luiz Paulo; COLETTA, Ricardo D.; MAKITIE, Antti A.; SALO, Tuula; LEIVO, Ilmo
BackgroundThe clinical significance of single cell invasion and large nuclear diameter is not well documented in early-stage oral tongue squamous cell carcinoma (OTSCC).MethodsWe used hematoxylin and eosin-stained sections to evaluate the presence of single cell invasion and large nuclei in a multicenter cohort of 311 cases treated for early-stage OTSCC.ResultsSingle cell invasion was associated in multivariable analysis with poor disease-specific survival (DSS) with a hazard ratio (HR) of 2.089 (95% CI 1.224-3.566, P = 0.007), as well as with disease-free survival (DFS) with a HR of 1.666 (95% CI 1.080-2.571, P = 0.021). Furthermore, large nuclei were associated with worse DSS (HR 2.070, 95% CI 1.216-3.523, P = 0.007) and with DFS in multivariable analysis (HR 1.645, 95% CI 1.067-2.538, P = 0.024).ConclusionSingle cell invasion and large nuclei can be utilized for classifying early OTSCC into risk groups.
article 0 Citação(ões) na Scopus
Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis
(2024) BELKOVSKY, Mikhael; PASSEROTTI, Carlo Camargo; MAIA, Ronaldo Soares; ARTIFON, Everson Luiz de Almeida; OTOCH, Jose Pinhata; CRUZ, Jose Arnaldo Shiomi Da
Flexible ureterolithotripsy is a frequent urological procedure, usually used to remove stones from the kidney and upper ureter. Reusable uretero-scopes were the standard tool for that procedure, but recent concerns related to sterility and maintenance and repair costs created the opportunity to develop new technologies. In 2016, the first single-use digital flexible ureteroscope was introduced. Since then, other single-use ureteroscopes were developed, and studies compared them with the reusable ureteroscopes with conflicting results. The purpose of this study is to describe the literature that compares the performance of single-use and reusable flexible ureteroscopes in retrograde intrarenal surgery for urinary stones. A Systematic Review was performed in October 2022 in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). A search in MEDLINE, EMBASE, Web of Science, Google Scholar and LILACS retrieved 10,039 articles. After screening, 12 articles were selected for the Meta-Analysis. No differences were found in stone-free rate (OR 1.31, CI 95% [0.88, 1.97]), operative time (MD 0.12, CI 95% [-5.52, 5.76]), incidence of post-operative fever (OR 0.64, CI 95% [0.22, 1.89]), or incidence of post-operative urinary tract infection (OR 0.63 CI 95% [0.30, 1.32]). No differences were observed in the studied variables. Hence, the device choice should rely on the availability, cost analysis and surgeons' preference.
article 0 Citação(ões) na Scopus
Malignant tumors affecting the head and neck region in ancient times: Comprehensive study of the CRAB Database
(2024) AULESTIA-VIERA, Patricia Veronica; RODRIGUES-FERNANDES, Carla Isabelly; BRANDAO, Thais Bianca; ROCHA, Andre Caroli; VARGAS, Pablo Agustin; LOPES, Marcio Ajudarte; JOHNSON, Newell Walter; KOWALSKI, Luiz Paulo; RIBEIRO, Ana Carolina Prado; SANTOS-SILVA, Alan Roger
In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.