ALEXANDRE SILVA E SILVA
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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conferenceObject In Bag Morcellation: details and logistics of the technique(2016) FERNANDES, R.; ARAUJO, M.; SILVA, A. Silva e; CARVALHO, P. Mancusi de; ANTON, C.; GENTA, M. L. Nogueira Dias; RIBEIRO JR., A. Dias; SAMPAIO, D.; MIGLINO, G.; SADALLA, J. C.; CARVALHO, J. Paula- BORDERLINE OVARIAN TUMORS-10 YEARS SINGLE CENTER EXPERIENCE(2019) FERNANDES, R.; ANTON, C.; SILVA, A. Silva e; CARVALHO, J. P. Mancusi; ARAUJO, M.; GENTA, M. L. Dias; SAMPAIO, D.; MIGLINO, G.; DIAS JR., A.; SADALLA, J. C.; CARVALHO, J. Paula
- A novel model to estimate lymph node metastasis in endometrial cancer patients(2017) ANTON, Cristina; SILVA, Alexandre Silva e; BARACAT, Edmund Chada; DOGAN, Nasuh Utku; KOHLER, Christhardt; CARVALHO, Jesus Paula; FAVERO, Giovanni Mastrantonio diOBJECTIVES: To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy. METHODS: A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis. RESULTS: Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration > 50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value > 21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%. CONCLUSION: Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.
- Persistent postoperative ascites successfully identified and treated with laparoscopic indocyanine green fluorescence(2020) FERNANDES, Rodrigo; ANTON, Cristina; LOPES, Andre; SILVA, Alexandre Silva e; LEBLANC, Eric; JR, Ulysses Ribeiro; CARVALHO, Jesus Paula
- Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes(2020) ANTON, Cristina; KLEINE, Rodolpho Truffa; MAYERHOFF, Eric; DIZ, Maria del Pilar Esteves; FREITAS, Daniela de; CARVALHO, Heloisa de Andrade; CARVALHO, Joao Paulo Mancusi de; SILVA, Alexandre Silva e; GENTA, Maria Luiza Nogueira Dias; SILVA, Andre Lopes de Faria e; SALIM, Rafael Calil; ARANHA, Andrea; LOPEZ, Rossana Veronica Mendoza; CARVALHO, Filomena Marino; BARACAT, Edmund Chada; CARVALHO, Jesus PaulaFew reports have described the clinical and prognostic characteristics of endometrial cancer, which is increasing worldwide, in large patient series in Brazil. Our objective was to analyze the clinicopathological characteristics, prognostic factors, and outcomes of patients with endometrial cancer treated and followed at a tertiary Brazilian institution over a 10-year period. This retrospective study included 703 patients diagnosed with endometrial cancer who were treated at a public academic tertiary hospital between 2008 and 2018. The following parameters were analyzed: age at diagnosis, race, body mass index, serum CA125 level before treatment; histological type and grade, and surgical stage. Outcomes were reported relative to histological type, surgical staging, serum CA125, lymph-vascular space involvement (LVSI), and lymph-node metastasis. The median patient age at diagnosis was 63 (range, 27-93) years (6.4% were < 50 years). Minimally invasive surgeries were performed in 523 patients (74.4%). Regarding histological grade, 468 patients (66.5%) had low-grade endometrioid histology and 449 patients (63.9%) had stage I tumors. Tumors exceeded 2.0 cm in 601 patients (85.5%). Lymphadenectomy was performed in 551 cases (78.4%). LVSI was present in 208 of the patients' tumors (29.5%). Ninety-three patients (13.2%) had recurrent tumors and 97 (13.7%) died from their malignant disease. The robust prognostic value of FIGO stage and lymph node status were confirmed. Other important survival predictors were histological grade and LVSI [overall survival: hazard ratio (HR) = 3.75, p < 0.001 and HR = 2.01, p = 0.001; recurrence: HR = 2.49, p = 0.004 and HR = 3.22, p = 0.001, respectively). Disease-free (p = 0.087) and overall survival (p = 0.368) did not differ significantly between patients with stage II and III disease. These results indicate that prognostic role of cervical involvement should be explored further. This study reports the characteristics and outcomes of endometrial cancer in a large population from a single institution, with systematic surgical staging, a predominance of minimally invasive procedures, and well-documented outcomes. Prognostic factors in the present study population were generally similar to those in other countries, though our patients' tumors were larger than in studies elsewhere due to later diagnosis. Our unexpected finding of similar prognoses of stage II and III patients raises questions about the prognostic value of cervical involvement and possible differences between carcinomas originating in the lower uterine segment versus those originating in the body and fundus. The present findings can be used to guide public policies aimed at improving the diagnosis and treatment of endometrial cancer in Brazil and other similar countries.
- Single-Site Robotic Radical Hysterectomy and Sentinel Lymphnode Biopsy in Cervical Cancer: A Case Report(2017) SILVA E SILVA, Alexandre; FERNANDES, Rodrigo Pinto; ARAUJO, Marcia Pereira de; CARVALHO, João Paulo Mancusi de; CARVALHO, Filomena Marino; FAVERO, Giovani Mastrantônio; CARVALHO, Jesus PaulaABSTRACT Robotic surgeries for cervical cancer have several advantages compared with lapa-rotomic or laparoscopic surgeries. Robotic single-site surgery has many advantages compared with the multiport approach, but its safety and feasibility are not established in radical oncologic surgeries. We report a case of a Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma whose radical hysterectomy, sentinel lymph node mapping, and lymph node dissection were entirely performed by robotic single-site approach. The patient recovered very well, and was discharged from the hospital within 24 hours.
conferenceObject Borderline Ovarian Tumors: 15 year experience from a Single institute(2016) FERNANDES, R.; ANTON, C.; SILVA, A. Silva e; ARAUJO, M.; SAMPAIO, D.; MIGLINO, G.; CARVALHO, J. P. Mancusi de; RIBEIRO JR., A. Dias; SADALLA, J. C.; GENTA, M. L. Nogueira Dias; CARVALHO, J. Paula- Mucinous Cystadenoma Arising in a Uterine Isthmocele: A Case Report(2023) CARVALHO, Jesus Paula; SILVA, Alexandre Silva e; KLEINE, Rodolpho Truffa; BERTOLAZZI, Marilia Albanezi; FERNANDES, Rodrigo Pinto; CARVALHO, Filomena MarinoIsthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world's highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.
- Vaginal Morcellation Inside Protective Pouch: A Safe Strategy for Uterine Extration in Cases of Bulky Endometrial Cancers:. Operative and Oncological Safety of the Method(2015) FAVERO, Giovanni; MIGLINO, Giovanni; KOEHLER, Christhardt; PFIFFER, Tatiana; SILVA, Alexandre Silva e; RIBEIRO, Altamiro; LE, Xin; ANTON, Cristina; BARACAT, Edmund Chada; CARVALHO, Jesus PaulaObjective: To evaluate the operative and oncologic outcomes of an innovative technique for organ morcellation in patients scheduled for laparoscopic treatment of uterine malignancies. ] Background: Endoscopy is currently considered the standard of care for the operative treatment of endometrial cancer; however, the use of minimal invasive surgery (MIS) is restricted in patients with a bulky uterus or narrow vagina. Conventional unprotected intraperitoneal uterine fragmentation is indeed contraindicated in these cases. Consequently, oncologically safe methods to render these patients eligible for MIS are urgently needed. Intervention: Prospective study of women with histologically proven endometrial cancer in which uterus removal was a realistic concern owing to both organ size and proportionality. The patients underwent laparoscopic staging, including retroperitoneal lymphadenectomy, total hysterectomy, and bilateral salpingo-oophorectomy, followed by vaginal morcellation of the uterus inside a protective pouch (LapSac). Results: In our series of 30 cases, we achieved successful completion in all patients, without conversion to laparotomy. No surgery-related casualty or intraoperative morbidity was observed. The mean organ size was 246 g (range, 148-420 g), and the average additional operative time related to vaginal morcellation was 16 minutes (range, 9-28 minutes). Proper histopathological staging according to 2009 FIGO staging guidelines could be performed in all specimens. Two patients (6%) presented with significant postoperative complications, 1 each with vesicovaginal fistula and vaginal vault dehiscence. Fourteen patients (46%) needed adjuvant therapy. After a median follow-up of 20 months (range, 6-38 months), the 12-month and 24-month overall survival was 100% and 73.4% (95% confidence interval, 51%-96%), respectively. Four patients with positive lymph nodes died of distant metastasis. No case of pelvic or local relapse was observed. Conclusion: Vaginal morcellation following oncologic principles is a feasible method that permits rapid uterine extraction and potentially avoids unnecessary laparotomies. This series suggests that the technique may be oncologically safe and also can be used in cases of uterine pathology of uncertain malignancy.
- Ovarian cancer: Current applications of minimally invasive techniques(2018) FAVERO, G.; KöHLER, C.; SILVA, A. Silva e; CARVALHO, J. P.