LUIZ PAULO KOWALSKI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
173 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 173
- Clinical predictors of malignant transformation and recurrence in oral potentially malignant disorders: A systematic review and meta-analysis(2022) PAGLIONI, Mariana de Pauli; KHURRAM, Syed Ali; RUIZ, Blanca Iciar Indave; LAUBY-SECRETAN, Beatrice; NORMANDO, Ana Gabriela; RIBEIRO, Ana Carolina Prado; BRANDAO, Thais Bianca; PALMIER, Natalia Rangel; LOPES, Marcio Ajudarte; GUERRA, Eliete Neves da Silva; MELETI, Marco; MIGLIORATI, Cesar Augusto; CARVALHO, Andre Lopes; MATOS, Leandro Luongo de; KOWALSKI, Luiz Paulo; SANTOS-SILVA, Alan RogerObjective. We performed a systematic review dedicated to pooling evidence for the associations of clinical features with malignant transformation (MT) and recurrence of 3 oral potentially malignant disorders (OPMDs) (actinic cheilitis [AC], oral leukoplakia [OL], and proliferative verrucous leukoplakia [PVL]). Study Design. We selected studies that included clinical features and risk factors (age, sex, site, size, appearance, alcohol intake, tobacco use, and sun exposure) of OL, PVL, and AC associated with recurrence and/or MT. Results. Based on the meta-analysis results, non-homogeneous OL appears to have a 4.53 times higher chance of recurrence after treatment. We also found 6.52 higher chances of MT of non-homogeneous OL. Another clinical feature related to higher MT chances is the location (floor of the mouth and tongue has 4.48 higher chances) and the size (OL with >200 mm2 in size has 4.10 higher chances of MT). Regarding habits, nonsmoking patients with OL have a 3.20 higher chance of MT. The only clinical feature related to higher chances of MT in patients with PVL was sex (females have a 2.50 higher chance of MT). Conclusions. Our study showed that some clinical features may indicate greater chances of recurrence after treatment and MT of OPMD.
- Implication of the New AJCC pT Classification of SCC of the Lip Comparing With Other Oral Subsites(2021) TOLEDO, Loic Monginet; OLIVEIRA, Adriana Santos de; PINHEIRO, Renan Aguera; LEITE, Ana Kober Nogueira; MELLO, Evandro Sobroza de; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio V.; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoObjective To determine the implication of the new AJCC staging system for pT classification in a cohort of patients with SCC of the lip mucosa and compare it to other oral cavity sites. Methods Retrospective cohort of 744 patients treated between 2002 and 2017, by the Head and Neck Surgery Department of the University of Sao Paulo. Results Of 95 lip patients, 42 had pT upstage (58.1% of pT1 to pT2-3 and 50% of pT2 to pT3). Similar DFS/OS observed for those pT1 maintained or upstaged to pT2-3, pT2 patients upstaged to pT3 presented worse OS (49.4% versus 92.3%, P = .032). The comparison between lip and other mouth topographies, denoted better prognosis for pT1-2, but not for pT3-4a. Lip tumors had lower DOI, rates of perineural/angiolymphatic invasion, nodal metastasis, recurrence, and death. Conclusion The inclusion of DOI to the new pT classification better stratifies patients with SCC of the lip mucosa upstaged to pT3 by assessing inferior OS. Level of Evidence 3 Laryngoscope, 2021
- Distant metastasis from head and neck cancer: role of surgical treatment(2022) VARTANIAN, Jose Guilherme; GROSS, Jefferson Luis; KOWALSKI, Luiz PauloPurpose of review The rates of distant metastases in patients with head and neck squamous cell carcinoma varies from 3 to 50%. Metastases are usually multiple, diagnosed within 24 months after treatment and sited in the lungs, bone or liver. This review highlights the importance of a personalized treatment approach in such patients. Recent findings In patients with primary tumor controlled and with oligometastatic disease, surgical options can be considered, especially for lung metastases. Overall survival for patients who are candidates for lung metastasectomy can be as high as 59%. In bone and liver metastases, resection is not frequently used but radiofrequency ablation is a promising option. Finally, mediastinal and axillary lymph node metastasis are classified as distant metastases, and lymph node dissection is the treatment of choice whenever the disease is limited to these sites. Patients with distant metastases usually are considered incurable; however, an aggressive local treatment of solitary distant metastases should be considered in highly selected patients, with a potential increase of overall survival.
- Standardization for oncologic head and neck surgery(2021) RONEN, Ohad; ROBBINS, K. Thomas; BREE, Remco de; GUNTINAS-LICHIUS, Orlando; HARTL, Dana M.; HOMMA, Akihiro; KHAFIF, Avi; KOWALSKI, Luiz P.; LOPEZ, Fernando; MAKITIE, Antti A.; NG, Wai Tong; RINALDO, Alessandra; RODRIGO, Juan P.; SANABRIA, Alvaro; FERLITO, AlfioThe inherent variability in performing specific surgical procedures for head and neck cancer remains a barrier for accurately assessing treatment outcomes, particularly in clinical trials. While non-surgical modalities for cancer therapeutics have evolved to become far more uniform, there remains the challenge to standardize surgery. The purpose of this review is to identify the barriers in achieving uniformity and to highlight efforts by surgical groups to standardize selected operations and nomenclature. While further improvements in standardization will remain a challenge, we must encourage surgical groups to focus on strategies that provide such a level.
bookPart Resgate das recidivas(2022) RAMOS, Daniel Marin; KOWALSKI, Luiz Paulo- Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology(2023) LOPEZ, Fernando; GHUZLAN, Abir Al; ZAFEREO, Mark; POORTEN, Vincent Vander; ROBBINS, K. Thomas; HAMOIR, Marc; NIXON, Iain J.; TUFANO, Ralph P.; RANDOLPH, Gregory; PACE-ASCIAK, Pia; ANGELOS, Peter; COCA-PELAZ, Andres; KHAFIF, Avi; RONEN, Ohad; RODRIGO, Juan Pablo; SANABRIA, Alvaro; PALME, Carsten E.; MAKITIE, Antti A.; KOWALSKI, Luiz P.; RINALDO, Alessandra; FERLITO, AlfioSimple Summary In non-well differentiated thyroid cancer, the rate of nodal involvement is variable and depends on the histology of the tumor. We aim to highlight the opinions of several experts from different parts of the world on the current management of the less common types of thyroid cancer to provide a consensus on the treatment of regional lymphatics for these entities. The rate of lymph node involvement is variable and depends on the histology of the tumor. Within undifferentiated tumors', there is an established consensus on the treatment of anaplastic carcinoma, medullary carcinoma and poorly differentiated carcinoma of the thyroid. However, treatment of other rarer tumors must be individualized, taking into account both the aggressiveness of the histology and the anatomical distribution of the disease. In general, prophylactic treatment of the neck is not indicated. Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer.
bookPart Cuidados pré e pós-operatórios em cirurgia de cabeça e pescoço(2023) MONTENEGRO, Fábio Luiz de Menezes; MAGNABOSCO, Felipe Ferraz; KOWALSKI, Luiz PauloconferenceObject Enrichment Analysis of the Amplified Genes by Array-based Comparative Genomic Hybridization in the Carcinoma Ex Pleomorphic Adenoma(2022) EGAL, Erika; SCARINI, Joao; SABINO, Wellington Lima; HELMS, My; LIMA-SOUZA, Reydson de; GONDAK, Rogerio; KOWALSKI, Luiz; ALTEMANI, Albina; KREPISCHI, Ana Cristina Victorino; MARIANO, Fernanda- Impacts of Environmental Factors on Head and Neck Cancer Pathogenesis and Progression(2021) MIRANDA-GALVIS, Marisol; LOVELESS, Reid; KOWALSKI, Luiz Paulo; TENG, YongEpidemiological and clinical studies over the past two decades have provided strong evidence that genetic elements interacting with environmental components can individually and collectively influence one's susceptibility to cancer. In addition to tumorigenic properties, numerous environmental factors, such as nutrition, chemical carcinogens, and tobacco/alcohol consumption, possess pro-invasive and pro-metastatic cancer features. In contrast to traditional cancer treatment, modern therapeutics not only take into account an individual's genetic makeup but also consider gene-environment interactions. The current review sharpens the focus by elaborating on the impact that environmental factors have on the pathogenesis and progression of head and neck cancer and the underlying molecular mechanisms involved. Recent advances, challenges, and future perspectives in this area of research are also discussed. Inhibiting key environmental drivers of tumor progression should yield survival benefits for patients at any stage of head and neck cancer.
- Update of Radiofrequency Ablation for Treating Benign and Malignant Thyroid Nodules. The Future Is Now(2021) TUFANO, Ralph P.; PACE-ASCIAK, Pia; RUSSELL, Jonathon O.; SUAREZ, Carlos; RANDOLPH, Gregory W.; LOPEZ, Fernando; SHAHA, Ashok R.; MAKITIE, Antti; RODRIGO, Juan P.; KOWALSKI, Luiz Paulo; ZAFEREO, Mark; ANGELOS, Peter; FERLITO, AlfioThermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer.