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
72 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 72
- 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.
- 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.
- 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.
conferenceObject 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.
- Tracheal and Cricotracheal Resection With End-to-End Anastomosis for Locally Advanced Thyroid Cancer: A Systematic Review of the Literature on 656 Patients(2021) PIAZZA, Cesare; LANCINI, Davide; TOMASONI, Michele; D'CRUZ, Anil; HARTL, Dana M.; KOWALSKI, Luiz P.; RANDOLPH, Gregory W.; RINALDO, Alessandra; SHAH, Jatin P.; SHAHA, Ashok R.; SIMO, Ricard; POORTEN, Vincent Vander; ZAFEREO, Mark; FERLITO, AlfioAirway involvement by advanced thyroid carcinoma (TC) constitutes a negative prognosticator, besides being a critical clinical issue since it represents one of the most frequent causes of death in locally advanced disease. It is generally agreed that, for appropriate laryngo-tracheal patterns of invasion, (crico-)tracheal resection and primary anastomosis [(C)TRA] is the preferred surgical technique in this clinical scenario. However, the results of long-term outcomes of (C)TRA are scarce in the literature, due to the rarity of such cases. The relative paucity of data prompts careful review of the available relevant series in order to critically evaluate this surgical technique from the oncologic and functional points of view. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement on the PubMed, Scopus, and Web of Science databases. English-language surgical series published between January 1985 and August 2021, reporting data on >= 5 patients treated for TC infiltrating the airway by (C)TRA were included. Oncologic outcomes, mortality, complications, and tracheotomy-dependency rates were assessed. Pooled proportion estimates were elaborated for each end-point. Thirty-seven studies were included, encompassing a total of 656 patients. Pooled risk of perioperative mortality was 2.0%. Surgical complications were reported in 27.0% of patients, with uni- or bilateral recurrent laryngeal nerve palsy being the most common. Permanent tracheotomy was required in 4.0% of patients. Oncologic outcomes varied among different series with 5- and 10-year overall survival rates ranging from 61% to 100% and 42.1% to 78.1%, respectively. Five- and 10-year disease specific survival rates ranged from 75.8% to 90% and 54.5% to 62.9%, respectively. Therefore, locally advanced TC with airway invasion treated with (C)TRA provides acceptable oncologic outcomes associated with a low permanent tracheotomy rate. The reported incidence of complications, however, indicates the need for judicious patient selection, meticulous surgical technique, and careful postoperative management.
- Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review (vol 40, pg 3681, 2023)(2023) SANABRIA, Alvaro; OLIVERA, Maria Paula; CHIESA-ESTOMBA, Carlos; HAMOIR, Marc; KOWALSKI, Luiz P.; LOPEZ, Fernando; MAKITIE, Antti; ROBBINS, K. Thomas; RODRIGO, Juan Pablo; PIAZZA, Cesare; SHAHA, Ashok; SJOGREN, Elizabeth; SUAREZ, Carlos; ZAFEREO, Mark; FERLITO, Alfio
- Cervical Lymph Node Metastases from Central Nervous System Tumors: A Systematic Review(2022) COCA-PELAZ, Andres; BISHOP, Justin A.; ZIDAR, Nina; AGAIMY, Abbas; GEBRIM, Eloisa Maria Mello Santiago; MONDIN, Vanni; COHEN, Oded; STROJAN, Primoz; RINALDO, Alessandra; SHAHA, Ashok R.; BREE, Remco de; HAMOIR, Marc; MAKITIE, Antti A.; KOWALSKI, Luiz P.; SABA, Nabil F.; FERLITO, AlfioIntroduction: Lymph node metastasis (LNM) from primary tumors of the central nervous system (CNS) is an infrequent condition, and classically it was thought that CNS tumors could not spread via the lymphatic route. Recent discoveries about this route of dissemination make its knowledge necessary for surgeons and pathologists to avoid delays in diagnosis and unnecessary treatments. The aim of this paper is to review the literature and to discuss the relevant pathogenetic mechanism and the cytologic features along with recommendations for surgical treatment of these cervical LNM. Materials and Methods: Using PRISMA guidelines, we conducted a systematic review of the literature published from 1944 to 2021, updating the comprehensive review published in 2010 by our group. Results: Our review includes data of 143 articles obtaining 174 patients with LNM from a primary CNS tumor. The mean age of the patients was 31.9 years (range, 0.1-87) and there were 61 females (35.1%) and 103 males (59.2%), and in 10 cases (5.7%) the gender was not specified. The more frequent sites of distant metastasis were bones (23%), lungs (11.5%) and non-cervical lymph nodes (11%). Conclusion: Cervical LNM from CNS tumors is infrequent. Pathologic diagnosis can be obtained by fine-needle aspiration cytology in most cases, giving surgeons the option to plan the appropriate surgical treatment. Given the poor prognosis of these cases, the most conservative possible cervical dissection is usually the treatment of choice.
- Complications related to the Cook-Swarz implantable Doppler probe use in head and neck microvascular reconstruction: a systematic review(2023) CHIESA-ESTOMBA, Carlos M.; GONZALEZ-GARCIA, Jose A.; GENDEN, Eric M.; PIAZZA, Cesare; GUNTINAS-LICHIUS, Orlando; VANDER-POORTEN, Vincent; KOWALSKI, Luiz P.; LOPEZ, Fernando; QUER, Miquel; RODRIGO, Juan P.; SANABRIA, Alvaro; FERNANDEZ-ALVAREZ, Veronica; SUAREZ, Carlos; COHEN, Oded; BREE, Remco de; SHAHA, Ashok R.; MAKITIE, Antti A.; FERLITO, AlfioPurpose Vascular perfusion research has been dedicated to identify inexpensive, effective, and easy to use methods to assess free flap perfusion for both buried and non-buried flaps. Methods Systematic review of complications in patients underwent Head and Neck microsurgical reconstruction and vascular implantable Doppler monitoring. Results Sixteen articles were included for qualitative analysis. 2535 (92.2%) patients received IDP monitorization. Venous thrombosis was the most common vascular complication effecting 28 (1.1%). Regarding complications potentially related to the use of the IDP, just one study described the presence of granuloma formation along the suture line in 2 (0.07%) patients. Conclusions Our findings indicated that Cook-Swartz IDP will represents a safe and effective device for FF monitoring in HN reconstructive micro-surgery. A detailed prospective registration of the results and complications related to the use of IDP remains mandatory to precisely estimate results, cost, and complications.