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
15 resultados
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- Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature(2024) PIAZZA, Cesare; LANCINI, Davide; TOMASONI, Michele; ZAFEREO, Mark; POORTEN, Vincent Vander; HANNA, Ehab; MAKITIE, Antti A.; FERNANDEZ-ALVAREZ, Veronica; KOWALSKI, Luiz P.; CHIESA-ESTOMBA, Carlos; FERLITO, AlfioMalignant carotid body tumors (MCBT) are rare and diagnosed after detection of nodal or distant metastases. This systematic review (SR) focuses on MCBT initially approached by surgery. Preferred Reporting Items for SR and Meta-Analysis (MA) guided the articles search from 2000 to 2023 on PubMed, Scopus, and Web of Science. Among 3548 papers, 132 (337 patients) were considered for SR; of these, 20 (158 patients) for MA. Malignancy rate was 7.3%, succinate dehydrogenase (SDH) mutation 17%, age at diagnosis between 4th and 6th decades, with a higher prevalence of females. MCBTs were mostly Shamblin III, with nodal and distant metastasis in 79.7% and 44.7%, respectively. Malignancy should be suspected if CBT >4 cm, Shamblin III, painful or otherwise symptomatic, at the extremes of age, bilateral, with multifocal disease, and SDHx mutations. Levels II-III clearance should be performed to exclude nodal metastases and adjuvant treatments considered on a case-by-case basis.
- Primary hyperparathyroidism: A disease of diverse genetic, symptomatic, and biochemical phenotypes(2021) MEDINA, Jesus E.; RANDOLPH, Gregory W.; ANGELOS, Peter; ZAFEREO, Mark E.; TUFANO, Ralph P.; KOWALSKI, Luiz P.; MONTENEGRO, Fabio L. M.; OWEN, Randall P.; KHAFIF, Avi; SUAREZ, Carlos; SHAHA, Ashok R.; RODRIGO, Juan P.; KREMPL, Greg A.; RINALDO, Alessandra; SILVER, Carl E.; FERLITO, AlfioGenetic, symptomatic, and biochemical heterogeneity of patients with primary hyperparathyroidism (PHPT) has become apparent in recent years. An in-depth, evidence-based review of the phenotypes of PHPT was conducted. This review was intended to provide the resulting information to surgeons who operate on patients with hyperparathyroidism. This review revealed that the once relatively clear distinction between familial and sporadic PHPT has become more challenging by the finding of various germline mutations in patients with seemingly sporadic PHPT. On the one hand, the genetic and clinical characteristics of some syndromes in which PHPT is an important component are now better understood. On the other hand, knowledge is emerging about novel syndromes, such as the rare multiple endocrine neoplasia type IV (MEN4), in which PHPT occurs frequently. It also revealed that, currently, the classical array of symptoms of PHPT is seen rarely upon initial presentation for evaluation. More common are nonspecific, nonclassical symptoms and signs of PHPT. In areas of the world where serum calcium levels are checked routinely, most patients today are ""asymptomatic"" and they are diagnosed after an incidental finding of hypercalcemia; however, some of them have subclinical involvement of bones and kidneys, which is demonstrated on radiographs, ultrasound, and modern imaging techniques. Last, the review points out that there are three distinct biochemical phenotypes of PHPT. The classical phenotype in which calcium and parathyroid hormone levels are both elevated, and other disease presentations in which the serum levels of calcium or intact parathyroid hormone are normal. Today several, distinct phenotypes of the disease can be identified, and they have implications in the diagnostic evaluation and treatment of patients, as well as possible screening of relatives.
- Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients(2021) LIRA, Renan Bezerra; CICCO, Rafael De; RANGEL, Leonardo Guimaraes; BERTELLI, Antonio Augusto; SILVA, Guilherme Duque; VANDERLEI, Joao Paulo de Medeiros; KOWALSKI, Luiz PauloBackground Well-established conventional thyroidectomy has satisfactory outcomes; however, robotic and endoscopic thyroid surgery can avoid visible anterior neck scars. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most recent of these techniques. Methods This was a retrospective review of 412 patients who underwent TOETVA from 2017 to 2020 in 13 Brazilian centers. Results The study included 359 (87.1%) females and 53 (12.9%) males, with a mean age of 40 years. There were 231 (56.1%) total thyroidectomies. The conversion rate was 0.7%. The transient vocal cord palsy rate was 7.6% (30 patients). Temporary and persistent hypocalcemia rates were 4.0% and 0.8%, respectively. There were two cases of infection (0.5%). Discussion This is a large multi-institute TOETVA study, with one of the largest cohorts published to date that; despite its retrospective nature and selection bias, reached outcomes comparable to previously reported series, this study reinforced safeness, feasibility, and nationwide reproducibility for this technique.
- The impact of worst pattern of invasion on the extension of surgical margins in oral squamous cell carcinoma(2022) KOHLER, Hugo Fontan; VARTANIAN, Jose Guilherme; PINTO, Clovis Antonio Lopes; RODRIGUES, Ivete Fabelo Pereira da Silva; KOWALSKI, Luiz PauloBackground To evaluate margins for oral carcinoma according to types of invasion front. Methods Retrospective cohort of 772 patients with worst pattern of invasion (WPOI) graded 1-5. Local recurrence was the outcome of interest. Results Local recurrences occurred in 164 patients (21.2%) and was affected by WPOI type 4/5, margin distance, perineural invasion, and adjuvant radiotherapy. In patients with WPOI types 1/2/3, a cutoff of 1.7 mm was considered ideal margin extent and in patients with WPOI types 4/5, the cutoff was 7.8 mm. Patients below these thresholds had a significantly higher incidence of local recurrence. Conclusions Different WPOI determine the ideal extent of surgical margins as 1.7 mm for patients with types 1-3, and 7.8 mm in patients with types 4/5.
- MicroRNA-mediated extracellular matrix remodeling in squamous cell carcinoma of the oral cavity(2021) MENDERICO JUNIOR, Gilberto Mendes; THEODORO, Therese Rachell; PASINI, Fatima Solange; ISHIKAWA, Marina de Menezes; SANTOS, Nayara Stephanie Sousa; MELLO, Evandro Sobroza de; PINHAL, Maria Aparecida da Silva; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio Vamondes; DEDIVITIS, Rogerio Aparecido; CERNEA, Claudio Roberto; KOWALSKI, Luiz Paulo; MATOS, Leandro Luongo deBackground We evaluated microRNAs and extracellular matrix component profiles in squamous cell carcinoma of the oral cavity (OSCC) in comparison to healthy mucosa. Methods Retrospective study investigating 64 microRNAs related to oncogenic process and to constituents of the extracellular matrix. We also performed immunohistochemical assays for molecules involved in the same biological processes. Results High expression of miR-21-5p (p < 0.001) and miR-106-5p (p < 0.001) and low expression of miR-320a (p = 0.001) and miR-222-3p (p = 0.001) were predictors of malignancy. Individually, miR-21-5p exhibited the best statistical performance (area under the curve = 0.972; 95% confidence interval: 0.911-1.000) in the differentiation between tumor tissue and healthy mucosa. Moreover, tumor sample showed increased expression of MMP-2, MMP-9, alpha-laminin, and beta-laminin in tumor-related fibroblasts and lower continuity of type IV collagen in the basement membrane. Conclusion The present study demonstrates the biological effects of microRNAs on the carcinogenesis of OSCC as well as the intense modification of the tumor microenvironment.
- Impact of lymph node ratio and number of lymph node metastases on survival and recurrence in laryngeal squamous cell carcinoma(2023) MOLTENI, Gabriele; NOCINI, Riccardo; MATTIOLI, Francesco; NAKAYAMA, Meijin; DEDIVITIS, Rogerio A.; MANNELLI, Giuditta; CROSETTI, Erika; CHIESA-ESTOMBA, Carlos Miguel; SISTIAGA-SUAREZ, Jon A.; GIORDANO, Leone; GALLI, Andrea; LIONELLO, Marco; MERCANTE, Giuseppe; RALLI, Massimo; FERMI, Matteo; KLEIN-RODRIGUEZ, Alejandro; MAYO-YANEZ, Miguel; SERAFINI, Edoardo; PIROLA, Francesca; PADERNO, Alberto; CAMBRIA, Francesca; ORIDATE, Nobuhiko; SANO, Daisuke; BOSCOLO-RIZZO, Paolo; MARCUZZO, Alberto Vito; PARRINELLO, Giampiero; MARCHI, Filippo; SAIBENE, Alberto Maria; TUCCIARONE, Manuel; VISCASILLAS, Guillem; ZELENIK, Karol; RAMOS, Daniel Marin; PALACIOS-GARCIA, Jose; TIRELLI, Giancarlo; PELLINI, Raul; PALUDETTI, Gaetano; GALLI, Jacopo; ROSSI, Giorgia; VINCENTIIS, Marco De; CERNEA, Claudio Roberto; SPRIANO, Giuseppe; BUSSI, Mario; PERETTI, Giorgio; SUCCO, Giovanni; PIAZZA, Cesare; BERTOLIN, Andy; KOWALSKI, Luiz Paulo; PRESUTTI, Livio; SACCHETTO, AndreaIntroductionThe aim of this study is to assess the impact of lymph node ratio (LNR) and number of positive lymph nodes (NPLN) on mortality and recurrence rates in patients with laryngeal squamous cell carcinoma. Materials and methodsWe conducted a retrospective multicenter international study involving 24 Otorhinolaryngology-Head and Neck Surgery divisions. Disease-specific survival (DSS) and disease-free survival (DFS) were evaluated as the main outcomes. The curves for DSS and DFS according to NPLN and LNR were analyzed to identify significant variations and establish specific cut-off values. Results2507 patients met the inclusion criteria. DSS and DFS were significantly different in the groups of patients stratified according to LNR and NPLN. The 5-year DSS and DFS based on LNR and NPLN demonstrated an improved ability to stratify patients when compared to pN staging. ConclusionOur data demonstrate the potential prognostic value of NPLN and LNR in laryngeal squamous cell carcinoma.
- COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice(2020) KOWALSKI, Luiz P.; SANABRIA, Alvaro; RIDGE, John A.; NG, Wai Tong; BREE, Remco de; RINALDO, Alessandra; TAKES, Robert P.; MAKITIE, Antti A.; CARVALHO, Andre L.; BRADFORD, Carol R.; PALERI, Vinidh; HARTL, Dana M.; POORTEN, Vincent Vander; NIXON, Iain J.; PIAZZA, Cesare; LACY, Peter; RODRIGO, Juan P.; GUNTINAS-LICHIUS, Orlando; MENDENHALL, William M.; D'CRUZ, Anil; LEE, Anne W. M.; FERLITO, AlfioThe 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.
- Oral squamous cell carcinoma outcome in adolescent/young adult: Systematic review and meta-analysis(2022) KAMINAGAKURA, Estela; TANGO, Rubens Nisie; CRUZ-PEREZ, Danyel; BONAN, Roberta; ALMEIDA, Luciana Yamamoto de; LANCA, Maria Leticia de Almeida; BONAN, Paulo; MARTINS, Helder; JR, Ademar Takahama; ITO, Fabio Augusto; COUTINHO-CAMILLO, Claudia Malheiros; LOURENCO, Silvia Vanessa; CANEPPELE, Taciana; SIKORA, Andrew G.; KOWALSKI, Luiz Paulo; YOUNG, SimonTo perform a systematic review focusing on the prognosis of oral cavity squamous cell carcinoma (OSCC) in young patients (<= 40 years old) compared to older (>40 years old). Four databases were used in our search strategy. First, all titles were systematically organized using the Covidence platform online. In the second phase, 118 full texts of potentially eligible studies were analyzed by reviewers independently and in pairs. Twelve studies were considered eligible for data extraction. The relapse was higher in the young than in controls (pooled relative risk (RR) = 1.31; 95% CI [1.10-1.56]). The 5-year disease-free survival (DFS) was worse in young group (pooled hazard ratio (HR) = 0.73; 95% CI [0.63-0.85]) but the 5-year overall survival (OS) estimate was similar between the groups (pooled HR = 0.84; 95% CI [0.70-1.00]). While the 5-year OS was similar between groups, the number of relapses and 5-year DFS were worse in patients with OSCC <= 40 years old.
- Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review(2022) SANABRIA, Alvaro; PINILLOS, Pilar; LIRA, Renan B.; SHAH, Jatin P.; TUFANO, Ralph P.; ZAFEREO, Mark E.; NIXON, Iain J.; RANDOLPH, Gregory W.; SIMO, Ricard; POORTEN, Vincent Vander; RINALDO, Alessandra; MEDINA, Jesus E.; KHAFIF, Avi; ANGELOS, Peter; MAKITIE, Antti A.; SHAHA, Ashok R.; RODRIGO, Juan P.; HARTL, Dana M.; KOWALSKI, Luiz P.; FERLITO, AlfioMost cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.
- Sentinel lymph node biopsy for early squamous cell carcinoma of the lip and oral cavity: Real-world experience in Brazil(2022) MATOS, Leandro Luongo; CAPUZZO, Renato Castro; PEDRUZZI, Paola Andrea Galbiatti; FARIAS, Terence; FARIAS, Jose Wilson Mourao de; CHONE, Carlos Takahiro; KOHLER, Hugo Fontan; VARTANIAN, Jose Guilherme; DIAS, Fernando Luiz; COUTO, Eduardo Vieira; PINTO, Fabio Roberto; CARVALHO, Andre Lopes; KOWALSKI, Luiz PauloBackground This study aimed to evaluate the accuracy and oncological results of sentinel lymph node biopsy in patients with early lip and oral cavity squamous cell carcinoma (SCC) in a real-world scenario. Methods Retrospective study including seven Brazilian centers. Results Four-hundred and seven cN0 patients were accrued for 20 years. The rate of occult metastasis was 23.1% and 22 patients (5.4%) had regional failure. We found, for 5 years of follow-up, 85.3% of regional recurrence-free survival; 77.1% of disease-free survival; 73.7% of overall survival; and 86.7% of disease-specific survival. The rate of false-negative cases was 5.4%. Conclusion In a real-world scenario, sentinel lymph node biopsy for patients with SCC of the lip and oral cavity proved feasible in different settings and to be oncologically safe, with similar rates of occult lymph node metastasis and false-negative cases, when compared to elective neck dissection, and with similar long-term survival to that reported historically.