Material Científico

Material Científico 2015-04-21T03:40:05+00:00

Late surgical outcomes of carotid resection and saphenous vein graft revascularization in patients with advanced head and neck squamous cell carcinoma.

Ann Vasc Surg. 2014 Nov;28(8):1878-84. doi: 10.1016/j.avsg.2014.07.011. Epub 2014 Aug 6.

Nishinari K, Krutman M, Valentim LA, Chulam TC, Yazbek G1, Kowalski LP, Wolosker N.



In head and neck squamous cell carcinoma, invasion of the carotid artery is a severe mortality predictor. We report an updated experience of 19 patients who underwent head and neck resection for squamous cell carcinoma with concomitant carotid reconstruction. This study aims to analyze overall survival rates, primary patency of the reconstructions, vascular and nonvascular complications, radiotherapy dosing as well as late follow-up and outcomes.



Analysis of surgical margins in oral cancer using in situ fluorescence spectroscopy.

Oral Oncol. 2014 Jun;50(6):593-9. doi: 10.1016/j.oraloncology.2014.02.008. Epub 2014 Mar 13.

Francisco AL, Correr WR, Pinto CA, Gonçalves Filho J, Chulam TC, Kurachi C, Kowalski LP.



Oral cancer is a public health problem with high prevalence in the population. Local tumor control is best achieved by complete surgical resection with adequate margins. A disease-free surgical margin correlates with a lower rate of local recurrence and a higher rate of disease-free survival. Fluorescence spectroscopy is a noninvasive diagnostic tool that can aid in real-time cancer detection. The technique, which evaluates the biochemical composition and structure of tissue fluorescence, is relatively simple, fast and, accurate.



Warthin’s tumour of the parotid gland: our experience.

Acta Otorhinolaryngol Ital. 2013 Dec;33(6):393-7.

Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP.



Benign tumours account for approximately 60-80% of parotid neoplasms and among these, Warthin’s tumour is the second most common benign neoplasm accounting for approximately 15% of all parotid epithelial tumours. The medical records of 100 consecutive patients with Warthin’s tumour of the parotid gland admitted for treatment at the Department of Head and Neck Surgery and Otorhinolaryngology, Hospital A.C. Camargo, São Paulo, Brazil, between 1983 and 2011 were retrospectively analyzed. The surgical procedures included 104 (96%) subtotal parotidectomies and 4 (3.7%) total parotidectomies. One hundred and eight parotidectomies were performed in 100 patients with Warthin’s tumour. Postoperative complications occurred in 67 (62.3%) of surgical procedures, and facial nerve dysfunction was the most frequent complication, occurring in 51 of 108 surgeries (47.2%). The marginal mandibular branch of the facial nerve was affected in 46 of the 48 cases (95.8%) of facial nerve dysfunction. Frey’s syndrome was diagnosed in the late postoperative period in 19 patients (17.6%). We conclude that either superficial or total parotidectomy with preservation of facial nerve are the treatment of choice for Warthin’s tumour with no case of recurrence seen after long-term follow-up. Facial nerve dysfunction and Frey’s syndrome were the main complications associated with this surgery. Thus, if on one hand total parotidectomy is an appropriate radical resection of parotid parenchyma reducing, in theory, the risk of recurrence, on the other hand superficial parotidectomy is also a radical and efficient method with lower morbidity in terms of facial nerve dysfunction and Frey’s syndrome.



Ultrasound dye-assisted surgery (USDAS): a promising diagnostic and therapeutic tool for the treatment of cancer recurrences in the neck.

Acta Otorhinolaryngol Ital. 2011 Aug;31(4):222-7.

Giugliano G, DE Fiori E, Proh M, Chulam Celestino T, Grosso E, Cattaneo A, Gibelli B, Massaro M, Ansarin M.



The evolution of new techniques for cancer surgery has led to important changes in cancer care in recent years. The endpoint of cancer treatment is now to treat the patient with minimum discomfort while respecting quality of life. New techniques, such as mini-invasive surgery, must respect the correct oncological indications, when technically feasible. The surgery for nodal spread or recurrence of disease, after previous surgery on T or T and N for neck cancer, can represent a diagnostic and therapeutic challenge, especially in the neck, which is characterized by small spaces and noble structures. Often lesions become enveloped in scar tissue and can be difficult to visualize during surgery, representing a genuine problem for the surgeon. Ultrasound dye-assisted surgery is a procedure that combines ultra-sound localization of pathological nodes with the use of methylene blue to mark diseased structures to simplify their visualization (and thus removal) in the surgical field. The technique is simple and can be used in surgically and oncologically experienced hands, even in hospitals that do not have sophisticated technology.



Prognostic Factors in Patients with Well-Differentiated Thyroid Carcinoma with Locoregional Recurrence Submitted for Salvage Treatment

Thyroid Disorders Ther 2014, Rec date: Nov 16, 2013,Acc date: Feb 25, 2014,Pub date: Feb 27, 2014

Bernardo Fontel Pompeo, Thiago Celestino Chulam, Ana Lucia Noronha Francisco and Luiz Paulo Kowalski



Well-differentiated thyroid carcinoma is characterized by an excellent prognosis; however, recurrence rates range from 5% to 23%, and mortality after salvage treatment ranges from 38% to 69%. Objectives: To identify prognostic factors in patients who have undergone salvage therapy for well-differentiated thyroid carcinoma. Patients and methods: This is a retrospective cohort series including 102 patients with respectable locoregional recurrences who underwent salvage treatment. One hundred twenty loco-regional recurrences were observed amongst 102 patients. Univariate survival analysis was performed using the Kaplan-Meier method. Results: Five-year overall survival rates were significantly associated with age over 45 years (67.6%) (p <0.0001), site of recurrence (local or regional recurrence and distant metastasis (65.8%), only local recurrence (88.8%), only regional recurrence (92.2%) (p=0.0267), and histology (papillary carcinoma (90.3%) and follicular carcinoma, (72.2%) (P=0.0156). Conclusion: Age over 45 years, follicular carcinoma and location of recurrence were significant prognostic factors in patients with well-differentiated thyroid carcinoma who underwent salvage treatment.


Clinicopathological factors are predictors of distant metastasis from major salivary gland carcinomas.

 Int J Oral Maxillofac Surg. 2011 May;40(5):504-9. doi: 10.1016/j.ijom.2010.12.002. Epub 2011 Jan 19

Mariano FV, da Silva SD, Chulan TC, de Almeida OP, Kowalski LP.



The risk of distant metastasis of salivary gland cancers has usually been associated with histological type, tumour size, and site. The aim of this study was to evaluate a series of patients with major salivary gland carcinomas in order to identify potential risk factors associated with distant metastasis. 255 patients treated for major salivary gland carcinoma in Brazil from 1953 to 2004 were reviewed. Clinical and treatment data were obtained from the medical records and histological features reviewed. 57 (22%) of 255 patients had distant metastasis. The lungs were the most common metastatic site (40 cases, 65%) and adenoid cystic carcinoma the most frequent histological type involved (27 cases, 47%). The percentage of tumours in the submandibular, parotid, and sublingual glands that presented distant metastasis was 42%, 20%, and 17%, respectively. These results provide evidences that clinicopathological factors (tumour site and histology) are significant predictors of distant metastasis in patients with major salivary gland carcinomas.

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