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Article: Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery.

Kowalski, Luiz P

International archives of otorhinolaryngology

2023 Volume 27, Issue 3, Page(s) e536–e546

Abstract: This paper is a transcript of the ... ...

Abstract	This paper is a transcript of the 29
Language	English
Publishing date	2023-08-04
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2578584-9
ISSN	1809-4864 ; 1809-9777
ISSN (online)	1809-4864
ISSN	1809-9777
DOI	10.1055/s-0043-1761170
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery*

Kowalski, Luiz P.

International Archives of Otorhinolaryngology

2023 Volume 27, Issue 03, Page(s) e536–e546

Abstract: This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in ... ...

Abstract	This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors—including treatment, decision-making, and quality—can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.
Keywords	head and neck cancer ; prognosis ; survival ; surgeon ; treatment
Language	English
Publishing date	2023-07-01
Publisher	Thieme Revinter Publicações Ltda.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2578584-9
ISSN	1809-4864 ; 1809-9777 ; 1809-4864
ISSN (online)	1809-4864
ISSN	1809-9777 ; 1809-4864
DOI	10.1055/s-0043-1761170
Database	Thieme publisher's database

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Article ; Online: Anatomy, technique, and results of robotic retroauricular approach to neck dissection.

Kowalski, Luiz P / Lira, Renan B

Anatomical record (Hoboken, N.J. : 2007)

2021 Volume 304, Issue 6, Page(s) 1235–1241

Abstract: In the attempt to improve the cosmetic and functional outcomes in head and neck surgeries, robotic or video-assisted neck dissection using remote access has gained ground in recent years. Retroauricular approach emerged as the most versatile option, ... ...

Abstract	In the attempt to improve the cosmetic and functional outcomes in head and neck surgeries, robotic or video-assisted neck dissection using remote access has gained ground in recent years. Retroauricular approach emerged as the most versatile option, allowing proper dissection at all neck levels. In this technique, after retroauricular incision, a skin flap is elevated and a self-retaining retractor is placed, creating working space for the robotic, or endoscopic neck dissection. Numerous published series have shown the safety and favorable outcomes of retroauricular robotic neck dissections, without any major complications or surgery-related deaths. The only consistently reported disadvantage is a longer operative time. Our group has an experience of 190 retroauricular neck dissections performed over the last 5 years, without any major setbacks. The oncologic and safety outcomes have been comparable to the conventional technique, with clearly superior aesthetic results. In the process of expansion of Robotic Surgery in Brazil, our center is currently providing training and proctoring to capacitate other head and neck surgeons, and enable other centers to offer this surgical modality.
MeSH term(s)	Humans ; Neck/surgery ; Neck Dissection/methods ; Robotic Surgical Procedures/methods ; Thyroidectomy/methods
Language	English
Publishing date	2021-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2269667-2
ISSN	1932-8494 ; 1932-8486
ISSN (online)	1932-8494
ISSN	1932-8486
DOI	10.1002/ar.24621
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Article ; Online: Priority setting in head and neck oncology in low-resource environments.

Kowalski, Luiz P / Sanabria, Alvaro

Current opinion in otolaryngology & head and neck surgery

2019 Volume 27, Issue 3, Page(s) 198–202

Abstract: Purpose of review: Most information about priority setting comes from developed countries. In low-resource settings, many factors should be considered to select the best candidate for the treatments that are available. The physician is always under ... ...

Abstract	Purpose of review: Most information about priority setting comes from developed countries. In low-resource settings, many factors should be considered to select the best candidate for the treatments that are available. The physician is always under pressure to obtain better results in spite of the lower quantity of resources. This exposes physicians to daily ethical dilemmas and increases their anxiety and burnout. Recent findings: Most low-resource settings have restrictions in major treatments, and the number of specialized centers that have all the services is low. The surgeon has to navigate through the system as a patient advocate, taking the responsibilities of other health system actors, has to 'negotiate' to design a treatment based on outdated results or to wait for new results and has to decide whether to start or to wait for other treatments to be ready to comply with protocol recommendations. Summary: The surgeons face the dilemma of offering the best treatment with scarce resources but with a higher possibility of completion. Finally, we must do the best we can with what we have.
MeSH term(s)	Decision Making ; Developing Countries ; Ethics, Clinical ; Head and Neck Neoplasms/surgery ; Health Priorities/ethics ; Humans ; Resource Allocation/ethics
Language	English
Publishing date	2019-05-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1232518-1
ISSN	1531-6998 ; 1068-9508
ISSN (online)	1531-6998
ISSN	1068-9508
DOI	10.1097/MOO.0000000000000530
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Article ; Online: Microscopic positive surgical margins in thyroid carcinoma: a proposal for thyroid oncology teams.

Sanabria, Alvaro / Kowalski, Luiz P / Nixon, Iain J / Simo, Ricard

Langenbeck's archives of surgery

2021 Volume 406, Issue 3, Page(s) 563–569

Abstract: Purpose: In the case of well-differentiated thyroid cancer, the importance of microscopic margin status remains controversial. We discuss the relevance of the effect of microscopic positive surgical margins in the early stages of differentiated thyroid ... ...

Abstract	Purpose: In the case of well-differentiated thyroid cancer, the importance of microscopic margin status remains controversial. We discuss the relevance of the effect of microscopic positive surgical margins in the early stages of differentiated thyroid cancer. Methods: A comprehensive literature search and review of available evidence in English literature was undertaken. Results: A previous meta-analysis did not find an association between microscopic positive surgical margins and local recurrence. Heterogeneity of definitions and differences between microscopic surgical margins and extrathyroid extension are discussed. Impact on clinical decision-making is explored. Conclusion: The finding of microscopic positive surgical margins in a patient with a thyroid tumor without intraoperative evidence of macroscopic invasion to adjacent structures, with complete resection made by the surgeon and without pathological report of extrathyroid extension, does not have a worse prognostic effect. We present a classification of surgical margins that may help thyroid oncology teams to tailor further management in patients with thyroid cancer.
MeSH term(s)	Humans ; Margins of Excision ; Neoplasm Recurrence, Local/surgery ; Prognosis ; Retrospective Studies ; Thyroid Neoplasms/surgery
Language	English
Publishing date	2021-02-08
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-021-02095-y
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Article ; Online: Comparing Mohs micrographic surgery and wide local excision in the management of head and neck dermatofibrosarcoma protuberans: a scoping review.

Sanabria, Alvaro / Pinillos, Pilar / Chiesa-Estomba, Carlos / Guntinas-Lichius, Orlando / Kowalski, Luiz P / Mäkitie, Antti A / Rao, Karthik N / Ferlito, Alfio

The Journal of dermatological treatment

2023 Volume 35, Issue 1, Page(s) 2295816

Abstract: Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the ... ...

Abstract	Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.
MeSH term(s)	Adult ; Humans ; Dermatofibrosarcoma/surgery ; Mohs Surgery/methods ; Neoplasm Recurrence, Local/surgery ; Retrospective Studies ; Skin Neoplasms/surgery
Language	English
Publishing date	2023-12-26
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	1036299-x
ISSN	1471-1753 ; 0954-6634
ISSN (online)	1471-1753
ISSN	0954-6634
DOI	10.1080/09546634.2023.2295816
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Article ; Online: A training and implementation model for head and neck oncology service delivery in Mozambique.

Chulam, Thiago C / Bambo, Arquimedes Wamarremula Pedro / Machava, Pedro Rafael / Kowalski, Luiz P

Current opinion in otolaryngology & head and neck surgery

2022 Volume 30, Issue 3, Page(s) 201–206

Abstract: Purpose of review: There is an extreme shortage of head and neck surgeons in Africa. In Mozambique prior to 2000, there were no surgeons with specific training in head and neck surgical oncology. Here, we introduce a training model and report our ... ...

Abstract	Purpose of review: There is an extreme shortage of head and neck surgeons in Africa. In Mozambique prior to 2000, there were no surgeons with specific training in head and neck surgical oncology. Here, we introduce a training model and report our experience with implementation following the training of the first two head and neck surgeons from Mozambique. Recent findings: This training program, undertaken in Brazil, facilitated the formation of the first two head and neck surgeons from Mozambique. These surgeons received comprehensive training in head and neck surgical oncology and multidisciplinary care, allowing them to then treat their patients under continuous online mentorship collaboration. This model is expected to help in the local formation of new specialists and in the establishment of this specialty in Mozambique. Summary: The program started with remote training and support provided by the MD Anderson Cancer Center, in Texas, USA, as part of the Extension for Community Healthcare Outcomes program. Further training was then undertaken at an established fellowship program in Brazil as a focal point for 2 years, and the knowledge gained was replicated and disseminated locally.
MeSH term(s)	Africa ; Head and Neck Neoplasms/surgery ; Humans ; Mozambique
Language	English
Publishing date	2022-05-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1232518-1
ISSN	1531-6998 ; 1068-9508
ISSN (online)	1531-6998
ISSN	1068-9508
DOI	10.1097/MOO.0000000000000802
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Article ; Online: Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature.

Piazza, Cesare / Lancini, Davide / Tomasoni, Michele / Zafereo, Mark / Poorten, Vincent Vander / Hanna, Ehab / Mäkitie, Antti A / Fernandez-Alvarez, Veronica / Kowalski, Luiz P / Chiesa-Estomba, Carlos / Ferlito, Alfio

Head & neck

2024 Volume 46, Issue 3, Page(s) 672–687

Abstract: Malignant 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 ... ...

Abstract	Malignant 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.
MeSH term(s)	Female ; Humans ; Male ; Carotid Body Tumor/genetics ; Carotid Body Tumor/surgery ; Head and Neck Neoplasms ; Mutation
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.27624
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Article ; Online: Treatment Options for Hypopharyngeal Cancer in Developing Countries in Africa/South America/Asia.

Fagan, Johannes J / Chaturvedi, Pankaj / Kowalski, Luiz P

Advances in oto-rhino-laryngology

2019 Volume 83, Page(s) 159–166

Abstract: Most cancers occur in developing countries, and therefore, a discussion about cancer care would be incomplete without providing a developing world perspective. This chapter focuses on challenges and practices relating to hypopharyngeal cancer in limited- ... ...

Abstract	Most cancers occur in developing countries, and therefore, a discussion about cancer care would be incomplete without providing a developing world perspective. This chapter focuses on challenges and practices relating to hypopharyngeal cancer in limited-resource public healthcare systems in developing countries and specifically in Sub-Saharan Africa, India and South America and by extension, most patients in the developing world. Management of hypopharyngeal cancer must be adapted to the availability of specialised diagnostic and therapeutic services, radiotherapy and surgical expertise, and tailored to patient factors such as reliability of follow-up and social support. A particular challenge for physicians is to decide who can be denied the opportunity to be cured when the burden of cancer cases exceeds available resources. Public education campaigns about reducing risk factors for hypopharyngeal cancer are an important aspect of reducing the burden of cancer.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Asia/epidemiology ; Developing Countries ; Head and Neck Neoplasms/epidemiology ; Head and Neck Neoplasms/therapy ; Humans ; Hypopharyngeal Neoplasms/epidemiology ; Hypopharyngeal Neoplasms/therapy ; Resource Allocation ; South America/epidemiology
Language	English
Publishing date	2019-02-12
Publishing country	Switzerland
Document type	Journal Article
ISSN	1662-2847 ; 0065-3071
ISSN (online)	1662-2847
ISSN	0065-3071
DOI	10.1159/000492360
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Article ; Online: Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies.

Asarkar, Ameya A / Chang, Brent A / de Bree, Remco / Kowalski, Luiz P / Guntinas-Lichius, Orlando / Bradley, Patrick J / de Graaf, Pim / Strojan, Primož / Rao, Karthik N / Mäkitie, Antti A / López, Fernando / Rinaldo, Alessandra / Palme, Carsten / Genden, Eric M / Sanabria, Alvaro / Rodrigo, Juan P / Ferlito, Alfio

Advances in therapy

2024

Abstract: Introduction: Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy.: Methods: A review of literature using PubMED was performed for studies reporting the management ... ...

Abstract	Introduction: Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. Methods: A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. Results: Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. Conclusion: The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.
Language	English
Publishing date	2024-04-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632651-1
ISSN	1865-8652 ; 0741-238X
ISSN (online)	1865-8652
ISSN	0741-238X
DOI	10.1007/s12325-024-02861-6
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