Murilo Catafesta das Neves

Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common neoplasm in humans and the most frequent in Brazil (80% in the head and neck region, 20% mortality). Brazil is a world leader in organ transplants (more than 30,000 transplants in 2019). The risk of transplant patients (Tx) developing CSCC is 65–250 times higher, with deeper infiltration, advanced stage, higher local recurrence, occult metastases, and worse survival. Objective: To investigate the prognostic factors of locally advanced cutaneous squamous cell carcinoma (LACSCC) of the head and neck region in transplant patients. Methods: 16-year retrospective, single-center series of patients with LACSCC in the head and neck region who underwent surgical treatment. Clinical and Tx data, clinical/pathological stage, surgical treatment, parotid/regional and distant metastases, recurrence, and survival were analyzed. Results: 156 patients were included: 69.2% women, 65.3 years; mean primary size: 4.24 cm, 66% T3/T4 tumors, 71% grade 2/3 differentiation, 20.5% transplant recipients, follow-up: 33.6 months. The most affected regions were malar/nasal (28.8%) and auricular (19.2%). Surgeries included wide resection with reconstruction (58.9%), exenteration (14.1%), and temporalectomy (11.5%). Univariate analysis: Recurrence: immunosuppressor drugs (p = 0.009), transplanted (p = 0.006), compromised margin (p = 0.049); Mortality: immunosuppression (p = 0.028), total resection and reconstruction (p = 0.013), stage (8ed) III-IV (p < 0.001), compromised margin (p < 0.001), neck metastasis with extranodal extension (p = 0.018). Multivariate analysis: Recurrence: transplanted HR: 3.69 (p < 0.001), neck metastasis extranodal extension HR: 5.41 (p < 0.001), evolution to distant metastasis HR: 5.27 (p < 0.001); Mortality: neck metastasis extranodal extension HR: 1.94, (p = 0.032), compromised margins HR: 1.87 (p = 0.001). Main surgical procedures: temporalectomy HR: 2.83 (p = 0.007), major rhinectomy HR: 2.47 (p = 0.005); Worst overall survival: Tx compared to NonTx (p = 0.069); Worst survival with recurrence: Tx compared to NonTx (p = 0.005). Conclusions: The LACSCC and transplanted (immunosuppressed) group present low survival, worse prognosis; The formulation of specific guidelines to standardize treatment and predict outcomes on this population are strictly necessary.

Background: Squamous cell carcinoma of the skin (SCC) is the second most common neoplasm in humans and the most frequent in Brazil (80% in the head and neck region, 20% mortality). Brazil is a world leader in organ transplants (more than 30,000 transplants in 2019). The risk of transplant patients (Tx) developing SCC is 65-250 times higher, with deeper infiltration, advanced stage, higher local recurrence, occult metastases and worse survival. Objective: To investigate the prognostic factors of locally advanced cutaneous squamous cell carcinoma (LASCC) of the head and neck region in transplant patients. Methods:16-year retrospective, single-center series of patients with LASCC in the head and neck region who underwent surgical treatment. Were analyzed: clinical and Tx data, clinical/pathological stage, surgical treatment, parotid/regional and distant metastases, recurrence and survival. Results: 156 patients were included: 69.2% women, 65.3 years; mean primary size: 4.24 cm, 66% T3/T4 tumors, 71% grade 2/3 differentiation, 20.5% transplant recipients, follow-up: 33.6 months. Most affected regions: malar/nasal (28.8%), auricular (19.2%). Surgeries: wide resection with reconstruction (58.9%), exenteration (14.1%), temporalectomy (11.5%). Univariate analysis: Recurrence: immunosuppressor drugs (p=0.009), transplanted (p=0.006), compromised margin (p=0.049), Mortality: immunosuppression (p=0.028), Total Resection and reconstruction (p=0.013), Stage(8ed) III-IV (p<0.001), compromised margin (p<0.001), neck metastasis with extranodal extension (p=0.018). Multivariate analysis: Recurrence: Transplanted HR:3.69 (p<0.001), Neck metastasis extranodal extension HR:5.41 (p<0.001), Evolution to Distant metastasis HR:5.27 (p<0.001); Mortality: Neck metastasis extranodal extension HR:1.94, (p=0.032), Compromised Margins HR:1.87 (p=0.001), Main Surgical Procedures: Temporalectomy HR:2.83 (p=0.007); Major Rhinectomy HR:2.47 (p=0.005); Worst Overall Survival: Tx compared to NonTx (p=0.069), Worst Survival with Recurrence: Tx compared to NonTx (p=0.005). Conclusions: The LASCC and Transplanted (immunosuppressed) group present low survival, worse prognosis, high risk of recurrence and mortality outcome, formulation of specific guidelines to standardize treatment and predict outcomes in this population are strictly necessary.

Sialolithiasis is a common cause of obstructive salivary gland disease, occurring in both submandibular and parotid glands. The treatment has evolved with the introduction of Sialendoscopy and micro-instruments (baskets, wires, and balloons), which allow intraductal manipulations, including stone removal and strictures, to be dilated. Nowadays, it is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life. The objective of the present 10-year retrospective review is to standardize the basic steps involved in successfully removing intraductal sialolithiasis with a Basket instrument. A consecutive ten-year series (January/2014 to June/2024) of patients with obstructive submandibular and parotid glands due to sialolithiasis who underwent sialendoscopy using a basket successfully removed were analyzed. The procedure was conducted following the standards; all interventions were video-recorded and performed by the same surgical team using a semi-rigid modular sialendoscope (1.3 mm/1.7 mm diameter) with working channel, salivary probes, dilatators, different baskets (0.4 mm diameter and 3, 4 and 6 wires) for stones and dilatations, using some steps previously reported. In 10 years, we have performed 224 sialendoscopy due to salivary gland obstructive disease, 84.4% from sialolithiasis. The successful sialolith removal with the basket was performed using pure sialendoscopy (PS-study group) in 132 (69.8%) patients: 79.5% female patients, mean age 44.8 years; 68.9% in the submandibular gland, 65.9% single stones, with 0% major complications. The basic steps were a) how to localize; b) to evaluate (mobile/hard/single stone); c) to estimate sialolith size; d) to choose basket type; e) to choose approach technique (A: Frontal:9.1%, B: Side-to-Side: 35.6%, C: Back-to-Forward: 55.3%). All sialoliths were completely removed, and the patients recovered uneventfully. This article details the standardization of the use of basket in removing ductal stones during sialendoscopy, which is necessary to achieve a high success rate in its removal.

Sialolithiasis is a common cause of obstructive salivary gland disease, occurring in both submandibular and parotid glands. The treatment has evolved with the introduction of Sialendoscopy and micro-instruments (baskets, wires, and balloons), which allow intraductal manipulations, including stone removal and strictures, to be dilated. Nowadays, it is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life. The objective of the present 10-year retrospective review is to standardize the basic steps involved in successfully removing intraductal sialolithiasis with a Basket instrument. A consecutive ten-year series (January/2014 to June/2024) of patients with obstructive submandibular and parotid glands due to sialolithiasis who underwent sialendoscopy using a basket successfully removed were analyzed. The procedure was conducted following the standards; all interventions were video-recorded and performed by the same surgical team using a semi-rigid modular sialendoscope (1.3 mm/1.7 mm diameter) with working channel, salivary probes, dilatators, different baskets (0.4 mm diameter and 3, 4 and 6 wires) for stones and dilatations, using some steps previously reported. In 10 years, we have performed 224 sialendoscopy due to salivary gland obstructive disease, 84.4% from sialolithiasis. The successful sialolith removal with the basket was performed using pure sialendoscopy (PS-study group) in 132 (69.8%) patients: 79.5% female patients, mean age 44.8 years; 68.9% in the submandibular gland, 65.9% single stones, with 0% major complications. The basic steps were a) how to localize; b) to evaluate (mobile/hard/single stone); c) to estimate sialolith size; d) to choose basket type; e) to choose approach technique (A: Frontal:9.1%, B: Side-to-Side: 35.6%, C: Back-to-Forward: 55.3%). All sialoliths were completely removed, and the patients recovered uneventfully. This article details the standardization of the use of basket in removing ductal stones during sialendoscopy, which is necessary to achieve a high success rate in its removal.

Objective: This study aimed to assess the effectiveness of intraoperative parathyroid hormone (PTH) measurements from bilateral internal jugular veins (BIJVs) in determining parathyroid gland laterality during surgery for primary hyperparathyroidism (PHPT).Study Design: Prospective cohort study.Setting: Single tertiary care center, February 2021 to February 2023.Methods: All patients underwent intraoperative BIJV PTH measurements during parathyroidectomy. Preoperative localization of abnormal parathyroid glands was performed using cervical ultrasound (USG) and sestamibi scans (MIBI). Receiver operating characteristic (ROC) analysis was performed to determine the best performance (sensitivity and specificity) for predicting parathyroid gland laterality.Results: A total of 124 patients underwent surgery during the study. PTH measurements from BIJV successfully confirmed the laterality of parathyroid adenomas in 102 cases (82.3%, P = .001). Intraoperative BIJV PTH measurements proved to be the most effective method for determining parathyroid gland laterality, with an accuracy of 82.3%. ROC curve analysis identified an optimal cutoff point of 16.7% for the percentage difference between right and left BIJV PTH values. The area under the curve (AUC) was 0.882, indicating high diagnostic accuracy. This cutoff yielded a sensitivity of 76.5% and a specificity of 95.5%. Additionally, no patients experienced complications related to the internal jugular vein (IJV) procedure.Conclusion: Intraoperative BIJV PTH measurement is a valuable adjunct in parathyroidectomy, improving localization and enhancing surgical outcomes in PHPT patients.

A 32-year-old man with renal hyperparathyroidism was referred for surgical treatment after exhausting clinical measures for metabolic control.,Combined analysis of neck ultrasound () and Sestamibi ()/SPECT-CT () findings enabled the identification of three possible enlarged parathyroid glands.The right and left superior parathyroid glands were located in their usual positions beneath the thyroid gland, while the right inferior parathyroid gland was found in the upper mediastinum. […] Ectopic parathyroid and its role in surgical failure

RESUMO A Sociedade Brasileira de Cirurgia Oncológica e a Sociedade Brasileira de Cirurgia de Cabeça e Pescoço elaboraram um consenso técnico sobre a codificação hierarquizada na cirurgia da tireoide, considerando o papel da Classificação Brasileira Hierarquizada de Procedimentos Médicos no enquadramento das indicações para cada cirurgia. O documento foi elaborado por um colegiado de 40 especialistas, reconhecidas lideranças de representatividade acadêmica e assistencial, provenientes de diferentes regiões do país, que avaliaram a pertinência dos códigos aplicáveis às principais cirurgias da tireoide. As deliberações foram realizadas por meio de votação eletrônica entre 37 participantes, sendo o consenso estabelecido quando se atingiu concordância ≥ 80%. Foram avaliados cenários de tireoidectomia total para doenças benignas, malignas e para ressecção de bócio mergulhante, incluindo códigos de exploração de nervos laríngeos, monitorização neurofisiológica, ligadura de ramos da carótida, biópsia e reimplante de paratireoide, linfadenectomia e esvaziamentos cervicais. Houve consenso favorável à pertinência dos seguintes códigos: exploração de nervos (83,3%), monitorização neurofisiológica (97,3%), biópsia e reimplante de paratireoide (89,2%), linfadenectomia cervical (89,2%) e esvaziamentos uni ou bilaterais (97,3% e 94,6%), ratificando a utilização destes códigos. Não houve consenso para inclusão do código de ligadura da carótida e/ou ramos nem para agregar um código de tireoidectomia parcial em casos de bócio mergulhante apenas unilateral, afastando a validação destes. O consenso fornece normatização clara e objetiva para a codificação hierarquizada nas cirurgias da tireoide, fundamentada em critérios técnico-científicos e éticos. Destina-se a orientar médicos assistentes e auditores, promovendo uniformidade, transparência e redução de conflitos na prática clínica e administrativa.