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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2004.tde-04042007-100743
Document
Author
Full name
Luiz Roberto Terzian
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2004
Supervisor
Committee
Festa Neto, Cyro (President)
Pimentel, Eugênio Raul de Almeida
Sanches Junior, Jose Antonio
Title in Portuguese
Estudo retrospectivo da cirurgia micrográfica de Mohs nos portadores de carcinoma espinocelular cutâneo da cabeça para a determinação de fatores preditivos do número de fases cirúrgicas, acompanhados no ambulatório de cirurgia dermatológica da Divisão de Dermatologia do HC da FMUSP/SP
Keywords in Portuguese
Carcinoma de células escamosas/cirurgia
carcinoma de células escamosas/classificação
Carcinoma de células escamosas/epidemiologia
Cirurgia de MOHS/estatística & dados numéricos
Cirurgia de MOHS/tendências
Estudos retrospectivos
Literatura de revisão
Neoplasias de cabeça e pescoço/cirurgia
Registros médicos/estatística & dados numéricos
Abstract in Portuguese
A cirurgia micrográfica de Mohs (CMM) é realizada em fases sucessivas de retirada tumoral. Cada fase demora de uma a duas horas, dependendo do tamanho da lesão; portanto, é muito importante conseguir predizer o número de fases da cirurgia a fim de poder programar melhor o tempo de uso da sala cirúrgica e da equipe cirúrgica, o uso de anestésicos, os custos da cirurgia, melhor orientar o paciente e assegurar a remoção completa do tumor. Com o intuito de encontrar fatores preditivos do número de fases da CMM no tratamento do carcinoma espinocelular da cabeça, realizou-se o levantamento dos prontuários de 44 pacientes submetidos a 51 CMM no ambulatório de cirurgia dermatológica da Divisão de Dermatologia do HC-FMUSP/SP, de 1994 a 2003. Foram constituídos três grupos quanto ao número de fases da CMM: uma fase, duas fases e três ou mais fases. Os grupos foram comparados em relação às variáveis: duração da lesão até a cirurgia, morfologia, tamanho e limites da lesão, tumor primário ou recidivado, grau de diferenciação histológica do tumor e localização anatômica do tumor. Identificou-se um único fator significante na análise univariada: a distribuição dos tumores recidivados segundo o número de fases da cirurgia e que diferiu da distribuição dos tumores primários (p=0,081, teste exato de Fisher), sendo maior o número de fases para os tumores recidivados. Na análise multivariada, não houve fatores estatisticamente significantes que pudessem estar associados ao número de fases da cirurgia. Na análise da razão de chances, observou-se maior chance de apresentar maior número de fases para as variáveis: limites clínicos imprecisos, tumor ulcerado, tumor recidivado, tumor mais agressivo histologicamente e tumor maior que 1 cm.
Title in English
Retrospective study of Mohs micrographic surgery for patients with skin squamous cell carcinoma of the head attended in the dermatologic surgical facility of the Dermatological Division of the HC from FMUSP/SP, to establish predictive factors for the number of surgical
Keywords in English
Head and neck neoplasms/surgery
Medical files/statistics and numeric data
MOHS surgery/statistics and numeric data
MOHS surgery/tendency
Retrospective studies
Review article
Squamous cell carcinoma/classification
Squamous cell carcinoma/epidemiology
Squamous cell carcinoma/surgery
Abstract in English
Mohs micrographic surgery (MMS) is proceeded in successive stages of cancer removal. Each stage lasts from 1 to 2 hours, depending on the tumor size. So it is very important to predict the number of phases of the surgery so that one can plan better the time of the surgical room use, the time of the surgeon and his team, the use of anaesthetics, the surgical costs, to give the patient better orientations about his surgery and to ensure complete tumor erradication. With the intention to find predictive factors of the number of stages of MMS in the treatment of squamous cell carcinoma, we reviewed the record of 44 patients on a total of 51 surgeries proceeded in the dermatologic surgical clinic of the Dermatological Division of HC-FMUSP/SP from 1994 to 2003. For the number of stages in the MMS we established 3 groups: 1 stage, 2 stages and 3 or more stages. These groups were compared with regard to this variables: continuance of the lesion until the surgery, morphology and size of the lesion, lesion limits, primary or recurrent cancer, histological grade (Broders) and anatomic localization. In the univariated analysis one single factor was significant: the distribution of the recurrent cancers related to the number of stages of the surgery that was different from the distribution of the primary ones (p=0.081, Fisher's exact test), been higher the number of stages for the recurrent cancers. In the multivariated analysis, there were no statistically significant factors associated with higher number of stages of the surgery. In the analysis of the odss ratio, we noted a higher chance of a higher number of stages for the variables: inaccurate clinical limits, ulcerated lesions, recurrent cancer, higher aggressive histology and tumor bigger than 1 cm.
 
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Publishing Date
2007-04-09
 
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