[Initial surgical management of squamous carcinoma of the vulva]. / Manejo quirúrgico inicial del carcinoma epidermoide vulvar.

Vulvar cancer accounts for approximately 4% of gynecological malignancies. At the Instituto Nacional de Cancerologia in Mexico it occupies the fourth place. The purpose of this study is to assess the management of squamous carcinoma of the vulva with initial surgical treatment. It is a descriptive retrospective, observational study, from January 1, 2002 to December 31, 2012. Twenty-seven patients, clinical stages I, II, or III, initial surgical management, with at least one year of follow-up were included. In 51.85% a partial vulvectomy was performed and in 40.74% a wide excision; 66.66% underwent inguinofemoral dissection. Recurrence occurred in 25.91% of cases and the overall survival at 10 years was 63%. It is concluded that with invasion of up to 1 mm of lymph node, affection is 0%; with invasion of 1 mm and up to 5 mm this increases to 25%; an invasion of more than 5 mm implies up to 45%. Recurrence in our study was primarily distant, necessitating long-term monitoring with emphasis on symptoms to request imaging studies when suspected. Adjuvant therapy should be offered to patients with positive nodes, close or positive margins, and tumors larger than 4 cm.

Acrometastasis: The Tip of the Iceberg of Metastatic Disease from Thyroid Cancer. Two Cases Report.

Acrometastasis, especially in the hands and fingers, is a rare clinical condition resulting from primary cancers such as lung, breast, kidney, and, rarely, thyroid cancer. Acrometastasis tends to be the tip of the iceberg in patients with extensive systemic disease, which could be regional, pulmonary, skeletal, neurological, or all of them combined. Even though these tumors are clearly visible and symptomatic, the diagnosis is usually misleading because such distal metastatic disease is not thought of at first. In general, systemic treatments should be given to any patient presenting digital acrometastasis. We describe two cases of papillary thyroid carcinoma and digital acrometastasis as a sign of advanced disease.

Upper lip malignant neoplasms. A study of 59 cases.

OBJECTIVES: To present the demographic data, clinico-pathologic features and therapeutic outcome of a series of upper lip malignancies. STUDY DESIGN: Retrospective study at a single Cancer Institution in Mexico City during a 14-year period. RESULTS: There were 59 cases, (30 males and 29 females); age range: 14 to 106 years (mean: 73 yr.). Antecedents of ultraviolet light and tobacco exposure were found in 20 (33.9%) and 16 cases (27%) respectively. There were 35 squamous cell carcinomas (59.3%), 19 basal cell carcinomas (32.2%) and one case each (1.7%) of adenocarcinoma NOS, adenoid cystic carcinoma, angiosarcoma, Merkel cell carcinoma and melanoma. There were 14 cases in stage I (23.7%), 14 in stage II (23.7%), 3 in stage III (5.1%) 14 in stage IV (23.7%) and 14 were not classified (23.7%). There were no significant differences with respect to the overall survival curve and the disease-free survival curve among surgical treatment and radiotherapy. In addition, there was not statistically significant difference in the overall survival and disease-free survival among squamous cell carcinoma and basal cell carcinoma cases with respect to the type of treatment. CONCLUSIONS: Upper lip malignant neoplasms are infrequent lesions. The present series describes the main clinico-pathological features in a hospital-based population in Mexico city and demonstrates some differences with respect to those found in the lower lip.

Osteogenic sarcoma of the maxillary region in a Mexican mestizo population.

BACKGROUND AND OBJECTIVES: This study analyzed maxillary osteosarcoma in a mestizo population, with particular emphasis on the type of treatment and disease-free and overall survival. METHODS: This is a retrospective study including all mestizo patients with osteosarcoma of the maxilla seen in a single cancer institution in Mexico during a 20-year period. RESULTS: There were 21 patients. Age ranged from 16 to 76 years (mean, 37.5 y). Mean evolution time to diagnosis was 13 months, with a mean tumor size of 7 × 6 cm2. Surgery was the initial treatment in 19 patients, 17 of whom received adjuvant treatment. Disease-free survival according to surgical margin and overall survival were not statistically significant. Disease-free survival was 29% at 5 years, and overall survival was 50% and 25% at 5 and 10 years, respectively. CONCLUSIONS: Osteosarcomas of the maxilla are infrequent lesions that merit early diagnosis and proper treatment because of their rapid evolution. Treatment is currently based on a well-planned surgery with free surgical margins plus adjuvant radiotherapy and/or chemotherapy.

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy in patients with radiation therapy failure.

BACKGROUND: To assess functional results, complications, and success of larynx preservation in patients with recurrent squamous cell carcinoma after radiotherapy. METHODS: From a database of 40 patients who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) from June 2001 to April 2006, eight patients were treated previously with radiotherapy due to squamous cell carcinoma of the glottic region and were treated for recurrence at the site of the primary cancer. RESULTS: SCPL with CHEP was performed in six men and two women with a mean age of 67 years due to recurrence and/or persistence at a mean time of 30 months postradiotherapy (in case #8 after concomitant chemoradiotherapy). Bilateral neck dissection at levels II-V was performed in six patients. Only case #8 presented metastasis in one node. In case #5, Delphian node was positive. It was possible to preserve both arytenoids in five cases. Definitive surgical margins were negative. Complications were encountered in seven patients. Follow-up was on average 44 months (range: 20-67 months). Organ preservation in this series was 75%, and local control was 87%. Overall 5-year survival was 50%. CONCLUSIONS: In selected patient with persistence and/or recurrence after radiotherapy due to cancer of the larynx, SCPL with CHEP seems to be feasible with acceptable local control and toxicity. Complications may occur as in previously non-irradiated patients. These complications must be treated conservatively to avoid altering laryngeal function.

Primary retroperitoneal mucinous cystadenocarcinoma: report of two cases.

BACKGROUND: Retroperitoneal cystadenocarcinomas are rare lesions, the majority of cases presented as one-patient reports. METHODS: We present two cases of retroperitoneal cystadenocarcinoma, both in women of reproductive age: one with aggressive behavior, and the remaining case, with a more indolent clinical evolution. RESULTS: One case presented as pelvic tumor, was treated with surgical resection of the disease, but manifested with recurrent disease a few months later despite use of chemotherapy. The second case involved a patient with diagnosis of abdominal tumor; during laparotomy, a retroperitoneal tumor was found and was totally removed. At follow-up, the patient is disease-free with no other treatment. CONCLUSION: The behavior and treatment of retroperitoneal cystadenocarcinoma are controversial. We suggest aggressive surgery including radical hysterectomy and bilateral salpingoopherectomy with adjuvant chemotherapy in these cases.

Control of Frey's syndrome in patients treated with botulinum toxin type A.

AIM: To identify the severity of Frey s syndrome and its response to botulinum toxin type A. METHODS: Minor test was performed in all cases to assess the extent of the affected area, using the contralateral side as control. Severity was assessed according to the proposal of Luna-Ortiz et al. Response was evaluated after 3 and 6 months, and was compared with the basal data. RESULTS: Frey s syndrome was documented in 38 patients, but only 23 cases accepted the botulinum toxin type A treatment. Severity was moderate in 8 (35%) and severe in 15 (65%) cases. Mean applied dose was 1.41 MU/cm2 in 21 patients (91%), whereas one patient was treated with 10 MU for a 0.8 cm2 affected area (12.5 MU/cm2) and another patient with 10 MU for a 0.5 cm2 affected area (20 MU/cm2) due to severity of their symptomatology. Average affected area at the beginning was 14.2 cm2, while after 3 and 6 months of treatment it was 4.1 cm2 and 4.4 cm2 respectively (p<0.001). The two patients that received higher doses of botulinum toxin A had complete response. Complete response was observed in 13 patients (56.5%) at 3 months, but in only nine (39%) this lack of symptomatology persisted at 6 months. In three cases (13%) no response was obtained at 3 months, and the application of an additional dose of botulinum toxin type A produced no response in two of them after 6 months. Comparison of the severity score of the average basal value vs. that obtained at 3 and 6 months revealed a significant difference (p<0.05); however, no statistically significant difference was found when comparing outcome at 3 vs. 6 months. There were no statistically significant differences using the independent samples test when comparing outcome after treatment in relation to gender, type of surgery, or use of postoperative radiation therapy (p>0.05). In conclusion, botulinum toxin A remains as the treatment of choice for Frey s syndrome.

Free osseous and soft tissue surgical margins as prognostic factors in mandibular osteosarcoma.

Osteosarcoma is an infrequent, locally aggressive neoplasm in the head and neck region. To date, surgery is the mainstay of treatment. However, patients with mandibular osteosarcomas usually have a locally advanced disease at diagnosis and therefore represent a therapeutic challenge because surgical margins are difficult to obtain due to aesthetic and functional concerns. To evaluate possible prognostic factors implicated in recurrence, persistence or relapse in osteosarcoma of the mandible, with special reference to the soft tissue and bone surgical margins. A series of 20 patients with mandibular osteosarcomas treated at the Instituto Nacional de Cancerología (México) from 1985 to 1999 are reviewed. There were 14 female and 6 male patients. Twelve cases were treated with surgery alone, 3 patients with surgery and adjuvant radiotherapy, 1 had neoadjuvant chemotherapy followed by surgery, 1 had neoadjuvant chemotherapy, surgery and postoperative radiotherapy, 1 with surgery and adjuvant chemotherapy, 1 with surgery followed by adjuvant chemotherapy and radiotherapy and one patient rejected treatment. Between 1985 and 1992 these neoplasms were treated by means of total mandibulectomy, independently of tumor size, but between 1993 and 1999 the policy was to practice smaller resections but long enough to obtain macroscopic surgical free margins. In the first period the relationship between mandibular size resection and tumor size was 1.9, meanwhile in the second period the relation was 1.5. There was not significant difference between both periods in terms of tumor size (6.0 cm vs. 6.02 cm at the time of surgery) nor in local control and survival. Soft tissue involvement as reported by histological study was strongly associated with recurrence (p = 0.0024). Overall 5-year survival was 20%. A policy of total mandibulectomy is not associated with a better local control or survival. Extent of resection must be tailored with tumor size. Extent of margins in soft tissue is the limiting factor for local control.

[Laryngeal cancer in patients younger than 40 years]. / Cáncer de laringe en pacientes menores de 40 años.

BACKGROUND: We undertook this study to report demographic data of laryngeal cancer patients <40 years old and treatment results. METHODS: In a retrolective study we reviewed the clinical records of 500 patients with laryngeal cancer in the period from 1989 to 2004 and included those patients<40 years of age. RESULTS: We found 15 patients, representing 4.4% of the series. Nine (60%) were men and six (40%) were women, with a 1.5:1 ratio. Average group age was 35 years (range 21-40 and median of 37 months). Average time of evolution at the time of diagnosis was 14.4 months (range 0-36 and median of 12 months); 60% of the patients were smokers and 40% admitted to drinking alcohol; dysphonia was the main symptom found in 87% of the patients. The most frequent location was the glottis in 11 (73%) patients. Well-differentiated tumors represented 53% of the cases. Initial treatment was surgery in four (27%) patients; radiotherapy in five (33%) patients receiving an average of 63.44 Gy; concomitant chemoradiotherapy in one patient (7%) using gemcitabine; four (27%) patients were treated with neoadjuvant chemotherapy followed by radiotherapy; and one patient did not receive treatment. The average time in which the patients relapsed after the first treatment was 19.57 months (range 2-63) and four were classified as persistent. Survival time was 32 months (range 2-106 and median 27 months). Finally, organ preservation rate was obtained in 28.5%. CONCLUSIONS: Squamous cell carcinoma of the larynx is rare in patients<40 years old in our study. Gender relation seems to be equal, although a slight predominance of men does still exist. Classical risk factors were present in 60% of the cases. Prognosis for these patients was determined by the initial clinical stage.

Adenoid Cystic Carcinoma in a Mexican Population.

OBJECTIVE: To analyze the demographic data, clinical behavior, management (surgery/radiotherapy), disease-free survival (DFS) and overall survival (OS) in Mexican Mestizos with adenoid cystic carcinoma (ACC). MATERIAL AND METHODS: A retrospective study comprising all cases with histologic diagnosis of ACC of the head and neck treated from 1986 to 2012. RESULTS: There were 101 cases (69 women and 32 men), with a mean age of 50 years; mean evolution time before diagnosis was 25 months (range 1-180 months). Most tumors involved maxillary sinus (25.8 %), followed by hard palate (15.9 %) and parotid gland (10.9 %). Surgery was the treatment in 81 cases (80.2 %), radiotherapy alone in 3 cases (3 %), chemo-radiotherapy in 4 cases (4 %) and 13 cases (12.9 %) did not receive any treatment. Post-surgery adjuvant radiotherapy was used in 58 cases (57.4 %); 6 cases (5.9 %) had adjuvant chemo-radiotherapy after surgery and 37 (36.6 %) cases did not receive any adjuvant treatment. Mean follow-up time was 52 months (range 1-288 months). Histologic patterns were cribriform (50.5 %), solid (28.7 %), and tubular (11.9 %) types. OS was 57.6 % and 42.3 % at 5 and 10 years respectively. DFS was 57.8 % at 5 years and 49.7 % at 10 years. CONCLUSIONS: Initial management in most cases within this series was surgery followed by radiotherapy. There is more to learn about real benefits of molecular therapies. There were no significant differences in DFS and OS depending on site of involvement. OS did not show statistically significant differences amongst patients with positive and negative lymph nodes.

Carotid body tumors: review of a 20-year experience.

Carotid body tumors (CBT) are a rare entity that should be considered in evaluating every lateral neck mass. The objective of the study was to compare demographic data, complications and evolution of patients treated at our institution. A retrospective study was made of 66 patients with 69 CBT that were treated at our institution between 1982 and 2002. We reviewed the demographic characteristics, clinical features, surgical approach and complications. Women significantly predominated (96.9%) with a female:male ratio of 31.2:1. Ages ranged from 18 to 94 (mean=50.2). Fifty-four per cent of the patients lived at altitudes higher than 2200 m above sea level. The most common chief complaint was a painless neck mass (78.7%). No patient had any malignant tumors or a familial history of CBT. Both sides were similarly affected. There were four tumors grouped in Shamblin's class I, 24 in class II, and 35 in class III. Six tumors were of undetermined Shamblin's class as inferred from their medical records. Fifty-three patients received treatment: 46 (86.8%), surgery; 6 (11.3%), radiotherapy; 1 (1.9%), radiotherapy following surgery. Three patients (6.3%) underwent vascular reconstruction. In 23 (49%) patients neurological deficit was observed after surgery. Minor complications occurred in five (10.6%) patients. Median follow-up was 38 months, one patient died from a cause not related to the CBT, and the rest remain disease-free and asymptomatic. We found an overwhelming predominance of women, which opens the possibility that we are dealing with a different disease in female Latin populations. Most of the tumors were of Shamblin's class III CBT. Early surgical management is recommended to avoid neurological deficit due to a Shamblin's class III tumor.

Lip cancer experience in Mexico. An 11-year retrospective study.

Lip cancer is the most frequent malignant neoplasm of the oral cavity; however, there is no information available on the incidence of this type of cancer in Mexico. This study provides information about the clinico-pathological features of lip cancer patients admitted at a cancer hospital in Mexico City during an 11-year period and describes the treatment modalities performed and their results. A total of 113 patients were studied. There were 74 men (65.5%) and 39 women (34.5%), ranging in age from 14 to 106 years (mean 70 years). In 53 cases (46.9%) an association was found between the disease and chronic sun exposure. Additionally, positive smoking antecedents were recorded in 58 cases (51.3%). As 15 patients were followed for less than 1 month, they were excluded for further analysis. There were 82 cases (83.7%) of squamous cell carcinoma, 10 (10.2%) basal cell carcinomas, and one case (1%) each of adenocarcinoma NOS, melanoma, adenoid cystic carcinoma, Merkel cell carcinoma, lymphoepithelioma and angiosarcoma. We observed an incidence of malignant neoplasms in the upper lip of 33.7%, which is higher than most of the published series and may be due to the fact that in this series we included all histological types of lip cancers. Fifty percent of the cases were found in stages III and IV. Cervical lymph node metastases were found in 21% of patients with no previous treatment, and they developed in 5.3% after treatment. Our data suggest that tumoral size is directly related to the possibility of developing node metastases, as none of them occurred in patients T1, whereas 10 (62.5%) of the patients in T4 presented them. Seven deaths were documented (7.1%), five of which corresponded to squamous cell carcinoma, one to Merkel cell carcinoma, and one to adenocarcinoma. Deaths were directly related to the disease in six cases, and one patient died due to surgical complications. Distant metastases were found in only two patients, one of which coursed with an adenocarcinoma and the other with a Merkel cell carcinoma. Based on the present results, we suggest that the differences encountered with respect to other series, particularly the higher incidence found in women, the frequent presentation of this type of neoplasms in the upper lip, the wide variety of histopathological diagnoses and the high frequency of cases with cervical lymph node affection, should lead us to search for multi-modal treatment alternatives in this population.

Conjunctival melanoma: survival analysis in twenty-two Mexican patients.

PURPOSE: To describe the cases of conjunctival melanoma (CM) and report the disease-free interval (DFI) and overall survival (OS). METHODS: The charts of 22 patients who were admitted to two hospitals between 1985 and 2006 were reviewed for pertinent data, including demographics, site of involvement in the conjunctiva and sub-sites, surgical treatment, and adjuvant treatment. RESULTS: There were 10 (45.45%) males and 12 (54.55%) females. Mean age was 52.3 years. In this group, 15 patients (68.1%) involved the bulbar conjunctiva, and 7 (31.9%) involved the palpebral conjunctiva. Of the 22 patients, 72.72% had a history of conjunctival melanosis. The average tumor size was 20.4 mm. Eight (36.36%) patients underwent orbital exenteration, 2 (9.06%) had enucleation, 5 (22.72%) had wide excision of the lesion followed by radiotherapy, 2 (9.06%) had orbital exenteration with neck dissection, and the remaining 5 patients (22.72%) were considered adequately treated only with wide excision. Eight (36.36%) patients received adjuvant treatment. Disease-free survival at 5 years was 51% and the overall survival at 5 and 10 years was 50% and 37%, respectively. CONCLUSION: Conjunctival melanoma is a rare entity. Tumor behavior is aggressive, and the optimal treatment is surgery with adjuvant therapy.

Uterine sarcomas: review of 26 years at The Instituto Nacional de Cancerologia of Mexico.

UNLABELLED: Uterine sarcomas are a group of uncommon tumors that account for approximately 1% of malignant neoplasms of the female genital tract and between 3 and 8.4% of malignant uterine neoplasms. OBJECTIVE: To evaluate the factors associated with the clinical behavior of uterine sarcomas. MATERIALS AND METHODS: In the period from October 1983 to December 2009, clinical files of patients with a confirmed diagnosis of uterine sarcoma at the National Institute of Cancerology of Mexico (INCan) were reviewed and evaluated. RESULTS: We identified 77 cases with complete information; average age at presentation was 51.6 years (range, 14-78 years); most frequent histology was leiomyosarcoma (LMS) in 53/77 (68.8%) cases; most frequent symptom reported at the time of diagnosis was abnormal vaginal bleeding in 36/77 (46.7%) cases, and the most frequent clinical stage was clinical stage (CS) I in 31/77 (40.2%) cases. Initial treatment was total abdominal hysterectomy (TAH) and bilateral salpingo-oophrectomy (BSO) in 53/77 (68.9%) cases. Disease-free period was 27.8 months (range, 0-184 months), with disease recurrence in 33/77 (42.85%) cases, most frequent site as lung in 13/33 (39.39%) cases. Management of recurrences was surgery and chemotherapy (CT) in 5/33 (15.15%) and CT in 10/33 (30.30%) of cases. At present, 40.3% of the patients (31/77) are found to be Disease-free. CONCLUSION: Notwithstanding that uterine sarcomas are aggressive neoplasms, most accepted management to date is TAH + BSO, observing that the fact that this procedure is not performed by oncologists does not affect the DFP nor OS, contrary to what occurs in other gynecological neoplasms.

[Hypothyroidism incidence after multimodal treatment for laryngeal cancer]. / Incidencia de hipotiroidismo secundario a tratamiento multimodal en cáncer de laringe.

BACKGROUND: Hypothyroidism following total laryngectomy or radiotherapy treatment for laryngeal cancer is not a rare event, especially in advanced stages. There are no reports on the incidence of hypothyroidism in patients who received chemotherapy and radiotherapy. The objective of this study is to determine the incidence of thyroid dysfunction in a group of patients with laryngeal cancer who underwent surgery as sole treatment, total laryngectomy or radiotherapy alone, and patients with combined treatment: surgery plus radiotherapy, concomitant chemoradiation therapy and chemoradiation therapy plus salvage surgery. METHODS: A prospective study of patients diagnosed with laryngeal cancer whose serum TSH and T4 levels were evaluated in a serial fashion. RESULTS: 70 patients with laryngeal cancer were studied; the average age at diagnosis was 70.2 years. Male patients were more affected, with a men-women ratio of 3.6:1. Glottic localization was the most frequent (44%). 64% of tumors were locally advanced carcinomas and 51% received multimodal treatment. 45 patients (63%) were diagnosed with hypothyroidism; 49% of the patients with subclinical hypothyroidism, and 51% with clinical hypothyroidism. CONCLUSIONS: Hypothyroidism is a complication following treatment for laryngeal cancer. It is recommended to evaluate the thyroid function periodically for timely detection.

[Laryngeal cancer in patients younger vs older than 40 years old: a matched-paired analysis]. / Cáncer de laringe en pacientes menores de 40 años comparado con mayores de 40 años: análisis de pares.

BACKGROUND: To compare clinical and demographic data between laryngeal cancer patients younger and older than 40 years old. METHODS: Is a matched-paired study, realized from 1989 to 2002. We selected 500 laryngeal cancer patients treated in the National Cancer Institute of Mexico. Fifteen cases of patients younger than 40 years that accomplished inclusion criteria were identified, pair-matched and compared by clinical stage with 33 patients older than 40 years. We analyzed demographic factors and disease-free and Overall Survival by Kaplan-Meier method. RESULTS: We included 9 male and 6 female patients with a mean age of 34 years in contrast to a mean age of 62 years in the comparison group. Four cases in clinical stage I, none clinical stage II, 6 in stage III and 5 in stage IV were included in the younger group and compared to 8 patients in stage I, 15 in stage III and 10 in stage IV in the older group. No differences in demographic variables or lifestyle habits were found. All patients in stage I, are alive in both groups. Disease-free survival not show any differences when comparing stages III and IV (p=NS). Mean disease-free survival was 66 months and mean overall survival was 83 months in the younger group. CONCLUSION: Laryngeal carcinoma is rare in patients younger than 40 years. No gender, clinical or prognostic differences could be identified among the two groups. The prognosis of these patients seems to be only determined by the initial clinical stage.

Comparative study between two different staging systems (AJCC TNM VS BALLANTYNE’S) for mucosal melanomas of the Head & Neck

BACKGROUND: Mucosal melanoma (MM) of head and neck (H&N) is a rare entity with a quite poor prognosis. Ballantyne's staging system has been commonly used since 1970. In the 7th edition of the AJCC Staging Manual a new chapter for the staging of TNM Classification system for mucosal melanoma (MM) of the head and neck (H&N) has been introduced to reflect the particularly aggressive biological behavior of this neoplasm. The aim of this study was to analyze and compare among Ballantyne's staging system vs TNM H&N in terms of overall survival (OS) and disease-free survival (DFS) in a consecutive population of patients with MM in a cancer centre. MATERIAL AND METHODS: Descriptive analysis of demographic, clinical and pathological variables of MM of the Head & Neck were performed. We compared the survival curves for both systems according to the Kaplan-Meier method using the Log-rank test. RESULTS: An up-staging migration effect from Ballantyne's localized disease to moderately and very advanced disease according to AJCC staging system. The 5-year DFS and OS for Ballantyne's Localized Disease and AJCC Stage III were 31% and 36% vs. 47% and 50%, respectively. For locoregional disease the 5-year DFS / OS were 5% / 10% for Bal-lantyne's system vs. 13.8% / 17.8% and 0 / 0% for AJCC Stages IVA and IVB, respectively. CONCLUSIONS: In this series, the TNM staging system for MM of the H&N predicted better the prognosis of the disease when comparing with Ballantyne's system

Carotid body tumour resection with LigaSure device.

OBJECTIVE: We carried out this study in patients who underwent resection of carotid body tumour (CBT). Shamblin's classification system was used as well as the modified Shamblin classification. We sought to determine whether surgical time and bleeding could be reduced with the use of the LigaSure system. METHODS: A prospective study was carried out in patients with CBT. RESULTS: A decrease in both time and bleeding was shown, although only overall time showed statistical significance. Cases were classified as Shamblin I, II and III in two, six, and four cases, respectively, and after surgical treatment were classified as modified Shamblin I, II, IIIa and IIIb in two, one, and six cases, respectively, by infiltration to the carotid. There was nerve damage in four cases, and there were three carotid resections. CONCLUSIONS: Use of LigaSure decreased bleeding and surgical time in CBTs. Lesions of the artery are mainly caused by infiltration or by muscular hypotrophy of the artery, which frequently requires vascular reconstruction. Nerve injury continues to be an important postoperative complication, which may result in a reduction in the quality of life for the patient. The rates of nerve injury as a result of surgery were unchanged.

Vertical partial hemilaryngectomy with reconstruction by false cord imbrication.

BACKGROUND: To evaluate global survival, disease-free period, complications, evolution and function in vertical partial hemilaryngectomy (VPHL) plus reconstruction with false cord. METHODS: Descriptive and retrospective study. In aertiary care medical center in Mexico City. Eight patients with early diagnosis of early glottic cancer (T1 and T2), treated with VPHL plus reconstruction with false cord imbrication. RESULTS: Fifty percent of the patients were clinical stage I, 37.5% stage II and 12.5% stage III. Nasogastric tube was not placed and oral feeding was reinitiated within 3 days on average. Tracheostomy was removed after an average of 2.1 days. Average hospital stay was 3.3 days. Average of the PSS-HNC (Performance Status for Head and Neck Cancer) and Karnofsky Performance Status evaluation was 91 to 97 and 100 at 1 year of evaluation. Voice evaluation demonstrated normal voice in 87.5% of patients. Intensity was below normal with improvement on annual evaluation. Global survival was 100% and disease-free period was 71% at 3 years. CONCLUSIONS: VPHL with reconstruction by false cord imbrication is an excellent therapeutic option for early glottic cancers. Multiple functional advantages are demonstrated without sacrificing oncological control as well as providing an audible and intelligible voice. In cases of recurrence, various management options are available.

Demographic data of laryngeal cancer at the Instituto Nacional de Cancerología in Mexico City.

BACKGROUND: We undertook this study to describe the demographic data of patients with laryngeal cancer treated at the Instituto Nacional de Cancerología in Mexico City. METHODS: We retrospectively reviewed the clinical files from 1986 to 2002, revealing 500 patients. RESULTS: Included were 452 men (90.4%) and 48 women (9.6%) (M:F ratio--10.6:1). Average age of patients was 62.37 years. The highest incidence of patients was among those aged 56 to 70 years. Smoking and alcoholism were present in most patients from this series. The cardinal symptom of presentation was dysphonia in 458 patients (91.6%). The mean evolution time of symptomatology was 11.6 months. The most common localization of the tumor was the glottis (61.6%). One hundred forty two patients (28.4%) presented early-stage tumors (T1-T2) and 354 patients (70.8%) presented with late-stage tumors (T3-T4). Clinically, 165 patients (33.0%) presented adenopathies and 13 patients (2.6%) had metastases at the time of diagnosis; 483 patients (96.6%) presented with invasive epidermoid cancer. Of these, 325 patients received treatment. One hundred forty six patients (44.9%) presented local recurrence, in nine patients (2.8%) there was regional recurrence, and one patient (0.3%) recurred with a distant tumor. Adequate control of the primary tumor was achieved with the established treatment in 169 patients (52%). verage survival time of the 325 treated patients was 38 months. CONCLUSIONS: Cancer of the larynx is a potentially curable entity. In any patient with major dysphonia of >1 month evolution, a differential diagnosis of cancer must be made. The survival prognosis for patients with cancer of the larynx is determined by the initial clinical stage.