Controversies in the management of endometrial cancer.

Endometrial cancer (EC) remains the most common malignancy of the female genital tract. The median age at diagnosis is the sixth decade, with abnormal uterine bleeding at the presentation in 90% of the patients. Surgical treatment, including complete hysterectomy, removal of remaining adnexal structures, and an appropriate surgical staging, represents the milestone of curative therapy for patients with EC. Adjuvant therapy is necessary in patients at high risk of recurrence. Conservative treatment approaches should be used in selected cases for women with a desire of fertility preservation. This review summarizes the management of EC and discusses current controversies regarding the role of lymphadenectomy and radiotherapy in patients with intermediate-risk tumors confined to the uterus.

[Carcinoma of the lip: a retrospective study of 86 cases]. / Carcinoma del labro. Studio retrospettivo su 86 casi.

Carcinoma of the lip is a common lesion which is not always acknowledged as as a potentially lethal disease. The risk of cancer occurs most commonly among aging white men. The risk factors normally associated with lip cancer are rural residence and outdoor occupation. In addition, both actinic radiation and tobacco smoking have been considered casually related to lip cancer. The present study is based on a retrospective review of 86 patients (82 males, 4 females, mean age 65) affected by carcinoma of the lip, treated in Florence from 1970 to 1988. The most frequent site for carcinoma of the lip proved to be the lower lip (71 cases); other sites included the upper lip (7) and the commissure (8). The lip tumor was a squamous cell carcinoma in 82 patients and a basal cell carcinoma in the remaining four. Good prognosis was found for all those with relatively small lesions (T1-T2). On the contrary, the prognosis proved quite poor for those who exhibited tumor fixation to the mandible or erosion of the mandible (23.5%, 5 year survival). Primary radiotherapy may be used for the smaller lesions as cure rates proved equivalent to those achieved surgically although the authors found surgery is always preferable as a primary method of treatment. Surgical excision of the tumor is a relatively minor procedure with a minimum of morbidity as compared with radiation therapy which may lead to local tissue reaction and may disturb function. Surgical management is also recommended as it bears the advantage of being to give a histologically accurate tumor margin assessment. Moreover, with surgery, functional results are good.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical treatment in 155 cases of hypopharyngeal carcinoma: analysis of results and causes of failure]. / Sul trattamento chirurgico di 155 carcinomi dell'ipofaringe: analisi dei risultati e delle cause di insuccesso.

A retrospective study has been performed on 155 cases of surgically treated hypopharyngeal carcinomas in order to bring to light what effect the type of surgery has on survival and the reasons for failure. The following operations were performed: 103 hemipharyngectomies with total laryngectomy (HPTL); 28 total circular pharyngectomies with total laryngectomy (CPTL); 16 hemipharyngectomies with partial laryngectomy (HPPL); 4 exereses in lateral pharyngectomy; 2 total laryngectomies and 2 hemipharyngectomies in lateral pharyngotomy. Analysis of the results is only performed on the three most numerous groups of patients. The overall neoplastic mortality rate at 5 years was 79% for the HPTL group while it was 50% and 61% in the CPTL and HPPL groups, respectively. The actuarial survival curves show a higher, statistically significant, cumulative 5-year survival rate for the CPTL group (55.9%) than for the HPTL group (30.5%). The authors conclude that, considering the particular submucosa spreading to which hypopharyngeal carcinoma is subject and the good functional recovery which can be obtained with modern reconstructive surgery of the alimentary tract, CPTL should be the treatment of choice, even in the less advanced cases, in order to significantly reduce the risk of local recurrences.

[Local flaps in the reconstruction of the hypopharyngeal-esophageal tract]. / Lembi locali nella ricostruzione del tratto ipofaringo-esofageo.

The authors present the developments made in the use of cutaneous cervical flaps in the reconstruction of the hypopharyngo-cervical esophagus since Mikulicz first introduced the technique in 1886. Mention is made of the most recent, valid reconstructive possibilities which have resulted in a progressive reduction in the use of cervical flaps. The advantages and disadvantages of the Wookey-operation are enumerated and considerations are made regarding the validity of this technique. The authors conclude that the use of cutaneous cervical flaps remains an effective method, particularly when more limited extirpation and/or further reconstructive stages are required or when a patient's poor general state contraindicates more stressing procedures.

'Pseudotumors' of the clavicle subsequent to radical neck dissection.

The authors describe a rare complication of radical neck dissection, a 'pseudotumor' with fracture of the medial portion of the clavicle. Out of 899 radical neck procedures carried out in the ENT Department of Florence University, there were four such cases.