RESUMO
Our review aims to clarify the incidence of carotid artery stenosis, risks of development, screening, management, and primary prevention strategies documented in the literature after radiation therapy for head and neck cancers. The high prevalence of carotid stenosis after radiation therapy for head and neck cancers has made surveillance and risk stratification critical. In addition to general cardiovascular risk factors such as smoking, diabetes, and dyslipidemia, risk factors for carotid artery stenosis after head and neck radiation included total plaque score, radiotherapy use and dosage, length of time after radiotherapy, and age greater than 50. Cancer subtype, namely nasopharyngeal cancer, may be correlated with increased risk as well, though contrasting results have been found. Interestingly, however, no significant relationship has been found between radiotherapy dose and stroke risk. Surgical management of post-radiation carotid stenosis is similar to that of stenosis unrelated to radiation, with carotid endarterectomy considered to be the gold standard treatment and carotid artery stenting being an acceptable, less-invasive alternative. Medical management of these patients has not been well-studied, but antiplatelet therapy, statins, and blood pressure control may be beneficial. The mainstay of screening for radiation-induced stenosis has been Doppler ultrasound, with measurement of changes in the intima-media thickness being a primary marker of disease development. A literature review was carried out using the MeSH terms "Carotid Artery Stenosis," "Head and Neck Neoplasms," and "Radiotherapy."
Assuntos
Estenose das Carótidas , Neoplasias de Cabeça e Pescoço , Humanos , Estenose das Carótidas/terapia , Estenose das Carótidas/etiologia , Neoplasias de Cabeça e Pescoço/terapia , Fatores de RiscoRESUMO
Interventional strategies for dealing with microvascular free flap failure are varied among institutions and even individual surgeons. This systematic review aims to identify the published methods for salvaging a failing free flap and provide surgeons with a comprehensive toolset for successful intervention. A title and abstract search of the PubMed, Embase, and Web of Science databases was performed. 1694 abstracts were screened by three reviewers according to Prisma guidelines. 62 full text articles meeting inclusion criteria detailed techniques which were separated into the categories of thrombectomy, thrombolysis, leech therapy, vascular fistula, and an "other" category outlining techniques which did not fit into the prior framework. Assessment of the efficacy of individual salvage techniques is limited due to limited empirical data, however, the approach to successful salvage should be based on timely identification of flap compromise, followed by the implementation of one or several of the aforementioned techniques.
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Retalhos de Tecido Biológico , Humanos , Retalhos de Tecido Biológico/cirurgia , Estudos Retrospectivos , Complicações Pós-Operatórias/terapia , Cabeça , Pescoço , Terapia de Salvação/métodosRESUMO
OBJECTIVE: Endolymphatic sac tumors are rare neoplasms originating in the endolymphatic sac. Current literature is limited to case reports and small case series. The objective of this study was to systematically review the literature to better describe clinical presentation, treatment options, and outcomes in endolymphatic sac tumors. DATA SOURCE: PubMed, Embase, and Cochrane Library. REVIEW METHODS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines describing human endolymphatic sac tumors. Risk of bias was assessed using a validated critical appraisal checklist for case series. Studies without inclusion of individual patient characteristics, corresponding treatments, and outcomes were excluded. Heterogeneity of data precluded meta-analysis. RESULTS: A total of 82 studies met inclusion criteria, and 253 discrete tumors were analyzed. A total of 23.4% of patients had von Hippel-Lindau disease. Von Hippel-Lindau-associated tumors affected females to males in a 2.4:1 ratio. Patients with von Hippel-Lindau disease displayed earlier average age at diagnosis compared to the sporadic cohort. Surgery was the primary treatment modality and was performed in 88.9% of cases. Adjuvant radiation therapy was employed in 18.7% of cases; 16.2% cases recurred, and 10.6% had progression of residual disease after treatment. Mean time to recurrence or progression was 53.1 ± 52.4 months with a range of 3 to 240 months. CONCLUSION: Endolymphatic sac tumors require a high degree of suspicion for early diagnosis. Complete resection is the standard of care. No strong evidence supports routine use of adjuvant radiation therapy. Given the high rate of recurrence and wide-ranging time to recurrence, long-term follow-up is necessary.
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Adenoma , Neoplasias Ósseas , Neoplasias da Orelha , Saco Endolinfático , Doença de von Hippel-Lindau , Masculino , Feminino , Humanos , Doença de von Hippel-Lindau/complicações , Doença de von Hippel-Lindau/diagnóstico , Doença de von Hippel-Lindau/patologia , Saco Endolinfático/cirurgia , Detecção Precoce de Câncer , Neoplasias da Orelha/cirurgia , Neoplasias da Orelha/diagnóstico , Neoplasias Ósseas/patologia , Adenoma/patologia , Resultado do TratamentoRESUMO
There is a narrow window of opportunity between surgical scheduling and the operative date to optimize patients for an elective surgical procedure. Traditionally, preoperative care has involved extended routine testing batteries with intermittent referrals for medical clearance. These traditions are costly, inefficient, and yield no clear reduction in perioperative morbidity and mortality. Evidence, which has evolved over the past decade, suggests that optimal preoperative care requires a patient-centric, personalized, and often multidisciplinary approach. We present an up-to-date overview of this literature with a focus on the otolaryngologic surgical population. An algorithmic approach to preoperative patient assessment is also proposed in hopes of both optimizing patient outcome and streamlining routine clinical workflow. Laryngoscope, 130:38-44, 2020.
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Procedimentos Cirúrgicos Eletivos , Medicina Baseada em Evidências , Otorrinolaringologistas , Otorrinolaringopatias/cirurgia , Cuidados Pré-Operatórios , Agendamento de Consultas , HumanosRESUMO
While disparities in the incidence, treatment, and mortality of oral cancer have been investigated in underrepresented groups, the Hispanic migrant farmworker population is understudied. A questionnaire was designed to assess oral cancer knowledge, awareness, and care-seeking behavior in this population. We aim to review this survey and outline its development.
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Neoplasias Bucais , Migrantes , Agricultura , Fazendeiros , Hispânico ou Latino , Humanos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy. STUDY DESIGN: Retrospective case series with chart review. SETTING: Five academic tertiary care centers. SUBJECTS AND METHODS: Patients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence. RESULTS: A total of 102 patients were included (76% OCSCC, 24% OPSCC). Five-year overall survival was 31% (95% CI, 21%-41%) and was significantly improved among patients with human papillomavirus-associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95% CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95% CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95% CI, 1.94-17.01). Twenty-five patients (25%) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control. CONCLUSION: Patients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.
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Carcinoma de Células Escamosas/cirurgia , Neoplasias Bucais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Orofaríngeas/cirurgia , Terapia de Salvação , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Terapia Combinada , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/virologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/virologia , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/virologia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
PURPOSE: To determine whether inclusion of chemoradiation history increases estimated risk for complications following total laryngectomy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator. MATERIALS AND METHODS: A retrospective review of 96 patients with laryngeal cancer, approximately half of who had received prior chemoradiation, who underwent laryngectomy between January 2010 and December 2014. NSQIP estimates were calculated and compared to actual event occurrence using receiver operating characteristic (ROC) curves, Brier scores, and risk estimates. RESULTS: Patients who had received prior chemoradiation were at significantly greater risk for complication postoperatively (OR=2.63, 95% CI=1.145-6.043). NSQIP Calculator discriminability and accuracy were generally poor for this sample. While NSQIP estimates significantly predicted risk for any postoperative complication, pneumonia, and discharge to nursing care for primary laryngectomy patients, predictive capability was lost among salvage laryngectomy patients. NSQIP adjustments to both Somewhat Higher and Significantly Higher Risk categories did not improve predictive capability. Of the risk factors considered by NSQIP, preoperative functional status (p=0.041), age at time of surgery (p<0.008), and inclusion of neck dissection (p=0.035) emerged as significant predictors of actual postoperative complications, though again estimates lost significance among salvage laryngectomy patients. CONCLUSIONS: The NSQIP Calculator may be poorly calibrated to estimate postoperative complication risk for patients previously exposed to chemoradiation undergoing salvage laryngectomy. Caution should be used when estimating postoperative risk among patients undergoing salvage procedures, especially those of older age, poorer functional status, and those requiring neck dissection.
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Neoplasias Laríngeas/terapia , Laringectomia , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Medição de Risco , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/epidemiologia , Masculino , Estadiamento de Neoplasias , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To heighten awareness of increased postoperative thromboembolic complications in patients with ß-hemoglobinopathies. PATIENT: A 42-year-old African American woman with previously undiagnosed ß-hemoglobinopathies suffers from sensorineural hearing loss caused by bacterial meningitis and undergoes bilateral cochlear implantation. INTERVENTION(S): Diagnostic: hemoglobin electrophoresis. Therapeutic: cochlear implantation, anticoagulation. MAIN OUTCOME MEASURE(S): Risk of thromboembolic event. RESULTS: Five days after surgery, the patient developed pulmonary embolism and infarct in the right lower lobe, which was treated with a 4-month course of anticoagulation. Hemoglobin electrophoresis showed that the patient had a previously undiagnosed rare ß-hemoglobinopathy known as sickle/ß+ thalassemia. CONCLUSION: ß-Hemoglobinopathies are associated with a higher incidence of thromboembolism; thus, they should be managed aggressively to prevent or treat perioperative thrombosis.