Induction chemotherapy for the individualised treatment of hypopharyngeal carcinoma with cervical oesophageal invasion: a retrospective cohort study.

BACKGROUND: This study aimed to evaluate the potential of induction chemotherapy as an indicator of the management of advanced hypopharyngeal carcinoma with cervical oesophageal invasion. METHODS: Sixty-eight patients admitted to our hospital between February 2003 and November 2016 with stage IVB hypopharyngeal carcinoma with cervical oesophageal invasion were retrospectively analysed. Patients were divided into two groups according to the treatment they selected following an explanation of the different treatments available. Patients in group A received induction chemotherapy and had (1) complete/partial remission following chemotherapy and radiotherapy/concurrent chemoradiotherapy or (2) stable disease following chemotherapy and surgery. Patients in group B underwent surgery followed by adjuvant radiotherapy/concurrent chemoradiotherapy. Survival analyses were performed using the Kaplan-Meier method, and differences between the groups were evaluated using the log-rank test. Laryngeal and oesophageal retention rates were compared using the cross-tabulation test. RESULTS: The 3- and 5-year overall survival rates were 22.86% and 11.43% in group A and 24.25% and 6.06% in group B, respectively (all P > 0.05). The laryngeal and oesophageal retention rates were 40.0% and 74.3% in group A and 0.0% and 27.3% in group B, respectively (all P < 0.01). There was no statistically significant difference in the incidence of post-operative complications between the two groups (group A 8.6%, group B 12.1%; P > 0.05). CONCLUSIONS: Induction chemotherapy may be an appropriate first choice to ensure laryngeal and oesophageal preservation in the individualised treatment of advanced hypopharyngeal carcinoma with cervical oesophageal invasion.

Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor.

BACKGROUND: Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure. METHODS: A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years, with a mean age of (34 ± 3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy. RESULTS: All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation. The patients were satisfied with the cosmetic results of the surgery. CONCLUSION: The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.

[Application of modified pectoralis major myocutaneous island flap in head and neck surgeries].

OBJECTIVE: To preserve the function of the donor site and good cervical shape, a modified pectoralis major myocutaneous island flap was designed. METHODS: The modified pectoralis major myocutaneous flaps were used to repair primarily the defect in head and neck surgery. In all 17 cases, six cases were patients with recurrence of larynx or hypopharynx cancer, four cases with hypopharynx cancer, three cases with base of tongue cancer, two cases with recurrence of maxillary cancer, one case with tonsillar cancer and one case with pharyngeal fistula after hypopharyngeal cancer surgery. Before operation, ultrasound was used to mark the projection of the pectoral branches of thoracoacromial artery, and the pectoralis major myocutaneous were designed according to the axle between lowest entering muscle point of the artery and the fourth intercostals perforator spot of mammary artery; the incision was designed to turn laterally in an oriental direction at the top of the flap and upward along the anterior axillary line; the internal pectoral nerve was reserved, as well as the partial lateral pectoral nerve. The flaps were transferred to recipient site either above or below the clavicle on the premise of the integrity of clavicular part. RESULTS: The distance of the lowest entering muscle point of pectoral branche measuring during operation, which was all in sternocostal part, to the midpoint of inferior clavicula margin was (4.9 +/- 1.2) cm (average +/- s), and in 76.5% (13/17) of the patients, the location was coincidence by ultrasound. The length between entering muscle point and the fourth intercostals perforator spot of mammary artery was (1.8 +/- 0.5) cm. All the myocutaneous flaps were alive except one case. The flap was given up as a result of the vessel pedicle injure. The distal end of the flap was dehisced from the residual tongue in one case with base of tongue cancer and healed with changing dressing. Two pharyngeal fistulas in another two cases were healed with conserved treatment. The rate of the flap survival was 94.1% (16/17). Functions as adduction and adtorsion of major pectoral muscle were integrated within 4 weeks to 3 months. Also, the good looking of the neck and upper chest was maintained. CONCLUSIONS: The location of pectoral branches of thoracoacromial artery and the site of the lowest entering muscle point marked by ultrasound detection could help the design of the flap. The modified pectoral' s major myocutaneous flap designing presented better functional protection and reach longer distance and left a better looking for neck and upper chest.

[Spiral computed tomographic analysis of frontal recess regions].

OBJECTIVE: The purpose of the study was to determine the prevalence of frontal recess cells in Chinese patients who did not have frontal sinus disease related symptoms. METHODS: Forty-nine Chinese patients without frontal sinus disease symptoms were undergone spiral computed tomography (CT). Then multiplanar reconstruction images were evaluated using a standard triplanar reconstruction protocol on a computer workstation. RESULTS: The prevalence of agge rnasi cell was 94% (92/98). Sixty-four uncinate processes (65%, 64/98) had one superior attachment for each uncinate process, the other thirty-four uncinate processes (35%, 34/98) had two superior attachments for each uncinate process. The uncinate process' single superior attachment into the surrounding structures was identified to have the following distribution: 53% (52/98) to the lamina papyracea, 9% (9/98) to the middle turbinate, 3% (3/98) to the skull base. Most of the uncinate process' two superior attachments were either into the lamina papyracea and the skull base (24%, 23/98) or into the lamina papyracea and the middle turbinate (10%, 10/98). Only one uncinate process (1%) superiorly attached to the skull base and the middle turbinate. The prevalence of recessus terminalis was 87% (85/98). Of all the frontal cells identified in 32 sides (33%) of frontal recesses, the prevalence of type I, type II, type II and type IV cells were 23% (23 sides), 2% (2 sides), 7% (7 sides) and 0% (0 side) respectively. Supra bullar cell, frontal bullar cell and interfrontal septal cell were identified in 30 sides (31%), 7 sides (7%) and 7 patients (14%) respectively. CONCLUSIONS: The result characterized normal frontal recess pneumatization in Chinese. That, together with the variations of the uncinate process' superior attachment emphasized the roles of agger nasi cell and the uncinate process in endoscopic frontal sinus surgery.