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1.
Eur Arch Otorhinolaryngol ; 271(6): 1747-54, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24071858

RESUMEN

The aim is to determine if tumor thickness is a risk factor related to the development of early recurrences in surgically treated oral cavity squamous cell carcinoma (SCC). Retrospective cohort study conducted at Instituto do Câncer do Estado de São Paulo (ICESP). Fifty-seven patients with oral cavity SCC (excluding lip tumors and patients previously submitted to any treatment) were analyzed regarding the occurrence of an early disease progression (locoregional or distant metastasis) within the first 12 months after initial treatment. Tumor thickness and other histological characteristics related to the development of recurrence up to 1 year after treatment were tested. Results demonstrated that tumor thickness greater than 10 mm (P = 0.034), as well as angiolymphatic invasion (P = 0.001), perineural invasion (P = 0.041) and lymph-node metastasis (P = 0.021) was associated with a worse 12-month disease-free survival (Log-Rank test). In multivariate analysis, tumor thickness greater than 10 mm emerged as an independent risk factor for early recurrence in oral cavity tumors (HR = 3.4, 95% CI: 1.005-11.690; P = 0.049--Cox regression). Post-operative radiotherapy seems to be a protective factor for early recurrences in patients with tumor thickness greater than 10 mm (P = 0.017--Log-Rank test; HR = 0.32, 95% CI: 0.12-0.87, P = 0.026--Cox regression). The results of the present research suggest that tumor thickness greater than 10 mm may be an independent adverse factor for early progression of surgically treated oral cavity SCC. Adjuvant therapies, in particular post-operative radiotherapy, should be advocated in this group of patients, regardless of the co-existence of other well-described histological risk factors.


Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/patología , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia , Anciano , Carcinoma de Células Escamosas/cirugía , Estudios de Cohortes , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Análisis Multivariante , Invasividad Neoplásica , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Carcinoma de Células Escamosas de Cabeza y Cuello , Carga Tumoral
2.
ScientificWorldJournal ; 2012: 384179, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22645420

RESUMEN

INTRODUCTION: The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications. OBJECTIVES: Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. METHODS: A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. RESULTS: Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx (P = 0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P = 0.002). The former condition is also associated with major reconstruction failure (P = 0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P = 0.044). CONCLUSION: Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Músculos Pectorales/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Estudios Transversales , Cabeza/cirugía , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Masculino , Oncología Médica/métodos , Persona de Mediana Edad , Morbilidad , Músculos Pectorales/trasplante , Complicaciones Posoperatorias/epidemiología , Reproducibilidad de los Resultados , Terapia Recuperativa/métodos , Colgajos Quirúrgicos , Resultado del Tratamiento
3.
Braz J Otorhinolaryngol ; 88(3): 434-438, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-33422480

RESUMEN

INTRODUCTION: Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown. OBJECTIVE: The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection. METHODS: Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire. RESULTS: The evaluation of the questionnaires showed a late worsening of the domains appearance (p=0.035) and chewing (p=0.041), as well as a decrease of about 10% of general quality of life (p=0.025) in patients undergoing selective neck dissection ​​in comparison to those undergoing sentinel lymph node biopsy. CONCLUSION: Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.


Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Estudios Transversales , Neoplasias de Cabeza y Cuello/patología , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Estadificación de Neoplasias , Calidad de Vida , Biopsia del Ganglio Linfático Centinela/métodos , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía
4.
Head Neck ; 44(7): 1604-1615, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35427429

RESUMEN

BACKGROUND: This study aimed to evaluate the accuracy and oncological results of sentinel lymph node biopsy in patients with early lip and oral cavity squamous cell carcinoma (SCC) in a real-world scenario. METHODS: Retrospective study including seven Brazilian centers. RESULTS: Four-hundred and seven cN0 patients were accrued for 20 years. The rate of occult metastasis was 23.1% and 22 patients (5.4%) had regional failure. We found, for 5 years of follow-up, 85.3% of regional recurrence-free survival; 77.1% of disease-free survival; 73.7% of overall survival; and 86.7% of disease-specific survival. The rate of false-negative cases was 5.4%. CONCLUSION: In a real-world scenario, sentinel lymph node biopsy for patients with SCC of the lip and oral cavity proved feasible in different settings and to be oncologically safe, with similar rates of occult lymph node metastasis and false-negative cases, when compared to elective neck dissection, and with similar long-term survival to that reported historically.


Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Brasil , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/patología , Humanos , Labio/patología , Disección del Cuello/métodos , Estadificación de Neoplasias , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela/métodos
5.
Eur Arch Otorhinolaryngol ; 267(7): 1141-6, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20082197

RESUMEN

The aim of this paper was to determine if the subclavicular route of rotation improved the pectoralis major myocutaneous flap's ability to reach head and neck sites in comparison to the traditional supraclavicular rotation. We dissected 50 flaps in 25 fresh adult male cadavers. The length of the pedicle and the flap's ability to reach five anatomical head and neck sites (laryngeal prominence of thyroid cartilage, mentum, angle of the mandible, external auditory canal, and orbit) were tested by supraclavicular and subclavicular rotation. Although the average length of the flap's pedicle was higher when the subclavicular rotation was employed, there was no statistical difference between the two techniques concerning the flap's ability to reach the studied sites. Our results suggest that the subclavicular route apparently adds little to the reconstruction of head and neck defects using the pectoralis major myocutaneous flap. We believe that the indication of this technique should be evaluated on a case-by-case basis before it is recommended to keep from unnecessarily increasing the potential morbidity of the reparative procedure.


Asunto(s)
Cabeza/cirugía , Cuello/cirugía , Músculos Pectorales/trasplante , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Cadáver , Clavícula , Humanos , Masculino
6.
Eur Arch Otorhinolaryngol ; 266(4): 553-8, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18688627

RESUMEN

Our aim was to determine whether histological changes occur in the cutaneous portion of pectoralis major flaps employed for upper aero-digestive tract reconstruction and, if present, to characterize these changes and try to infer their cause. Seven patients submitted to repair of aero-digestive tract defects secondary to cancer resection with pectoralis major myocutaneous flap were included in this study. All patients received adjuvant radiotherapy. Biopsies were taken from: the cutaneous portion of the flap; buccal mucosa; irradiated neck skin and chest skin opposite the donor site. Histological changes toward a "mucosalization" occur in the cutaneous portion of the pectoralis major flaps, characterized by disappearance of the horny layer or a reduction of its thickness and a decrease of the amount of cutaneous appendages. These changes are probably a result of continuous exposure to the intraoral environment in association with radiotherapy effects and may represent an advantageous adaptation for the patient.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Músculos Pectorales/patología , Procedimientos de Cirugía Plástica , Piel/patología , Colgajos Quirúrgicos , Anciano , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Membrana Mucosa/patología , Radioterapia Adyuvante , Factores de Tiempo
7.
Ann Otol Rhinol Laryngol ; 117(8): 581-6, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18771073

RESUMEN

OBJECTIVES: In this report we aim to describe the surgical technique required to utilize the pedicled temporoparietal galeal flap for repair of selected intraoral defects and to report our experience with this type of reconstructive procedure. METHODS: The charts of 6 consecutive patients submitted to reconstruction of intraoral defects using the pedicled temporoparietal galeal flap were reviewed. All of the defects were located in the posterior oral cavity and oropharynx. After resection of the oral cancer, the temporoparietal galeal flap, based on the superficial temporal vessels, was raised and transposed to the mouth through a tunnel under the zygomatic arch. The oral defect was repaired, and no skin graft was applied over the flap. RESULTS: There were no flap losses, and the reconstructive goal was achieved in all cases. The patients' deglutition and phonation abilities were restored, and the donor site scars were well hidden by hair growth. CONCLUSIONS: The pedicled temporoparietal galeal flap is another option for selected cases of reconstruction of intraoral defects--mainly those located in the posterior oral cavity and oropharynx, in which thin and pliable tissues are usually required.


Asunto(s)
Fascia/trasplante , Neoplasias de la Boca/cirugía , Orofaringe/cirugía , Adulto , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Hueso Parietal , Colgajos Quirúrgicos , Hueso Temporal , Músculo Temporal
8.
Laryngoscope ; 128(5): 1113-1119, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-28988428

RESUMEN

OBJECTIVES/HYPOTHESIS: Locoregional recurrences of oral cavity squamous cell carcinoma (SCC) may be diagnosed during follow-up of surgically treated patients. Nevertheless, few studies have investigated factors that impact salvage surgery failure and the mortality rates of these patients. The objectives were to identify predictive factors of salvage surgery failure and mortality in patients who undergo surgical treatment for recurrent oral cavity SCC and to compare the overall survival rates of these patients with those of patients who undergo only one surgical treatment. STUDY DESIGN: Retrospective cohort study. METHODS: Forty-six patients submitted to salvage surgery for local or locoregional recurrence. RESULTS: The presence of lymph node metastasis and positive surgical margins at the salvage surgery time were the only independent factors associated with both recurrence rates (hazard ratio [HR]: 5.04 and 2.82, respectively) and mortality (HR: 3.51 and 3.24, respectively). When the overall survival rates of the 199 patients who only underwent one surgical treatment were compared to those of the 46 patients subjected to salvage surgery, a similarity was evident when patients who underwent salvage surgery did not have a new disease recurrence (70.7% vs. 54.7%, respectively; P = .158). Likewise, patients with new recurrences after salvage surgery and patients who received palliative treatment for relapsed disease had similar overall survival rates (0.6% vs. 0.0%, respectively; P = .475). CONCLUSIONS: The presence of lymph node metastasis at the time of recurrence and positive surgical margins after the salvage surgery were associated with a worse overall survival rate in patients with oral cavity SCC relapse. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:1113-1119, 2018.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/cirugía , Terapia Recuperativa , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Metástasis Linfática/patología , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia/patología , Radioterapia Adyuvante , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Insuficiencia del Tratamiento
9.
Braz. j. otorhinolaryngol. (Impr.) ; Braz. j. otorhinolaryngol. (Impr.);88(3): 434-438, May-June 2022. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1384167

RESUMEN

Abstract Introduction Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown. Objective The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection. Methods Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire. Results The evaluation of the questionnaires showed a late worsening of the domains appearance (p = 0.035) and chewing (p = 0.041), as well as a decrease of about 10% of general quality of life (p = 0.025) in patients undergoing selective neck dissection ​​in comparison to those undergoing sentinel lymph node biopsy. Conclusion Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.


Resumo Introdução A biópsia de linfonodo sentinela é um método comprovado para estadiamento cervical em pacientes com carcinoma espinocelular inicial da cavidade oral, porque apresenta menor taxa de morbidade do que o método tradicional de esvaziamento cervical seletivo, com os mesmos resultados oncológicos. Porém, o verdadeiro efeito desse método na qualidade de vida desses pacientes permanece desconhecido. Objetivo Avaliar a qualidade de vida de pacientes com carcinoma espinocelular de cavidade oral T1/T2N0 submetidos a biópsia do linfonodo sentinela em comparação aos pacientes nos quais o esvaziamento cervical seletivo foi feito. Método Estudo transversal que incluiu 24 pacientes, após 36 meses de seguimento, dos quais 15 foram submetidos a biópsia do linfonodo sentinela e nove a esvaziamento cervical seletivo. Todos os pacientes responderam ao questionário de qualidade de vida da University of Washington. Resultados A avaliação dos questionários evidenciou pioria tardia dos domínios aparência (p = 0,035) e mastigação (p = 0,041), bem como diminuição de cerca de 10% da qualidade de vida geral (p = 0,025) nos pacientes submetidos a esvaziamento cervical seletivo em comparação com aqueles submetidos a biópsia do linfonodo sentinela. Conclusão Pacientes com carcinoma espinocelular de cavidade oral em estágio inicial submetidos a biópsia do linfonodo sentinela apresentaram melhores resultados tardios de qualidade de vida geral, principalmente quanto à aparência e à mastigação, quando comparados aos pacientes submetidos a esvaziamento cervical seletivo.

10.
Head Neck ; 39(5): 960-964, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28276113

RESUMEN

BACKGROUND: The purpose of the present study was to investigate the role of tumor volume in the prognosis of patients with oral cavity squamous cell carcinoma (SCC). METHODS: One hundred twenty-three patients with T4a oral cavity SCCs underwent surgical treatment. The volumes of the primary cancer were calculated by the multiplication of 3 macroscopic dimensions of the surgical specimen and related to recurrence and death. RESULTS: There were 54 recurrences (43.9%) and 75 deaths (60.9%). The mean tumor volume among the patients living without disease during the follow-up period was 28.2 cc, compared to 88.2 cc for patients living with disease, and to 78.9 cc for patients who died of the disease (p < .001). Multivariate analyses showed that volume and perineural invasion were independent factors for recurrence, whereas volume and lymph node metastasis were independent factors for death. CONCLUSION: Among patients who already have advanced cancers, tumor volume can significantly impact their prognoses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 960-964, 2017.


Asunto(s)
Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia/epidemiología , Anciano , Carcinoma de Células Escamosas/terapia , Estudios Transversales , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/terapia , Invasividad Neoplásica , Factores de Riesgo , Tasa de Supervivencia , Carga Tumoral
11.
Braz J Otorhinolaryngol ; 81(3): 248-54, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25890681

RESUMEN

INTRODUCTION: Elective neck dissection is recommended in cases of oral cavity squamous cell carcinoma without lymph node metastasis because of the risk of occult metastasis. OBJECTIVE: The present study aimed to evaluate predictive factors for occult lymph node metastasis in patients with oral cavity squamous cell carcinoma treated with elective neck dissection and their impact on overall and disease-free survival. METHODS: Forty surgically treated patients were retrospectively included. RESULTS: Ten cases (25%) had lymphatic metastasis. Of the studied variables, perineural and angiolymphatic invasion in addition to tumor thickness were statistically associated with lymph node metastasis. Only angiolymphatic invasion was identified as an independent risk factor for occult metastasis in the logistic regression (OR=39.3; p=0.002). There was no association between overall and disease-free survival with the presence of occult lymph node metastasis. CONCLUSION: Metastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Procedimientos Quirúrgicos Electivos , Ganglios Linfáticos/patología , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Métodos Epidemiológicos , Femenino , Humanos , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Estadificación de Neoplasias , Tasa de Supervivencia
12.
Artículo en Inglés | MEDLINE | ID: mdl-24906946

RESUMEN

OBJECTIVE: The aim of the study was to compare the thickness of primary tumors with the frequency of nodal metastases and survival in patients surgically treated for T1/T2N0 oral tongue squamous cell carcinoma. STUDY DESIGN: This is a retrospective longitudinal study with 74 patients. RESULTS: None of the patients with a tumor thickness (TT) ≤ 7 mm presented with nodal metastasis, whereas 25 of the patients with a TT > 7 mm (51.0%) developed metastases (P < .0001). Multivariate analysis showed that TT > 7 mm was a risk factor for occult nodal metastasis (odds ratio = 8.7; P = .002) with 81.9% accuracy. TT > 10 mm was also a predictive factor of worse disease-free survival in these patients (hazard ratio = 12.2; P = .003). CONCLUSIONS: Tumor thickness of greater than 7 mm is predictive of a higher incidence of lymph node metastasis, and a TT > 10 mm is predictive of worse disease-free survival in squamous cell carcinoma of the oral tongue.


Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias de la Lengua/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Estudios Longitudinales , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tasa de Supervivencia
13.
Ear Nose Throat J ; 91(1): 34-6, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22278868

RESUMEN

The author reports a case of congenital fistula from an accessory parotid gland and describes its diagnosis and treatment. The patient was referred to the author's clinic for evaluation of a continuous serous discharge from a small orifice in the left cheek near the angle of the mouth. A left preauricular appendix was also noted. Fistulography detected an aberrant duct leading to an accessory parotid gland. The main parotid gland and its duct were normal. The anomalous duct was dissected in continuity with a small ellipse of skin and sutured to the buccal mucosa. The patient's recovery was uneventful. The author also discusses the embryologic origin of this rare anomaly.


Asunto(s)
Fístula Cutánea/diagnóstico , Glándula Parótida/anomalías , Fístula de las Glándulas Salivales/diagnóstico , Adolescente , Fístula Cutánea/congénito , Fístula Cutánea/cirugía , Humanos , Masculino , Fístula de las Glándulas Salivales/congénito , Fístula de las Glándulas Salivales/cirugía
14.
Ear Nose Throat J ; 90(3): E20-4, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21412728

RESUMEN

We describe an unusual technique for performing delayed pharyngoesophageal reconstruction following circumferential pharyngolaryngectomy. The patient was a 52-year-old man who underwent a circumferential pharyngolaryngectomy for the treatment of hypopharyngeal carcinoma. In view of the patient's poor clinical status, we opted to perform a pharyngostomy and an esophagostomy and to postpone pharyngoesophageal reconstruction for a more appropriate occasion. After the patient's clinical condition had sufficiently improved, the repair was planned. Microsurgical flaps were contraindicated because the blood flow through the cervical vessels was unreliable. Pharyngoesophageal continuity was restored with a cervical flap vascularized by the prevertebral fascia, a pectoralis major myocutaneous flap, and a deltopectoralis flap. A reasonable degree of deglutition was achieved, and no signs of stricture were detected. Although our technique was unusual, we believed that it might provide a valid alternative when a delayed pharyngoesophageal reconstruction is required and free flaps are contraindicated for any reason.


Asunto(s)
Carcinoma/cirugía , Neoplasias Hipofaríngeas/cirugía , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Carcinoma/patología , Humanos , Neoplasias Hipofaríngeas/patología , Laringectomía , Masculino , Persona de Mediana Edad , Faringectomía
15.
Rev Assoc Med Bras (1992) ; 57(2): 171-6, 2011.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-21537703

RESUMEN

OBJECTIVE: To assess the cigarette smoking and alcohol intake maintenance rate in patients treated for head and neck squamous cell carcinoma and to compare the observed outcome with the type of oncological treatment employed. METHODS: One hundred and ten patients treated for high aero-digestive tract squamous cell carcinoma were included and divided into a surgical group, treated with a surgery, and a medical group, treated with chemotherapy and/or radiation. The patients were interviewed to determine whether or not they had persisted with the smoking and drinking behavior after treatment. The habit maintenance rate was compared with the treatment modality employed. The relationship between the oncological status of the patients and the cigarette smoking and alcohol intake rates found was also tested. RESULTS: Among smokers, 35% maintained the habit after treatment. The medical group had a significantly higher percentage of patients maintaining smoking compared with the surgical group (58.3% vs 25.0%; p = 0.004). Among alcohol users, 16.6% kept drinking alcoholic beverages, with a percentage also shown higher for the medical group (23.8% vs 13,3%), but with no statistically significant difference. The oncological status of patients was not related to the maintenance of the habits studied. CONCLUSION: Smoking and alcoholism maintenance rates are high after head and neck squamous cell carcinoma is treated, especially if we consider smoking in patients treated with chemotherapy and/or radiation. A more effective multidisciplinary approach is required in order to obtain better rates of tobacco and alcohol quitting, especially in patients undergoing non-surgical treatments.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/terapia , Fumar/epidemiología , Cese del Uso de Tabaco , Consumo de Bebidas Alcohólicas/efectos adversos , Brasil/epidemiología , Carcinoma de Células Escamosas/etiología , Estudios Transversales , Femenino , Neoplasias de Cabeza y Cuello/etiología , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Recurrencia , Factores de Riesgo , Fumar/efectos adversos
16.
Sao Paulo Med J ; 128(6): 336-41, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21308156

RESUMEN

CONTEXT AND OBJECTIVE: Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. The aim of this study was to identify factors that may cause complications and influence the final result from reconstructions using pectoralis major myocutaneous flaps (PMMFs) for head and neck defect repair following cancer resection. DESIGN AND SETTING: Cross-sectional study at the Hospital de Ensino Padre Anchieta of Faculdade de Medicina do ABC (FMABC). METHODS: Data on 58 patients who underwent head and neck defect reconstruction using PMMFs were reviewed. The final result from the reconstruction (success or failure) and the complications observed were evaluated in relation to the patients' ages, area reconstructed, disease stage, previous oncological treatment and need for blood transfusion. RESULTS: There were no total flap losses. The reconstruction success rate was 93.1%. Flap-related complications occurred in 43.1% of the cases, and half of them were considered major. Most of the complications were successfully treated. Defects originating in the hypopharynx were correlated with the development of major complications (p = 0.02) and with reconstruction failure (p < 0.001). Previous oncological treatment negatively influenced the reconstruction success (p = 0.04). CONCLUSIONS: Since the risk factors for developing major complications and reconstruction failure are known, it is important to heed the technical details and provide careful clinical support for patients in a more critical condition, so that better results from using PMMFs can be obtained.


Asunto(s)
Cabeza/cirugía , Cuello/cirugía , Músculos Pectorales/trasplante , Procedimientos de Cirugía Plástica/efectos adversos , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Procedimientos de Cirugía Plástica/métodos , Factores de Riesgo , Colgajos Quirúrgicos/efectos adversos , Colgajos Quirúrgicos/patología , Resultado del Tratamiento
17.
Braz. j. otorhinolaryngol. (Impr.) ; Braz. j. otorhinolaryngol. (Impr.);81(3): 248-254, May-Jun/2015. tab, graf
Artículo en Inglés | LILACS | ID: lil-751907

RESUMEN

INTRODUCTION: Elective neck dissection is recommended in cases of oral cavity squamous cell carcinoma without lymph node metastasis because of the risk of occult metastasis. OBJECTIVE: The present study aimed to evaluate predictive factors for occult lymph node metastasis in patients with oral cavity squamous cell carcinoma treated with elective neck dissection and their impact on overall and disease-free survival. METHODS: Forty surgically treated patients were retrospectively included. RESULTS: Ten cases (25%) had lymphatic metastasis. Of the studied variables, perineural and angiolymphatic invasion in addition to tumor thickness were statistically associated with lymph node metastasis. Only angiolymphatic invasion was identified as an independent risk factor for occult metastasis in the logistic regression (OR = 39.3; p = 0.002). There was no association between overall and disease-free survival with the presence of occult lymph node metastasis. CONCLUSION: Metastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor .


INTRODUÇÃO: O esvaziamento cervical eletivo é realizado de maneira sistemática nos casos de carcinoma espinocelular da cavidade oral sem linfonodos clinicamente comprometidos devido à alta incidência de metástases ocultas. OBJETIVO: Avaliar pacientes com carcinoma espinocelular de cavidade oral tratados com esvaziamento cervical eletivo quanto a fatores preditivos para ocorrência de metástases ocultas e o impacto das mesmas na sobrevivência global e livre de progressão destes pacientes. MÉTODO: Quarenta pacientes cirurgicamente tratados foram avaliados em estudo retrospectivo. RESULTADOS: Dez casos (25%) apresentaram metástases ocultas. Das variáveis analisadas, invasão perineural e angiolinfática e também a espessura tumoral foram estatisticamente significantes à análise univariada. Apenas a invasão angiolinfática foi fator independente de risco de metástases ocultas pela regressão logística (OR = 39,3; p = 0,002). A presença de metástase oculta não apresentou diferença estatisticamente significante em relação às taxas de sobrevivência global e livre de progressão. CONCLUSÃO: A incidência de metástase oculta foi semelhante à literatura. A invasão perineural, angiolinfática e a espessura tumoral foram fatores associados à presença de metástase oculta, porém apenas a invasão angiolinfática apresentou-se como um fator de risco independente para ocorrência do fenômeno. .


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/cirugía , Procedimientos Quirúrgicos Electivos , Ganglios Linfáticos/patología , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Métodos Epidemiológicos , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Estadificación de Neoplasias , Tasa de Supervivencia
18.
Rev. Assoc. Med. Bras. (1992, Impr.) ; Rev. Assoc. Med. Bras. (1992, Impr.);57(2): 171-176, mar.-abr. 2011. graf, tab
Artículo en Portugués | LILACS | ID: lil-584068

RESUMEN

OBJETIVO: Avaliar a taxa de manutenção do tabagismo e etilismo em pacientes tratados por carcinoma epidermoide da cabeça e pescoço e comparar o resultado observado com a modalidade do tratamento oncológico empregado. MÉTODOS: Foram incluídos 110 pacientes tratados por carcinoma epidermoide das vias aereodigestivas altas, divididos em grupo cirúrgico, tratado com cirurgia, e grupo clínico, tratado com quimioterapia e/ou radioterapia. Os pacientes foram entrevistados a fim de determinar se houve manutenção dos hábitos após o tratamento. Comparou-se a taxa de manutenção dos hábitos com a modalidade de tratamento empregada. Testou-se também a relação entre o status oncológico dos pacientes com as taxas de tabagismo e etilismo encontradas. RESULTADOS: Entre os tabagistas, 35 por cento mantiveram este hábito após o tratamento. No grupo clínico, houve um percentual significativamente maior de pacientes que mantiveram o tabagismo com relação ao grupo cirúrgico (58,3 por cento x 25 por cento; p = 0,004). Entre os etilistas, 16,6 por cento continuaram a ingerir bebidas alcoólicas, percentagem que também se mostrou maior no grupo clínico (23,8 por cento x 13,3 por cento), porém sem diferença estatisticamente significativa. O status oncológico dos pacientes não apresentou relação com a manutenção dos hábitos estudados. CONCLUSÃO: São altas as taxas de manutenção de tabagismo e etilismo após o tratamento do carcinoma epidermoide de cabeça e pescoço, especialmente se considerarmos o tabagismo nos pacientes tratados com quimioterapia e/ou radioterapia. Uma abordagem multidisciplinar mais efetiva é necessária com vista a obter melhores taxas de abandono do tabaco e do álcool, especialmente no grupo de pacientes submetidos a tratamentos não cirúrgicos.


OBJECTIVE: To assess the cigarette smoking and alcohol intake maintenance rate in patients treated for head and neck squamous cell carcinoma and to compare the observed outcome with the type of oncological treatment employed. METHODS: One hundred and ten patients treated for high aero-digestive tract squamous cell carcinoma were included and divided into a surgical group, treated with a surgery, and a medical group, treated with chemotherapy and/or radiation. The patients were interviewed to determine whether or not they had persisted with the smoking and drinking behavior after treatment. The habit maintenance rate was compared with the treatment modality employed. The relationship between the oncological status of the patients and the cigarette smoking and alcohol intake rates found was also tested. RESULTS: Among smokers, 35 percent maintained the habit after treatment. The medical group had a significantly higher percentage of patients maintaining smoking compared with the surgical group (58.3 percent vs 25.0 percent; p = 0.004). Among alcohol users, 16.6 percent kept drinking alcoholic beverages, with a percentage also shown higher for the medical group (23.8 percent vs 13,3 percent), but with no statistically significant difference. The oncological status of patients was not related to the maintenance of the habits studied. CONCLUSION: Smoking and alcoholism maintenance rates are high after head and neck squamous cell carcinoma is treated, especially if we consider smoking in patients treated with chemotherapy and/or radiation. A more effective multidisciplinary approach is required in order to obtain better rates of tobacco and alcohol quitting, especially in patients undergoing non-surgical treatments.


Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Bebidas Alcohólicas/epidemiología , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/terapia , Fumar/epidemiología , Cese del Uso de Tabaco , Consumo de Bebidas Alcohólicas/efectos adversos , Brasil/epidemiología , Carcinoma de Células Escamosas/etiología , Estudios Transversales , Neoplasias de Cabeza y Cuello/etiología , Aceptación de la Atención de Salud , Recurrencia , Factores de Riesgo , Fumar/efectos adversos
19.
Arq. bras. ciênc. saúde ; 35(2)maio-ago. 2010.
Artículo en Portugués | LILACS | ID: lil-555479

RESUMEN

Objetivo: Os retalhos livres, considerados o padrão-ouro na cirurgia reparadora, não podem ser utilizados na reconstrução de todos os defeitos pós-excisionais cervicofaciais, principalmente naqueles pacientes portadores de severas comorbidades clínicas. Dessa forma, retalhos pediculados clássicos, como o retalho temporofrontal, ainda representam uma alternativa ao cirurgião de cabeça e pescoço. Este trabalho teve por objetivo descrever nossa experiência com a utilização do retalho temporofrontal, baseado na artéria temporal superficial para a reconstrução de defeitos pós-excisionais em cabeça e pescoço. Método: Foi realizado um estudo retrospectivo de cinco casos consecutivos de pacientes portadores de neoplasias malignas do território da cabeça e pescoço, tratados entre 2000 e 2009, nos quais foi utilizado o retalho temporofrontal. Nos cinco pacientes, os retalhos livres estavam contraindicados devido a comorbidades clínicas ou à falta de condições técnicas para a realização de microcirurgia. Resultados: Não foi observada perda total do retalho em nenhum caso. Houve integração completa do enxerto de pele na área doadora nos cinco casos. Todos os pacientes receberam alta precoce, sem complicações imediatas. Os objetivos da reconstrução foram alcançados em quatro dos cinco pacientes. Conclusão: Analisando os nossos resultados, observamos que o retalho temporofrontal apresentou boa evolução na maioria dos casos, com reabilitação funcional satisfatória em quatro dos cinco pacientes. Em função das limitações da microcirurgia em nosso meio, a utilização de retalhos loco-regionais pediculados, como o retalho temporofrontal, deve fazer parte da formação do cirurgião de cabeça e pescoço.


Objective: The free flaps are considered the gold standard for surgical reconstruction. However, this technique cannot be employed to the reconstruction of all cervicofacial post-excision defects, principally in those patients with serious clinical comorbidities. Hence, classical pedicle flaps, like the forehead flap, are still an option for the head and neck surgeon. The aim of this paper was to describe our experience with the use of the forehead flap, based on the superficial temporal artery for post-excision head and neck defects reconstruction. Method: We performed a retrospective study of five consecutive cases, from 2000 to 2009, in which the pedicle forehead flap was utilized to treat head and neck cancer patients. In these five cases, the free flaps were contraindicated due to clinical comorbidities or the lack of technical condition for the employment of microsurgery. Results: There were no total flap losses. The skin graft was entirely integrated to the donor area in all cases. All patients were discharged in a few days without early complications. The objectives of the reconstruction were achieved in four of five patients. Conclusion: The pedicle forehead flap presented a good outcome in most of the cases, with acceptable functional rehabilitation in four of five patients. Due to the limitations of microsurgery, the employment of pedicle loco-regional flaps, like the forehead flap, must be part of professional formation of head and neck surgeons.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Neoplasias de Cabeza y Cuello/cirugía , Reimplantación , Colgajos Quirúrgicos , Arterias Temporales
20.
São Paulo med. j ; São Paulo med. j;128(6): 336-341, Dec. 2010. ilus, tab
Artículo en Inglés | LILACS | ID: lil-573995

RESUMEN

CONTEXT AND OBJECTIVE: Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. The aim of this study was to identify factors that may cause complications and influence the final result from reconstructions using pectoralis major myocutaneous flaps (PMMFs) for head and neck defect repair following cancer resection. DESIGN AND SETTING: Cross-sectional study at the Hospital de Ensino Padre Anchieta of Faculdade de Medicina do ABC (FMABC). METHODS: Data on 58 patients who underwent head and neck defect reconstruction using PMMFs were reviewed. The final result from the reconstruction (success or failure) and the complications observed were evaluated in relation to the patients' ages, area reconstructed, disease stage, previous oncological treatment and need for blood transfusion. RESULTS: There were no total flap losses. The reconstruction success rate was 93.1 percent. Flap-related complications occurred in 43.1 percent of the cases, and half of them were considered major. Most of the complications were successfully treated. Defects originating in the hypopharynx were correlated with the development of major complications (p = 0.02) and with reconstruction failure (p < 0.001). Previous oncological treatment negatively influenced the reconstruction success (p = 0.04). CONCLUSIONS: Since the risk factors for developing major complications and reconstruction failure are known, it is important to heed the technical details and provide careful clinical support for patients in a more critical condition, so that better results from using PMMFs can be obtained.


CONTEXTO E OBJETIVO: Retalhos pediculados têm grande importância nos centros de tratamento do câncer, principalmente em países emergentes e em desenvolvimento. O objetivo deste trabalho foi identificar fatores que determinam complicações e influenciam no resultado final das reconstruções com retalho miocutâneo de peitoral maior (RMPM) no reparo de defeitos cirúrgicos por ressecções de cânceres de cabeça e pescoço. TIPO DE ESTUDO E LOCAL: Estudo transversal no Hospital de Ensino Padre Anchieta da Faculdade de Medicina do ABC. MÉTODOS: Dados de 58 pacientes submetidos a reconstruções de defeitos de cabeça e pescoço com RMPM foram revisados. O resultado final da reconstrução (sucesso ou falha) e as complicações observadas foram avaliados de acordo com a idade do paciente, área reconstruída, estágio da doença, tratamento oncológico prévio e necessidade de transfusão sanguínea. RESULTADOS: Não houve perda total de retalho. A taxa de sucesso da reconstrução foi de 93,1 por cento. Complicações relacionadas ao retalho ocorreram em 43,1 por cento dos casos e 50 por cento delas foram considerados como complicações maiores. A maioria das complicações foi tratada com sucesso. Os defeitos originados da hipofaringe relacionaram-se com o desenvolvimento de complicações maiores (p = 0,02) e falhas na reconstrução (p < 0,001). Tratamento oncológico prévio influenciou negativamente no sucesso da reconstrução (p = 0,04). CONCLUSÕES: Como os fatores de risco para o desenvolvimento de complicações maiores e de falha na reconstrução são conhecidos, é importante atentar para detalhes técnicos e empregar suporte clínico cuidadoso aos pacientes mais críticos para que sejam obtidos melhores resultados com o uso do RMPM.


Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Cabeza/cirugía , Cuello/cirugía , Músculos Pectorales/trasplante , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica/efectos adversos , Colgajos Quirúrgicos , Estudios Transversales , Necrosis , Procedimientos de Cirugía Plástica/métodos , Factores de Riesgo , Colgajos Quirúrgicos/efectos adversos , Colgajos Quirúrgicos/patología , Resultado del Tratamiento
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