The Role of Open Conservation Surgery in the Era of Minimally Invasive Surgery for Hypopharyngeal Cancer.

Background and Objectives: Total laryngectomy with partial pharyngectomy is traditionally the principal curative treatment for hypopharyngeal cancer; however, conservative surgical approaches that minimize functional disability are attracting increasing interest. Thus, we evaluated the appropriateness and oncological outcomes of open conservation surgery for such patients. Materials and Methods: We reviewed the medical records of 49 patients who underwent vertical hemipharyngolaryngectomy from 1998 to 2018 at a single institution. Results: Locoregional recurrences developed in 19 patients (38.8%) and distant metastases in 6 (12.2%). Histopathologically, paraglottic space invasion was apparent in 13 patients (26.5%), pre-epiglottic space invasion in 4 (8.2%), thyroid cartilage invasion in 9 (18.4%), thyroid gland invasion in 2, perineural invasion in 11 (22.4%), and lymphovascular invasion in 35 (71.4%). The 5-year overall survival of patients who underwent open conservation surgery was comparable to that of patients who underwent total laryngectomy with partial pharyngectomy (68.7% vs. 48.4%, p = 0.14). Pre-epiglottic space invasion significantly decreased the 5-year disease-free survival rate after open conservation surgery (69.7% vs. 17.9%, p = 0.01). Conclusions: We found that pre-epiglottic space invasion negatively impacted disease control after open conservation surgery, emphasizing the crucial role played by a preoperative evaluation during patient selection.

Synergistic association between underweight and type 2 diabetes on the development of laryngeal cancer: a national population-based retrospective cohort study.

BACKGROUND: Although cigarette smoking is the most significant risk factor for laryngeal cancer, other risk factors might also be associated with the development of laryngeal cancer. We investigated whether underweight and type 2 diabetes are associated with laryngeal cancer in a Korean population. METHODS: A total of 9,957,059 participants (≥20 years) without prior history of cancer who underwent a National Health Insurance Service health checkup in 2009 were followed up until December 31, 2018. Newly diagnosed laryngeal cancer was identified using claim data, and underweight was defined as body mass index (BMI) < 18.5 kg/m2. A Cox proportional-hazards models with multivariable adjustment were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs). RESULTS: During the median follow-up period of 8.3 years, 3504 cases of laryngeal cancer occurred. Underweight was associated with increased risk of laryngeal cancer after adjusting for potential confounders (HR: 1.43, 95% CI: 1.22-1.69) compared to those who were not underweight. Underweight and type 2 diabetes were synergistically associated with higher risk of laryngeal cancer (HR: 2.33, 95% CI: 1.54-3.51), compared to those without either condition. This relationship was stronger in those with an age < 65 years (HR: 3.33, 95% CI: 1.88-5.87) and alcohol consumption (HR: 2.72, 95% CI: 1.64-4.53). CONCLUSIONS: These results suggest that underweight may be a significant risk factor for laryngeal cancer and that underweight and type 2 diabetes might synergistically increase the risk of laryngeal cancer.

Prognostic Significance of the Metastatic Lingual Lymph Node in Oral Tongue and Floor of Mouth Squamous Cell Carcinoma.

PURPOSE: The lingual lymph node (LLN) located on the internal surface of mylohyoid muscle is not currently included in oral cavity cancer surgery or conventional neck dissection. We investigated the risk factors for LLN metastasis and evaluated its oncologic significance in patients with oral tongue and floor of mouth squamous cell carcinoma. PATIENTS AND METHODS: Adult patients (≥20 years) undergoing upfront surgery and LLN dissection for oral tongue and floor of mouth squamous cell carcinoma between 2009 and 2018 were retrospectively analyzed. Patients who had relapsed after previous treatment or had neoadjuvant chemotherapy or had not undergone surgery were excluded. Association between clinicopathological risk factors (age, gender, tumor differentiation, stage, lymphatic invasion, perineural invasion, vascular invasion, metastatic lymph node ratio, and extranodal extension) and LLN metastasis was evaluated using logistic regression analysis. Disease-free survival in accordance with LLN metastasis was evaluated by the Kaplan-Meier method. RESULTS: A total of 51 patients were included, and LLN metastasis was found in 9 patients (17.6%). LLN metastasis was significantly associated with advanced nodal stage, poor tumor differentiation, and vascular invasion. Cox proportional-hazards regression models showed that LLN metastasis was associated with an 8.0-fold higher risk of mortality than the absence of LLN metastasis. Patients with LLN metastasis had significantly worse 5-year disease-free survival rate than those without metastasis (22.2% vs 85.7%; P < .001). CONCLUSIONS: This study suggests that LLN metastasis is a poor prognostic factor in patients with oral tongue and floor of mouth squamous cell carcinoma. The sublingual space should be carefully evaluated preoperatively and intraoperatively.

A Case of Juvenile Psammomatoid Ossifying Fibroma on Skull Base.

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare tumor that occurs in maxillary sinus or orbit. Complete removal is required due to the aggressive and locally destructive nature. It is hard to distinguish from psammomatoid meningioma in cranial lesion and to remove completely. The authors are presenting a case of 26-year-old male with JPOF on skull base and report this case with review of literature.