Factores dependientes del paciente adulto y su relación con la hemorragia y el dolor postamigdalectomía en régimen ambulatorio / Dependent factors in the adult patient and their relationship with post-tonsillectomy bleeding and pain in an outpatient setting

Introducción y objetivo: La amigdalectomía realizada de forma ambulatoria en pacientes adultos presenta como principales complicaciones postoperatorias la hemorragia y el dolor.El seguimiento de directrices como la técnica quirúrgica fría, protocolos analgésicos, entrevista preoperatoria y seguimiento postoperatorio ayudan a un mejor control del proceso. No obstante, existen factores dependientes del paciente como el sexo, la edad, la indicación de la amigdalectomía y el tiempo transcurrido entre la última infección amigdalar y la intervención quirúrgica que pueden influir en las complicaciones postoperatorias y deben ser considerados.El objetivo de este trabajo es evaluar la influencia de la edad, el sexo, la indicación de la amigdalectomía y el periodo transcurrido entre la última infección amigdalar y la intervención quirúrgica sobre la hemorragia y el control del dolor.MétodosPara ello se realizó un estudio prospectivo, descriptivo, observacional, con 96 pacientes adultos que fueron intervenidos en régimen ambulatorio bajo anestesia general, empleando técnica quirúrgica fría, evaluando estas complicaciones en función de la edad, sexo, indicación para la amigdalectomía y el tiempo transcurrido tras la última amigdalitis.ResultadosLos pacientes intervenidos a lo largo de las cuatro semanas posteriores a un episodio de amigdalitis presentaron más dolor postoperatorio. No se encontró relación entre este periodo de tiempo y la hemorragia postoperatoria. (AU)

Introduction and objective: Tonsillectomy performed on an outpatient basis in adult patients presents bleeding and pain as main postoperative complications.Following rules such as cold surgical technique, analgesic protocols, preoperative interview, and postoperative follow-up help to better control the process. However, there are patient-dependent factors such as sex, age, indication for tonsillectomy and the time elapsed between the last tonsil infection and surgical intervention that can influence postoperative complications and should be considered.The objective of this work is to evaluate the influence of age, sex, the indication for tonsillectomy and the period elapsed between the last tonsil infection and surgery on bleeding and pain control.MethodsA prospective, descriptive, and observational study was carried out in 96 adult patients who underwent outpatient surgery under general anaesthesia, using cold surgical technique, evaluating these complications based on age, sex, indication for tonsillectomy and time elapsed after the last tonsillitis.ResultsThe patients operated on during the 4 weeks after an episode of tonsillitis presented more postoperative pain. No relationship was found between this period and postoperative bleeding.ConclusionsMale patients had a higher incidence of bleeding than women.The period elapsed between the last tonsil infection and the surgical procedure was associated with greater postoperative pain, but not with greater postoperative bleeding. (AU)

Dependent factors in the adult patient and their relationship with post-tonsillectomy bleeding and pain in an outpatient setting.

INTRODUCTION AND OBJECTIVE: Tonsillectomy performed on an outpatient basis in adult patients presents bleeding and pain as main postoperative complications. Following rules such as cold surgical technique, analgesic protocols, preoperative interview, and postoperative follow-up help to better control the process. However, there are patient-dependent factors such as sex, age, indication for tonsillectomy and the time elapsed between the last tonsil infection and surgical intervention that can influence postoperative complications and should be considered. The objective of this work is to evaluate the influence of age, sex, the indication for tonsillectomy and the period elapsed between the last tonsil infection and surgery on bleeding and pain control. METHODS: A prospective, descriptive, and observational study was carried out in 96 adult patients who underwent outpatient surgery under general anaesthesia, using cold surgical technique, evaluating these complications based on age, sex, indication for tonsillectomy and time elapsed after the last tonsillitis. RESULTS: The patients operated on during the 4 weeks after an episode of tonsillitis presented more postoperative pain. No relationship was found between this period and postoperative bleeding. CONCLUSIONS: Male patients had a higher incidence of bleeding than women. The period elapsed between the last tonsil infection and the surgical procedure was associated with greater postoperative pain, but not with greater postoperative bleeding.

Resultados de la laringectomía total en carcinomas localmente avanzados de hipofaringe / Results of total laryngectomy as treatment for locally advanced hypopharyngeal cancer

Introducción y objetivos: La laringectomía total (LT), más eventual radioterapia, ha demostrado ser un tratamiento eficaz en los casos de cáncer de hipofaringe localmente avanzado. El objetivo de este trabajo es analizar los resultados oncológicos de este procedimiento en pacientes con cáncer de hipofaringe T3 y T4. Métodos: Se incluyeron 59 pacientes (33 pacientes con estadio T3 y 26 con estadio T4a) con carcinoma epidermoide primario de hipofaringe tratados mediante LT entre los años 1998 y 2012. Resultados: La edad media fue de 61 años, con predominio de varones (96,6%). Todos los pacientes excepto uno eran fumadores y el 96% consumía alcohol. Se realizó vaciamiento cervical funcional unilateral en 12 pacientes, radical unilateral en 11 pacientes, funcional bilateral en 20 pacientes y funcional más radical en 14. El 66% de los pacientes recibieron radioterapia postoperatoria. Un 81% de los pacientes presentaba metástasis ganglionares y de estos un 56% presentaba invasión extracapsular. Un 29% de los pacientes presentaron recidiva locorregional, un 17% desarrollaron metástasis a distancia y un 25% un segundo tumor primario. La supervivencia específica fue del 46% a los 5 años. Conclusiones: La LT ampliada a faringe (con eventual radioterapia complementaria) ofrece buenos resultados oncológicos en términos de control locorregional de la enfermedad y supervivencia en el cáncer de hipofaringe localmente avanzado, de modo que los protocolos de preservación de órgano deben alcanzar resultados oncológicos similares a los demostrados por la LT (AU)

Introduction and objectives: Total laryngectomy (TL), with eventual postoperative radiotherapy, has proven to be effective in treating cases of locally advanced hypopharyngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with hypopharyngeal cancer classified T3 and T4. Methods: We studied 59 patients (33 T3 and 26 T4a) with primary squamous cell carcinoma of the hypopharynx treated with TL from 1998 to 2012. Results: Mean age was 61 years with a male predominance (96.6%). All the patients were smokers and 96% consumed alcohol. Unilateral selective neck dissection (ND) was performed in 12 patients, unilateral radical ND in 11 patients, bilateral selective ND in 20 patients and radical ND plus selective ND in 14 patients. 66% of the patients received postoperative radiotherapy. Lymph node metastases occurred in 81% of the patients and extranodal invasion in 56% of them. 29% of the patients had loco-regional recurrence, 17% developed distant metastases, and 25% a second primary tumour. The 5-year disease-specific survival was 46%. Conclusions: TL extended to pharynx (with eventual postoperative radiotherapy) offers good oncological results in terms of loco-regional control and survival in locally advanced hypopharyngeal cancer, so organ preservation protocols should achieve similar oncological results to those shown by TL (AU)

Results of total laryngectomy as treatment for locally advanced hypopharyngeal cancer. / Resultados de la laringectomía total en carcinomas localmente avanzados de hipofaringe.

INTRODUCTION AND OBJECTIVES: Total laryngectomy (TL), with eventual postoperative radiotherapy, has proven to be effective in treating cases of locally advanced hypopharyngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with hypopharyngeal cancer classified T3 and T4. METHODS: We studied 59 patients (33 T3 and 26 T4a) with primary squamous cell carcinoma of the hypopharynx treated with TL from 1998 to 2012. RESULTS: Mean age was 61 years with a male predominance (96.6%). All the patients were smokers and 96% consumed alcohol. Unilateral selective neck dissection (ND) was performed in 12 patients, unilateral radical ND in 11 patients, bilateral selective ND in 20 patients and radical ND plus selective ND in 14 patients. 66% of the patients received postoperative radiotherapy. Lymph node metastases occurred in 81% of the patients and extranodal invasion in 56% of them. 29% of the patients had loco-regional recurrence, 17% developed distant metastases, and 25% a second primary tumour. The 5-year disease-specific survival was 46%. CONCLUSIONS: TL extended to pharynx (with eventual postoperative radiotherapy) offers good oncological results in terms of loco-regional control and survival in locally advanced hypopharyngeal cancer, so organ preservation protocols should achieve similar oncological results to those shown by TL.