RESUMO
BACKGROUND: Sinonasal mucosal melanoma is an aggressive malignancy with a 5-year survival rate ranging from 20% to 39%. Despite the evolving surgical and radiotherapy techniques, and introduction of immune-checkpoint inhibitor therapy, overall survival rates remain poor. METHODOLOGY: A retrospective cohort study was conducted at the Hospital Clinic de Barcelona and the Hospital de la Santa Creu i Sant Pau between 1984 and 2020; primary outcome measures were 3 and 5-year melanoma-specific survival (MSS). Kaplan-Meier survival analysis and Cox proportional hazards model were performed to identify predictors of survival. RESULTS: Fifty patients were included, the mean age was 70.4, MSS at 3 and 5 years was 51.2%, and 29.5%, respectively. The median follow-up was 39.6 months during which 46% presented locoregional recurrence and 36%, metastasis. The univariate and multivariate analyses found as survival predictors the N category, the treatment received, the surgical margins and the mitotic index. CONCLUSIONS: We found an overall 5-year MSS of 29.5%. Those patients with intention-to-cure (stages III and IVa) treated by surgery that were N0 at diagnosis, with < 10 mitoses per HPF showed a 5-year MSS rate of 74.1%. More studies will be needed to adequately define the patients' profiles that will benefit from a better survival outcome.
Assuntos
Melanoma , Neoplasias dos Seios Paranasais , Idoso , Intervalo Livre de Doença , Humanos , Inibidores de Checkpoint Imunológico , Melanoma/cirurgia , Recidiva Local de Neoplasia/patologia , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Sociedades Médicas , Traqueostomia/normas , Anestesiologia , Broncoscopia/efeitos adversos , Broncoscopia/normas , COVID-19 , Contraindicações de Procedimentos , Unidades de Cuidados Coronarianos , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Humanos , Unidades de Terapia Intensiva , Otolaringologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Pandemias , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Respiração Artificial/normas , Ressuscitação , SARS-CoV-2 , Espanha/epidemiologia , Fatores de Tempo , Traqueostomia/efeitos adversos , Traqueostomia/métodosRESUMO
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
