Pharyngocutaneous Fistula Following Total Laryngectomy: a High-Volume Tertiary Centre Series.

Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding risk factors for fistula development. A standard score for fistula prediction is lacking. Study population included all patients submitted to total laryngectomy (with or without pharyngectomy) due to laryngeal or hypopharyngeal tumours, occurring between January 1st, 2012, and December 31st, 2016. Patient demographics were recorded as well as disease and treatment variables. Statistical analysis was performed using the IBM SPSS Statistics 25®. A previously described predictive model for fistula occurrence was applied. A total of 212 patients were included, the vast majority with advanced local disease (97.5%). Only 10% were submitted to rescue surgery. Fistula incidence was 39.9%. Our rates of locally advanced tumours, with extensive hypopharyngeal involvement, were higher than in most series. Age, tumour location, diabetes, previous chemoradiotherapy, advanced local and regional disease, extensive pharyngectomy, flap reconstruction, manual suture and low post-operative albumin level were associated to fistula occurrence on univariate analysis. Only salvage surgery and advanced local disease remained significant on multivariate analysis. An adapted Cecatto score correlated with fistula occurrence but has not achieved statistical significance. Predictive models for fistula occurrence are lacking. Cecatto score showed promising results in our population but large multicentric studies are necessary for cut-off adjustments.

Comparison Between Clinical and Pathological Staging After Elective Neck Dissection in Head and Neck Cancer.

INTRODUCTION: Head and neck squamous cell carcinomas (HNSCC) are the most common malignancies in the head and neck. Previous studies have shown discrepancies in clinical and pathological staging, with a significant number of head and neck cancer patients who were not correctly staged. This has important implications regarding the treatment and prognosis of these patients. The aim of this study was to analyze potential disagreements in clinical and pathological staging in patients with head and neck cancer who underwent elective neck dissection. METHODS: A retrospective study of patients with squamous cell carcinoma of the head and neck, who underwent elective neck dissection, between January 2018 and December 2020. RESULTS: We analyzed 87 patients, with an average age of 64 ± 10.05 years, of whom 96.6% were male. The primary tumor location was the glottis (31%), oropharynx (26.4%), hypopharynx (19.5%), supraglottis (11.5%), and oral cavity (11.5%). In 87.3% there was a history of smoking and/or drinking. Pathological N (pN) staging was higher than clinical staging in 34.3% of patients (N1 in 22.9%; N2 in 8%; N3 in 3.4%). There were no significant differences between the number of nodes removed and the pN staging. However, there was a significant survival difference in patients with>15 nodes removed (p=0.05). There was also a significant difference in patients with pN up-staging regarding survival (p=0.005). Pathological T staging was different from clinical T staging (p<0.05), with an up-staging in 18.4% of the patients and a down-staging in 14.9%, without significant differences regarding survival or recurrence (p>0.05). Adjuvant treatment with radiotherapy was performed in 41.4% and with chemo-radiotherapy in 13.8% of the patients. Locoregional recurrence occurred in 17.5%. CONCLUSION: This study revealed that clinical and pathological N staging after elective neck dissection disagreed in a substantial number of patients, with pathological upstaging and significant differences regarding survival. With relation to T staging, there were no significant differences regarding survival. We should be aware of staging disagreements since they can have significant implications on the treatment and prognosis of cancer patients.

Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy.

Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding which patients are at higher risk for fistula development. This article comprised a literature review about risk factors for fistula development. All articles published on an on-line database (PUBMED™) using MESH terms "larynx cancer" and "fistula" in a 5-year period (January 1st, 2014 to January 27th, 2019) were included. Further articles were selected due to expert suggestion by one of the senior surgeons. Only articles written in Portuguese or English were included. Animal studies were excluded. 151 articles were selected and abstracts analysed. 82 articles were selected for full text revision. 32 were later excluded because they described single clinical cases, experimental surgical technics, irrelevant data or poor methodology. Final selection comprised 50 studies: 9 systematic reviews, one non-systematic review, 34 unicentric and 4 multicentric retrospective analysis and two prospective studies. There is no consensus regarding risk factors for fistula development. Patients submitted to salvage surgery for advanced disease seem to be at greater risk. Bad nutritional status is a logical contributor, but the ideal surrogate marker is still missing. Several variables are inconsistently pointed as risk factors and should be abandoned unless proved otherwise. There are no standard scores for fistula occurrence despite being a common complication following surgery.

Sinonasal adenocarcinomas: Retrospective analysis from an oncology center.

INTRODUCTION AND OBJECTIVES: Sinonasal adenocarcinomas are rare and heterogeneous tumors and for this reason remain understudied. Our purpose is to analyze clinical presentation, outcomes and factors affecting survival of patients with sinonasal adenocarcinomas, treated at our institution. MATERIAL AND METHODS: Retrospective review of clinical records of patients with sinonasal adenocarcinoma, treated at a tertiary oncology institution (January 2010 to December 2019). RESULTS: Sixty patients diagnosed with adenocarcinoma were included, with male preponderance (54.90%) and a mean age of 57.5±14.9 years. Adenocarcinoma was the most frequent type of sinonasal cancer, contrary to previous reports from our institution. In most patients, it was detected at an advanced disease stage, significantly decreasing their survival rate when compared to patients diagnosed at initial stages (p<0.029). Intestinal type adenocarcinoma was established in 47 patients, the most frequent being the colonic subtype (24%). Tumors with good/moderate histologic differentiation presented a survival advantage over those that were poorly differentiated (p=0.043). The most common treatment modality was surgery followed by radiotherapy. Endoscopic resection was performed in 53% of the patients and an external approach was used in 40% of the patients. Estimated overall survival rates at 3 and 5-years were 64% and 53%, respectively, and cancer specific survival 72% and 65%, for the same period. Recurrence rate was 32% and occurred mainly locally. Disease Free Survival rate was 71% at 3 years and 65% at 5 years. CONCLUSIONS: Despite being the most common sinonasal malignancy in our sample, in contrast to other series, sinonasal adenocarcinomas are still rare tumors with a substantial local failure rate of around 30%. Advanced stage at diagnosis and histologic differentiation grade negatively affected prognosis of these tumors.

Nasopharyngeal carcinoma in a non-endemic country-Validation of the new NPC staging system.

BACKGROUND: Nasopharyngeal carcinoma (NPC) staging has recently been updated, with the eighth edition of the AJCC/UICC. In the last ten years, Intensity Modulated Radiotherapy (IMRT) has become a standard treatment for NPC. The authors aim to assess the benefits of the new AJCC staging system in predicting prognosis, as well as the improvement in survival outcomes in the IMRT era, in non-edemic population. METHODS: Retrospective study selecting patients treated for NPC between January 2009 and December 2019 in a cancer treatment center in Portugal. Initial TNM staging (according to the seventh edition of the AJCC/UICC) was collected and each patient was restaged according to the new TNM staging system. Overall survival (OS) and Distant Metastasis Free Survival (DMFS) stratified by T and N classification and stage (according to the both TNM staging systems) were analyzed. Univariate and multivariate analysis was performed to evaluate which factors influence OS and DMFS. Data in this series was compared with a previous report from the same institution, before IMRT standard use. RESULTS: 113 patients were included, averaging 53.74 (±1.4) years old. With the new TNM staging, 5 patients were downstaged and 3 patients were upstaged. Over a median follow-up time of 41 months, the 5-year OS and DMFS were 77% and 79.8%, respectively. Neither the seventh nor the eighth editions of the AJCC/UICC staging system had good overall discrimination between each T classification OS and DMFS curves. Both the seventh and the eighth editions of the AJCC/UICC staging system had statistically significant overall discrimination between each N group and each stage group classification OS curves. Only N classification predicted OS in multivariate analysis. When comparing to a previous report from the same institution, OS has not improved majorly, especially in locoregionally advanced disease. CONCLUSIONS: TNM staging still presents limitations in adequately predicting OS and DMFS.

Sinonasal adenocarcinomas: Retrospective analysis from an oncology center

Introduction and objectives: Sinonasal adenocarcinomas are rare and heterogeneous tumors and for this reason remain understudied. Our purpose is to analyze clinical presentation, outcomes and factors affecting survival of patients with sinonasal adenocarcinomas, treated at our institution.Material and methodsRetrospective review of clinical records of patients with sinonasal adenocarcinoma, treated at a tertiary oncology institution (January 2010 to December 2019).ResultsSixty patients diagnosed with adenocarcinoma were included, with male preponderance (54.90%) and a mean age of 57.5±14.9 years. Adenocarcinoma was the most frequent type of sinonasal cancer, contrary to previous reports from our institution. In most patients, it was detected at an advanced disease stage, significantly decreasing their survival rate when compared to patients diagnosed at initial stages (p<0.029). Intestinal type adenocarcinoma was established in 47 patients, the most frequent being the colonic subtype (24%). Tumors with good/moderate histologic differentiation presented a survival advantage over those that were poorly differentiated (p=0.043). The most common treatment modality was surgery followed by radiotherapy. Endoscopic resection was performed in 53% of the patients and an external approach was used in 40% of the patients. Estimated overall survival rates at 3 and 5-years were 64% and 53%, respectively, and cancer specific survival 72% and 65%, for the same period. Recurrence rate was 32% and occurred mainly locally. Disease Free Survival rate was 71% at 3 years and 65% at 5 years.ConclusionsDespite being the most common sinonasal malignancy in our sample, in contrast to other series, sinonasal adenocarcinomas are still rare tumors with a substantial local failure rate of around 30%. Advanced stage at diagnosis and histologic differentiation grade negatively affected prognosis of these tumors. (AU)

Introducción y objetivos: Los adenocarcinomas sinonasales son tumores raros y heterogéneos y, por esta razón, son poco estudiados. Nuestro objetivo es analizar la presentación clínica, los resultados y los factores que afectan la supervivencia de los pacientes con adenocarcinoma sinonasal tratados en nuestra institución.Material y métodosRevisión retrospectiva de las historias clínicas de los pacientes con adenocarcinoma sinonasal tratados en una institución oncológica terciaria (enero de 2010 a diciembre de 2019).ResultadosSe incluyeron 60 pacientes diagnosticados de adenocarcinoma, con predominio masculino (54,90%) y una edad media de 57,5±14,9años. El adenocarcinoma fue el tipo de tumor sinonasal más frecuente, a diferencia de los informes previos de nuestra institución. En la mayoría de los pacientes se ha diagnosticado en un estadio avanzado de la enfermedad, lo que disminuyó significativamente su tasa de supervivencia en comparación con los pacientes diagnosticados en estadios iniciales (p<0,029). El adenocarcinoma de tipo intestinal se estableció en 47 pacientes, siendo el subtipo colónico el más frecuente (24%). Los tumores con diferenciación histológica buena/moderada presentaron más probabilidad de supervivencia sobre los mal diferenciados (p=0,043). La modalidad de tratamiento más frecuente fue la cirugía, seguida de la radioterapia. La resección endoscópica se realizó en el 53% de los pacientes y el abordaje externo se llevó a cabo en el 40%. Las tasas de supervivencia global estimadas a los 3 y a los 5 años fueron del 64% y del 53%, respectivamente, y la supervivencia específica del cáncer, del 72% y del 65%, para el mismo periodo. La tasa de recurrencia fue del 32% y ha ocurrido principalmente a nivel local. La tasa de supervivencia libre de enfermedad fue del 71% a los 3años y del 65% a los 5 años. (AU)

Nasopharyngeal carcinoma in a non-endemic country—Validation of the new NPC staging system

Background: Nasopharyngeal carcinoma (NPC) staging has recently been updated, with the eighth edition of the AJCC/UICC. In the last ten years, Intensity Modulated Radiotherapy (IMRT) has become a standard treatment for NPC. The authors aim to assess the benefits of the new AJCC staging system in predicting prognosis, as well as the improvement in survival outcomes in the IMRT era, in non-edemic population.MethodsRetrospective study selecting patients treated for NPC between January 2009 and December 2019 in a cancer treatment center in Portugal. Initial TNM staging (according to the seventh edition of the AJCC/UICC) was collected and each patient was restaged according to the new TNM staging system. Overall survival (OS) and Distant Metastasis Free Survival (DMFS) stratified by T and N classification and stage (according to the both TNM staging systems) were analyzed. Univariate and multivariate analysis was performed to evaluate which factors influence OS and DMFS. Data in this series was compared with a previous report from the same institution, before IMRT standard use.Results113 patients were included, averaging 53.74 (±1.4) years old. With the new TNM staging, 5 patients were downstaged and 3 patients were upstaged. Over a median follow-up time of 41 months, the 5-year OS and DMFS were 77% and 79.8%, respectively. Neither the seventh nor the eighth editions of the AJCC/UICC staging system had good overall discrimination between each T classification OS and DMFS curves. Both the seventh and the eighth editions of the AJCC/UICC staging system had statistically significant overall discrimination between each N group and each stage group classification OS curves. Only N classification predicted OS in multivariate analysis. When comparing to a previous report from the same institution, OS has not improved majorly, especially in locoregionally advanced disease.ConclusionsTNM staging still presents limitations in adequately predicting OS and DMFS. (AU)

Antecedentes: La estadificación del carcinoma nasofaríngeo (NPC, por sus siglas en inglés) se ha actualizado recientemente, con la octava edición del AJCC/UICC. En los últimos 10 años, la radioterapia de intensidad modulada (IMRT, por sus siglas en inglés) se ha convertido en un tratamiento estándar para la NPC. Los autores pretenden evaluar los beneficios del nuevo sistema de estadificación del AJCC en la predicción del pronóstico, así como la mejora en los resultados de supervivencia en la era de la IMRT, en una población non endémica.MétodosEstudio retrospectivo de selección de pacientes tratados por NPC entre enero de 2009 y diciembre de 2019 en un centro de tratamiento del cáncer en Portugal. Se recopiló la estadificación TNM inicial (según la séptima edición del AJCC/UICC) y se reestadificó cada paciente de acuerdo con el nuevo sistema de estadificación TNM. Se analizaron la supervivencia global (SG) y la supervivencia libre de metástasis a distancia (SLMD) estratificadas por clasificación T y N y estadio (según ambos sistemas de estadificación TNM). Se realizó un análisis univariante y multivariante para evaluar qué factores influyen en la SG y la SLMD. Los datos de esta serie se compararon con un informe anterior de la misma institución, antes del uso estándar de la IMRT.ResultadosSe incluyeron 113 pacientes, con una edad promedio de 53,74 (±1,4) años. Con la nueva estadificación TNM, 5 pacientes aumentaron estadio y 3 pacientes disminuyeron estadio. Durante una mediana de tiempo de seguimiento de 41 meses, la SG y la SLMD a 5 años fueron del 77 y del 79,8%, respectivamente. (AU)

Elective Revision Surgery in Head and Neck Cancer Patients: A Retrospective Analysis at an Oncology Centre in Porto, Portugal.

Introduction Elective revision surgery in head and neck cancer is crucial for refining and optimizing outcomes, ensuring complete tumor removal, and enhancing both functional and aesthetic aspects, ultimately improving the overall quality of life for patients. The aim of this study is to analyze the overall survival (OS) of head and neck cancer patients who underwent elective revision surgery with or without adjuvant treatment between 2019 and 2022, reflecting on the practice between those years in IPO-Porto, Porto, Portugal. Methods This study included 58 patients who underwent 116 major neck surgeries. Multidisciplinary head and neck follow-up records were obtained for every patient. Overall survival and disease-specific survival (DSS) curves were calculated using the Kaplan-Meier method, and statistical significance was determined by the Log-Rank test. We did a retrospective study with an anterograde direction, evaluating the treatments that were previously done by the patients. Results The sample comprised 51 males (87.9%) and seven females (12.1%), with a mean age of 59.02±11.014 years. Head and neck pathology was mostly in the larynx (36.2%). The type of the first surgery was mainly directed to the primary tumor in 62.1% (n=36). In the other 37.9% (n=22), surgery was directed to the primary tumor in association with neck dissection. The type of the second surgery was mainly revision surgery. We found that T4 tumors (HR (hazard ratio) = 10.219, p = 0.006) and hypopharynx tumors (HR = 5.306, p =0.035) were significantly associated with inferior OS. Conclusion In our sample, we found that a T4 and a tumor located in the hypopharynx were significantly associated with inferior OS in elective head and neck oncologic revision surgery. Disease-free survival in patients undergoing revision surgery in our sample is generally poor. In our sample, there was a statistically significant difference in overall survival between the group who underwent surgery for microscopic evidence of persistent tumor (R1) versus clinical and imagiological tumoral persistency. In our sample, the time between the first and second surgeries wasn't linked with an inferior OS. Further studies with larger populations and prospective design, with longer follow-ups can be the road to a better understanding of this issue.

Traumatic Isolated Thumb Carpometacarpal Joint Dislocation - Report of Two Clinical Cases.

Isolated thumb carpometacarpal joint dislocation is a rare lesion that accounts for less than 1% of all hand lesions. The authors present two cases of traumatic isolated thumb carpometacarpal joint dislocation. One of them was treated with closed reduction and cast immobilization, and the other was treated with closed reduction, Kirschner-wires pinning, and cast immobilization. The first patient had a good functional outcome and showed no signs of thumb carpometacarpal instability. The patient treated with Kirschner wires presented signs of clinical instability and radiological subluxation. Isolated thumb carpometacarpal dislocation is a rare lesion that can cause joint instability, which interferes with the normal function of the hand and can lead to articular degenerative changes. The best management of this lesion is still controversial, since there is lack of evidence in the literature showing superiority of one treatment over the other.

Psychometric validity of the Portuguese version of SWAL-QOL for head and neck cancer / Validez psicométrica de la versión portuguesa de SWAL-QOL en el cáncer de cabeza y cuello

Introduction and aim: In Portugal there are no instruments that measure the impact of dysphagia on the quality of life. The aim of this study was the assessment of the psychometric properties of the Portuguese version of SWAL-QOL, in a head and neck cancer population. Materials and methods: It was a case–control study, with a consecutive sample of 300 subjects that was divided into 3 groups (2 controls and 1 case). We performed principal components analysis, assessed reliability and clinical validity. For concurrent validity of the Portuguese version of SWAL-QOL, the Functional Scale of Oral Intake (FOIS) and the Performance Status Scale (PSS) for patients with head and neck cancer were used. Results: The sample was predominantly male (66%) with a mean age of 57 years. Regarding the patients with head and neck cancer, 22% were in stage IIIA, and 43% had lesions on the larynx. As to the treatment provided, 33% underwent surgery and radiotherapy, and 80% of cases had oral feeding. The psychometric validity of SWAL-QOL was established, with good results for internal consistency (from .665 to .952), reproducibility (from .628 to .877) and construct validity. SWAL-QOL also showed good correlation with the clinical variable dysphagics vs. non-dysphagics. There were no statistical significant differences for the consistency of food and fluids, and oral vs. non-oral nutrition. Conclusions: The validation of SWAL-QOL for the Portuguese language revealed that this instrument is psychometrically valid and appropriate for use with dysphagic patients with head and neck cancer.(AU)

Introducción y objetivo: En Portugal no existen instrumentos que midan el impacto de la disfagia en la calidad de vida. El objetivo de este estudio fue evaluar las propiedades psicométricas de la versión portuguesa de SWAL-QOL, en una población de pacientes de cáncer de cabeza y cuello. Materiales y métodos: Estudio de control de casos, con una muestra consecutiva de 300 sujetos, que se dividió en 3 grupos (2 grupos control y un caso). Realizamos un análisis de los componentes principales, y evaluamos la fiabilidad y la validez clínica. Para la validez concurrente de la versión portuguesa de SWAL-QOL, utilizamos la Functional Scale of Oral Intake (FOIS) y la Performance Status Scale (PSS) para los pacientes de cáncer de cabeza y cuello. Resultados: La muestra se compuso fundamentalmente de varones (66%), con una edad media de 57 años. Con relación a los pacientes de cáncer de cabeza y cuello, el 22% estaba en estadio IIIA y el 43% tenía lesiones en la laringe. En cuanto a la terapia suministrada, el 33% recibió cirugía y radioterapia y el 80% de los casos recibió alimentación oral. Se estableció la validez psicométrica de SWAL-QOL, con buenos resultados para consistencia interna (de 0,665 a 0,592), reproducibilidad (de 0,628 a 0,877), y validez del constructo. SWAL-QOL reflejó también una buena correlación con la variable clínica disfágicos vs no disfágicos. No se produjeron diferencias estadísticamente significativas para la consistencia de alimentos y líquidos y nutrición oral vs no oral. Conclusiones: La validación de SWAL-QOL para el idioma portugués reveló que se trata de un instrumento psicométricamente válido para uso con pacientes disfágicos de cáncer de cabeza y cuello.(AU)

"Bone-shot fracture" - An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report.

CASE: A young adult male sustained a high-energy crash suffering multiple injuries including a comminuted right femoral shaft fracture and an ipsilateral iliac wing fracture. The iliac fracture was caused by a femoral fragment which was projected and pierced the iliac wing. The patient underwent surgery with retrieval of the femoral fragment and fixation of the iliac and femoral fractures. The lesions healed uneventfully. CONCLUSION: This is the first reported case of an iliac fracture caused by a projectile of autologous bone. High-energy trauma may present unusual or never seen injury patterns to the trauma surgeon.

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Abstract Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen's Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen' Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3-4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Is Increased Time From Diagnosis to Treatment in Advanced Hypopharynx Cancer Associated With Poorer Outcomes: A Single-Centre Analysis.

OBJECTIVE: To assess the potential influence of increased time from diagnosis to treatment on survival outcomes in patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HSCC). METHODS: Retrospective study of patients with a primary diagnosis of HSCC proposed for primary surgical treatment. RESULTS: The study population included a total of 121 Caucasian patients (121 males) with HSCC. Mean age at diagnosis was 60.4 years (range: 43-83 years). All patients had cT3 or cT4 hypopharyngeal tumors. The sample presented a 5-year overall survival (OS) of 59.6% and a disease-specific survival of 74.9%. Considering univariable analysis (unadjusted), duration of adjuvant treatment (T5), pN, margins, and extracapsular spread (ECS) are factors associated with poorer survival outcomes. An increase in T5 was associated with lower OS. Results revealed that T5 higher than 43 days, pN1, pN2, pN3, no free margins, and presence of ECS were associated with lower OS. These patients have 7.465 higher hazard of death. CONCLUSION: This study suggests that duration of adjuvant therapy may be more important than other timing metrics from diagnosis to treatment. For locoregionally advanced HSCC, duration of adjuvant therapy after primary surgery higher than 6 weeks is an important feature for worse survival outcome. Preventing strategies in order to avoid radiotherapy or chemoradiotherapy breaks should be developed and optimized.

Optimizing classical risk scores to predict complications in head and neck surgery: a new approach.

PURPOSE: To validate tools to identify patients at risk for perioperative complications to implement prehabilitation programmes in head and neck surgery (H&N). METHODS: Retrospective cohort including 128 patients submitted to H&N, with postoperative Intermediate Care Unit admittance. The accuracy of the risk calculators ASA, P-POSSUM, ACS-NSQIP and ARISCAT to predict postoperative complications and mortality was assessed. A multivariable analysis was subsequently performed to create a new risk prediction model for serious postoperative complications in our institution. RESULTS: Our 30-day morbidity and mortality were 45.3% and 0.8%, respectively. The ACS-NSQIP failed to predict complications and had an acceptable discrimination ability for predicting death. The discrimination ability of ARISCAT for predicting respiratory complications was acceptable. ASA and P-POSSUM were poor predictors for mortality and morbidity. Our new prediction model included ACS-NSQIP and ARISCAT (area under the curve 0.750, 95% confidence intervals: 0.63-0.87). CONCLUSION: Despite the insufficient value of these risk calculators when analysed individually, we designed a risk tool combining them which better predicts the risk of serious complications.

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis / Complicaciones infecciosas en cirugía de cabeza y cuello: análisis retrospectivo del Instituto de Oncología de Porto

Objective: To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries. Methods: A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate. Results: In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization. Conclusion: The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial

Objetivo: Analizar el impacto de las complicaciones infecciosas en el período posoperatorio de las cirugías oncológicas mayores de cabeza y cuello, y estudio de los agentes microbianos implicados. Métodos: Estudio retrospectivo realizado en un instituto oncológico, en pacientes que desarrollaron complicaciones infecciosas después de la cirugía oncológica mayor de cuello, entre octubre de 2012 y mayo de 2016 (44 meses). Entre otros se recogieron el estadio TNM, la puntuación ASA, el índice de masa corporal, las comorbilidades, los hábitos tóxicos, los niveles de hemoglobina pre y postoperatoria, los niveles séricos de albúmina, los tratamientos previos a la cirugía, la duración de la hospitalización y los microorganismos aislados, así como las complicaciones sufridas y la tasa de mortalidad. Resultados: En este período se realizaron 761 cirugías cervicales mayores. De estas, 96 pacientes presentaron complicaciones (12,6%). Las que con mayor frecuencia se registraron fueron la fístula faringocutánea (FFC) (56%) y la neumonía nosocomial (23%). Fueron aislados 26 tipos de microorganismos, siendo la Pseudomonas aeruginosa la más frecuente (15%). Se registraron 12 fallecimientos. Tras el estudio estadístico con regresión lineal múltiple, se detecta que la necrosis cutánea o del colgajo y la FFC fueron las complicaciones con un mayor impacto estadístico en la estancia hospitalaria. Asimismo, fueron los factores que más influyeron en las hospitalizaciones de 30 días o más. Conclusión: Una buena evolución durante el período postoperatorio es fundamental para obtener éxito en el tratamiento de los pacientes oncológicos de cabeza y cuello. La FFC y la necrosis de colgajo o cutánea constituyeron las principales complicaciones con un mayor impacto en los resultados obtenidos. La detección precoz de estas complicaciones, así como su tratamiento, son cruciales

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis.

OBJECTIVE: To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries. METHODS: A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate. RESULTS: In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization. CONCLUSION: The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

Exploring sialyl-Tn expression in microfluidic-isolated circulating tumour cells: A novel biomarker and an analytical tool for precision oncology applications.

Circulating tumour cells (CTCs) originating from a primary tumour, lymph nodes and distant metastases hold great potential for liquid biopsies by providing a molecular fingerprint for disease dissemination and its temporal evolution through the course of disease management. CTC enumeration, classically defined on the basis of surface expression of Epithelial Cell Adhesion Molecule (EpCAM) and absence of the pan-leukocyte marker CD45, has been shown to correlate with clinical outcome. However, existing approaches introduce bias into the subsets of captured CTCs, which may exclude biologically and clinically relevant subpopulations. Here we explore the overexpression of the membrane protein O-glycan sialyl-Tn (STn) antigen in advanced bladder and colorectal tumours, but not in blood cells, to propose a novel CTC isolation technology. Using a size-based microfluidic device, we show that the majority (>90%) of CTCs isolated from the blood of patients with metastatic bladder and colorectal cancers express the STn antigen, supporting a link with metastasis. STn+ CTC counts were significantly higher than EpCAM-based detection in colorectal cancer, providing a more efficient cell-surface biomarker for CTC isolation. Exploring this concept, we constructed a glycan affinity-based microfluidic device for selective isolation of STn+ CTCs and propose an enzyme-based strategy for the recovery of viable cancer cells for downstream investigations. Finally, clinically relevant cancer biomarkers (transcripts and mutations) in bladder and colorectal tumours, were identified in cells isolated by microfluidics, confirming their malignant origin and highlighting the potential of this technology in the context of precision oncology.