Comparison of Patients With Total and Salvage Laryngectomy.

INTRODUCTION AND OBJECTIVES: Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival. METHODS: The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death. RESULTS: The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P = .000) and between fistula and infection (P = .000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P = .038), T4 (P = .026), lymphovascular invasion (P = .019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P = .005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P = .026). CONCLUSIONS: Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.

Comparación de pacientes con laringectomía total primaria y de rescate / Comparison of patients with total and salvage laryngectomy

Introducción y objetivos: La laringectomía total (LT) es uno de los tratamientos disponibles en los carcinomas de laringe localmente avanzados o como rescate ante el fracaso de la preservación de órgano, logrando altas tasas de supervivencia y escasas complicaciones. El objetivo de nuestro trabajo es analizar los resultados oncológicos obtenidos, comparándolos con la literatura actual y analizando sus complicaciones y supervivencia.MétodosSe incluyeron 62 pacientes con carcinoma primario de laringe tratados mediante LT primaria o de rescate entre los años 2003 y 2019. Analizamos las características demográficas, clínicas y anatomopatológicas, el estadio tumoral, los tratamientos complementarios, las complicaciones postoperatorias, las recidivas locorregionales, las metástasis y las causas de muerte.ResultadosLos pacientes tenían una edad media de 64 años, el 90,3% eran hombres, el 96,8% eran fumadores y el 43,5% tenían pluripatología. El 82,3% tenían un estadio localmente avanzado. Al 71% se les realizó LT primarias y al 29% de rescate. Al 59,6% se les practicó vaciamiento cervical asociado. El 30,6% tenían invasión linfovascular, el 30,6% invasión perineural y el 14,5% afectación de márgenes. Durante el seguimiento, el 17,7% presentaron una recidiva locorregional y el 11,3% metástasis a distancia. En cuanto a tratamientos complementarios, el 56,4% de los pacientes recibieron tratamiento adyuvante. La incidencia de hemorragia fue del 11,3%, la de infección del 14,5% y la de fístula faringocutánea del 21%. Hubo significación estadística entre la fístula y la hemorragia (p=0,000) y entre la fístula y la infección (p=0,000). No se encontraron diferencias estadísticamente significativas entre los factores estudiados de la LT primaria y de rescate.(AU)

Introduction and objectives: Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival.MethodsThe study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death.ResultsThe mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P=.000) and between fistula and infection (P=.000). No statistically significant differences were found between the studied factors of primary and salvage TL. (AU)

Comparison of patients with total and salvage laryngectomy. / Comparación de pacientes con laringectomía total primaria y de rescate.

INTRODUCTION AND OBJECTIVES: Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival. METHODS: The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death. RESULTS: The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P=.000) and between fistula and infection (P=.000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P=.038), T4 (P=.026), lymphovascular invasion (P=.019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P=.005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P=.026). CONCLUSIONS: Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.

Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología / Transoral oropharyngeal resection classification: Proposal of the SCORL working group

Introducción y objetivos: La cirugía mínimamente invasiva ha presentado una expansión muy importante en la última década. Con el objetivo de aportar un lenguaje común tras cirugía transoral de la orofaringe, se ha creado un sistema de clasificación de las resecciones en esta zona, independientemente de la instrumentalización utilizada. Métodos: Desde el Grupo de Trabajo en Oncología de la Sociedad Catalana de Otorrinolaringología, se presenta una propuesta de clasificación basada en una división topográfica de las diferentes zonas de la orofaringe, así como en la afectación de las estructuras anexas según las vías anatómicas de extensión de estos tumores. Resultados: La clasificación se inicia utilizando la letra D o I según la lateralidad sea derecha (D) o izquierda (I). A continuación se coloca el número del área resecada. Esta numeración define las zonas iniciando a nivel craneal donde el área I sería el paladar blando, el área II lateral en la zona amigdalina, el área III en la base de lengua, el área IV en los repliegues glosoepiglóticos, la epiglotis y repliegues faringoepiglóticos, el área V pared orofaríngea posterior y VI el trígono retromolar. Se añade el sufijo p si la resección afecta profundamente al plano submucoso de la zona comprometida. Las diferentes áreas propuestas tendrían, de una forma teórica, diferentes implicaciones funcionales. Conclusiones: Propuesta de sistema de clasificación por áreas que permite definir diferentes tipos de cirugía transoral de la orofaringe así como compartir los resultados y ayudar en la docencia de este tipo de técnicas (AU)

Introduction and goals: There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. Methods: From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. Results: The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. Conclusions: Proposal for a system of classification by area to define different types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique (AU)

Transoral oropharyngeal resection classification: Proposal of the SCORL working group. / Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología.

INTRODUCTION AND GOALS: There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. METHODS: From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. RESULTS: The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. CONCLUSIONS: Proposal for a system of classification by area to definedifferent types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique.

[The silent sinus syndrome]. / Síndrome del seno silente.

The silent sinus syndrome is a very infrequent pathology. It is described as an enophthalmos secondary to collapse and opacification of maxillary sinus without presenting sinus or nasal symptoms. Osteomeatal complex obstruction is the triggering physiopathologic factor. The clinical symptoms and imaging findings lead to the diagnosis. The treatment consists in restoring sinus ventilation and, if necessary, correcting the orbital floor. We report a case of a woman who was diagnosed and treated because of this entity in our hospital.

Síndrome del seno silente / The silent sinus syndrome

El síndrome del seno silente es una afección muy poco frecuente. Se describe como un enoftalmos unilateral secundario a colapso y opacificación del seno maxilar sin síntomas nasosinusales. La obstrucción del complejo osteomeatal es el factor fisiopatológico desencadenante. El diagnóstico se basa en los hallazgos clínicos y radiológicos. El tratamiento irá dirigido a restablecer la ventilación del seno y, si es necesario, corregir el suelo orbitario. Presentamos el caso de una mujer diagnosticada y tratada en nuestro hospital por esta entidad

The silent sinus syndrome is a very infrequent pathology. It is described as an enophthalmos secondary to collapse and opacification of maxillary sinus without presenting sinus or nasal symptoms. Osteomeatal complex obstruction is the triggering physiopathologic factor. The clinical symptoms and imaging findings lead to the diagnosis. The treatment consists in restoring sinus ventilation and, if necessary, correcting the orbital floor. We report a case of a woman who was diagnosed and treated because of this entity in our hospital

Variante desmoplástica de ameloblastoma de seno maxilar. Diagnóstico diferencial con el carcinoma escamoso / Desmoplastic ameloblastoma of the maxillary sinus. Differential diagnosis with squamous cell carcinoma

El ameloblastoma es una tumoración benigna con características invasivas. Representa un 1% de los tumores maxilares. La variante desmoplástica es muy poco frecuente y su diagnóstico puede ser difícil por la posibilidad de diferenciación escamosa de su componente epitelial. Se debe tener en cuenta en el diagnóstico diferencial de las tumoraciones del seno maxilar. Se presenta el caso clínico de un paciente varón de 43años de edad que acudió a nuestras consultas por presentar una tumoración de seno maxilar izquierdo, con biopsia positiva para carcinoma escamoso (T4 N0 M0).Se inicia tratamiento con quimioterapia y radioterapia seguido de exéresis radical de la lesión restante. El estudio anatomopatológico de la pieza fue informado como ameloblastoma desmoplástico

Ameloblastoma is a benign but locally invasive tumor. It accounts for 1% of maxillary tumors. Desmoplastic typeis relatively uncommon and its diagnosis can appear difficult because of the possibility of squamous differentiation of the epithelial component. It must be considered in the differential diagnosis of maxillary sinus tumors. We report a 43 years old man that arrived to our office presenting a left maxillary sinus tumor with squamous cell carcinoma positive biopsy (T4, N0, M0). The patientwas initially treated with chemotherapy and radiotherapy, followed by radical surgical resection. The diagnosis after hystologic study was desmoplastic ameloblastoma