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1.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563684

RESUMO

Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal disease, they present a unique opportunity to maximise tissue preservation in order to optimise both recovery and long-term functional outcomes. We present a case of laryngeal clear cell chondrosarcoma causing critical airway obstruction. An emergency tracheostomy was performed and mapping biopsies were taken. The tumour originated from the cricoid and extended into both arytenoid superstructures precluding cricotracheal resection. A modified narrow-field laryngectomy was performed, preserving all pharyngeal mucosa and neurovascularly intact infrahyoids. Organ preservation surgery is preferred in the management of laryngeal chondrosarcoma. If laryngectomy is required, the surgeon must ensure that all uninvolved, functional tissue is preserved carefully to improve swallow and voice outcomes postoperatively. We describe a novel technique used to achieve this outcome.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Condrossarcoma/complicações , Condrossarcoma/cirurgia , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/cirurgia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/cirurgia , Biópsia , Condrossarcoma/diagnóstico por imagem , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/cirurgia , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Laringectomia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Traqueostomia
2.
Mymensingh Med J ; 30(1): 171-175, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397870

RESUMO

To establish the frequency, risk factors and its relation with the outcome of the management of Pharyngocutaneous fistula (PCF) was aimed. This is an observational, cross-sectional study which was conducted in the Department of Otolaryngology and Head-Neck surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh since 2006-2018. Duration of this study was 13 years (2006-2018). Total number of patients was 252. Total PCF developed in 49 participants. PCF developed more in irradiated patients with multiple co-morbidities. Number of PCF healed spontaneously was 40. There were 9 PCF which required surgical interventions and among them 3 recurred. High incidence of pharyngocutaneous fistula mostly due to advanced stage of disease, positive margin, various levels of surgical expertise and post irradiated patients with multiple co-morbidities.


Assuntos
Neoplasias Laríngeas , Laringectomia , Bangladesh/epidemiologia , Estudos Transversais , Humanos , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos
6.
Codas ; 32(6): e20190006, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33237186

RESUMO

PURPOSE: This study aims to measure the pressure of the pharynx and the pharyngoesophageal segment (PES) at rest and during phonation in total laryngectomized patients, with different levels of voice production. METHODS: four total laryngectomized individuals participated in the study, All patients underwent High Resolution Manometry (MAR) at rest and during phonation. After this process, a descriptive analysis of the results was performed. RESULTS: we observed that during rest the patients had PES pressure below normal and this data may be related to changes in the muscular connections at the level of the upper esophageal sphincter (UES) especially the interruption of the cricopharyngeal plexus. During phonation, two patients presented higher UES pressure values during phonation, when compared to the values found at rest, suggesting that introduction of air into the esophagus is followed by pharyngoesophageal contraction and that during phonation the patients with good esophageal speech may develop more pressure in this region. CONCLUSION: Studies with a greater number of participants may help define, for example, subjects who may benefit from procedures such as cricopharyngeal myotomy or other medical conduct in order to facilitate the acquisition of esophageal voice in these patients.


Assuntos
Laringectomia , Voz Esofágica , Esôfago/cirurgia , Humanos , Manometria , Faringe , Fonação
7.
Otolaryngol Clin North Am ; 53(6): 1159-1170, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33039099
8.
Braz. j. otorhinolaryngol. (Impr.) ; 86(5): 609-616, Sept.-Oct. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1132647

RESUMO

Abstract Introduction: Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective: To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods: This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results: Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. Conclusion: Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.


Resumo Introdução: A laringectomia supratraqueal tem sido descrita como um procedimento cirúrgico com objetivo de preservar a função da laringe (respiração, fonação e deglutição), sem prejuízo no controle oncológico locorregional, para câncer glótico ou supraglótico com extensão à subglote e/ou envolvimento da articulação cricoaritenóidea. A opção pela laringectomia supracricoide nesses casos poderia resultar em grande risco para margens de ressecção comprometidas. Objetivo: Determinar a segurança, viabilidade, adequação das margens cirúrgicas e os resultados da laringectomia supratraqueal para o câncer de laringe intermediário e avançado através da revisão dos resultados de três instituições distintas no Brasil. Método: Estudo retrospectivo, com análise dos prontuários de 29 pacientes submetidos à laringectomia supratraqueal, de outubro de 1997 a junho de 2017. O tipo de laringectomia realizada foi classificado de acordo com a classificação da Sociedade Laringológica Europeia para laringectomias horizontais. Foram avaliados os resultados precoces e tardios. As taxas de sobrevida (global, específica, livre de doença e livre de laringectomia total) foram calculadas. O tempo médio de seguimento foi 44 meses. Resultados: Dos 29 pacientes submetidos à laringectomia supratraqueal, 25 não tinham tratamento prévio. Um paciente (3,4%) teve margens comprometidas. Quatro pacientes (13,8%) recidivaram. Desses, três tiveram recidiva local e um apresentou recidiva regional. Cinco pacientes (17,2%) necessitaram de totalização da laringectomia, duas por ruptura da pexia e três por recidiva local. Quatro desses pacientes (80%) obtiveram sucesso na totalização. Quatro pacientes (13,8%) foram a óbito, dois por complicações pós-cirúrgicas e dois por recidiva. As sobrevidas global, específica, livre de doença e livre de laringectomia total em 5 anos foram, respectivamente, 82,1%; 88,2%; 83,0% e 80,2%. Conclusão: Pacientes selecionados com câncer intermediário e avançado de laringe podem ser beneficiados com laringectomia supratraqueal, que ofereceu sobrevida livre de laringectomia total e sobrevida específica de 80,2% e 88,2%, respectivamente.


Assuntos
Humanos , Laringectomia , Brasil , Neoplasias Laríngeas , Estudos Retrospectivos , Resultado do Tratamento , Recidiva Local de Neoplasia
9.
Br J Anaesth ; 125(5): 722-729, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32900505

RESUMO

BACKGROUND: Expression of the mu-opioid receptor (MOR) is associated with poor long-term outcomes in various types of cancer. The association between MOR expression and clinical outcomes in laryngeal squamous cell carcinoma (LSCC) is not clear. METHODS: This retrospective study included patients who underwent laryngectomy for LSCC. The expression pattern of the MOR protein and OPRM1 gene in tumours and corresponding adjacent non-carcinoma specimens was measured. Propensity score matching was used to minimise bias. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were intraoperative sufentanil consumption, grade of surgical complications according to the Clavien-Dindo classification, and hospital length of stay. RESULTS: A total of 207 LSCC patients were enrolled. After propensity score matching, there was a significant difference in DFS between groups at 1, 3, and 5 yr (60.2% vs 81.2%, P=0.019; 39.4% vs 50.2%, P=0.026; 37.5% vs 42.5%, P=0.023, respectively) in patients with high MOR expression. The OS rates at 1, 3, and 5 yr were significantly lower in the high MOR expression group (81.2% vs 93.2%, P=0.027; 57.7% vs 78.3%, P<0.001; 42.5% vs 60.3%, P<0.001, respectively). The multivariate analysis indicated that high MOR expression was associated with worse DFS and OS (hazard ratio: 1.52, 95% confidence interval: 1.07, 2.25, P=0.034; hazard ratio: 1.42, 95% confidence interval: 1.17, 2.34, P=0.032). CONCLUSION: High MOR expression may be associated with poor prognosis in patients with LSCC, suggesting that MOR could be used as a valuable molecular biomarker to predict prognosis of LSCC patients.


Assuntos
Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/mortalidade , Neoplasias Laríngeas/genética , Neoplasias Laríngeas/mortalidade , Receptores Opioides mu/biossíntese , Adulto , Idoso , Anestesia , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Determinação de Ponto Final , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/cirurgia , Laringectomia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Receptores Opioides mu/genética , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
10.
BMC Surg ; 20(1): 173, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736545

RESUMO

BACKGROUND: Laryngeal rhabdomyosarcomas (RMSs) mainly occurred in children, while were extremely rare in adults. Consequently, less information was available to guide clinicians to manage adult RMSs in larynx. CASE PRESENTATION: A 42-year-old man presented with a 2-year history of gradually worsening hoarseness. Then, he underwent a surgery with suspension laryngoscope with initially being diagnosed as vocal cord cyst. Unexpectedly, the lesion was proved to be embryonal rhabdomyosarcoma (ERMS), pathologically. Next, he underwent chemoradiotherapy, while the tumor relapsed 18 months after the last treatment. Subsequently, a vertical hemilaryngectomy and a right selective neck dissection was performed, and the chemotherapy according to the anticancer drug sensitivity in vitro was arranged. Until the last check-up 18 months after chemotherapy, the patient did not display clinical or radiological signs of local recurrence and metastases. CONCLUSIONS: Misdiagnosis and missed diagnosis of laryngeal RMSs might appear when tumors presented as smooth protuberance. We reported the first case of laryngeal RMSs in an adult with the multidisciplinary strategy based on the chemosensitivity assay in vitro. Furthermore, a systematic review of the literature was also discussed, highlighting the initial diagnostic pitfalls and subsequent management problems that may occur with this uncommon tumor.


Assuntos
Neoplasias Laríngeas , Laringe , Recidiva Local de Neoplasia/terapia , Rabdomiossarcoma Embrionário , Adulto , Quimiorradioterapia , Terapia Combinada , Erros de Diagnóstico , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/terapia , Laringectomia , Laringe/cirurgia , Masculino , Esvaziamento Cervical , Rabdomiossarcoma Embrionário/diagnóstico , Rabdomiossarcoma Embrionário/cirurgia , Rabdomiossarcoma Embrionário/terapia
11.
Artigo em Chinês | MEDLINE | ID: mdl-32842220

RESUMO

Objective:To explore the effect of vocal cord reconstruction with sternohyoid muscle flap pedicled with vertical anterior laryngectomy. Method:The clinical data of 43 cases of laryngeal carcinoma were analyzed retrospectively. According to whether the vocal cords were reconstructed, they were divided into vocal cord reconstruction group and non reconstruction group. Among them, 20 patients in the reconstruction group were reconstructed with pedicled sternohyoid muscle flap and 23 patients in non-reconstruction group. In the non reconstruction group, the external membrane of thyroid cartilage was used to repair the wounds. Postoperative respiratory function, swallowing function, pronunciation function, postoperative prognosis, complications, and recurrence rate were compared between the two groups. Reconstruction of glottis after vocal cord reconstruction was evaluated by electronic laryngoscope and CT scan. Result:①Patients in both groups survived during the follow-up period. One patient in the non-reconstructed group had recurrence, and the reconstituted group had no relapse, 3 cases with complications occurred in the reconstruction group, including 2 cases with granulation tissue in the glottic area, 1 case with laryngeal fistula, and 2 cases with aspiration pneumonia were found in the non-reconstruction group. ②1 year postoperative tracheal cannula removal rate, gastric tube removal and pronunciation quality: the tracheal cannula removal rate was 100% in the two groups after surgery; the gastric tube removal time in the reconstruction group was(13.2±2.8) days, and (16.6±5.3) days in the non-reconstruction group (P<0.05); reconstruction group had good pronunciation in 10 cases, moderate in 6 cases, and poor in 4 cases. Non-reconstructed group had good pronunciation in 4 cases, medium in 14 cases, and poor in 5 cases. Those with moderate or higher were compared no significant difference (P>0.05), and those with good pronunciation were statistically different (P<0.05). ③The transverse and anteroposterior diameter in reconstruction group was similar with the normal people (P>0.05); however, the transverse and anteroposterior diameter in the non-reconstructed group was significantly different with that of the normal people (P>0.05), the transverse diameter of the reconstructed group and the non-reconstructed group were compared with no significant difference (P>0.05), but there was significant difference in the anteroposterior diameter between the two groups (P<0.05). The area in both groups were different with the normal people (P<0.05); ④Glottic area morphology: the two groups of patients showed different degrees of swelling in the arytenoid cartilage area, the shape of the glottic region in the reconstructed group was approximately triangular, and the glottic morphology in the non-reconstructed group was approximately circular. Conclusion:After vocal cord reconstruction, there were increased rate of tracheal cannula extubation, well covered wallowing and phonation function, and the quality of life of patients was improved.


Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia , Glote , Humanos , Recidiva Local de Neoplasia , Qualidade de Vida , Estudos Retrospectivos , Prega Vocal
12.
Artigo em Chinês | MEDLINE | ID: mdl-32842226

RESUMO

Objective:To compare the effect of closure of pharyngeal cavity with linear stapler and manual suture in total laryngectomy. Method:A retrospective study was conducted on 32 patients who underwent total laryngectomy with linear stapler to close the pharyngeal from December 2014 to March 2019. Among them, 25 patients used closed technique and 7 patients used open technique. At the same time, 23 patients who underwent total laryngectomy with manual suture the pharyngeal by the same operator from January 2010 to December 2014 were collected. The clinical parameters of the two groups were compared and analyzed. Result:Compared with the control group, the closed technical group had no significant difference in terms of gender, diabetes mellitus, second surgery, T stage, and surgical method(P> 0.05). While the age (63.60 ± 9.46) years and (54.35 ± 11.13) years , operation time (239.67 ± 88.43) min and (474.35 ± 140.16) min , oral feeding time (12.84 ± 3.65) min and (17.3 ± 9.71)min , hospitalization days after operation ( 15.48 ± 3.78) d and (20.22 ± 10.14) d, incidence of Pharygocutaneous fistula 4.0% (1/25) and 26.1% (6/23), had significant statistical differences (P <0.05) Between two groups; Compared with the control group, the opener group had no statistically significant difference in gender, T stage, oral feeding time, hospitalization days after operation,surgical method and incidence of Pharygocutaneous fistula (P> 0.05),while there was a statistically significant difference in diabetes mellitus, second surgery, and operation time (P<0.05). Conclusion:The linear stapler closed closure technique can reduce the incidence of Pharygocutaneous fistula, shorten the operation time and oral feeding time, and reduce the length of hospital stay.


Assuntos
Fístula Cutânea , Neoplasias Laríngeas/cirurgia , Doenças Faríngeas , Humanos , Laringectomia , Complicações Pós-Operatórias , Estudos Retrospectivos
14.
J Otolaryngol Head Neck Surg ; 49(1): 59, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778168

RESUMO

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Neoplasias Laríngeas/cirurgia , Laringectomia/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Laringectomia/métodos , Laringe Artificial , Masculino , Ontário , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Implantação de Prótese/métodos , Implantação de Prótese/estatística & dados numéricos , Medição de Risco
15.
J Laryngol Otol ; 134(7): 623-625, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32741379

RESUMO

BACKGROUND: Pharyngocutaneous fistula is a troublesome complication. Recently, synthetic materials such as fibrin sealant have been used as a secondary measure to treat fistula. This work assessed whether the primary use of fibrin sealant can reduce the rate of fistula. METHOD: A retrospective review of 50 cases from 2 centres was completed. Tisseel was an adjunct to primary closure in all cases. RESULTS: In the first centre, 3 out of 34 cases developed pharyngocutaneous fistula (fistula rate of 9 per cent). All three were salvage cases. In the second centre, 0 out of 16 cases developed a fistula. CONCLUSION: The incidence of pharyngocutaneous fistula post-radiation and post-chemoradiotherapy in laryngectomy cases has been quoted as 23 per cent and 34 per cent respectively. This study represents the first patient series on the use of fibrin sealant as an adjunct in primary closure following laryngectomy. The results are promising, encouraging the use of Tisseel as an adjunct to meticulous closure.


Assuntos
Fístula Cutânea/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Doenças Faríngeas/cirurgia , Fístula Cutânea/etiologia , Humanos , Laringectomia/efeitos adversos , Laringectomia/métodos , Doenças Faríngeas/etiologia , Estudos Retrospectivos , Terapia de Salvação/métodos , Resultado do Tratamento
16.
Braz. j. otorhinolaryngol. (Impr.) ; 86(4): 502-512, July-Aug. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1132610

RESUMO

Abstract Introduction Stomal recurrence is a troublesome complication after total laryngectomy. Despite a large number of studies having been performed, there is still controversy about which risk factors are most significant for the development of stomal recurrence. Objective The objective of the present meta-analysis was to analyze the potential factors leading to stomal recurrence after total laryngectomy. Methods PubMed, Web of Science, Cochrane Library, and Ovid databases were systematically searched using multiple search terms. Eighteen studies with 6462 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. Results The results showed that, tumor subsite (supraglottic vs. subglottic, RR = 0.292, 95% CI 0.142-0.600, p = 0.001; glottic vs. subglottic, RR = 0.344, 95% CI 0.175-0.676, p = 0.002), T stage (RR = 0.461, 95% CI 0.286-0.742, p = 0.001), preoperative tracheotomy (RR = 1.959, 95% CI 1.500-2.558, p < 0.001) were the high-risk factors associated with the development of stomal recurrence. Conclusion From the results of our study, tumor subsite, T stage and preoperative tracheotomy were the significant risk factors for stomal recurrence. Methodologically high-quality comparative investigations are needed for further evaluation.


Resumo Introdução A recorrência estomal pós-laringectomia total e é uma complicação de difícil manejo. Apesar de um grande número de estudos ter sido feito, ainda há controvérsias sobre quais fatores de risco são mais significativos para o seu desenvolvimento. Objetivo O objetivo da presente meta-análise foi analisar os fatores potenciais para recorrência estomal após a laringectomia total. Método As bases de dados PubMed, Web of Science, Cochrane Library e Ovid foram sistematicamente pesquisadas com vários termos de busca. Dezoito estudos com 6.462 pacientes foram identificados. A qualidade da evidência foi avaliada pelo National Institute for Health and Clinical Excellence. Resultados Os resultados mostraram que o subsítio tumoral (supraglótico vs. subglótico, RR = 0,292, IC 95% 0,142 ± 0,600, p = 0,001; glótico vs. subglótico, RR = 0,344, IC 95% 0,175 ± 0,676, p = 0,002), estágio T (RR = 0,461, IC 95% 0,286 ± 0,742, p = 0,001), traqueotomia pré-operatória (RR = 1,959, IC 95% 1.500 ± 2.558, p < 0,001) foram os fatores de alto risco associados ao desenvolvimento de recorrência estomal. Conclusão Com base nos resultados de nosso estudo, o subsítio do tumor, o estágio T e a traqueotomia pré-operatória foram fatores de risco significativos para recorrência estomal. São necessárias investigações comparativas metodologicamente de alta qualidade para maior avaliação.


Assuntos
Humanos , Neoplasias Laríngeas/cirurgia , Carcinoma de Células Escamosas , Fatores de Risco , Laringectomia , Recidiva Local de Neoplasia
17.
J Laryngol Otol ; 134(7): 626-631, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32723416

RESUMO

OBJECTIVE: To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique. METHODS: A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent). RESULTS: Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009). CONCLUSION: Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.


Assuntos
Laringectomia/métodos , Faringe/cirurgia , Técnicas de Sutura , Idoso , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Artigo em Inglês | MEDLINE | ID: mdl-32604875

RESUMO

(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved (p = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.


Assuntos
Laringe Artificial , Fístula Traqueoesofágica , Idoso , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Fístula Traqueoesofágica/cirurgia , Qualidade da Voz
19.
J Laryngol Otol ; 134(6): 553-557, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32624009

RESUMO

BACKGROUND: ENT presentations are prevalent in clinical practice but feature little in undergraduate curricula. Consequently, most medical graduates are not confident managing common ENT conditions. In 2014, the first evidence-based ENT undergraduate curriculum was published to guide medical schools. OBJECTIVE: To assess the extent that current UK medical school learning outcomes correlate with the syllabus of the ENT undergraduate curriculum. METHOD: Two students from each participating medical school independently reviewed all ENT-related curriculum documents to determine whether learning outcomes from the suggested curriculum were met. RESULTS: Sixteen of 34 curricula were reviewed. Only a minority of medical schools delivered teaching on laryngectomy or tracheostomy, nasal packing or cautery, and ENT medications or surgical procedures. CONCLUSION: There is wide variability in ENT undergraduate education in UK medical schools. Careful consideration of which topics are prioritised, and the teaching modalities utilised, is essential. In addition, ENT learning opportunities for undergraduates outside of the medical school curriculum should be augmented.


Assuntos
Currículo/normas , Educação de Graduação em Medicina/métodos , Otolaringologia/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Cauterização/métodos , Cauterização/estatística & dados numéricos , Competência Clínica , Currículo/estatística & dados numéricos , Educação Médica/estatística & dados numéricos , Humanos , Laringectomia/educação , Laringectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Faculdades de Medicina/normas , Faculdades de Medicina/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Ensino/normas , Traqueostomia/educação , Traqueostomia/estatística & dados numéricos , Reino Unido/epidemiologia
20.
PLoS One ; 15(7): e0236122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673371

RESUMO

OBJECTIVE: To determine the predictive factors of postoperative hospital stay and total hospital medical cost among patients who underwent total laryngectomy. METHODS: A total of 213 patients who underwent total laryngectomy in a tertiary referral center for tumor ablation were enrolled retrospectively between January 2009 and May 2018. Statistical analyses including Pearson's chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and outcomes. The outcomes of interest including postoperative length of hospital stay and inpatient total medical cost. Logistic regression analyses were performed to reveal the relationship between clinical factors and postoperative length of hospital stay or total inpatient medical cost. RESULTS: Preoperative radiotherapy (p = 0.007), method of wound closure (p < 0.001), postoperative serum albumin level (p = 0.025), and postoperative serum hemoglobin level (p = 0.04) were significantly associated with postoperative hospital stay in univariate analysis. Postoperative hypoalbuminemia (odds ratio [OR]: 2.477; 95% confidence interval [CI]: 1.189-5.163; p = 0.015) and previous radiotherapy history (OR 2.194; 95% CI: 1.228-3.917; p = 0.008) are independent predictors of a longer postoperative hospital stay in multiple regression analysis. With respect to total inpatient medical cost, method of wound closure (p < 0.001), preoperative serum albumin level (p = 0.04), postoperative serum albumin level (p < 0.001), and history of liver cirrhosis (p = 0.037) were significantly associated with total inpatient medical cost in univariate analysis. Postoperative hypoalbuminemia (OR: 6.671; 95% CI: 1.927-23.093; p = 0.003) and microvascular free flap reconstruction (OR: 5.011; 95% CI: 1.657-15.156; p = 0.004) were independent predictors of a higher total inpatient medical cost in multiple regression analysis. CONCLUSIONS: Postoperative albumin status is a significant factor in predicting prolonged postoperative hospital stay and higher inpatient medical cost among patients who undergo total laryngectomy. In this cohort, the inpatient medical cost was 48% higher and length of stay after surgery was 35% longer among hypoalbuminemia patients.


Assuntos
Análise Custo-Benefício , Hospitais/estatística & dados numéricos , Laringectomia/economia , Tempo de Internação/economia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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