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2.
J Laryngol Otol ; 135(3): 259-263, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33509309

RESUMO

OBJECTIVE: Treatment of locally advanced hypopharyngeal cancer can cause significant morbidity and late toxicity. Pharyngo-laryngo-oesophagectomy can achieve adequate surgical margins, but data on survival and functional outcome are limited, especially in Wales. This study aimed to describe mortality, morbidity and functional outcome following pharyngo-laryngo-oesophagectomy in a Welsh population. METHOD: This study was a retrospective case note review of pharyngo-laryngo-oesophagectomy cases in Wales over 12 years. RESULTS: Fifteen patients underwent pharyngo-laryngo-oesophagectomy; all but one underwent gastric pull-up. Median survival and disease-free survival were 17 months (range, 2-53 months) and 14 months. Censored 3-month, 1-year and 3-year survival was 93, 71 and 50 per cent, respectively. Common Terminology Criteria for Adverse Events grading of long-term dysphagia was 1 in 58 per cent, 2 in 33 per cent and 3 in 8 per cent, and 87.5 per cent achieved a 'moderate' or 'good' voice rehabilitation. CONCLUSION: These results demonstrate favourable survival and reasonable functional outcome following pharyngo-laryngo-oesophagectomy, suggesting pharyngo-laryngo-oesophagectomy should be considered in all appropriate surgical candidates.


Assuntos
Terapia Combinada/mortalidade , Esofagectomia/mortalidade , Neoplasias Hipofaríngeas/cirurgia , Laringectomia/mortalidade , Faringectomia/mortalidade , Intervalo Livre de Doença , Esofagectomia/métodos , Feminino , Humanos , Neoplasias Hipofaríngeas/mortalidade , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Faringectomia/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , País de Gales
3.
J Surg Oncol ; 123(4): 872-880, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33497489

RESUMO

INTRODUCTION: Hypopharyngeal cancer (HPC) is well characterized by the early submucosal spread of cancer cells into adjacent subsites of the hypopharynx and deep tissues, advocating a wide extent of treatment. However, the microscopic extensions (ME) from gross tumors, according to the primary tumor dimensions, has not been reported in detail. METHODS: We included patients who underwent upfront curative surgery, and retrospectively reviewed pathology specimens from 45 HPC cases. The distance of the MEs, defined as tumor infiltration beyond the gross tumor border on the submucosal and deep sides, was measured. We analyzed potential correlations between MEs and various physical tumor factors. RESULTS: A rough linear correlation between the submucosal ME and the maximal diameter of tumors was found (p < .001, r2 = 0.225). Deep MEs did not correlate with tumor physical factors. However, the MEs differed significantly by the T status (p = .033 and .015 in submucosal and deep sides). In T1-2 tumors, the submucosal MEs were less than 0.5 cm, whereas those of T3-4 tumors were 1.5-2.0 cm. CONCLUSION: In HPC, local MEs beyond the gross tumor border correlated with primary tumor T status. Our findings support that the surgical safety margin for HPC can be adjusted according to tumor dimension.


Assuntos
Neoplasias Hipofaríngeas/patologia , Neoplasias Hipofaríngeas/cirurgia , Laringe/cirurgia , Tratamentos com Preservação do Órgão/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
4.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 55(12): 1126-1130, 2020 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-33342127

RESUMO

Objective: To evaluate clinical applications and efficacy of submental artery perforator flap in reconstruction surgery after removal of pharyngeal carcinoma. Methods: A total of 27 patients in the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University were included, 23 males and 4 females with age from 40 to 70 years old, and 17 patients were hypopharyngeal carcinoma (HPC) and 10 patients were oropharyngeal carcinoma (OPC). All patients underwent tumor resection followed by simultaneously reconstruction surgery using submental artery perforator flap between January 2015 and December 2019. Of 5 patients with palatine tonsil cancer, 4 underwent the combined approach of neck and oral resection and 1 with madibulotomy. All 5 patients with tongue base cancer received transhyoid partial glossotomy with or without partial laryngectomy. Sixteen patients with pyriform sinus carcinoma received partial laryngo-pharyngectomy with preservation of laryngeal functions. One patient with posterior hypopharyngeal wall carcinoma had partial pharyngectomy. Prognosis and laryngeal functions were analyzed after reconstruction surgery with submental artery perforator flap in patients with pharyngeal carcinoma. Results: The 27 patients were followed up for 6-66 months, with a median of 13 months, of them 24 patients were alive without recurrence or metastasis, 1 patient died of recurrence, 1 patient died of esophageal carcinoma and 1 patient was alive with the recurrence of tongue base carcinoma. Postoperative complications included flap failure for 1 case, pharyngeal fistula for 1 case, subcutaneous hydrops for 2 cases and lymphatic fistula for 1 case. Total 2 and 3 year survival rates were 92.9% and 88.9%, respectively. Total decanulation rate was 92.6%; decanulation rate and intubation time were 16/17 and 3.5 months in HPC patients; and decanulation rate and intubation time were 9/10 and 2 months in OPC patients. Total oral feeding rate was 92.6% and nasogastric feeding time was 3.5 weeks in HPC patients and 3 weeks in OPC patients. Conclusion: The submental artery perforator flap is an excellent choice for reconstruction surgery after removal of oropharyngeal and hypopharyngeal carcinoma, with good outcomes of laryngeal functions.


Assuntos
Carcinoma , Neoplasias Hipofaríngeas , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Idoso , Artérias , Carcinoma/cirurgia , Feminino , Humanos , Neoplasias Hipofaríngeas/cirurgia , Masculino , Pessoa de Meia-Idade
5.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 55(12): 1137-1142, 2020 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-33342129

RESUMO

Objective: To evaluate the efficacy of curved suspension laryngoscope assistant transoral surgery (CLATOS) in the examination of hypopharynx, and diagnosis and surgery of early hypopharyngeal carcinoma. Methods: Thirty-four patients who underwent detailed examination for lower part of hypopharynx and surgery for early hypopharyngeal carcinoma with CLATOS technique in the Second Affiliated Hospital of Harbin Medical University from January 2019 to January 2020 were analyzed retrospectively. The age ranged from 42 to 74 years old including 28 males and 6 females. Among them, 25 patients complaining of foreign body sensation in the pharynx for more than half a year with a poor exposure of the lower pharynx in the examination with flexible laryngoscope in the outpatient department were admitted to the hospital for the further examination with rigid curved laryngoscopy and 9 patients with stage T1-2 hypopharyngeal squamous cell carcinoma were operated with CLATOS technique. Preoperative, intraoperative and postoperative data were analized. Results: One case of squamous cell carcinoma in esophageal entrance (T1N0M0) and one case of carcinoma in pyriform sinus (T1N0M0) with cervical esophageal carcinoma (T1N0M0) were found in the 25 patients with foreign body sensation in the pharynx. En bloc resection of cancer was obtained in 9 patients with stage T1-2 hypopharyngeal carcinomas and 2 of them underwent tracheotomy. One patient with T1 retrocricoid carcinoma was found to have a carcinoma in situ at the lower part of posterior hypopharyngeal wall in the examination during follow-up, which was resected simultaneously. Postoperatively this patient developed a stenosis in the esophageal entrance, which was dilated twice until swallowing normally. Two patients of T2N0M0 and one of T2N1M0 underwent bilateral neck lymph node dissection just after the removal of primary tumors. During follow-up, none of the 9 patients showed tumor recurrence and complications such as dysphonia and dyspnea. Conclusion: CLATOS technique can provide a promising way in the examination of hypopharynx and the detection of early lesions of hypopharynx and esophageal entrance, and this technique has also the advantages such as full visual angle and easy operation for the resection of early hypopharyngeal carcinoma. The quality of life of patients can be improved while the tumor is removed en bloc with this technique.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Hipofaríngeas , Laringoscópios , Adulto , Idoso , Feminino , Humanos , Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos
8.
Zhonghua Zhong Liu Za Zhi ; 42(8): 687-691, 2020 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-32867463

RESUMO

Objective: To explore the impact of surgical treatment on the life quality of patients with locally advanced hypopharyngeal carcinoma. Methods: A retrospective analysis of the clinical data of 21 patients with advanced hypopharyngeal carcinoma who underwent surgery at the Shenzhen Hospital of Chinese Academy of Medical Sciences Cancer Hospital from January 1, 2017 to December 31, 2019 was conducted. There were 3 patients with recurrence after radiotherapy and chemotherapy, 4 cases of postoperative recurrence, 3 cases of postoperative recurrence after radiotherapy and chemotherapy. Three cases were hypopharyngeal carcinoma with esophageal carcinoma and 8 cases were stage Ⅳ hypopharyngeal carcinoma. Among them, 3 cases were repaired by stomach, 4 cases by free jejunum, 2 case by great saphenous vein for internal carotid artery, 1 case by artificial blood vessel for internal carotid artery, 5 cases by transfer of pectoralis major musculocutaneous flap and 2 cases by transfer of submental island flap. The 21 patients were scored using the European Cancer Research and Treatment Organization's Quality of Life Head and Neck Tumor Special Scale (EORTC QLQ-H&N35) on the 3 months before and after surgery, and the changes in postoperative life quality were compared. Results: The preoperative life quality score of 21 patients was (56.86±7.95) points and life quality score of 3 months after operation was (50.93±7.91) points. The postoperative life quality was significantly improved (P<0.05). The improvement of the postoperative life quality of the patients mainly included the improvements of the head and neck pain, swallowing function, diet, taking analgesics and indwelling nasal feeding tubes. The preoperative scores were (7.58±1.56) points, (8.46±1.63) points, (7.94±0.43) points, (1.76±0.12) points and (1.86±0.28) points, respectively, while the scores of 3 months after operation were (5.02±1.23) points, (6.28±1.58) points, (6.34±0.36) points , (1.12±0.08) points and (1.24±0.18) points, the differences were statistically significant (all P<0.05). Conclusion: The flexible selection of flap repair for locally advanced hypopharyngeal carcinoma is still feasible, and surgery can improve the life quality of patients.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/psicologia , Humanos , Neoplasias Hipofaríngeas/psicologia , Hipofaringe , Recidiva Local de Neoplasia , Qualidade de Vida , Estudos Retrospectivos
9.
J Comput Assist Tomogr ; 44(4): 540-545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32558774

RESUMO

OBJECTIVE: To compare the diagnostic accuracy of positron emission tomography/magnetic resonance (PET/MR) versus PET/computed tomography (PET/CT) for T and N staging of hypopharyngeal cancer. METHODS: Integrated PET/MR and PET/CT examinations were performed in 20 patients with hypopharyngeal cancer after same-day single injection. Eleven of 20 patients underwent surgery with histologic findings directly compared with imaging findings. Statistical analysis included Spearman correlation and McNemar test. RESULTS: Accuracy of PET/MR, PET/CT, and MRI for T staging was 81.8%, 63.6%, and 72.7%, respectively. Sensitivity and specificity for detecting metastatic lymph nodes was 88.2% and 98.2% on PET/MR, 76.5% and 98.3% on PET/CT, and 64.7% and 94.7% on MRI. CONCLUSIONS: The PET/MR and PET/CT provide comparable results for assessing hypopharyngeal carcinoma and detecting metastatic lymph nodes.


Assuntos
Neoplasias Hipofaríngeas/diagnóstico por imagem , Neoplasias Hipofaríngeas/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Humanos , Neoplasias Hipofaríngeas/cirurgia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sensibilidade e Especificidade
11.
Am J Otolaryngol ; 41(4): 102505, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32354480

RESUMO

INTRODUCTION: Hypopharyngeal squamous cell carcinoma (SCC) is rare, but highly aggressive. Due to the advanced stage of this cancer at the time of diagnosis, radical surgery with reconstruction of pharynx is the standard care with high morbidity and mortality rate. A safer partial pharyngectomy could also be used for invasive hypopharyngeal cancer. In this study, we investigated the short and long-term outcomes in patients with SCC of the pyriform sinus apex undergoing standard partial pharyngectomy using a new suturing technique, called end to side technique. METHODS: This case series was performed on 8 patients with SCC of the pyriform sinus apex at the otorhinolaryngology clinic. All participants underwent standard partial pharyngectomy using "end to side technique". Post-operative evaluations included 6 and 12 months CT scan and 1-year barium swallow. RESULTS: Of 8 patients, 7 were male (87.5%) and 1 was female (12.5%) with a mean age of 60 years old. All patients were diagnosed at stage III of hypopharyngeal cancer and cervical lymph node involvement was reported in 3 patients (37.5%). Tumor margins were negative in all patients. Fistula was reported in 2 patients (25%) which was managed using conservative treatments. CONCLUSIONS: According to our study, the standard partial pharyngectomy with end to side technique is a safe and feasible method for the surgical resection of the squamous cell carcinoma of the pyriform sinus apex with good short-term and long-term outcomes.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Faringectomia/métodos , Seio Piriforme/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hipofaríngeas/mortalidade , Masculino , Pessoa de Meia-Idade , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Fatores de Tempo , Resultado do Tratamento
13.
Laryngoscope ; 130(8): 2013-2018, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32406940

RESUMO

OBJECTIVE: To evaluate the effectiveness of the nasal airflow-inducing maneuver (NAIM) using the Sniffin' Sticks (Burghart, Wedel, Germany) olfactory threshold test, Open Essence (OE, FUJIFILM Wako Pure Chemical Corporation, Osaka, Japan) olfactory identification test, and self-administered odor questionnaire (SAOQ) for olfactory perception in NAIM experienced and NAIM first-time groups. For NAIM first-time group, the relationships between time from laryngectomy to first NAIM, olfactory threshold, and identification ability were also evaluated. STUDY DESIGN: Retrospective cohort study. METHODS: Sixty-six patients who had undergone laryngectomy (NAIM experienced group: 23; NAIM first-time group: 43) underwent the threshold test, OE, and SAOQ. RESULTS: Mean results of the threshold test were 2.7 (±2.3) and 2.5 (±3.0) for the NAIM experienced and NAIM first-time groups, respectively, indicating no significant differences (P = .35). The mean number of correct responses in OE was 4.5 (±2.7) and 3.2 (±3.0) in the NAIM experienced and nonrehabilitation groups, respectively, indicating a higher number in the NAIM experienced group (P = .06). Mean result of SAOQ was 47.9% (±30.9%) and 25.5% (±27.0%) in the NAIM experienced and NAIM first-time groups, respectively, indicating a significantly higher result in the NAME experienced group (P = .003). There were no correlations of threshold test and identification test scores with time from laryngectomy to the first NAIM (threshold test: r = 0.03, P = .87; OE: r = -0.03, P = .87). CONCLUSION: NAIM enabled odor perception in patients who underwent laryngectomy, and SAOQ was an effective method for evaluating this. Further, olfactory tests in both groups showed that NAIM might restore olfaction irrespective of time elapsed since laryngectomy. LEVEL OF EVIDENCE: 4. Laryngoscope, 130: 2013-2018, 2020.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia , Ventilação Pulmonar , Olfato/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Autorrelato , Resultado do Tratamento , Bocejo
14.
Medicine (Baltimore) ; 99(9): e19361, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118779

RESUMO

Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1 ±â€Š5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ±â€Š6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ±â€Š6.7 days) than in the skin grafts group (24.1 ±â€Š5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.


Assuntos
Derme Acelular/normas , Neoplasias Hipofaríngeas/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , China , Estudos de Coortes , Feminino , Humanos , Neoplasias Hipofaríngeas/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Transplante de Pele/métodos , Transplante de Pele/normas
15.
J Laryngol Otol ; 134(3): 256-262, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32079554

RESUMO

BACKGROUND: Total laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year period. METHOD: A retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n = 173), dividing patients into primary and salvage total laryngectomy cohorts. RESULTS: A shift towards organ-sparing management was observed. Primary total laryngectomy was performed for locoregionally advanced disease and utilised reconstruction less than salvage total laryngectomy. Overall, 11 per cent of patients developed pharyngocutaneous fistulae (primary: 6 per cent; salvage: 20 per cent) and 11 per cent neopharyngeal stenosis (primary: 9 per cent; salvage: 15 per cent). Pharyngocutaneous fistulae rates were higher in the reconstructed primary total laryngectomy group (24 per cent; 4 of 17), compared with primary closure (3 per cent; 3 of 90) (p = 0.02). Patients were significantly more likely to develop neopharyngeal stenosis following pharyngocutaneous fistulae in salvage total laryngectomy (p = 0.01) and reconstruction in primary total laryngectomy (p = 0.02). Pre-operative haemoglobin level and adjuvant treatment failed to predict pharyngocutaneous fistulae development. CONCLUSION: Complications remain hard to predict and there are continuing causes of morbidity. Additionally, prior treatment continues to affect surgical outcomes.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Causalidade , Fístula Cutânea/epidemiologia , Fístula Cutânea/etiologia , Feminino , Humanos , Laringoestenose/epidemiologia , Laringoestenose/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Reino Unido/epidemiologia
16.
Artigo em Chinês | MEDLINE | ID: mdl-32074753

RESUMO

Objective: Meta-analysis was used to compare the long-term efficacy and laryngeal function preservation rate of patients with advanced hypopharyngeal cancer treated with surgery plus radio(chemo)therapy (SRT) or non-surgery chemoradiotherapy (CRT). Methods: We searched publicly published articles on case-control studies of surgical and non-surgical comprehensive treatment of advanced hypopharyngeal cancer in PubMed, the Cochrane Library, Wanfang Database, Chinese Journal Full-text Database, and Chinese Science and Technology Periodical Database. The search language was limited to Chinese and English, and the period was from 1990 to 2018. These literatures were rigorously screened by inclusion and exclusion criteria. The data needed for this study were extracted and the Meta analysis was performed using RevMan 5.3 software. Results: A total of 13 literatures were included, and the overall quality of the literature was relatively high, and no significant publication bias was suggested. A total of 1 994 subjects, including 720 in the SRT group and 1 274 in the CRT group. The average 3-year overall survival rates were 42.9% in SRT group and 44.8% in CRT group,with no significant difference (OR=1.14, 95%CI: 0.62-2.06, P=0.68). The average 5-year overall survival rate (OR=1.42, 95%CI: 1.10-1.84, P<0.01), 5-year local recurrence-free survival rate (OR=1.68, 95%CI: 1.11-2.55, P=0.01) and 5-year local control rate (OR=2.17, 95%CI: 1.52-3.12, P<0.01) of SRT group were 46.4%, 47.4% and 71.2%, respectively, which were higher than those of non-surgical group (37.9%, 32.0%, and 52.2% respectively). The average laryngeal function preservation rate was 19.8%,being significantly lower than 80.6% of the non-surgical group(OR=0.03, 95%CI: 0.01-0.07, P<0.01). Conclusions: SRT has better long-term efficacy, while CRT has better preservation of laryngeal function.


Assuntos
Neoplasias Hipofaríngeas/terapia , Quimiorradioterapia , Terapia Combinada , Humanos , Neoplasias Hipofaríngeas/cirurgia , Hipofaringe , Laringe , Taxa de Sobrevida
17.
Asian J Surg ; 43(9): 907-912, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31959573

RESUMO

BACKGROUND: Free colon flap is the preferred method of hypopharynx reconstruction when the defect is substantial, or simultaneous voice reconstruction is planned. Most of the complications in free colon flaps are located at the anastomosis between colon and thoracic esophagus due to size mismatch of the lumen. We present our experience comparing a modified anastomosis technique and a conventional anastomosis technique at the distal end of interposed colonic segment. METHODS: In this retrospective review, 94 patients, divided into two groups, underwent hypopharynx reconstruction. Group A (18 patients), conventional anastomoses between colon and thoracic esophagus was performed, while in Group B (76 patients), underwent the modified method of anastomosis. RESULTS: The average follow-up period was 46 months in group A and 54 months in group B. Fistula formation was found in 2 patients from Group A, and 1 patient from Group B. Strictures were observed in 4 patients from Group A, and 1 patient from Group B. Difference between both groups regarding complications of leakage and stricture formation was statistically significant (p < 0.05). CONCLUSION: Modified method for anastomosis between colon and thoracic esophagus was found to be effective in the reduction of complications associated with the use of a free colon flap for hypopharyngeal reconstruction. Further advances of this technique could gain momentum in the future.


Assuntos
Anastomose Cirúrgica/métodos , Colo/cirurgia , Esôfago/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Seguimentos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Jpn J Clin Oncol ; 50(2): 185-192, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-31711185

RESUMO

BACKGROUND: Long-term side effects after radiotherapy for organ preservation 'could deteriorate' the laryngeal function. This study intended to identify the incidence of severe late dysphagia following the multimodal treatment for stage III/IV laryngeal and hypopharyngeal cancer 'to evaluate the function of larynx'. METHODS: The medical records of patients successfully treated for laryngeal and hypopharyngeal cancer with a multimodal approach, including radiotherapy, were retrospectively analyzed. 'Functional larynx was defined as tolerable oral diet without severe late dysphagia or tracheostoma'. RESULTS: The study included 99 patients with a median follow-up period of 72 months. 'Tracheostomy during the follow-up period was required in only one patient due to aspiration pneumonia, and dysphagia is the main determinant for functional larynx'. The probability of maintaining functional larynx was 63% for 10 years, when the treatment was started with radiotherapy or concurrent chemoradiotherapy. In upfront surgery (operation first and adjuvant radiotherapy/concurrent chemoradiotherapy) group, 37% of patients required total laryngectomy as primary treatment and 43% of patients could maintain laryngeal function for 10 years. And severe late dysphagia in the latter group developed mainly after laryngeal preservation surgery. The patients aged ≥65 years showed significantly higher incidence of dysphagia. Severe late dysphagia was very rare in laryngeal cancer successfully cured with radiotherapy/concurrent chemoradiotherapy (1/25, 4%); however, it gradually increased over time in hypopharyngeal cancer patients showing a statistically significant difference from laryngeal cancer patients (P = 0.040). CONCLUSION: Severe late dysphagia occurred in 19.2% of patients treated for laryngeal and hypopharyngeal cancers, regardless of whether treatment started with radiotherapy/concurrent chemoradiotherapy or surgery.


Assuntos
Transtornos de Deglutição/etiologia , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia/efeitos adversos , Terapia Combinada/efeitos adversos , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Neoplasias Hipofaríngeas/fisiopatologia , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/fisiopatologia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Laringectomia/métodos , Laringe/fisiopatologia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
20.
J Plast Reconstr Aesthet Surg ; 73(1): 103-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31494055

RESUMO

BACKGROUND: Jejunal free flap (JFF) reconstruction is a popular treatment option for advanced hypopharyngeal cancer. Several factors including ischemia-reperfusion injury (IRI) can cause mucosal damage and progressive flap necrosis. We investigated the development and time-related progression of morphological and cellular changes in patients with JFF reconstruction including cold preservation of the graft. METHODS: Eleven patients were enrolled. Biopsies were taken during surgery from normally perfused tissue, before loop isolation (T0), at the end of back-table surgery (T1), immediately before reperfusion (T2), 15' after reperfusion (T3), and at the end of the digestive anastomoses (T4) and from the external monitor daily from the 1st to the 5th postoperative day (M1-M5). Histomorphological and immunohistochemical parameters in the intraoperative and postoperative samples were evaluated and compared. RESULTS: Delayed flap necrosis was observed in 2 patients. The cold ischemia phase did not negatively affect mucosal regeneration after reperfusion; morphological and cellular damage parameters returned to normal by the end of surgery or along the early postoperative period. Significant enterocyte replication activity was observed at the end of revascularization, which continued in the postoperative phase, leading to recovery of the epithelial morphological integrity and disappearance of apoptotic cells. An inflammatory infiltrate persisted in the M samples, and in a significant proportion of samples, mucosal fibrosis developed by the end of the postoperative observation. CONCLUSION: Cold perfusion and preservation of the JFF can effectively limit the negative effects of IRI and to prevent short- and medium-term complications that can compromise the final outcome.


Assuntos
Isquemia Fria/métodos , Retalhos de Tecido Biológico/fisiologia , Neoplasias Hipofaríngeas/cirurgia , Jejuno/transplante , Traumatismo por Reperfusão/prevenção & controle , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Idoso , Biópsia , Retalhos de Tecido Biológico/patologia , Sobrevivência de Enxerto/fisiologia , Humanos , Neoplasias Hipofaríngeas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Traumatismo por Reperfusão/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Resultado do Tratamento
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