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1.
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
2.
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
3.
HNO ; 67(12): 955-976, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31720696

RESUMO

Total laryngectomy provides a curative approach for patients with advanced laryngeal and hypopharyngeal cancer without distant metastasis. Especially in stage cT4a disease, laryngectomy is superior to primary radio(chemo)therapy in retrospective studies. Further relevant indications for the procedure are tumor-related laryngeal dysfunction such as dysphagia and aspiration, as well as cancer recurrence after primary radio(chemo)therapy. The surgical procedure is highly standardized, with an appropriate safety profile. The subsequent loss of voice must be compensated by voice rehabilitation (voice prosthesis, ructus). The current overview provides information about indications for laryngectomy, preoperative clinical diagnostics, the surgical procedure, complications, alternative treatment, rehabilitation, and prognosis. Total laryngectomy remains a standard procedure in modern head and neck oncology.


Assuntos
Neoplasias Hipofaríngeas , Neoplasias Laríngeas , Laringectomia/métodos , Laringe Artificial , Humanos , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 98(41): e17499, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593117

RESUMO

This retrospective study evaluated operative outcomes when using a supraclavicular artery island flap (SAIF) combined with a sternohyoid muscle flap (SHMF) to reconstruct defects after hypopharyngeal carcinoma resection. Reconstructive surgery for hypopharyngeal and laryngeal defects was performed with the SAIF + SHME combination in 6 patients during 2016 to 2018. Within 14 to 16 days after the surgery, all 6 patients could ingest food and block the tube (avoiding aspiration), with no pharyngeal fistulas. They then underwent irradiation up to a total of 60.5 Gy during the 4 weeks postoperatively. All 6 flaps survived, and there were no donor-site complications except minor dehiscence in 1 patient. Thus, the SAIF + SHMF combination can be used to reconstruct hypopharyngeal and laryngeal defects after hemi-laryngectomy in patients with hypopharyngeal carcinoma involving the unilateral larynx. This technique effectively preserved the swallowing function and phonation of the patients, thereby improving their quality of life.


Assuntos
Artérias/transplante , Músculos do Pescoço/transplante , Retalhos Cirúrgicos/transplante , Idoso , Cervicoplastia/métodos , Clavícula/irrigação sanguínea , Terapia Combinada/métodos , Deglutição/fisiologia , Humanos , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Laringectomia/métodos , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Deiscência da Ferida Operatória/epidemiologia
5.
Medicine (Baltimore) ; 98(35): e16944, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464933

RESUMO

INTRODUCTION: Head and neck cancer patients are at a high risk to suffer from malnourishment, a risk that increases in postoperative condition and with the use of enteral nutrition (EN). Until now patients who are suffering from indigestion in the intensive care unit (ICU) received treatment in the form of prokinetic drugs, drugs that can lead to serious side effects and only can partially improve digestion functions. Acupuncture was used successfully in several clinical trials to improve postoperative indigestion in cancer patients without any reported adverse events. The study aims are to investigate acupuncture effect in combination with prokinetic drugs in the treatment of indigestion in postoperative oral and hypopharyngeal cancer patients in the ICU. METHODS: Single-center, double-blind randomized control trial will compare between 2 equal groups. A total of 28 patients that will meet the inclusion criteria: age 30 to 80, postplastic surgery for oral cancer or hypopharyngeal cancer, developed feeding intolerance 2 times in the first postoperative day, Apache score <20, and needed EN. Patients will be randomly divided (1:1) into treatment group or control group for 3 treatments in 3 days along with routine ICU treatment. The main outcome measurement will be the number of days a patient needs to reach his total energy expenditure. EXPECTED OUTCOME: The results will shed light on the effectiveness and safety of acupuncture in a double-blind design treating postoperative ICU cancer patients. In addition, the study presents a revolutionary double-blind design that if, will prove as successful might influence the way double-blind acupuncture studies are performed today. OTHER INFORMATION: The study will be conducted in the surgical ICU department, of China medical university hospital, Taichung 404, Taiwan. The study is conducted on stable ICU patients and is anticipated to have minimum risk for adverse events. Patients enrollment and data collection will start from May 15, 2019. The study expected completion time: June 2021.


Assuntos
Terapia por Acupuntura/métodos , Cuidados Críticos/métodos , Dispepsia/terapia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Bucais/cirurgia , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Dispepsia/etiologia , Nutrição Enteral/métodos , Feminino , Humanos , Neoplasias Hipofaríngeas/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/complicações , Cuidados Pós-Operatórios , Projetos de Pesquisa , Taiwan
6.
Acta Otolaryngol ; 139(9): 816-822, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31268399

RESUMO

Background: We aimed to reduce the morbidity related to treatment and to preserve organ function in patients with hypopharyngeal squamous cell carcinoma (HPSCC) by applying a new surgical treatment protocol based on transoral robotic surgery (TORS). Aims/objectives: In this study, we analyzed the prognostic factors related to survival to confirm the validity and effectiveness of TORS in patients with advanced-stage HPSCC. Methods: We retrospectively analyzed the data of 44 HPSCC patients who had undergone TORS-based therapy. Results: In univariate analysis, only the surgical marginal status showed a statistically significant correlation with the survival of the patients (p = .009). In multivariate analysis, surgical margin status was the only statistically significant prognostic factor related to survival (p = .008). Forty-one patients (93.2%) recovered speech function sufficiently to perform daily conversation without artificial aids. Forty-one patients (93.2%) were able to ingest food orally. Conclusions: In the treatment of advanced hypopharyngeal cancer, TORS-based therapy helped the surgeon obtain a clear surgical margin in patients with HPSCC, and it showed superior oncologic and functional outcomes compared to the existing treatment methods.


Assuntos
Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Adulto , Idoso , Análise de Variância , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hipofaríngeas/tratamento farmacológico , Neoplasias Hipofaríngeas/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Boca , Terapia Neoadjuvante , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Análise de Sobrevida
7.
Artigo em Chinês | MEDLINE | ID: mdl-31327214

RESUMO

Total laryngectomy or laryngopharyngectomy is the main treatment strategy of choice for advanced laryngeal/hypopharyngeal carcinoma.However,the operation is associated with important consequences over and above the loss of normal voice.Therefore,it is necessary toachieve voice in the absence of a functional larynx.The objective of this article is to provide an over view of current methods and a summary of the present progress about voice rehabilitation after total laryngectomy.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/reabilitação , Voz , Humanos , Faringectomia
8.
J Cancer Res Clin Oncol ; 145(10): 2565-2572, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31352569

RESUMO

PURPOSE: Metastatic lymph node (LN) burden is one of the most important prognosticators in human solid cancers, but has rarely been examined in laryngeal and hypopharyngeal cancers (LHC). We evaluated the nodal factors predictive of recurrence and survival in patients with LHC. METHODS: This study included 141 consecutive patients who underwent primary surgery and neck dissection for previously untreated LHC at our tertiary referral centre. Nodal factors included the presence of pathological LN metastasis, number of positive LNs, LN ratio, and extra-nodal extension (ENE). Our proposed N classification was analysed by recursive partitioning analysis and compared with the AJCC and other N classifications using the c-index. Univariate and multivariate Cox proportional hazard regression analyses were used to define significant predictors of post-treatment disease-free survival (DFS) and overall survival (OS). RESULTS: Of the 141 patients, 66 (46.8%) had positive LNs, and 27 (19.1%) had ENE. In multivariate analyses, the number of positive LNs was strongly associated with DFS and OS outcomes (P < 0.01). Our new N classification was proposed with four categories, such as N0 (0 LN +), N1 (1 LN +), N2 (2-4 LN + or ENE) and N3 (≥ 5 LN +). The C-index of our new N classification improved the OS prediction (0.718) compared with the AJCC and the other N classifications (0.704-0.713). CONCLUSION: Metastatic LN burden is an important predictor of survival in patients with LHC. A proposed N classification using the number of positive LNs and ENE might improve the LHC survival prediction.


Assuntos
Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/patologia , Linfonodos/patologia , Neoplasias Faríngeas/mortalidade , Neoplasias Faríngeas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Hipofaríngeas/cirurgia , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Faríngeas/cirurgia , Prognóstico , Curva ROC , Resultado do Tratamento
9.
Ann Otol Rhinol Laryngol ; 128(11): 1023-1029, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220916

RESUMO

OBJECTIVES: The indication of transoral robotic surgery for hypopharyngeal cancer is limited because of poor accessibility. The aim of this study was to explore the efficacy of a curved laryngopharyngoscope used in combination with a next-generation flexible robotic surgical system for accessing and resecting the hypopharynx. METHODS: A comparative evaluation of the curved laryngopharyngoscope versus standard straight-blade retractors using the flexible robotic surgical system was conducted on 2 cadavers. End points measured included visualization, accessibility, and ease of dissection for accessing and resecting the hypopharynx. RESULTS: Visualization, accessibility, and dissection were superior with the curved laryngopharyngoscope in all subareas of the hypopharynx. The advantages of accessibility and visualization were much more evident in the cadaver with a high body mass index. CONCLUSIONS: These preclinical data suggest that using a curved laryngopharyngoscope in combination with a flexible robotic surgical system may lead to technical innovations concerning transoral surgery of the hypopharynx.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Laringoscópios , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Idoso , Cadáver , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Boca
10.
Eur Arch Otorhinolaryngol ; 276(9): 2531-2539, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31240456

RESUMO

BACKGROUND: Providing cancer patients with adequate information is essential to their confidence and satisfaction regarding medical care. The aims of this study were to evaluate the information given to patients undergoing total pharyngolaryngectomy (TPL) as well as the evolution and predictors of patient quality of life (QoL). METHODS: We conducted a prospective multicentric study on patients undergoing TPL for a locally advanced laryngeal/hypopharyngeal cancer. All patients completed the EORTC QLQ-INFO25, QLQ-C30, and QLQ-H&N35 questionnaires, before and after surgery. RESULTS: This study enrolled 46 patients. Between the pre- and post-therapeutic periods, we observed no significant changes in the global QLQ-INFO25 and QLQ-C30 scores. However, we found a significant deterioration in 4 QLQ-INFO25 scales/items and in social functioning, as well as an increase of sense, speech, and social contact problems. N-stage and professional activity were significant predictors of preoperative QLQ-INFO25 scores. Younger age was significantly associated with financial difficulties, whereas professional activity and lower education level were significant predictors of xerostomia and swallowing problems, respectively. CONCLUSION: In patients undergoing TPL, we observed significant changes in QLQ-INFO25 scores between the pre- and post-treatment periods and, particularly, a deterioration of patient satisfaction with the information received. Several clinical factors were identified as significant predictors of QLQ-INFO25 and QoL scores.


Assuntos
Neoplasias Hipofaríngeas , Neoplasias Laríngeas , Laringectomia/educação , Educação de Pacientes como Assunto , Faringectomia/educação , Complicações Pós-Operatórias/psicologia , Qualidade de Vida , Idoso , Feminino , Humanos , Neoplasias Hipofaríngeas/psicologia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/psicologia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/estatística & dados numéricos , Satisfação do Paciente , Faringectomia/métodos , Estudos Prospectivos , Inquéritos e Questionários
12.
Artigo em Chinês | MEDLINE | ID: mdl-30991777

RESUMO

Objective: To determine the relationship between nodal disease distribution patterns and oncological outcome and optimum management of cN0/cN1 patients with hypopharyngeal squamous cell carcinoma (HPSCC). Methods: The collected clinical data and the follow-up disease-free survival (DFS) information from 154 patients with HPSCC treated between 2001 and 2014 in Eye Ear Nose and Throat Hospital of Fudan University were retrospectively analyzed. Kaplan-Meier method was used to calculate DFS rate. Log-rank test and Cox regression model were performed to evaluate the survival prognostic factors for univariate and multivariate analyses. Results: Among 154 patients (63 cN0 patients, 91 cN1 patients) with HPSCC,in whom 148 were male, 6 were female, with an arerage age of (58.6±9.9), 63 cN0 patients received lateral neck dissection, of whom 9 were histologically positive nodes. Particularly, occult metastasis rate was 15.6%(7/45) for HPSCC in pyriform sinus and 18.2%(2/11) for HPSCC in posterior pharyngeal wall. Among 91 cN1 HPSCC, 34 underwent radical neck dissection and 54 underwent selective neck dissection. DFS for patients(T3-4N1) with radical neck dissection was lower than that for patient with selective neck dissection(15.2% vs.39.5%, χ(2)=5.153, P<0.05). The DFS of cN0 HPSCC was overestimated by the false-negative patients (cN0→pN+) for cN0 HPSCC and the DFS of cN1 HPSCC was underestimated by the false-positive(cN1→pN0) for cN1 HPSCC. Conclusions: For cN1 HPSCC, compared with radical neck dissection, selective neck dissection may be considered as a more adequate method for removal of metastatic lymph nodes. Postoperative combined therapy and follow-up strategy should be established according to pathological N staging.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Esvaziamento Cervical , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/patologia , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
13.
Adv Otorhinolaryngol ; 83: 126-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943471

RESUMO

Quality of life (QoL) is an important consideration in the management of individuals with head and neck cancer. The poor prognosis and significant impact of treatment modalities on function of the salivary glands, larynx and pharynx combine to make hypopharyngeal carcinoma a particularly challenging condition to treat. The impact of diagnosis and treatment on health related QoL is substantial. There is increased understanding that organ preservation does not necessarily correlate with function preservation as was previously expected. The impact on QoL, of chemoradiotherapy (CRT) or surgery, must be taken into account when managing individuals and deciding on treatment. Several QoL tools have been developed to understand the subjective consequences of functional impairment. The number and quality of studies specifically for hypopharyngeal carcinoma are low. The effects on QoL differ for surgery and CRT, as one would expect, but there are no demonstrable significant differences in most domains. Those treated with CRT show higher levels of dry mouth and sticky saliva, while those patients who have undergone surgery report greater levels of sensory disturbance. Significant differences were not noted in speech outcomes or global (general) health scores. The psychological morbidity and lack of good coping strategies are thought to play an important role in the high suicide rates of these patients (12-fold higher than the average population in the USA). Large, long-term, longitudinal studies of patients surviving treatment, answering both general and disease-specific questionnaires are required to direct clinicians towards the least morbid treatment strategies. The ability to cope and the availability of emotional support probably have a greater impact on subjective QoL than the functional outcomes of treatment.


Assuntos
Quimiorradioterapia/efeitos adversos , Neoplasias Hipofaríngeas/terapia , Complicações Pós-Operatórias , Qualidade de Vida , Humanos , Neoplasias Hipofaríngeas/cirurgia , Radioterapia/efeitos adversos
14.
Ann Surg Oncol ; 26(7): 2122-2126, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30989496

RESUMO

INTRODUCTION: Given the few reports regarding the salvage methods for managing jejunal necrosis, finding candidates for a meta-analysis or systematic review is difficult. Thus, this study aimed to describe the interventions for jejunal necrosis and investigate important points relating to this condition. METHODS: The interventions used to treat free jejunal necrosis are external fistula formation with jejunal debridement, secondary reconstruction of the local site, and overall status improvement, and re-free jejunal transfer with removal of the necrotic jejunum. Selecting the optimal procedure for each patient depends on the following factors. First, patients must have a good overall status to be able to endure re-free jejunal transfer, and next, the procedure is also dependent on local factors, including the intensity of the infections of the postoperative wound. RESULTS: One of the most common factors of jejunal necrosis is necrosis due to blood flow deficiency of the transferred tissue. However, among jejunal necrotic cases, some patients had no blood circulation disorder. We inferred that a non-occlusive mesenteric ischemia like occurred in the transferred jejunum, and also considered patients' overall status and necrotic association. Thus, patients who underwent re-free jejunal transfer are at an increased risk of experiencing re-necrosis. Based on these findings, we designed a jejunal necrosis algorithm. CONCLUSIONS: Early debridement and re-free jejunal transfer are optimal treatment options for patients with early-stage jejunal necrosis. Because re-jejunum transfer is a possible state after necrosis, it was thought that coping was the most important aspect of detection at an early stage.


Assuntos
Neoplasias Esofágicas/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Jejuno/transplante , Necrose , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia de Salvação/métodos , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Humanos , Neoplasias Hipofaríngeas/patologia , Jejuno/patologia , Faringectomia/efeitos adversos , Prognóstico
15.
Adv Otorhinolaryngol ; 83: 135-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943500

RESUMO

Recurrent hypopharyngeal cancer (rHPC) is a high-risk fatal disease associated with poor prognosis and high risk of complications in patients who are suitable to undergo salvage treatment. The treatment of such patients should be managed by a dedicated multidisciplinary team, most frequently a tertiary centre. and with the agreement of the patient. Close follow-up is crucial in achieving early detection and being able to treat the recurrence with curative intention. When persistent or recurrent disease is suspected, cross-sectional computed tomography imaging (CT) and positron emission tomography-CT scanning followed by panendoscopy with biopsies are the initial steps that need to be done in order to confirm diagnosis and accurate staging. The current treatment modality, which results in the best survival outcomes for rHCP is surgery. For most suitable patients, total pharyngolaryngectmy remains the best surgical modality, although open partial surgery OPS and transoral surgery are options for a small number of patients who have recurrences following treatment of an early stage disease. Free tissue transfer flaps or pedicled myocutaneous flaps will be necessary for most patients to reconstruct the excised pharynx. When making such a treatment plan it is most important to explain to each patient of the likely outcome both in terms of quantity and quality of life expectation. Many factors that are likely to increase the risk of treatment complications have been reported and are best anticipated and avoided. It is essential to perform a thorough preoperative assessment, follow a tried and trusted protocoled surgical plan and to have established enhanced recovery pathways for postoperative care that is available.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Faringectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia de Salvação/métodos , Humanos , Neoplasias Hipofaríngeas/patologia , Estadiamento de Neoplasias , Seleção de Pacientes , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Retalhos Cirúrgicos
16.
Adv Otorhinolaryngol ; 83: 54-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943502

RESUMO

There has been a general shift in the treatment of hypopharyngeal cancer from open surgical techniques (either radical or partial "organ" preserving) toward non-surgi cal "organ preserving" strategies (radiotherapy [RT] or chemoradiotherapy [CRT]) and minimally invasive transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Oncologic outcomes reported are comparable whatever modality is chosen, but better functional outcomes are observed in the RT/CRT and TLM/TORS-treated patients. Because of the high rate of second primary malignancies, which influences overall survival, one could favor an up-front transoral surgical procedure as a primary treatment modality for early hypoharyngeal carcinoma, leaving the (chemo)radiotherapeutic option open for treatment of a likely later emerging second primary. However, the TLM and TORS studies report a high rate of adjuvant irradiation-based treatment for close or positive margin excisions. Concerning post-treatment functionality, both RT/CRT and TLM/TORS yield satisfactory results, especially when compared to the open surgical procedures, but it remains unclear which of these options will result in the long-term best laryngopharyngeal functional outcome. There is a need for multi-institutional randomized controlled trials comparing the long term oncologic and functional outcomes of up-front minimal invasive transoral surgery with/without adjuvant treatment, to a primary non-surgical organ preservation treatment.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Humanos , Neoplasias Hipofaríngeas/terapia , Microcirurgia , Cirurgia Endoscópica por Orifício Natural , Estadiamento de Neoplasias , Radioterapia , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Operatórios/métodos
17.
Adv Otorhinolaryngol ; 83: 66-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943506

RESUMO

It is not uncommon for patients with hypopharyngeal cancer to present at an advanced stage of disease. Surgical treatment provides a cure for the tumour with immediate relief from obstruction to the airway and the swallowing passage. Careful planning of surgery is important to ensure good outcome of treatment and prevent complications, some of which may be fatal. The shape of the hypopharynx resembles that of a funnel, with a wide circumference above in continuity with the oropharynx, and a small circumference below where it joins with the cervical oesophagus. As a result, while small tumours require the partial removal of the hypopharynx, large tumours, especially those involving the post-cricoid region, warrant a complete, circumferential pharyngectomy. For tumours that invade the cervical esophagus, transcervical approach is still feasible, and this is facilitated by the removal of the manubrium, allowing access to the tumour and resection with clear margins. In the presence of synchronous tumours lower down in the esophagus, pharyngo-laryngo-esophagectomy is indicated. Successful reconstruction of defects after tumour extirpation allows proper wound healing and early delivery of adjuvant radiotherapy. It is also important to ensure quick recovery of the long-term swallowing function. It ranges from the use of the soft tissue flap with skin island that is sutured as a patch to the remnants of the pharyngeal mucosa, to the use of a visceral flap, such as the free jejunal flap, to repair the circumferential pharyngectomy defects. The treatment protocol is personalized according to the extent of the tumour and the characteristics of the patients.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Humanos , Neoplasias Hipofaríngeas/patologia , Neoplasias Hipofaríngeas/reabilitação , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Operatórios/métodos
18.
Adv Otorhinolaryngol ; 83: 148-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943508

RESUMO

Hypopharyngeal cancer patients have a very poor prognosis and limited therapeutic options. Seventy to eighty per cent of all hypopharyngeal cancer patients will require palliative and/or end-of-life care for incurable end-stage disease during the course of their illness. The overall proportion of hypopharyngeal cancer patients not qualifying for initial curative treatment, or requiring palliation and supportive care over time is higher than for any other subsite of the head and neck. Surgery and radiotherapy usually have a very limited role in this setting, while systemic therapy will usually compete with supportive care as the best approach. Advances in medicine and oncological treatments for the management of patients with recurrent head and neck cancer have given physicians the opportunity to prolong life where possible. However, this increase in survival might not be clinically meaningful if patients do not simultaneously experience palliative benefits, such as a reduction in symptoms and an improvement in their overall quality of life (QoL). The optimal outcome of palliative treatment is the control of symptoms with minimal treatment toxicities while improving QoL. It remains unclear if current palliative treatment options are better at improving QoL than the best supportive care. An intervention that results in insufficient or unacceptable functional status to the extent that the patient cannot achieve treatment goals - even in the course of prolonging life - is questionable. When used for palliative care purposes, surgery, chemotherapy and radiotherapy commonly have limited effectiveness in improving QoL. Moreover, if these treatments are not congruent with a patient's end-of-life goals, they could constitute low-value care.


Assuntos
Neoplasias Hipofaríngeas/terapia , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Humanos , Neoplasias Hipofaríngeas/tratamento farmacológico , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/cirurgia , Imunoterapia , Prognóstico , Qualidade de Vida
19.
Adv Otorhinolaryngol ; 83: 47-53, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943512

RESUMO

Patients with hypopharyngeal cancer are difficult to treat because they typically present with advanced disease, poor general health status and severe nutritional problems. Currently, treatment options for previously untreated and newly diagnosed hypopharyngeal cancer patients include surgery of the primary tumour and lymph nodes metastasis, radiotherapy, systemic medical treatment, including traditional chemotherapy and immunotherapy. Currently, a multimodal treatment approach is preferred using surgery, radiotherapy and systemic therapy with curative intent and best supportive care in patients considered unfit for curative treatment or patients presenting with distant metastatic spread. More detailed topics regarding the choice of treatment include biological and immunological host factors and their use for defining individualised cancer care, integration of novel therapies, integration of patient autonomy into clinical reasoning and dealing with patients' trade-offs between oncological outcome and individual quality of life, local availability of diagnostic therapeutic procedures and volume-outcome relationships for head and neck cancer surgery, radiotherapy and specialised supportive care. They also include considerations regarding potential delay between diagnosis and treatment, and between different treatment modalities within the frame of multimodal therapy. To date only one randomised trial comparing surgical versus non-surgical approaches has been published. Most randomised trials dealing with hypopharyngeal cancer compare different chemo- and radiotherapy regimen, but do not compare with a surgical approach. On the other hand, most studies on the results of surgery are best considered to be of low-quality case series. At the same time, many of the chemotherapy and radiation oncology studies in head and neck cancer include patients with different primary sites, where hypopharyngeal cancer patients when included usually account for a minority of the study population. Therefore, choosing the best treatment for an individual patient with hypopharyngeal cancer relies on personal experience and local expertise of the multidisciplinary team involved in the therapeutic process.


Assuntos
Neoplasias Hipofaríngeas/terapia , Hipofaringe/cirurgia , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Humanos , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/cirurgia , Imunoterapia
20.
Eur Arch Otorhinolaryngol ; 276(5): 1439-1446, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30927102

RESUMO

PURPOSE: This study was performed to examine the relationship of social adjustment with occupation and life changes in patients with laryngeal and hypopharyngeal cancer, from before laryngectomy to 1 year after hospital discharge. METHODS: The subjects were 27 patients with laryngeal and hypopharyngeal cancer who were admitted to hospital for laryngectomy and provided informed consent for participation in the study. The patients answered questionnaire surveys before surgery, and 3, 6, and 12 months after hospital discharge. Regarding social adjustment, social functioning (SF) and mental health (MH) in SF-36V2 were used as dependent variables, and time, occupation status, age, family structure, and sex as independent variables. Repeated measures analysis of variance was used to examine the main effect, and second- and third-order interactions were also examined. RESULTS: The age of the subjects was 62.9 ± 6.4 years and about 30% had an occupation. Loss of voice was the reason for 30% leaving work. In an examination of the main effects of the four variables, only age was significant regarding SF, and SF was favorable in subjects aged ≥ 64 years old. Regarding MH, age and family structure were significant, and MH was higher in older subjects who lived alone. The interaction between time and the other 3 variables was not significant. Only time/age/occupation was significant for MH. Regarding SF, a weak interaction was suggested, but it was not significant. CONCLUSION: Older subjects showed better social adjustment, and those who lived alone had better MH. These findings may have been due to a reduced environmental influence. MH of subjects with an occupation decreased more at 3 months or later after hospital discharge, compared to those without an occupation. Especially for younger patients, development of new approaches is required to allow families and colleagues of patients to understand the difficulties of patients with laryngeal and hypopharyngeal cancer.


Assuntos
Emprego , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/psicologia , Qualidade de Vida/psicologia , Ajustamento Social , Idoso , Feminino , Seguimentos , Humanos , Neoplasias Hipofaríngeas/psicologia , Neoplasias Laríngeas/psicologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Inquéritos e Questionários , Resultado do Tratamento
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