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1.
Einstein (Sao Paulo) ; 18: eAO5390, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32428067

RESUMO

Objective To describe functional and quality of life results after extended supratracheal laryngectomy. Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing. Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects. Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.


Assuntos
Deglutição/fisiologia , Laringectomia/métodos , Qualidade de Vida , Voz/fisiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
2.
Health Qual Life Outcomes ; 18(1): 92, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245483

RESUMO

INTRODUCTION: The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients. OBJECTIVE: Describe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy. METHOD: Observational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used. RESULTS: The study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice. CONCLUSION: The high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.


Assuntos
Laringectomia/psicologia , Qualidade de Vida , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
3.
Medicine (Baltimore) ; 99(16): e19771, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311983

RESUMO

BACKGROUND: For a long time, postoperative nutritional support for laryngeal cancer patients has depended on the gastric tube for enteral nutrition. Silica gel gastric tube is often used in clinical practice; however, the gastric tube placed in the conventional depth often leads to various complications in the stomach, thus damaging the nutritional status of patients and leading to the poor prognosis. METHODS/DESIGN: A total of 80 patients with laryngeal cancer in otolaryngology, head and neck surgery department of Deyang people's hospital from May 2020 to April 2022 will be selected and randomly divided into control group and experimental group according to the numerical table. Patients in the control group will receive conventional gastric tube placement, with a depth of 45 to 55 cm, which can extract gastric juice. B-ultrasound accurately positioned the gastric tube in the stomach instead of the cardia, and postoperative nasal feeding nutrition will be provided. In the experimental group, the gastric tube will be pulled out 10 cm after conventional placement and no gastric juice will be extracted. B-ultrasonography verified that the gastric tube will be located below the esophagus or above the cardia, and routine nasal feeding will be performed postoperatively. Analysis for comfort and prognosis were performed by general comfort questionnaire and various index including height, body mass index, albumin value, electrolyte, wound healing, pharyngeal fistula. DISCUSSION: In this study, visual simulation scale and general comfort questionnaire developed by Kolaba, an American comfort nursing specialist, were used to evaluate the comfort level of the 2 groups of patients, including pain, acid reflux, upper abdominal burning sensation, and hiccup. Objective indexes such as height, body mass index, albumin value, electrolyte, wound healing, and pharyngeal fistula were used to evaluate the prognosis of the 2 groups of patients. The visual simulation scale can preliminarily judge the subjective feelings of patients. TRIAL REGISTRATION: It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000030378), Registered February 29, 2020.


Assuntos
Nutrição Enteral/instrumentação , Neoplasias Laríngeas/cirurgia , Humanos , Período Pós-Operatório
4.
Head Neck ; 42(6): 1131-1136, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298006

RESUMO

BACKGROUND AND METHODS: There is an added level of complexity in the management of head and neck cancer patients with underlying immunosuppressive disorders during the COVID-19 pandemic. Head and neck oncologists are tasked with balancing the dual risks of cancer progression in the setting of impaired tumor immunity and increased susceptibility to life-threatening complications from exposure to viral infection for patients and providers. Through two cases of immunocompromised patients with newly diagnosed head and neck malignancies, we aim to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under these difficult circumstances. RESULTS: After careful consideration of the options, we took different approaches in the care of these two patients. CONCLUSIONS: Ultimately, there is no uniform set of rules to apply to this heterogeneous group of immunocompromised patients. We provide some general principles to help guide patient management during the current pandemic.


Assuntos
Tratamento Conservador/métodos , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Hospedeiro Imunocomprometido , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Tempo para o Tratamento/organização & administração , Adulto , Tomada de Decisão Clínica , Controle de Doenças Transmissíveis/métodos , Gerenciamento Clínico , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Comunicação Interdisciplinar , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Segurança do Paciente , Medição de Risco , Amostragem , Fatores de Tempo , Estados Unidos , Prega Vocal/patologia , Prega Vocal/cirurgia
5.
Int J Surg ; 76: 163-170, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32173614

RESUMO

BACKGROUND: Recurrence is still major obstacle to long-term survival in laryngeal squamous cell carcinoma (LSCC). We aimed to establish and validate a nomogram to precisely predict recurrence probability in patients with LSCC. METHODS: A total of 283 consecutive patients with LSCC received curative-intend surgery between 2011 and 2014 at were enrolled in this study. Subsequently, 283 LSCC patients were randomly assigned to a training cohort (N = 171) and a validation cohort (N = 112) in a 3:2 ratio. According to the results of multivariable Cox regression analysis in the training cohort, we developed a nomogram. The predictive accuracy and discriminative ability of the nomogram were evaluated by calibration curve and concordance index (C-index), and compared with TNM stage system by C-index, receiver operating characteristic (ROC) analysis. Decision curve analysis (DCA) was performed to estimate clinical value of our nomogram. RESULTS: Six independent factors rooted in multivariable analysis of the training cohort to predict recurrence were age, tumor site, smoking, alcohol, N stage and hemoglobin, which were all integrated into the nomogram. The calibration curve for the probability of recurrence presented that the nomogram-based predictions were in good correspondence with actual observations. The C-index of the nomogram was 0.81 (0.75-0.88), and the area under curve (AUC) of nomogram in predicting recurrence free survival (RFS) was 0.894, which were significantly better than traditional TNM stage. Decision curve analysis further affirmed that our nomogram had a larger net benefit than TNM stage. The results were confirmed in the validation cohort. CONCLUSION: A risk prediction nomogram for patients with LSCC, incorporating readily assessable clinicopathologic variables, generates more accurate estimations of the recurrence probability when compared TNM stage alone, but still needs additional data before being used in clinical implications.


Assuntos
Neoplasias Laríngeas , Recidiva Local de Neoplasia , Nomogramas , Adulto , Idoso , Área Sob a Curva , Calibragem , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Análise de Regressão , Estudos Retrospectivos
6.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 53-61, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090553

RESUMO

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças da Laringe/cirurgia , Doenças da Laringe/epidemiologia , Laringe/cirurgia , Microcirurgia , Papiloma/cirurgia , Riscos Ocupacionais , Envelhecimento/fisiologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/epidemiologia , Fatores Sexuais , Edema Laríngeo/cirurgia , Edema Laríngeo/epidemiologia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/epidemiologia , Registros Médicos , Estudos Transversais , Estudos Retrospectivos , Fatores Etários
8.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 4-10, mar. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1100756

RESUMO

Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)


A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Laríngeas/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/métodos , Prega Vocal/patologia , Qualidade da Voz , Traqueostomia/estatística & dados numéricos , Neoplasias Laríngeas/classificação , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/fisiopatologia , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/radioterapia , Estudos Prospectivos , Epiglote/patologia , Duração da Terapia , Intubação Gastrointestinal/estatística & dados numéricos
9.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(2): 261-263, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32220198

RESUMO

A 75-year-old male patient was hospitalized in hoarseness for 2 months. Laryngoscopy showed a mass protruding in right laryngeal chamber and covering the middle part of right vocal cord. Since tumor biopsy showed low differentiation cancer, he received total laryngectomy, and post-operative pathological result found composite carcinoma, which containing medium differentiated squamous cell carcinoma (about 5%) and low differentiated neuroendocrine carcinoma (about 95%). The growth status of tumor indicated it was collision carcinoma. After postoperative regular radiotherapy, no recurrence was found at 6 months of follow-up. The incidence of head and neck collision carcinoma is quite low, and the majority of them occurs in thyroid, which is rare in larynx. The confirmed diagnosis of larynx collision carcinoma is based on postoperative pathological study. The choice of treatment for collision cancer is closely related to the pathological components, the location of the disease and whether there is distant metastasis.


Assuntos
Carcinoma Neuroendócrino , Carcinoma de Células Escamosas , Neoplasias Laríngeas , Idoso , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/cirurgia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Diferenciação Celular , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringe/patologia , Masculino , Recidiva Local de Neoplasia
10.
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
11.
Ann Otol Rhinol Laryngol ; 129(7): 669-676, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32028778

RESUMO

BACKGROUND: Open partial laryngeal surgery (OPLS) represents a wide array of procedures that can be fitted to treat different types of laryngeal cancer (LC). We would like to present our 30-years' institutional experience, to analyze survival outcomes and to critically discuss prognostic factors. METHODS: We reviewed all cases of OPLS performed at our Institution from 1982 to 2016 for LC. Survival analysis by Kaplan-Meier estimate was performed and prognostic variables by multivariate analysis were identified. RESULTS: Mean follow-up time was 68.3 months, 30-day mortality 0.2%, subsequent functional total laryngectomy (TL) was 1.01%. Over 80% of cases were stage I to II. We had 25 local, 62 regional and eight distant recurrences. Local control was 94.9%, overall survival (OS) was 83.4% and disease-specific survival (DSS) was 87.7%. The two major risk factors significantly associated with the risk of death were cT and cN stage. CONCLUSIONS: We have confirmed that OPLS represents an oncologically sound option in the treatment of LC despite the emergence of non-surgical strategies and new transoral mininvasive techniques. Our results highlight that accurate staging, correct selection of the patient and a strong surgical expertise are of paramount importance in this type of surgery.


Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Neoplasias Ósseas/secundário , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Modelos Logísticos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Esvaziamento Cervical , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Prognóstico , Fatores de Risco , Terapia de Salvação , Taxa de Sobrevida , Adulto Jovem
12.
Artigo em Chinês | MEDLINE | ID: mdl-32086924

RESUMO

Objective:The aim of this study is to investigate the effect of CO2 laser cordectomy on the voice of early glottic carcinoma. Method:A retrospective analysis of 40 patients who underwent CO2 laser treatment early glottis preoperative clinical data of postoperative laryngeal cancer patients, patients with postoperative recurrence rate, survival rate, and the postoperative complications of patients with preoperative and postoperative laryngoscopy, voice disorders index(voice handicap index, VHI) simplified Chinese version(VHI 13) rating scale, affecting the stability sound quality postoperatively in patients with laryngeal cancer were discussed. Result:All patients underwent voice reexamination 8-97 months after surgery, and the survival rate was 100%, no local recurrence and no obvious postoperative complications. Compared with the healthy control group, there were statistically significant differences in the four indicators F0(fundamental frequency), Jitter(fundamental frequency perturbation), Shimmer(amplitude perturbation) and MPT(maximum pronunciation time), suggesting that CO2 laser surgery resulted in significant changes in acoustic parameters. Jitter and Shimmer indexes in the pre involved combined group were statistically significant different from those in the non involved combined group, suggesting that the sound quality of the pre involved combined group was worse in the postoperative stability period. The VHI score indicated that most patients with early glottic cancer were in severe voice disorder before operation and most were in moderate voice disorder after operation. Compared with the healthy control group, the VHI score and total score of the healthy control group were lower in terms of physiology, psychology and emotion. Compared with the healthy control group, the VHI score and physiology of the early glottic laryngeal cancer patients were lower in the early glottic laryngeal cancer patients before and after surgery, and they were statistically significant. Conclusion:CO2 laser surgery for early glottic cancer, the overall survival rate of patients, low recurrence rate, fewer complications, CO2 laser surgery led to significant changes in acoustic parameters, postoperative sound quality and whether the involvement of pre-associated factors; The total score of VHI and physiological score of early glottic carcinoma patients after CO2 laser operation were better than those before operation.


Assuntos
Neoplasias Laríngeas/cirurgia , Terapia a Laser , Lasers de Gás , Distúrbios da Voz/etiologia , Qualidade da Voz , Dióxido de Carbono , Glote/cirurgia , Humanos , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
13.
Br J Radiol ; 93(1109): 20190857, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32101463

RESUMO

OBJECTIVE: To study if pre-treatment CT texture features in locally advanced squamous cell carcinoma of laryngo-pharynx can predict long-term local control and laryngectomy free survival (LFS). METHODS: Image texture features of 60 patients treated with chemoradiation (CTRT) within an ethically approved study were studied on contrast-enhanced images using a texture analysis research software (TexRad, UK). A filtration-histogram technique was used where the filtration step extracted and enhanced features of different sizes and intensity variations corresponding to a particular spatial scale filter (SSF): SSF = 0 (without filtration), SSF = 2 mm (fine texture), SSF = 3-5 mm (medium texture) and SSF = 6 mm (coarse texture). Quantification by statistical and histogram technique comprised mean intensity, standard-deviation, entropy, mean positive pixels, skewness and kurtosis. The ability of texture analysis to predict LFS or local control was determined using Kaplan-Meier analysis and multivariate cox model. RESULTS: Median follow-up of patients was 24 months (95% CI:20-28). 39 (65%) patients were locally controlled at last follow-up. 10 (16%) had undergone salvage laryngectomy after CTRT. For both local control & LFS, threshold optimal cut-off values of texture features were analyzed. Medium filtered-texture feature that were associated with poorer laryngectomy free survival were entropy ≥4.54, (p = 0.006), kurtosis ≥4.18; p = 0.019, skewness ≤-0.59, p = 0.001, and standard deviation ≥43.18; p = 0.009). Inferior local control was associated with medium filtered features entropy ≥4.54; p 0.01 and skewness ≤ - 0.12; p = 0.02. Using fine filters, entropy ≥4.29 and kurtosis ≥-0.27 were also associated with inferior local control (p = 0.01 for both parameters). Multivariate analysis showed medium filter entropy as an independent predictor for LFS and local control (p < 0.001 & p = 0.001). CONCLUSION: Medium texture entropy is a predictor for inferior local control and laryngectomy free survival in locally advanced laryngo-pharyngeal cancer and this can complement clinico-radiological factors in predicting prognosticating these tumors. ADVANCES IN KNOWLEDGE: Texture features play an important role as a surrogate imaging biomarker for predicting local control and laryngectomy free survival in locally advanced laryngo-pharyngeal tumors treated with definitive chemoradiation.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Neoplasias Laríngeas/mortalidade , Laringectomia/mortalidade , Neoplasias Faríngeas/mortalidade , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/diagnóstico por imagem , Neoplasias Faríngeas/cirurgia , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
HNO ; 68(1): 59-68, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31950226

RESUMO

Transoral laser microsurgery (TLM) for treatment of laryngeal cancer has reduced temporary tracheotomies, increased organ preservation rates, and improved functional results. Gold standard for laser-based transoral resection of laryngeal cancer is the application of CO2 lasers. Oncologically safe radical resection and postoperative voice outcome must be weighed up individually. Angiolytic laser effects enable modification of the tumor micromilieu by targeted obliteration of microvessels and antagonization of angiogenesis with preservation of vibrating laryngeal tissue for good voice function. Introduction of the German S3 guideline on diagnosis, treatment, and follow-up of laryngeal cancer is a critical step towards national evidence-based standardization. Internationally, the evidence for treatment of laryngeal mucosal dysplasia and T1a cancer with angiolytic potassium titanyl phosphate (KTP) lasers is increasing. Angiolytic lasers are also used for juvenile papillomatosis and suspension microlaryngoscopy under general anesthesia or local anesthesia in selected patients.


Assuntos
Neoplasias Laríngeas , Laringe , Terapia a Laser , Microcirurgia , Adolescente , Humanos , Neoplasias Laríngeas/cirurgia , Laringoscopia , Laringe/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
15.
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
16.
Ann Otol Rhinol Laryngol ; 129(3): 273-279, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31672022

RESUMO

OBJECTIVES: The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics. METHODS: Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture). RESULTS: EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques. CONCLUSIONS: EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.


Assuntos
Laringectomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Idoso de 80 Anos ou mais , Cadáver , Cartilagem Cricoide/cirurgia , Epiglote/cirurgia , Estudos de Viabilidade , Humanos , Osso Hioide/cirurgia , Neoplasias Laríngeas/cirurgia , Masculino , Cirurgia Endoscópica por Orifício Natural/instrumentação , Músculos do Pescoço/cirurgia
19.
Braz J Otorhinolaryngol ; 86(2): 228-236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30683565

RESUMO

INTRODUCTION: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. OBJECTIVE: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. METHODS: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. RESULTS: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p=0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p=0.03) and large pharyngostomes (64.3% versus 0%, p=0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p=0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p=0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. CONCLUSIONS: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.


Assuntos
Fístula Cutânea/etiologia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Retalhos Cirúrgicos/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Cutânea/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
20.
BMC Infect Dis ; 19(1): 1060, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847817

RESUMO

BACKGROUND: To enhance awareness of the clinical features and prevention of endotracheal myiasis. CASE PRESENTATION: A case of intratracheal myiasis is reported. A 61-year-old male patient with a history of laryngectomy was admitted to hospital due to tracheostomal hemorrhage of 3 h duration. Intratracheal myiasis was confirmed by bronchoscopy, and the patient underwent bronchoscopic intervention, which was complicated by a tracheal-esophageal fistula and resolved by endotracheal stenting. Twenty months after stent placement, the fistula had not healed. CONCLUSION: Intratracheal myiasis has serious complications and is difficult to treat. For post-tracheostomy patients, healthcare providers and caregivers should pay attention to the care and monitoring of wounds and maintenance of a tidy, clean living environment to prevent intratracheal myiasis.


Assuntos
Eletrocoagulação/efeitos adversos , Miíase/cirurgia , Fístula Traqueoesofágica/etiologia , Animais , Broncoscopia , Cânula/parasitologia , Carcinoma de Células Escamosas/cirurgia , Seguimentos , Humanos , Larva , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Miíase/etiologia , Stents , Traqueia/parasitologia , Fístula Traqueoesofágica/terapia , Traqueostomia/efeitos adversos , Resultado do Tratamento
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