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1.
Rev Assoc Med Bras (1992) ; 66(3): 380-384, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32520162

RESUMO

INTRODUCTION: Radiotherapy (RT) plays an important role in the treatment of patients with head and neck neoplasia, and is frequently used as postoperative adjuvant therapy. This study aimed to review the literature about timing factors that may influence the clinical outcomes of patients with advanced head and neck neoplasia treated with adjuvant RT. RESULTS: Timing factors such as total treatment time, length of adjuvant RT, and the absence of interruptions during RT may influence the clinical outcome of these patients. CONCLUSIONS: In the same way that certain tumor factors can affect the prognosis of patients with squamous cell carcinoma of the head and neck, some therapeutic timing factors are also prognostic factors and therefore, must be carefully orchestrated in order to avoid loss at therapeutic outcomes for these patients.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Terapia Combinada , Intervalo Livre de Doença , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Radioterapia Adjuvante , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Taxa de Sobrevida , Fatores de Tempo
2.
Otolaryngol Head Neck Surg ; 162(6): 959-968, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32484763

RESUMO

OBJECTIVE: Identify risk factors and perioperative morbidity for patients undergoing branchial cleft cyst (BCC) excision. STUDY DESIGN: Cross-sectional analysis. SETTING: American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases (NSQIP and NSQIP-P). SUBJECT AND METHODS: Patients who underwent BCC excision (Current Procedural Terminology 42810, 42815) were queried via NSQIP (2005-2016) and NSQIP-P (2012-2016). Outcomes analyzed include patient demographics, medical comorbidities, admission type, operative characteristics, length of hospital stay, postoperative complications, and readmission. RESULTS: A total of 1775 children and 677 adults were identified. Mean age at time of surgery was 4.6 years for children and 38.6 years for adults. Outpatient procedures were performed in 87.1% of adults and 94.0% of children (P < .001). Postoperative complications were uncommon, occurring in <1% of adults and 3.9% of children (P < .001). Similarly, readmission occurred in 1.2% of adults and 1.1% of children. In adults, smoking status was shown to have a significant effect on postoperative complications (odds ratio, 6.25; P = .037). Age group did not have an effect on the complication rate in the pediatric population. Pediatric otolaryngologists had higher rates of postoperative complications (P = .001), prolonged operative times (P < .001), and fewer outpatient procedures (P < .001). Conversely, in adults, otolaryngologists had fewer postoperative complications. CONCLUSION: Postoperative complications following BCC excision are relatively uncommon, demonstrating procedural safety when performed at any age.


Assuntos
Branquioma/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
3.
Head Neck ; 42(6): 1179-1186, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459061

RESUMO

BACKGROUND: The novel coronavirus 2019 (COVID-19) pandemic has changed health care, challenged by resource constraints and fears of transmission. We report the surgical practice pattern changes in a Head and Neck Surgery department of a tertiary cancer care center and discuss the issues surrounding multidisciplinary care during the pandemic. METHODS: We report data regarding outpatient visits, multidisciplinary treatment planning conference, surgical caseload, and modifications of oncologic therapy during this pandemic and compared this data to the same interval last year. RESULTS: We found a 46.7% decrease in outpatient visits and a 46.8% decrease in surgical caseload, compared to 2019. We discuss the factors involved in the decision-making process and perioperative considerations. CONCLUSIONS: Surgical practice patterns in head and neck oncologic surgery will continue to change with the evolving pandemic. Despite constraints, we strive to prioritize and balance the oncologic and safety needs of patients with head and neck cancer in the face of COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/organização & administração , Oncologia Cirúrgica/organização & administração , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Pneumonia Viral/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Análise de Sobrevida , Centros de Atenção Terciária/organização & administração , Estados Unidos
4.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(3): 161-166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32362564

RESUMO

In Otorhinolaryngology - Head and Neck Surgery, clinical examination and invasive procedures on the respiratory tract and on airway-connected cavities, such as paranasal sinuses and the middle ear, expose people to direct transmission of SARS-CoV-2 by inhalation or ocular projection of contaminated droplets, and to indirect transmission by contact with contaminated hands, objects or surfaces. Estimating an R0 of COVID-19 at around 3 justified postponing non-urgent face-to-face consultations and expanding the use of teleconsultation in order to limit the risks of SARS-CoV-2 infection of patients or health workers and comply with the lockdown. The health authority recommends cancellation of all medical or surgical activities, which are not urgent as long as this does not involve a loss of chance for the patient. The purpose of this cancellation is to significantly increase critical care capacity, prioritise the reception of patients with COVID-19, prioritise the allocation of staff and provision of the equipment necessary for their medical or surgical management, and contribute to the smooth running of downstream critical care within their establishment. Another goal is to reduce the risks of patient contamination within healthcare facilities. This document provides guidance on how to proceed with and adapt ENT surgery in the current pandemic context, as well as on the management of postponed operations. This best practice advice must of course be adapted in each region according to the development of the epidemic and pre-existing arrangements. Their local application can only be decided within the framework of collaboration between the ENT teams, the operational hygiene units and all the other specialties concerned.


Assuntos
Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , França/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Otolaringologia/métodos , Otolaringologia/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
6.
Head Neck ; 42(6): 1209-1213, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298035

RESUMO

Head and neck cancer patients with tracheostomies and laryngectomies, as well as their healthcare providers, face unique challenges in the context of the current COVID-19 pandemic. This document consolidates best available evidence to date and presents recommendations to minimize the risks of aerosolization and SARS-CoV-2 exposures in both the inpatient and outpatient settings. The cornerstones of these recommendations include the use of closed-circuit ventilation whenever possible, cuffed tracheostomy tubes, judicious use of heat moisture exchange units, appropriate personal protective equipment for providers and patients, meticulous hand hygiene, and minimal manipulation of tracheostomy tubes.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Neoplasias de Cabeça e Pescoço/cirurgia , Laringectomia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Traqueostomia/métodos , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Medicina Baseada em Evidências , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Medição de Risco , Oncologia Cirúrgica/normas , Estados Unidos
7.
Head Neck ; 42(6): 1168-1172, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32329923

RESUMO

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has caused rapid changes in head and neck cancer (HNC) care. "Real-time" methods to monitor practice patterns can optimize provider safety and patient care. METHODS: Head and neck surgeons from 14 institutions in the United States regularly contributed their practice patterns to a shared spreadsheet. Data from 27 March 2020 to 5 April 2020 was analyzed. RESULTS: All institutions had significantly restricted HNC clinic evaluations. Two institutions stopped free-flap surgery with the remaining scheduling surgery by committee review. Factors contributing to reduced clinical volume included lack of personal protective equipment (PPE) (35%) and lack of rapid COVID-19 testing (86%). CONCLUSIONS: The COVID-19 pandemic has caused a reduction in HNC care. Rapid COVID-19 testing and correlation with infectious potential remain paramount to resuming the care of patients with head and neck cancer. Cloud-based platforms to share practice patterns will be essential as the pandemic evolves.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Microcirurgia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/organização & administração , Oncologia Cirúrgica/organização & administração , Técnicas de Laboratório Clínico , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Bases de Dados Factuais , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Oncologia/organização & administração , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Sociedades Médicas , Inquéritos e Questionários , Estados Unidos
8.
Head Neck ; 42(6): 1243-1247, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32338790

RESUMO

The 2019 novel coronavirus (COVID-19) pandemic has created significant challenges to the delivery of care for patients with advanced head and neck cancer requiring multimodality therapy. Performing major head and neck ablative surgery and reconstruction is a particular concern given the extended duration and aerosolizing nature of these cases. In this manuscript, we describe our surgical approach to provide timely reconstructive care and minimize infectious risk to the providers, patients, and families.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Neoplasias de Cabeça e Pescoço/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Centros Médicos Acadêmicos , Tomada de Decisão Clínica , Infecções por Coronavirus/prevenção & controle , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Comunicação Interdisciplinar , Masculino , Esvaziamento Cervical/métodos , Saúde do Trabalhador , Pandemias/prevenção & controle , Segurança do Paciente , Seleção de Pacientes , Pennsylvania , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Medição de Risco , Retalhos Cirúrgicos/transplante
9.
Head Neck ; 42(6): 1202-1208, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32338807

RESUMO

The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our health care system by the Coronavirus disease 2019 (COVID-19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.


Assuntos
Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Oncologia Cirúrgica/normas , Canadá , China , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/normas , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Monitorização Intraoperatória/métodos , Saúde do Trabalhador , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Segurança do Paciente , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/normas
10.
Head Neck ; 42(6): 1194-1201, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32342541

RESUMO

BACKGROUND: COVID-19 pandemic has strained human and material resources around the world. Practices in surgical oncology had to change in response to these resource limitations, triaging based on acuity, expected oncologic outcomes, availability of supportive resources, and safety of health care personnel. METHODS: The MD Anderson Head and Neck Surgery Treatment Guidelines Consortium devised the following to provide guidance on triaging head and neck cancer (HNC) surgeries based on multidisciplinary consensus. HNC subsites considered included aerodigestive tract mucosa, sinonasal, salivary, endocrine, cutaneous, and ocular. RECOMMENDATIONS: Each subsite is presented separately with disease-specific recommendations. Options for alternative treatment modalities are provided if surgical treatment needs to be deferred. CONCLUSION: These guidelines are intended to help clinicians caring for patients with HNC appropriately allocate resources during a health care crisis, such as the COVID-19 pandemic. We continue to advocate for individual consideration of cases in a multidisciplinary fashion based on individual patient circumstances and resource availability.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto/normas , Oncologia Cirúrgica/normas , Betacoronavirus , Institutos de Câncer , Controle de Doenças Transmissíveis/normas , Consenso , Infecções por Coronavirus/prevenção & controle , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Saúde do Trabalhador , Pandemias/prevenção & controle , Segurança do Paciente , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Triagem/normas , Estados Unidos
12.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(3): 159-160, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32303485

RESUMO

In the context of the current pandemic, there is a need for specific advice concerning treatment of patients with Head and Neck cancers. The rule is to limit as much as possible the number of patients in order to reduce the risks of contamination by the SARS-Cov-2 virus for both patients and the caregivers, who are particularly exposed in ENT. The aim is to minimize the risk of loss of opportunity for patients and to anticipate the increased number of cancer patients to be treated at the end of the pandemic, taking into account the degree of urgency, the difficulty of the surgery, the risk of contaminating the caregivers (tracheotomy) and the local situation (whether or not the hospital and intensive care departments are overstretched).


Assuntos
Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Oncologia Cirúrgica/métodos , Oncologia Cirúrgica/normas , Betacoronavirus/isolamento & purificação , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , França/epidemiologia , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia , Traqueostomia/métodos , Traqueostomia/normas
13.
Oral Oncol ; 105: 104684, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32330858

RESUMO

The COVID-19 pandemic demands reassessment of head and neck oncology treatment paradigms. Head and neck cancer (HNC) patients are generally at high-risk for COVID-19 infection and severe adverse outcomes. Further, there are new, multilevel COVID-19-specific risks to patients, surgeons, health care workers (HCWs), institutions and society. Urgent guidance in the delivery of safe, quality head and neck oncologic care is needed. Novel barriers to safe HNC surgery include: (1) imperfect presurgical screening for COVID-19; (2) prolonged SARS-CoV-2 aerosolization; (3) occurrence of multiple, potentially lengthy, aerosol generating procedures (AGPs) within a single surgery; (4) potential incompatibility of enhanced personal protective equipment (PPE) with routine operative equipment; (5) existential or anticipated PPE shortages. Additionally, novel, COVID-19-specific multilevel risks to HNC patients, HCWs and institutions, and society include: use of immunosuppressive therapy, nosocomial COVID-19 transmission, institutional COVID-19 outbreaks, and, at some locations, societal resource deficiencies requiring health care rationing. Traditional head and neck oncology doctrines require reassessment given the extraordinary COVID-19-specific risks of surgery. Emergent, comprehensive management of these novel, multilevel surgical risks are needed. Until these risks are managed, we temporarily favor nonsurgical therapy over surgery for most mucosal squamous cell carcinomas, wherein surgery and nonsurgical therapy are both first-line options. Where surgery is traditionally preferred, we recommend multidisciplinary evaluation of multilevel surgical-risks, discussion of possible alternative nonsurgical therapies and shared-decision-making with the patient. Where surgery remains indicated, we recommend judicious preoperative planning and development of COVID-19-specific perioperative protocols to maximize the safety and quality of surgical and oncologic care.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Oncologia/métodos , Pneumonia Viral/epidemiologia , Aerossóis , Betacoronavirus , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Controle de Infecções , Pandemias , Equipamento de Proteção Individual , Oncologia Cirúrgica
14.
Head Neck ; 42(6): 1159-1167, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298036

RESUMO

The COVID-19 pandemic has placed an extraordinary demand on the United States health care system. Many institutions have canceled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent-proceed with surgery, less urgent-consider postpone > 30 days, less urgent-consider postpone 30 to 90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Agendamento de Consultas , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Prioridades em Saúde , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Oncologia Cirúrgica/organização & administração , Estados Unidos
15.
Head Neck ; 42(6): 1308-1309, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298018

RESUMO

The 2019 novel coronavirus disease (COVID-19) has presented the world and physicians with a unique public health challenge. In light of its high transmissibility and large burden on the health care system, many hospitals and practices have opted to cancel elective surgeries in order to mobilize resources, ration personal protective equipment and guard patients from the virus. Head and neck cancer physicians are particularly affected by these changes given their scope of practice, complex patient population, and interventional focus. In this viewpoint, we discuss some of the many challenges faced by head and neck surgeons in this climate. Additionally, we outline the utility of telemedicine as a potential strategy for allowing physicians to maintain an effective continuum of care.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Neoplasias de Cabeça e Pescoço/cirurgia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Otolaringologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Telemedicina , Betacoronavirus , Humanos
17.
Otolaryngol Head Neck Surg ; 162(6): 795-796, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32255735

RESUMO

The recent Italian outbreak of coronavirus disease 2019 led to an unprecedented burden on our health care system. Despite head and neck-otolaryngology not being a front-line specialty in dealing with this disease, our department had to face several specific issues. Despite a massive reallocation of resources in the hospital, we managed to keep the service active, improving safety measures for our personnel, specifically during common otolaryngologic maneuvers known to produce aerosols. Furthermore, we strived to maintain our teaching role, giving residents an inclusive role in managing the response to the emergency state, and we progressively integrated our inactive specialists into other service rotations to relieve front-line colleagues' burden. Specific issues and management decisions are discussed in detail in the article.


Assuntos
Infecções por Coronavirus/epidemiologia , Efeitos Psicossociais da Doença , Surtos de Doenças/economia , Gastos em Saúde , Otolaringologia/economia , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/patologia , Surtos de Doenças/estatística & dados numéricos , Feminino , Cabeça/fisiopatologia , Cabeça/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/cirurgia , Recursos em Saúde/economia , Departamentos Hospitalares/economia , Humanos , Itália , Masculino , Pescoço/fisiopatologia , Pescoço/cirurgia , Otolaringologia/estatística & dados numéricos , Pandemias , Pneumonia Viral/patologia , Medição de Risco , Papel (figurativo)
18.
Zhonghua Zhong Liu Za Zhi ; 42(3): 247-251, 2020 Mar 23.
Artigo em Chinês | MEDLINE | ID: mdl-32252205

RESUMO

Objective: To investigate the causes and influencing factors of unplanned reoperation in head and neck neoplasms. Methods: A retrospective analysis was conducted on the clinical data of the operation treated patients with head and neck neoplasm in Cancer Hospital Chinese Academy of Medical Sciences from 2016 to 2018. Results: Among 15 113 cases of head and neck neoplasms, 122 cases underwent unplanned reoperation, with an incidence of 0.81%. Unplanned reoperation mainly occurred within 24 hours after operation. The main causes of reoperation were bleeding (65.57%), lymphatic fistula (15.57%) and vascular crisis (9.84%). Sex, surgical site, grade of the first operation, grade of incision and grade of American Society of Anesthesiologists were associated with unplanned reoperations. The first surgical sites with higher probability of unplanned reoperation were tonsils (15.79%), gingiva (8.93%), oropharynx (8.33%), hypopharynx (4.79%) and tongue (3.17%), respectively. Unplanned reoperation resulted in an average expand of 121.66% in hospitalization time and 99.35% in hospitalization expenses. Conclusions: Unplanned reoperation increases hospital operating costs and patients' burden. We should pay close attention to the situation of patients within 24 hours after operation, and focus on preventing bleeding, lymphatic fistula and vascular crisis.We should make adequate preoperative evaluation and preparation for elderly male patients with high surgical grade, surgical incision and ASA grade, especially for the patients whose surgical sites were tonsil, gingiva, oropharynx, hypopharynx and tongue.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Reoperação/estatística & dados numéricos , Idoso , Perda Sanguínea Cirúrgica , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Incidência , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
19.
J Cancer Res Clin Oncol ; 146(5): 1343-1350, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32144535

RESUMO

PURPOSE: Adenoid cystic carcinoma (AdCC) is generally slow growing but has highly metastatic potential to distant organs. Several factors and biomarkers are associated with metastasis and treatment outcomes, although further definition is needed. Therefore, this study aimed to evaluate the risk factors for survival and distant metastasis in patients with head and neck AdCC. METHODS: This study included 125 patients with previously untreated AdCC who underwent primary surgery with or without radiotherapy in our tertiary referral centre. Univariate and multivariate Cox proportional hazard regression analyses were used to identify risk factors associated with overall survival (OS), cause-specific survival (CSS), disease-free survival (DFS), and distant metastasis-free survival (DMFS). Factors associated with OS in patients with distant metastasis were separately analysed. RESULTS: During a median follow-up of 9.8 years (range 3.0-22.6 years), 58 patients (46.4%) had distant metastasis and 29 (23.2%) died of disease. Multivariate analyses showed that lymphovascular invasion, lymph node metastasis, and distant metastasis were independent factors of OS and CSS outcomes (all P < 0.05). The T classification and extranodal extension were independent factors of DFS and DMFS outcomes (P < 0.05). After patients presented with distant metastasis, the median survival was 5.8 years. Multivariate analyses showed that extranodal extension and regional recurrence were independent factors of survival after occurrence of distant metastasis (P < 0.05). CONCLUSION: Several clinicopathological factors can predict distant metastasis and survival of patients with AdCC treated with primary surgery. This may promote post-treatment surveillance in patients with AdCC.


Assuntos
Carcinoma Adenoide Cístico/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Adolescente , Adulto , Idoso , Carcinoma Adenoide Cístico/mortalidade , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/radioterapia , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
20.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(2): 115-118, 2020 Feb 09.
Artigo em Chinês | MEDLINE | ID: mdl-32074673

RESUMO

Objective: To introduce a new surgical procedure for the treatment of neck benign tumors by endoscopic techniques. Methods: Seventeen patients with neck benign tumor underwent surgery by endoscope through a concealed incision in Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University from January 2018 to August 2019 were analyzed, which included 3 cases of tumor in the submental area, 2 cases in submandibular region, 9 cases in lower pole region of parotid gland, 1 case in superior region of sternocleidomastoid muscle, 1 case in central region of sternocleidomastoid muscle, 1 case in inferior region of sternocleidomastoid muscle. All patients underwent routine preoperative examination and CT examination to evaluate tumor size, boundary, morphology and nature. According to the area where the tumor located, concealed incisions in different sites were designed. Lumps in the submental area and submandibular area were treated with oral vestibular sulcus incision. Benign tumors located in the lower pole region of parotid gland and the sternocleidomastoid muscle region were treated with approach of the short hidden postauricular incision. During the operation, the self-developed "maxillofacial suspension device" was used to provide the operating space. The tumors were completely removed with endoscope and all patients were followed up every 3 months. Results: All surgical procedures were performed as expected. Visual analogue scale (VAS) was 9.3 on average at 3 months after operation, all the patients were satisfied with the incision design and the cosmetic effect. No recurrences were found in patients with a follow-up period ranged from 1-15 months. Conclusions: These studies have shown that endoscope-assisted neck benign tumor resection is a surgical procedure with covert incision and good cosmetic results.


Assuntos
Endoscopia , Neoplasias de Cabeça e Pescoço/cirurgia , Endoscópios , Humanos
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