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1.
Neuroimaging Clin N Am ; 32(1): 37-53, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809843

RESUMO

Cancers of the pharynx and larynx are treated using a combination of chemotherapeutic, radiation, and surgical techniques, depending on the cancer type, biology, location, and stage, as well as patient and other factors. When imaging in the postsurgical setting, the knowledge of the type of tumor, preoperative appearance, and type of surgery performed is essential for accurate interpretation. Surgical anatomic changes, surgical implants/devices, and potential postsurgical complications must be differentiated from suspected recurrent tumors.


Assuntos
Neoplasias Laríngeas , Laringe , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Laringectomia , Laringe/diagnóstico por imagem , Laringe/cirurgia , Faringectomia , Faringe/diagnóstico por imagem , Faringe/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem
2.
Curr Opin Otolaryngol Head Neck Surg ; 30(1): 3-12, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34958319

RESUMO

PURPOSE OF REVIEW: Recently, endoscopic nasopharyngectomy (ENPG) has become an effective treatment for locally recurrent nasopharyngeal carcinoma (NPC). This article reviews recent publications on ENPG and specifically addresses the surgical anatomy of the nasopharynx and discusses several important issues regarding ENPG. RECENT FINDINGS: The surgical techniques for ENPG have been previously described in several studies. The latest published data revealed good outcomes of ENPG compared with intensity-modulated radiation therapy (IMRT) in recurrent NPC. In addition, ENPG avoids severe reirradiation side effects. This review highlights the surgical anatomy of ENPG, which is important in preventing possible serious complications. SUMMARY: ENPG is a good option for managing recurrent NPC. Careful preoperative evaluation and a full understanding of the surgical anatomy help in preventing damage to nearby critical neurovascular structure. Long-term follow-up is still needed to evaluate its eventual morbidity and efficacy.


Assuntos
Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Humanos , Carcinoma Nasofaríngeo/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Faringectomia
3.
Clin Nucl Med ; 46(12): 999-1001, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34735410

RESUMO

ABSTRACT: A 75-year-old woman had an occasional finding of a left tonsil mass for dysphagia, which resulted a high-grade squamous carcinoma. Therefore, the patient was sent to have a left pharyngectomy. After the pharyngectomy, the patient reported persistent swallowing disorders and nasal reflux. Consequently, she had an oropharyngoesophageal scintigraphy, demonstrating irregular oral and pharyngeal swallowing phases and confirming reflux episodes into the rhinopharynx and into the oropharynx. In line with these findings, the patient was send to rehabilitation; the abnormal functional mechanisms, previously identified by the scintigraphy, allowed to guide the speech therapy, with a progressive clinical improvement.


Assuntos
Carcinoma de Células Escamosas , Transtornos de Deglutição , Procedimentos Cirúrgicos Bucais , Idoso , Carcinoma de Células Escamosas/cirurgia , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Humanos , Faringectomia , Cintilografia
4.
Ann Surg Oncol ; 28(13): 8996-9007, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34585295

RESUMO

BACKGROUND: This study retrospectively analyzed the feasibility and surgical outcome of an algorithmic approach using negative pressure wound therapy for patients with synchronous hypopharyngeal and esophageal cancer undergoing pharyngolaryngoesophagectomy with gastric tube reconstruction. METHODS: Patients undergoing pharyngolaryngoesophagectomy and gastric tube reconstruction for hypopharyngeal cancer between 2011 and 2019 were candidates for this study. Data were collected on patient demographics, comorbidities, performance status, cancer stage, treatment, complication, and survival. Survival analysis was performed using the Kaplan-Meier method. The Cox proportional hazards model was used for prognostic factors. RESULTS: The study enrolled 43 patients. Anastomotic leakage was found in 21 of the patients with a conventional surgical drain (61.9%) and in 10 of the 22 patients with negative pressure wound therapy (45.5%) (p = 0.280). Nine patients in the conventional drain group (42.9%) and two patients in the negative pressure wound therapy group (9.1%) had leakage-associated complications (p = 0.011). The incidence of pulmonary complications was higher in the conventional surgical drain group (9 vs 2; p = 0.011). The number of complications requiring surgery was higher in the conventional drain group (7 vs 0; p = 0.004). The overall survival in the negative pressure wound therapy group was better (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.15-0.76; p = 0.009). Negative pressure wound therapy was independently associated with overall survival (HR, 0.31; 95% CI, 0.13-0.77; p = 0.011). CONCLUSIONS: Negative pressure wound therapy with an algorithmic approach improved the overall survival for the patients undergoing gastric tube reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal and esophageal cancer by preventing deadly complications secondary to anastomotic leakage.


Assuntos
Neoplasias Esofágicas , Tratamento de Ferimentos com Pressão Negativa , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Faringectomia/efeitos adversos , Estudos Retrospectivos
5.
J Plast Reconstr Aesthet Surg ; 74(8): 1779-1790, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33931325

RESUMO

BACKGROUND: There is a lack of consensus regarding the superiority of the common free flaps for the reconstruction of circumferential pharyngeal defects. METHODS: A systematic literature search was conducted to identify studies reporting the complications of circumferential pharyngeal reconstruction between 2005 and 2020. Anterolateral thigh free flaps (ALTFF), jejunal free flaps (JFF), and radial forearm free flaps (RFFF) were compared. Various complications were compared by meta-analysis. Primary endpoints were fistula and stricture rates. RESULTS: Forty studies were included (2230 patients). Stricture rate was similarly low with tubed ALTFF (13.3%, n = 36/270) and JFF (13.2%, n = 176/1334). Fistula rate was the lowest with JFF (9.2%, n = 58/634). ALTFF was associated with the lowest rates of partial and complete flap failure (3.8%, n = 6/157, and 2.8%, n = 5/178), infection (2.8%, n = 3/106), donor site morbidity (3.9%, n = 5/130), and mortality (0%, n = 0/101) within 30 days. A meta-analysis demonstrated that there was no statistically significant difference in stricture and fistula rates between ALTFF and JFF. Moreover, JFF was associated with a significantly lower fistula rate than that of RFFF (p < 0.001). ALTFF was associated with a significantly lower infection rate than that of JFF (p = 0.013). CONCLUSIONS: The data suggest the use of ALTFF for circumferential pharyngeal defects. In the absence of randomized, prospective data, the authors hope the results presented can be used as an evidence-based reference.


Assuntos
Retalhos de Tecido Biológico/transplante , Faringe/cirurgia , Antebraço/cirurgia , Humanos , Jejuno/cirurgia , Faringectomia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Coxa da Perna/cirurgia
6.
Medicine (Baltimore) ; 100(20): e25959, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011078

RESUMO

RATIONALE: Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of frequent syncopal episodes after laryngopharyngectomy for hypopharyngeal cancer. As all syncopal episodes were observed during the forenoon, we also evaluated the heart rate variability using ambulatory electrocardiography to determine why the syncopal episodes occurred during a specified period of the day. PATIENT CONCERNS: A 73-year-old Japanese man who underwent laryngopharyngectomy for recurrent hypopharyngeal cancer started experiencing frequent episodes of loss of consciousness that occurred during the same time period (10:00-12:00). He had never experienced syncopal episodes before the operation. From 23 to 41 days postoperatively, he experienced 9 syncopal episodes that occurred regardless of his posture. DIAGNOSES: Pharyngo-esophagoscopy revealed an anastomotic stricture between the free jejunum graft and the upper esophagus. Swallowing videofluoroscopy confirmed the dilatation of the jejunal autograft and a foreign body stuck on the oral side of the anastomosis. Contrast-enhanced computed tomography revealed that the carotid artery was slightly compressed by the edematous free jejunum. The patient was diagnosed with carotid sinus syndrome (CSS) as the free jejunum was dilated when consuming breakfast, which may have caused carotid sinus hypersensitivity and induced a medullary reflex. INTERVENTIONS: Administration of disopyramide was effective in preventing syncope. Heart rate variability analysis using ambulatory electrocardiography showed that parasympathetic dominancy shifted to sympathetic dominancy during 10:00 to 12:00. The significant time regularity of the syncopal episodes may have been affected by modified diurnal variation in autonomic tone activity. OUTCOMES: After the surgical release and re-anastomosis of the pharyngoesophageal stenosis via an open-neck approach, no recurrent episodes of syncope were reported. LESSONS: We reported a case of frequent syncopal episodes limited to the forenoon due to CSS after surgery for hypopharyngeal carcinoma. The patient was treated with anticholinergics followed by the release and re-anastomosis of the pharyngoesophageal stenosis. When syncope occurs after surgery for head and neck lesions, CSS due to postoperative structural changes should be considered as a differential diagnosis of syncope.


Assuntos
Seio Carotídeo/fisiologia , Estenose Esofágica/diagnóstico , Laringectomia/efeitos adversos , Faringectomia/efeitos adversos , Síncope/diagnóstico , Idoso , Anastomose Cirúrgica/efeitos adversos , Desjejum/fisiologia , Deglutição/fisiologia , Disopiramida/administração & dosagem , Eletrocardiografia , Estenose Esofágica/etiologia , Estenose Esofágica/fisiopatologia , Estenose Esofágica/cirurgia , Esôfago/cirurgia , Humanos , Neoplasias Hipofaríngeas/cirurgia , Laringectomia/métodos , Masculino , Faringectomia/métodos , Faringe/cirurgia , Síncope/etiologia , Síncope/fisiopatologia , Síncope/prevenção & controle , Síndrome
7.
J Laryngol Otol ; 135(4): 348-354, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33818328

RESUMO

OBJECTIVE: To compare the post-operative outcomes of transoral laser microsurgery, lateral pharyngotomy and transmandibular surgery in oropharyngeal cancer management. METHODS: Records of 162 patients treated with transmandibular surgery, transoral laser microsurgery or lateral pharyngotomy were reviewed. The transoral laser microsurgery cohort was matched with the lateral pharyngotomy and transmandibular surgery cohorts for tumour stage, tumour subsite and human papilloma virus status, and the intra- and post-operative outcomes were compared. RESULTS: Duration of surgery and hospital stay were significantly longer for transmandibular surgery. Tracheostomy and nasogastric feeding tube rates were similar, but time to decannulation and to oral feeding were longer in the transmandibular surgery group. Transmandibular surgery more frequently required flap reconstruction and had a greater complication rate. Negative margins were fewer in the lateral pharyngotomy group than in the transoral laser microsurgery and transmandibular surgery groups. CONCLUSION: In comparison with transmandibular surgery, transoral laser microsurgery and lateral pharyngotomy were associated with fewer complications and faster functional recovery. Lateral pharyngotomy had a higher rate of positive margins than transoral laser microsurgery, with a consequently greater need for adjuvant therapy. Many patients are nonetheless unsuitable for transoral surgery. All these factors should be considered when deciding on oropharyngeal cancer surgical treatment.


Assuntos
Terapia a Laser/métodos , Mandíbula/cirurgia , Microcirurgia/métodos , Neoplasias Orofaríngeas/cirurgia , Faringectomia/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Resultado do Tratamento
8.
Technol Cancer Res Treat ; 20: 15330338211011975, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33896244

RESUMO

AIM: Intensity-modulated radiotherapy (IMRT) is a widely accepted therapy for nasopharyngeal carcinoma (NPC), but it inevitably brings out radiation-related complications and seriously affects the quality of life (QoL). Endoscopic nasopharyngectomy (ENPG) has been successfully conducted in locally recurred NPC, but few studies evaluated its application in early NPC. This study aims to assess the feasibility and safety of ENPG combined with low-dose radiotherapy (LDRT) in T1-2 NPC. PATIENTS AND METHODS: We recruited 37 newly diagnosed localized T1-2 NPC patients who voluntarily accepted ENPG +LDRT from June 2013 to September 2016. Meanwhile, the data of 132 T1-2 NPC patients treated with IMRT were collected and used as control group. The survival outcomes, QoL score and late RT-related sequelaes were compared between the 2 groups. RESULTS: After a median follow-up of 54 months, only 1 patient in ENPG+LDRT group died along with hepatic metastases. The 5-year overall survival, distant metastasis-free survival, local relapse-free survival and regional relapse-free survival in ENPG+LDRT group were 97.3%, 97.3%, 100% and 100%, which were not statistically different from the control group (97.7%, 90.2%, 95. 5%, 97.0%, respectively, all P > 0.05). In comparison with IMRT group, ENPG+LDRT exhibited better QoL and less rate of late RT-related sequlaes including hearing loss (53.8% vs 27.0%, P = 0.005), xerostomia (46.2% vs 24.3%, P = 0.023) and dysphagia (25.8% vs 8.1%, P = 0.024). CONCLUSIONS: ENPG+LDRT provided satisfactory survival outcomes, and improved the QoL and reduced the incidence of sequelae for T1-2 NPC patients.


Assuntos
Carcinoma/terapia , Neoplasias Nasofaríngeas/terapia , Recidiva Local de Neoplasia , Faringectomia/métodos , Adulto , Carcinoma/secundário , Terapia Combinada , Transtornos de Deglutição/etiologia , Endoscopia , Feminino , Seguimentos , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/patologia , Nasofaringe/cirurgia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Faringectomia/efeitos adversos , Qualidade de Vida , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Taxa de Sobrevida , Xerostomia/etiologia
9.
J Otolaryngol Head Neck Surg ; 50(1): 17, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731216

RESUMO

BACKGROUND: Gastric pull-up is a reconstructive option for circumferential defects after resection of advanced laryngopharyngeal malignancy. Voice loss is expected and vocal rehabilitation remains a challenge. Our study objectives were to investigate the feasibility of secondary tracheoesophageal puncture following gastric pull-up and to analyze voice outcomes. METHODS: This was a prospective cohort study of patients with advanced laryngopharyngeal malignancies who underwent gastric pull-up and secondary tracheoesophageal puncture between 1988 and 2017 at a tertiary-care academic institution. Objective acoustic measures included fundamental frequency and vocal intensity. Perceptual analysis was performed using voice recordings ("Rainbow Passage") randomly presented in a blinded fashion to four clinicians using the validated GRBAS scale. Speech intelligibility was assessed in a blinded fashion using a validated 7-point scale. Additionally, the Voice Handicap Index-10 was administered as a validated patient self-reporting tool. RESULTS: Ten patients (7 male, 3 female) were included, all of whom preferentially used tracheoesophageal puncture for communication. These patients had abnormal median fundamental frequency of 250 (interquartile range (IQR) 214-265) Hz and a limited median vocal intensity of 65.8 (IQR 64.1-68.3) dB. Perceptual analysis (GRBAS) revealed a median 'moderate' degree of impairment [grade 2 (IQR 2-3), roughness 2 (IQR 2-3), breathiness 3 (IQR 2-3), asthenia 2 (IQR 1-2), strain 2 (IQR 1-2)] as did median intelligibility scores [median 5 (IQR 4-7)]. Most patients self-reported an abnormal voice handicap-10 [median 26.5 (IQR 22.8-35.0)]. CONCLUSION: Secondary tracheoesophageal puncture is a safe and feasible option for voice rehabilitation after gastric pull-up. Although analyses demonstrated moderate subjective and objective impairment, tracheoesophageal puncture provided patients with a self-reported means of functional verbal communication and was their preferred method of communication.


Assuntos
Esofagectomia/métodos , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Faringectomia/métodos , Inteligibilidade da Fala , Qualidade da Voz , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punções
10.
Eur Arch Otorhinolaryngol ; 278(11): 4509-4517, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33651150

RESUMO

PURPOSE: The aims of this study were to review the surgical experience and evaluate the feasibility of thoracoscopic total laryngo-pharyngo-oesophagectomy by multidisciplinary team in the patients with pharyngoesophageal junction cancer. METHODS: A total of 31 patients with pharyngoesophageal junction cancer who underwent thoracoscopic total laryngo-pharyngo-oesophagectomy with gastric pull-up reconstruction performed by a collaborative thoracic surgery and otolaryngology surgery team in our department from January 2009 to January 2019 were retrospectively analysed. Surgical experience, Postoperative morbidity, overall survival were evaluated. RESULTS: The median age was 62 years old. Among these patients, 20 had hypopharyngeal cancer, 11 had cervical oesophageal cancer. No patients died during the perioperative period, and the median operation time was 4 h 30 min. The mean hospital stay was 13 days. The rate of complications was 32.3%. There were two cases of anastomotic leakage, four cases of moderate pulmonary infection. The median follow-up period was 31 months. Four patients were lost to follow-up in the second and fourth years and were considered to have died at that time. The 3- and 5-year overall survival rates were 52.6% and 31.6%, respectively. CONCLUSION: As a salvage surgery, thoracoscopic total laryngo-pharyngo-oesophagectomy by multidisciplinary team can be performed with an acceptable level of perioperative morbidity and mortality, relatively good recovery, and acceptable survival outcome for patients with pharyngoesophageal junction cancer.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Neoplasias Esofágicas/cirurgia , Humanos , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Faringectomia , Estudos Retrospectivos
11.
Surgery ; 170(2): 541-549, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33663877

RESUMO

BACKGROUND: This study aimed to investigate the survival benefit of postoperative radiotherapy in patients with resected human papilloma virus-positive oropharyngeal squamous cell carcinoma using data from the Surveillance, Epidemiology, and End Results database. METHODS: A total of 2,589 human papilloma virus-positive oropharyngeal squamous cell carcinoma patients who underwent surgery were identified from the Surveillance, Epidemiology, and End Results database. Propensity score matching was performed to balance the baseline characteristics between patients who received postoperative radiotherapy and those who did not. Overall survival and disease-specific survival were estimated. RESULTS: After propensity score matching, postoperative radiotherapy did not increase overall survival and disease-specific survival. The subgroup analysis revealed that overall survival and disease-specific survival benefits of postoperative radiotherapy were observed only among patients with N2 or N3 stage disease. Multivariate analysis revealed that old age and advanced T, N stages were prognostic factors for disease-specific survival in oropharyngeal squamous cell carcinoma patients who underwent surgery. CONCLUSION: Postoperative radiotherapy might improve the survival of human papilloma virus-positive oropharyngeal squamous cell carcinoma patients with advanced N stage.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirurgia , Infecções por Papillomavirus/complicações , Faringectomia , Idoso , Carcinoma de Células Escamosas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/mortalidade , Pontuação de Propensão , Radioterapia Adjuvante , Estudos Retrospectivos , Programa de SEER , Taxa de Sobrevida , Resultado do Tratamento
12.
BMC Cancer ; 21(1): 317, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33765966

RESUMO

BACKGROUND: Positron-emission tomography (PET) is widely used to detect malignancies, but consensus on its prognostic value in oropharyngeal cancer has not been established. The purpose of this study was to analyze the PET parameters associated with tumor extent and survival in resectable oropharyngeal cancer. METHODS: The PET parameters in oropharyngeal cancer patients with regional node metastasis who underwent surgery and postoperative radiotherapy between January 2005 and January 2019 were analyzed. We calculated the SUVmax, tumor-to-liver ratio (TLR), metabolic tumor volume (MTV, volume over SUV 2.5), and total lesion glycolysis (TLG, MTV x mean SUV) of the primary lesion and metastatic nodes. Histologic findings, patient survival, and recurrence were reviewed in the medical records. RESULTS: Fifty patients were included, and the PET parameters were extracted for 50 primary lesions and 104 nodal lesions. In the survival analysis, MTV and TLG of the primary lesions showed significant differences in overall survival (OS) and recurrence-free survival (RFS). In the multiple regression analysis, TLG of the primary lesion was associated with the depth of invasion (DOI). MTV of the nodes was a significant factor affecting extranodal extension (ENE). CONCLUSIONS: PET parameters could be related with OS, RFS, DOI of the primary tumor, and ENE. PET would be expected to be a useful diagnostic tool as a prognosticator of survival and pathologic findings in oropharyngeal cancer.


Assuntos
Metástase Linfática/terapia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Orofaríngeas/terapia , Orofaringe/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Adulto , Idoso , Progressão da Doença , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Fluordesoxiglucose F18/administração & dosagem , Seguimentos , Humanos , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/patologia , Orofaringe/efeitos da radiação , Orofaringe/cirurgia , Faringectomia , Prognóstico , Compostos Radiofarmacêuticos/administração & dosagem , Radioterapia Adjuvante , Estudos Retrospectivos , Carga Tumoral/efeitos da radiação
13.
J Otolaryngol Head Neck Surg ; 50(1): 12, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33597031

RESUMO

OBJECTIVE: Recurrent nasopharyngeal carcinoma (rNPC) can be salvaged with re-irradiation, open nasopharyngectomy, and more recently endoscopic nasopharyngectomy. However, long-term outcomes of endoscopic approaches are lacking. Thus, we report 5-year outcomes following endoscopic nasopharyngectomy for rNPC. METHODS: Patients who underwent endoscopic nasopharyngectomy for rNPC between January 2000 and January 2012 were retrospectively reviewed. Patients were included if they had their first endoscopic nasopharyngectomy at least 5 years prior to this study. Presenting (cTNM) status and recurrent (rTNM) status for each recurrence was determined. Outcomes included margin status, disease recurrence, death, and complication rates. RESULTS: Thirteen patients were included. Four patients had a prior open nasopharyngectomy. Mean time follow-up was 74.3 months (range = 56.4-96 months). Negative margins were achieved in 77% of initial cases. Positive margins were associated with higher rT stages. Re-recurrence was seen in 6 patients, which was also associated with a higher cStage and rStage. All patients with positive margins had re-recurrence. Four patients required repeat endoscopic nasopharyngectomy and two received chemoradiation. All four with a second endoscopic procedure had further disease recurrence. Five-year local disease-free and overall survival rates were 53.9 and 84.6%, respectively. The minor complication rate was 52.6%, major operative complication rate was 0.0%, and late complication rate was 23.1%. CONCLUSION: Endoscopic nasopharyngectomy demonstrates promising 5-year overall survival rate for rT1 and rT2 cases of rNPC with favorable complication rates. Lower rStages were associated with a higher disease-free rate, and lower cStages were associated with improved overall prognosis. Close surveillance and prompt management of recurrences can be associated with favorable long-term tumor control. LEVEL OF EVIDENCE: 4.


Assuntos
Carcinoma Nasofaríngeo/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Cirurgia Endoscópica por Orifício Natural , Recidiva Local de Neoplasia/cirurgia , Faringectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais , Carcinoma Nasofaríngeo/mortalidade , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Estudos Retrospectivos , Terapia de Salvação , Taxa de Sobrevida
14.
Eur Ann Otorhinolaryngol Head Neck Dis ; 138(5): 397-401, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33431349

RESUMO

Three types of reconstruction are possible following total laryngopharyngectomy (TLP) for advanced hypopharyngeal cancer: locoregional tubularized island flaps, gastric pull-up and free flaps. Gastro-omental free flap (GOFF) is rarely used in this setting. However, because of its composite nature, this flap has the advantage of being able to restore digestive continuity and reconstruct part of the skin of the neck when it needs to be sacrificed because of tumour invasion or poor trophicity. The GOFF is a reliable and robust flap particularly indicated in hostile environments: repeated neck surgery, atrophic and devascularized skin after radiotherapy, sepsis in the context of fistula and/or pharyngostomy. It requires the collaboration of two or even three surgical teams. In this article, we describe the flap harvesting technique and the complications and functional outcome.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Hipofaríngeas , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Faringectomia
15.
J Laryngol Otol ; 135(3): 259-263, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33509309

RESUMO

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


Assuntos
Terapia Combinada/mortalidade , Esofagectomia/mortalidade , Neoplasias Hipofaríngeas/cirurgia , Laringectomia/mortalidade , Faringectomia/mortalidade , Intervalo Livre de Doença , Esofagectomia/métodos , Feminino , Humanos , Neoplasias Hipofaríngeas/mortalidade , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Faringectomia/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , País de Gales
16.
Laryngoscope ; 131(6): 1349-1357, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33280117

RESUMO

OBJECTIVE: Traditionally, after total laryngopharyngectomy (TLP), patients cannot speak without a prosthesis or an artificial larynx. In Taiwan, most patients use a commercialized pneumatic laryngeal device (PLD). Phonatory tube reconstruction with the anterolateral thigh (ALT) flap is a novel, modified version of synchronous digestive and phonatory reconstruction involving a free muscular cutaneous flap. This study reviewed and compared speech performance between patients who underwent novel flap reconstruction and conventional PLD users. METHOD: We retrospectively reviewed patients with laryngeal or hypopharyngeal cancer who underwent TLP from August 2017 to September 2019. The voice handicap index (VHI), speech intelligibility, acoustic and aerodynamic analysis results, and speech range profile (SRP) were compared between patients who underwent ALT phonatory tube reconstruction (ALT group) and those using PLDs (PLD group). RESULTS: Twenty patients were included; 13 patients were included in the ALT group, and 7 patients were included in the PLD group. Compared to the PLD group, the ALT group had a better fundamental frequency range (P < .001) and semitone range (P < .001) during speech but showed worse jitter, shimmer, and harmonic-to-noise ratios. The two groups showed comparable VHI and speech intelligibility performance. CONCLUSIONS: The ALT phonatory tube, a novel flap for reconstruction, can restore digestive and voice functions simultaneously. Compared with PLD use, ALT phonatory tube reconstruction yields an improved speech range and comparable levels of voice handicap and speech intelligibility, suggesting that the technique is a good alternative for patients after TLP. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1349-1357, 2021.


Assuntos
Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Voz Alaríngea/métodos , Fala/fisiologia , Distúrbios da Voz/cirurgia , Retalhos de Tecido Biológico , Humanos , Laringectomia/efeitos adversos , Laringe Artificial , Masculino , Pessoa de Meia-Idade , Faringectomia/efeitos adversos , Fonação/fisiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Inteligibilidade da Fala , Medida da Produção da Fala , Taiwan , Coxa da Perna/cirurgia , Resultado do Tratamento , Distúrbios da Voz/etiologia , Qualidade da Voz
17.
Eur Arch Otorhinolaryngol ; 278(5): 1337-1344, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32700234

RESUMO

PURPOSE: Post-laryngectomy hypoparathyroidism is associated with significant short- and long-term morbidities. This systematic review aimed to determine incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. METHODS: Medline, EMBASE and the Cochrane library were searched for relevant articles on hypocalcaemia and/or hypoparathyroidism after laryngectomy or pharyngectomy. Two authors independently screened titles and abstracts from the search. Data from individual studies were collated and presented (without meta-analysis). Quality assessment of included studies was undertaken. The review protocol was registered in the PROSPERO database (CRD42019133879). RESULTS: Twenty-three observational studies were included. The rates of transient and long-term hypoparathyroidism following laryngectomy with concomitant hemi- or total thyroidectomy ranged from 5.6 to 57.1% (n = 13 studies) and 0 to 12.8% (n = 5 studies), respectively. Higher transient (62.1-100%) and long-term (12.5-91.6%) rates were reported in patients who had concomitant oesophagectomy and total thyroidectomy (n = 4 studies). Other risk factors included bilateral selective lateral neck dissection, salvage laryngectomy and total pharyngectomy. There is a lack of data on prevention and management. CONCLUSION: Hypoparathyroidism occurs in a significant number of patients after laryngectomy. Patients who underwent laryngectomy with concomitant hemithyroidectomy may still develop hypoparathyroidism. Research on prevention and treatment is lacking and needs to be encouraged.


Assuntos
Hipoparatireoidismo , Laringectomia , Humanos , Hipoparatireoidismo/epidemiologia , Hipoparatireoidismo/etiologia , Hipoparatireoidismo/prevenção & controle , Incidência , Faringectomia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Tireoidectomia/efeitos adversos
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