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Prince ADP, Heft Neal ME, Buchakjian MR, Chinn SB, Stucken CL, Casper KA, Malloy KM, Prince MEP, Rosko AJ, McHugh JB, Spector ME. Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy. Otolaryngol Head Neck Surg 2024; 171:785-790. [PMID: 38881401 DOI: 10.1002/ohn.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/17/2024] [Accepted: 04/19/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk. STUDY DESIGN Retrospective cohort. SETTING Tertiary Medical Center. METHODS Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable. RESULTS Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized. CONCLUSION After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care.
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Affiliation(s)
- Andrew D P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Marisa R Buchakjian
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Andrew J Rosko
- ProMedica Physicians Ear, Nose and Throat-Sylvania, Sylvania, Ohio, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zhang D, Li L. Risk factors and prognostic models of lymph node metastatic hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2023; 280:5019-5029. [PMID: 37351665 DOI: 10.1007/s00405-023-08077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE To explore the risk factors for lymph node metastasis (LNM) and establish nomograms for predicting survival outcomes and assessing individual risk in patients with LNM and hypopharyngeal squamous carcinoma (HSCC). METHODS Clinical data of patients with HSCC were retrospectively reviewed. The study's primary endpoints were overall survival (OS) and disease-specific survival (DSS). Nomograms were established based on Cox regression analyses. The accuracy and calibration ability of the nomograms were evaluated using the C-index, area under the curve, calibration curves, and decision curve analysis. RESULTS Overall, 2888 patients were enrolled, and the LNM rate was 74.2%. Age ≤ 60 years, male sex, unmarried status, pyriform sinus location, grade III-IV, tumor larger than 4 cm, and advanced T stage increased the risk of LNM. In addition, LNM was a negative prognostic factor for OS and DSS. Ten variables were identified and incorporated into nomograms to estimate OS and DSS. Our nomograms outperformed the traditional staging system in training and validation cohorts. Patients were stratified into risk subgroups based on the OS- and DSS-nomogram scores. Patients in the high-risk subgroup had a higher risk of death and disease-specific mortality than those in the low- and intermediate-risk subgroups. CONCLUSIONS LNM worsens the prognosis of HSCC. This study identified the independent prognostic factors for HSCC with LNM and developed satisfactory OS- and DSS-monogram to provide individual prediction and risk classification for patients with this diagnosis.
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Affiliation(s)
- Di Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Pan jia yuan nan Road 17, Beijing, 100021, China
| | - Lixi Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Pan jia yuan nan Road 17, Beijing, 100021, China.
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Chen C, Hang L, Liu Y, Xie J, Yang J. Oncological Analysis and Surgical Outcomes in Postcricoid Carcinoma: A 14 Years Retrospective Study. Cancers (Basel) 2022; 14:cancers14133146. [PMID: 35804918 PMCID: PMC9264822 DOI: 10.3390/cancers14133146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Postcricoid carcinoma is a rare but aggressive type of hypopharyngeal carcinoma with poor prognosis and high mortality; thus, it is indispensable to investigate the surgical efficacy and multimodal strategies. Methods: This retrospective study included postcricoid carcinoma patients undergoing surgical resection from 2008 to 2022. Treatment methods and clinical characteristics were analyzed to evaluate prognostic factors for oncological outcomes. Results: Of 72 patients, 13 cases were in the I−II stage and 59 in the III−IV stage. The overall survival (OS) was 50.0%; the laryngeal function preservation rate was 69.4%. Univariate analysis found that high mortality was associated with low tumor differentiation, lymph node metastasis, neck recurrence, and smoke history via log-rank test (p < 0.05); postoperative radiotherapy (RT) remained positive in OS (p = 0.04). The multivariable model further revealed that lymph node metastasis was a dominant determinant after accounting for covariates (HR 1.75; 95% CI 0.85−3.59). The data also indicated that neoadjuvant chemotherapy (NAC) and tumor diameter ≤ 2 cm were causing lower rates of pharyngeal fistula and locoregional relapse. Conclusions: Surgeons should emphasize high-risk features and optimize individualized surgical procedures for postcricoid carcinoma patients. Combined with multimodal treatments, it is feasible to reconstruct laryngeal function and lessen postoperative morbidities in advanced patients.
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Affiliation(s)
- Chun Chen
- Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (C.C.); (Y.L.)
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Lei Hang
- Business School, Shanghai Normal University Tianhua College, Shanghai 201815, China;
| | - Yupeng Liu
- Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (C.C.); (Y.L.)
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jin Xie
- Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (C.C.); (Y.L.)
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
- Correspondence: (J.X.); (J.Y.)
| | - Jun Yang
- Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (C.C.); (Y.L.)
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
- Correspondence: (J.X.); (J.Y.)
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Clinical outcomes following pharyngolaryngectomy reconstruction: a 20-year single-centre study. The Journal of Laryngology & Otology 2022; 136:1105-1112. [DOI: 10.1017/s0022215122000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Advanced malignant neoplasms of the larynx and hypopharynx pose many therapeutic challenges. Total pharyngolaryngectomy and total laryngectomy provide an opportunity to cure these tumours but are associated with significant morbidity. Reconstruction of the pharyngeal defect following total pharyngolaryngectomy demands careful consideration and remains an area of debate within surgical discussions.
Methods
This paper describes a systemic analysis of pharyngeal reconstruction following total pharyngolaryngectomy and total laryngectomy, leveraging data collected over a 20-year period at a large tertiary referral centre.
Results
Analysing 155 patients, the results show that circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. In addition, free tissue transfer in larger pharyngeal defects showed lower rates of post-operative anastomosis leak and stricture.
Conclusion
Pharyngeal resection carries a substantial risk of post-operative complications, and free tissue transfer appears to be an effective means of reconstruction for circumferential defects.
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Zhang Y, Liu Y, Sun Y, Xu M, Wang XL. Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports. World J Clin Cases 2021; 9:10328-10336. [PMID: 34904107 PMCID: PMC8638055 DOI: 10.12998/wjcc.v9.i33.10328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/08/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas, such as hypopharyngeal carcinoma with thoracic esophageal carcinoma. However, neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.
CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case, and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up. Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.
CONCLUSION For selected patients, local random flaps (with a split thickness skin graft) can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis, especially when the necrosis extends below the thoracic inlet.
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Affiliation(s)
- Ye Zhang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu Sun
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Meng Xu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Lei Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Every JD, Sideris AW, Sarkis LM, Lam ME, Mackay SG, Pearson SJ. Hypocalcaemia in pharyngolaryngectomy: Preservation or autotransplantation of parathyroid glands. Laryngoscope Investig Otolaryngol 2021; 6:1208-1213. [PMID: 34667866 PMCID: PMC8513446 DOI: 10.1002/lio2.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe transient and permanent hypocalcaemia following partial and total pharyngolaryngectomy with parathyroid gland preservation or autotransplantation. METHODS Thirty patients underwent partial or total pharyngolaryngectomy by a single surgeon during the period 2009-2020. Intraoperative parathyroid gland preservation or autotransplantation (where the gland appeared devascularized) was routinely performed. Calcium levels performed on day 1, 3 months, and at 12 months postoperatively were collected. Rates of transient and permanent hypocalcaemia were calculated. RESULTS A total of 13% of patients had transient hypocalcaemia, and 10% permanent hypocalcaemia. Rates of transient and permanent hypocalcaemia in total pharyngolaryngectomy were 14% and 14%, respectively. Partial pharyngectomy hypocalcaemia rates were 13% for transient and 0% for permanent. The majority of patients underwent salvage surgery for oncological resection, often following radiotherapy (63%). Ipsilateral hemithyroidectomy was preferred to total (57% vs 7%), with high rates of concurrent neck dissection (67%) and reconstruction (87%). CONCLUSION This data supports preservation or autotransplantation of parathyroid glands as a means of reducing permanent postoperative hypocalcaemia. LEVEL OF EVIDENCE Level IV, case series, retrospective.
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Affiliation(s)
- James D. Every
- Department of Otolaryngology, Head and Neck SurgeryThe Wollongong HospitalWollongongAustralia
| | - Anders W. Sideris
- Department of Otolaryngology, Head and Neck SurgeryThe Wollongong HospitalWollongongAustralia
| | - Leba M. Sarkis
- Department of Otolaryngology, Head and Neck SurgeryThe Wollongong HospitalWollongongAustralia
| | - Matthew E. Lam
- Department of Otolaryngology, Head and Neck SurgeryThe Wollongong HospitalWollongongAustralia
| | - Stuart G. Mackay
- Department of Otolaryngology, Head and Neck SurgeryThe Wollongong HospitalWollongongAustralia
- Illawarra ENT Head & Neck ClinicWollongongAustralia
| | - Stephen J. Pearson
- Department of Otolaryngology, Head and Neck SurgeryThe Wollongong HospitalWollongongAustralia
- Illawarra ENT Head & Neck ClinicWollongongAustralia
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León X, García J, López M, Bulboa C, Pujals G, Quer M. Oncological Results of Salvage Treatment in Patients With Hypopharyngeal Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Meulemans J, Debacker J, Demarsin H, Vanclooster C, Neyt P, Mennes T, Vauterin T, Huvenne W, Laenen A, Delaere P, Vander Poorten V. Oncologic Outcomes After Salvage Laryngectomy for Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study. Ann Surg Oncol 2020; 28:1751-1761. [PMID: 32860174 DOI: 10.1245/s10434-020-09017-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to analyze oncologic outcomes and identify patterns of failure and negative prognostic factors in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx. METHODS This was a retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018 for residual/recurrent/second primary SCC in the larynx or hypopharynx after initial (chemo)radiation. Prognostic factors for oncologic outcomes were identified using univariable and multivariable analysis. RESULTS A total of 405 patients were included in the final analysis. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional relapse-free survival (LRFS) estimates were 47.7% (95% confidence interval [CI] 42.0-53.2%), 68.7% (95% CI 63.7-73.7%), 42.1% (95% CI 36.7-47.4%), and 44.3% (95% CI 38.8-49.7%), respectively. In a multivariable model, increasing clinical tumor stage of the residual/recurrent/second primary tumor, increasing number of metastatic cervical lymph nodes retrieved during neck dissection, hypopharyngeal and supraglottic tumor location, positive section margin status and perineural invasion were independent negative prognostic variables for OS, DSS, DFS, and LRFS. The type of second tumor was identified as an additional independent prognosticator for DSS, with local recurrences and second primary tumors having a better prognosis than residual tumor. CONCLUSIONS AND RELEVANCE Favorable oncologic outcomes are reported after STL. Increasing clinical tumor stage, increasing number of metastatic cervical lymph nodes, hypopharyngeal and supraglottic tumor location, positive section margins, and perineural invasion are identified as independent negative prognosticators for all oncologic outcome measures.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium
| | - Jens Debacker
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Hannelore Demarsin
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | | | - Peter Neyt
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, Belgium
| | - Tillo Mennes
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.,Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Brugge, Belgium
| | - Tom Vauterin
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Brugge, Belgium
| | - Wouter Huvenne
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Louvain, Belgium
| | - Pierre Delaere
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium. .,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium.
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León X, García J, López M, Bulboa C, Pujals G, Quer M. Oncological results of salvage treatment in patients with hypopharyngeal carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:85-91. [PMID: 32473712 DOI: 10.1016/j.otorri.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/18/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE The aim of this study is to analyse the variables related to the feasibility of salvage surgery with radical intention in patients with a local recurrence of hypopharyngeal carcinoma, and to evaluate the oncological performance of this type of surgery. METHODS Retrospective study of 96 patients with hypopharyngeal carcinoma with local tumour recurrence RESULT: Only 27 patients (28.1%) were considered for surgical salvage treatment. The variables related to feasibility of salvage surgery were non-surgical initial treatment of the tumour and a disease-free interval greater than 6 months. All 69 patients non-candidates for salvage surgery died as a result of tumour progression in a period of less than 2.5 years. The 5-year disease-specific survival rate for the patients treated with salvage surgery was 39.5%. The only variable significantly related to disease-specific survival was the status of the resection margins. Patients with extensive tumour recurrence (rT3-T4) or with simultaneous nodal involvement had a lower survival rate, but the differences did not reach statistical significance. CONCLUSION Only 28% of the patients with hypopharyngeal carcinoma with local recurrence of the tumour were eligible for salvage surgery with radical intention. The patients treated with salvage surgery had a 5 -year disease-specific survival of 39.5%.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Constanza Bulboa
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Gerard Pujals
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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10
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Yu S, Zhu Y, Shi X, Hu K, Bai C, Diao W, Zhu X, Gao Z, Chen X. Postoperative Concurrent Chemoradiotherapy versus Postoperative Radiotherapy Alone for Larynx Squamous Cell Carcinoma Patients with Lymphovascular Invasion: A Propensity Score Matching Study. Cancer Manag Res 2020; 12:4063-4071. [PMID: 32581580 PMCID: PMC7269631 DOI: 10.2147/cmar.s250621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To date, no guidelines have been proposed for the ideal treatment of postoperative larynx squamous cell carcinoma (LSCC) patients with lymphovascular invasion due to a lack of similar studies. The present study was conducted to compare the survival and toxicity in LSCC patients with lymphovascular invasion receiving either postoperative radiotherapy (PORT) or postoperative chemoradiotherapy (POCRT). The results can be applied for more appropriate treatment of these patients. Patients and Methods Three hundred eighty-eight eligible LSCC patients with lymphovascular invasion were enrolled in this retrospective study. Survival and treatment-related toxicities were compared in the POCRT and PORT group using propensity score matching (PSM) methodology (1:1). Results Five-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) of all patients were 48.7%, 58.2%, and 56.0%, respectively. Significantly, higher RFS rates (P=0.040) were found in the POCRT group than the PORT group in the PSM cohort. In the multivariate analysis, higher OS, DSS, and RFS rates were observed in the POCRT group than the PORT group (P=0.049, 0.024, and 0.011 respectively). Patients in the POCRT group presented more acute toxicities than those in the PORT group such as hematological toxicities (25.0% vs 0.9%, P<0.001) and mucositis (35.0% vs 19.1%, P=0.002). Conclusion In the context of no ideal treatment for LSCC patients with lymphovascular invasion, the present study proposes POCRT as a preferable modality compared with PORT, as POCRT was associated with higher RFS rates. Higher RFS, DFS, and OS rates were also observed in the POCRT group in the multivariate analysis.
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Affiliation(s)
- Shuting Yu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yingying Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiaohua Shi
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ke Hu
- Department of Radiotherapy, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Chunmei Bai
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Wenwen Diao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiaoli Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiqiang Gao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xingming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Cristalli G, Ferri E, Di Maio P, Spriano G, Mercante G, Ferreli F, Pellini R, Boscolo Nata F. Lateral conservative approach for recurrent/persistent hypopharyngeal carcinoma: a case series. Eur Arch Otorhinolaryngol 2020; 277:2375-2380. [PMID: 32367150 DOI: 10.1007/s00405-020-06009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Early persistent/recurrent hypopharyngeal tumours represent a challenge for surgeons who have to balance the need for oncological radicality and the desire to maintain a functioning larynx with preservation of the patient's quality of life. The aim of this study was primarily to understand the technical feasibility, functional outcomes, and the possibility of obtaining oncological radicality using lateral hypopharyngectomy with laryngeal preservation in early recurrent post-radio/(chemo)therapy hypopharyngeal tumours. METHODS Patients with recurrent T1 hypopharyngeal squamous cell carcinoma were retrospectively selected from our institutional database. The external lateral approach according to Spriano and a modified lateral hypopharyngectomy with laryngeal preservation were used to resect tumours of the lateral pyriform sinus wall. Reconstruction was obtained by direct approximation of the posterior border of the sectioned thyroid cartilage to the posterior hypopharyngeal wall, and this was reinforced with a second layer of vascularised and non-irradiated tissue that was provided by a microvascular fascial anterobrachial flap. Swallowing was assessed 3 weeks after surgery using videoendoscopic evaluation. RESULTS The surgical procedure was technically feasible, and complete resection was obtained in all patients. None of the patients experienced major post-operative complications (salivary fistula, bleeding, aspiration pneumonia). Mild dysphagia was observed in one patient who underwent swallowing rehabilitation. Tracheostomy was closed in all patients. No recurrence was recorded after a median follow-up of 20 months. CONCLUSION The reported experience shows that, in selected cases, it is possible to radically remove lateral hypopharyngeal cancer with acceptable functional results.
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Affiliation(s)
- G Cristalli
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy.
| | - E Ferri
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy
| | - P Di Maio
- Department of Otolaryngology, Head and Neck Surgery (P.D., M.G.), Civil Hospital, Via Giovanni Borea, 56, Sanremo, 18038, Imperia, Italy
| | - G Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - G Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - F Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - R Pellini
- Department of Otolaryngology Head and Neck Surgery, National Cancer Institute "Regina Elena", Via Elio Chianesi 53, 00144, Roma, Italy
| | - F Boscolo Nata
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy
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12
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León X, Montoro V, Rovira C, Neumann E, López M, García J, Quer M. Resultados oncológicos de la laringectomía de rescate en pacientes con carcinomas escamosos de laringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:70-77. [DOI: 10.1016/j.otorri.2019.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 11/16/2022]
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13
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Oncological Results of Salvage Laryngectomy in Patients With Laryngeal Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Total laryngopharyngectomy with circumferential reconstruction: Helsinki institutional study. Eur Arch Otorhinolaryngol 2019; 276:2577-2584. [PMID: 31240457 DOI: 10.1007/s00405-019-05526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Surgical complications after total laryngopharyngectomy (TLP) are common, reconstruction is challenging, and patients often lose their ability to swallow and speak. To evaluate these aspects, we analysed outcome after TLP. METHODS We reviewed all patients who underwent TLP and subsequent circumferential pharyngeal reconstruction through 2004-2017 at the Helsinki University Hospital. RESULTS For the 26 eligible patients, TLP was the primary treatment for 11 and salvage surgery for 15, followed by reconstruction with free flaps in 22 patients and pedicled flaps in 4. An early (≤ 30 days) pharyngocutaneous fistula developed in seven patients (27%; median time 13 days; range 6-26), and a late (> 30 days) fistula in five patients (19%; median time 370 days; range 46-785). In addition, ten patients (39%) developed an oesophageal stricture. Four patients (15%) resumed full oral feeding. A speech prosthesis was inserted for 15 patients (58%) and most of them could produce intelligible speech. We found acceptable survival figures for patients undergoing TLP both as a primary treatment and as salvage procedure: the overall survival at 1 year was 82% and 67%, and at 5 years 33% and 27%, respectively. Disease-specific survival at 1 year was 90% and 70%, and that at 5 years was 45% and 43%, respectively. CONCLUSIONS Despite fair survival, TLP carries a high risk for postoperative complications with limited functional outcome, thus necessitating cautious patient selection and surgical experience.
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15
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Kim YH, Roh J, Choi S, Nam SY, Kim SY. Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma. Head Neck 2019; 41:3002-3008. [DOI: 10.1002/hed.25786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/14/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Yong Han Kim
- Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Jong‐Lyel Roh
- Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Seung‐Ho Choi
- Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
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16
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Hoesli R, Brennan JR, Rosko AJ, Birkeland AC, Malloy KM, Moyer JS, Prince MEP, Shuman AG, Chinn SB, Stucken CL, Casper KA, Spector ME. Intraoperative Fluorescent Angiography Predicts Pharyngocutaneous Fistula After Salvage Laryngectomy. Ann Surg Oncol 2019; 26:1320-1325. [PMID: 30805812 DOI: 10.1245/s10434-019-07262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Technology to assess tissue perfusion is exciting with translational potential, although data supporting its clinical applications have been lagging. Patients who have undergone radiation are at particular risk of poor tissue perfusion and would benefit from this expanding technology. We designed a prospective clinical trial using intraoperative indocyanine green angiography to evaluate for wound-healing complications in patients undergoing salvage laryngectomy after radiation failure. PATIENTS AND METHODS This prospective trial included patients undergoing salvage laryngectomy at a National Cancer Institute-designated tertiary cancer center between 2016 and 2018. After tumor extirpation and prior to reconstruction, 10 mg indocyanine green dye was infused and the fluorescence (FHYPO) and ingress rate of the pharyngeal mucosa recorded. The primary outcome measure was formation of a pharyngocutaneous fistula (PCF). RESULTS Patients who developed a PCF had significantly lower FHYPO (87 vs 172, p < 0.001) and ingress rates (6.7 vs 15.8, p = 0.043) compared with those who did not develop a fistula. There were no fistulas in patients with FHYPO > 150 (n = 21) or ingress > 15 (n = 15). There was a 50% fistula rate in patients with FHYPO ≤ 103 (n = 10) and ingress rate ≤ 6 (n = 6). CONCLUSIONS Intraoperative indocyanine green angiography can assess hypoperfusion in patients and predict risk of PCFs after salvage laryngectomy, and can thus intraoperatively risk-stratify patients for postoperative wound-healing complications.
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Affiliation(s)
- Rebecca Hoesli
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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17
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Elbers JBW, Veldhuis LI, Bhairosing PA, Smeele LE, Jóźwiak K, van den Brekel MWM, Verheij M, Al-Mamgani A, Zuur CL. Salvage surgery for advanced stage head and neck squamous cell carcinoma following radiotherapy or chemoradiation. Eur Arch Otorhinolaryngol 2019; 276:647-655. [PMID: 30673847 DOI: 10.1007/s00405-019-05292-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/12/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma (HNSCC) is known to result in poor prognosis. As there are only small and heterogeneous studies available with wide variety in outcome measures, our purpose was to select and pool literature according to specific criteria. METHODS Systematic review and meta-analysis of clinical outcome after salvage surgery for recurrent advanced stage HNSCC following primary radiotherapy or chemoradiation. RESULTS 16 of 3956 screened studies were included for analysis (729 patients). Pooled 5-year OS was 37% (95% CI 30-45%, 12 studies, 17 outcome measurements, 540 patients). Outcome was presented for larynx (6 studies, 397 patients), hypopharynx (2 studies, 47 patients), larynx and hypopharynx combined (3 studies, 69 patients) or separately (1 study, 134 patients), oral cavity (1 study, 11 patients), oropharynx (1 study, 34 patients) and multiple subsites combined (2 studies, 37 patients). There was no significant difference in survival outcome between subsites (pheterogeneity = 0.8116). The pooled tumor-positive resection margin rate was 32% and pooled re-operation rate 17%. Complication rates from the pooled data were: fistulas 33%, wound infections 24% and flap failure 3%. Treatment-related mortality rate was 1% and mean hospital stay was 23 days. CONCLUSIONS Salvage surgery for recurrent advanced stage head and neck squamous cell carcinoma after primary (chemo)radiotherapy is a good last resort curative treatment option, resulting in 37% overall survival at 5 years. As data from advanced stage non-laryngeal tumors were sparse, no solid conclusions can be drawn with regard to outcome differences between tumor subsites.
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Affiliation(s)
- Joris B W Elbers
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lars I Veldhuis
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Patrick A Bhairosing
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Oral-Maxillofacial Surgery, AMC, Amsterdam, The Netherlands.
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18
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Elbers JBW, Al-Mamgani A, van den Brekel MWM, Jóźwiak K, de Boer JP, Lohuis PJFM, Willems SM, Verheij M, Zuur CL. Salvage Surgery for Recurrence after Radiotherapy for Squamous Cell Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2018; 160:1023-1033. [PMID: 30526317 DOI: 10.1177/0194599818818443] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Most studies that report on salvage surgery after primary radiotherapy for head and neck squamous cell carcinoma (HNSCC) are small and heterogeneous. Subsequently, some relevant questions remain unanswered. We specifically focused on (1) difference in prognosis per tumor subsite, corrected for disease stage, and (2) differences in prognosis after salvage surgery for local, regional, and locoregional recurrences. STUDY DESIGN Retrospective analysis. SETTING Single-center study (2000-2016). SUBJECTS AND METHODS Patients treated with salvage surgery for HNSCC recurrence after (chemo)radiotherapy. RESULTS In total, 189 patients were included. Five-year overall survival (OS) was 33%, and median OS was 18 (95% confidence interval [CI], 11-26) months. Treatment-related mortality was 2%. Larynx carcinoma was associated with more favorable local (adjusted hazard ratio [HR] = 4.02; 95% CI, 1.46-11.10; P = .007) and locoregional control (adjusted HR = 5.34; 95% CI, 1.83-15.61; P = .002) than pharyngeal carcinoma. American Society of Anesthesiologists (ASA) score (≥3 vs 1-2: adjusted HR = 3.04; 95% CI, 1.17-7.91; P = .023), pT stage (3-4 vs 1-2: adjusted HR = 4.41; 95% CI, 1.65-11.82; P = .003), and salvage surgery for locoregional recurrences (locoregional vs local: adjusted HR = 3.81; 95% CI, 1.13-11.82; P = .021) were independent predictors for disease-free survival (DFS). CONCLUSION Salvage surgery for larynx carcinoma, regardless of disease stage and other prognostic factors, results in more favorable loco(regional) control but not favorable DFS than pharyngeal carcinoma. The observed difference in DFS between salvage surgery for local and regional recurrences was not significant after correction for confounders. However, survival following salvage surgery for locoregional disease is significantly worse. For this subgroup, we propose to consider T status and comorbidity for clinical decision making, as high pT stage and ASA score are independent predictors for worse DFS.
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Affiliation(s)
- Joris B W Elbers
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,2 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- 2 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,3 Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- 4 Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J P de Boer
- 5 Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Peter J F M Lohuis
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,3 Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan M Willems
- 6 Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel Verheij
- 2 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L Zuur
- 1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,3 Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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19
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McSpadden R, Zender C, Eskander A. AHNS series: Do you know your guidelines? Guideline recommendations for recurrent and persistent head and neck cancer after primary treatment. Head Neck 2018; 41:7-15. [PMID: 30536532 DOI: 10.1002/hed.25443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022] Open
Abstract
Locoregional recurrent/persistent head and neck cancer following primary treatment is a significant challenge as it is usually difficult to treat and has worse outcomes compared to the primary setting. Surgical resection of a local or regional recurrence offers the best chance of cure when feasible. Local recurrence outcomes vary by subsite with laryngeal recurrences having the best prognoses and hypopharynx having the worst. Instances of persistent neck masses following primary nonsurgical treatment can be evaluated with positron emission tomography (PET) with CT (PET-CT) when there is no definitive diagnosis of a recurrence/persistence. Reirradiation with or without chemotherapy can be considered for primary treatment when surgery is not an option, for adjuvant treatment following salvage surgery, or for palliation. Immunotherapy represents a newer class of chemotherapeutic agents. Current guidelines recommend enrollment in clinical trials especially when surgery is not an option as outcomes remain universally poor in the recurrent/persistent setting.
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Affiliation(s)
- Ryan McSpadden
- Department of Head & Neck, Plastic and Reconstructive Surgery - Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Chad Zender
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, University Hospital Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, University of Toronto, Sunnybrook Health Sciences and the Odette Cancer Centre, Michael Garron Hospital, Toronto, Ontario, Canada
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20
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Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach. Head Neck 2018; 41:16-29. [DOI: 10.1002/hed.25192] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/03/2018] [Accepted: 03/02/2018] [Indexed: 11/08/2022] Open
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21
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Lee JR, Almuhaimid TM, Roh JL, Oh JS, Kim SJ, Kim JS, Choi SH, Nam SY, Kim SY. Prognostic value of 18
F-FDG PET/CT parameters in patients who undergo salvage treatments for recurrent squamous cell carcinoma of the larynx and hypopharynx. J Surg Oncol 2018; 118:644-650. [DOI: 10.1002/jso.25185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Jae Ryung Lee
- Department of Otolaryngology-Head & Neck Surgery; Keimyung University Dongsan Medical Center; Daegu Korea
| | - Turki M. Almuhaimid
- Department of Surgery; King Fahad Specialist Hospital; Dammam Saudi Arabia
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Soo-Jong Kim
- Department of Nuclear Medicine; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Seung-Ho Choi
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
| | - Sang Yoon Kim
- Department of Otolaryngology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Korea
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22
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The Current Role of Salvage Surgery in Recurrent Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2018; 10:cancers10080267. [PMID: 30103407 PMCID: PMC6115801 DOI: 10.3390/cancers10080267] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma of the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical primary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as the best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly confronted with considering operation among patients with significant effects of failed non-surgical primary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity of the procedure, the functional consequences of organ mutilation, and the likelihood of success. Accurate selection of patients suitable for surgery is a major issue. It is essential to establish objective criteria based on functional and oncologic outcomes to select the best candidates for SS. The authors propose first to understand preoperative prognostic factors influencing survival. Predictive modeling based on preoperative information is now available to better select patients having a good chance to be successfully treated with surgery. Patients with a high comorbidity index, advanced oropharyngeal or hypopharyngeal primary tumors, and both local and regional recurrence have a very limited likelihood of success with salvage surgery and should be strongly considered for other treatments. Following SS, identifying patients with postoperative prognostic factors predicting high risk of recurrence is essential because those patients could benefit of adjuvant treatment or be included in clinical trials. Finally, defining HPV tumor status is needed in future studies including recurrent oropharyngeal SCC patients.
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23
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Rosko AJ, Birkeland AC, Bellile E, Kovatch KJ, Miller AL, Jaffe CC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME. Hypothyroidism and Wound Healing After Salvage Laryngectomy. Ann Surg Oncol 2017; 25:1288-1295. [PMID: 29264671 DOI: 10.1245/s10434-017-6278-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients undergoing salvage laryngectomy are predisposed to radiation-induced hypothyroidism and impaired wound healing secondary to the tissue effects of prior treatment. The impact of hypothyroidism on postoperative wound healing is not established. METHODS A single-institution retrospective case series was performed. The inclusion criteria specified preoperatively euthyroid adults who underwent salvage laryngectomy with concurrent neck dissection between 1997 and 2015 for persistent or recurrent laryngeal squamous cell carcinoma after radiation or chemoradiation therapy (n = 182). The principal explanatory variable was postoperative hypothyroidism, defined as thyroid-stimulating hormone (TSH) higher than 5.5 mIU/L. The primary end points of the study were pharyngocutaneous fistulas and wounds requiring reoperation. Multivariate analysis was performed. RESULTS The fistula rate was 47% among hypothyroid patients versus 23% among euthyroid patients. In the multivariate analysis, the patients who experienced hypothyroidism in the postoperative period had a 3.6-fold greater risk of fistula [95% confidence interval (CI) 1.8-7.1; p = 0.0002]. The hypothyroid patients had an 11.4-fold greater risk for a required reoperation (24.4 vs 5.4%) than the euthyroid patients (95% CI 2.6-49.9; p = 0.001). The risk for fistula (p = 0.003) and reoperation (p = 0.001) increased with increasing TSH. This corresponds to an approximate 12.5% incremental increase in the absolute risk for fistula and a 10% increase in the absolute risk for reoperation with each doubling of the TSH. CONCLUSION Postoperative hypothyroidism independently predicts postoperative wound-healing complications. The association of hypothyroidism with fistula formation may yield opportunities to modulate wound healing with thyroid supplementation or to provide a biomarker of wound progression.
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Affiliation(s)
- Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Ashley L Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Craig C Jaffe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto Health System, Toronto, ON, Canada
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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24
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Saito Y, Omura G, Yasuhara K, Rikitake R, Akashi K, Fukuoka O, Yoshida M, Ando M, Asakage T, Yamasoba T. Prognostic value of lymphovascular invasion of the primary tumor in hypopharyngeal carcinoma after total laryngopharyngectomy. Head Neck 2017; 39:1535-1543. [PMID: 28580699 DOI: 10.1002/hed.24705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/28/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to determinate the prognostic value of lymphovascular invasion in the specimens resected during total laryngopharyngectomy for hypopharyngeal carcinoma. METHODS Patients who underwent total laryngopharyngectomy at our institution between 2004 and 2014 were included in this study and retrospectively analyzed. We then discriminated for vascular invasion and lymphatic invasion of the primary tumor in all cases. RESULTS We reviewed 135 records (120 men and 15 women; age range, 36-84 years). Tumors with lymphatic invasion tended to be associated with more metastatic lymph nodes and extracapsular spread (ECS) of metastatic lymph nodes. Tumors with vascular invasion tended to be associated with nonpyriform sinus locations. In a multivariate analysis, nonpyriform sinus locations, >3 metastatic lymph nodes, and vascular invasion remained significant prognostic factors for overall survival (OS); in recursive partitioning analysis, ECS and vascular invasion remained important categorical variables for OS. CONCLUSION Vascular invasion is a strong prognostic biomarker for advanced hypopharyngeal carcinoma. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1535-1543, 2017.
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Affiliation(s)
- Yuki Saito
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Go Omura
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Yasuhara
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Rikitake
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ken Akashi
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Osamu Fukuoka
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masafumi Yoshida
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mizuo Ando
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Asakage
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology - Head and Neck Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases. Plast Reconstr Surg 2017; 139:105e-119e. [PMID: 28027247 DOI: 10.1097/prs.0000000000002915] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes. METHODS A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes. RESULTS Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p < 0.001). CONCLUSIONS Neck resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.
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Rosko A, Birkeland A, Shuman A, Prince M, Bradford C, Wolf G, Worden F, Eisbruch A, Srinivasan A, Wong KK, Spector ME. Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer. Head Neck 2017; 39:980-987. [PMID: 28236331 DOI: 10.1002/hed.24719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 11/30/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the predictive value of positron emission tomography (PET)-CT in identifying occult nodal metastasis in clinically and radiographically N0 patients with recurrent laryngeal cancer undergoing salvage laryngectomy. METHODS Retrospective review of 46 clinically and radiographically N0 patients with recurrent laryngeal cancer who underwent a PET-CT examination before salvage laryngectomy with neck dissection from January 1, 2002, to December 31, 2014, was performed. RESULTS Two patients (16.7%) had true-positive PET-CT results, whereas 10 patients (83.3%) had false-negative scans, 1 patient (2.9%) had a false-positive result and 33 patients (97.1%) had a true-negative PET-CT. The sensitivity of PET-CT was 16.7% (95% confidence interval [CI], 3.5% to 46.0%) with a specificity of 97.1% (95% CI, 83.8% to 99.9%), positive predictive value (PPV) of 66.7% (95% CI, 20.2% to 94.4%), and negative predictive value (NPV) of 76.7% (95% CI, 62.1% to 87.0%). CONCLUSION PET-CT has poor sensitivity and NPV making PET-CT an imperfect predictor of nodal disease in recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 980-987, 2017.
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Affiliation(s)
- Andrew Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Andrew Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Mark Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Carol Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Gregory Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
| | - Francis Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ka Kit Wong
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan
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Hamoir M, Holvoet E, Ambroise J, Lengelé B, Schmitz S. Salvage surgery in recurrent head and neck squamous cell carcinoma: Oncologic outcome and predictors of disease free survival. Oral Oncol 2017; 67:1-9. [PMID: 28351561 DOI: 10.1016/j.oraloncology.2017.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Salvage surgery in recurrent SCCHN is associated with poor outcomes. This study aimed to better identify suitable surgical candidates and those at high risk of new recurrence. MATERIALS AND METHODS Single-center retrospective analysis of 109 patients undergoing salvage surgery for recurrent SCCHN. Univariate and multivariate analyses were used to identify prognostic factors affecting disease-free survival (DFS). RESULTS The following factors showed a significant impact on DFS: Disease-free interval >6months [HR 0.53; p=0.04], age>70years [HR 0.26; p=0.03], primary chemoradiotherapy [HR 2.39; p<0.01] compared to radiotherapy, oropharynx [HR 5.46; p<0.01] and hypopharynx [HR 3.92; p=<0.01] sites, compared to larynx, initial stage III [HR 7.10; p<0.01] and stage IV [HR 4.13; p<0.01], compared to stage I, locoregional recurrence [HR 4.57; p<0.01], compared to local recurrence. Univariate analysis also identified significant postoperative predictors of poor DFS including flap reconstruction [HR 3.44; p<0.01], postoperative complications [HR 2.09; p=0.01], positive margins [HR 3.64; p<0.01] and close margins [HR 3.83; p<0.01]. On multivariate analysis, oropharynx site [HR 3.98; p<0.01], initial stage III [HR 5.93; p<0.01] and locoregional recurrence [HR 2.93; p=0.04] were independent preoperative prognostic factors for DFS. Positive margins [HR 2.32; p=0.04], close margins [HR 2.94; p=0.02], extracapsular spread (ECS) [HR 4.04; p=0.03] and postoperative complications [HR 3.64; p<0.01] were independent postoperative prognostic factors. CONCLUSIONS Patients with advanced primary nonlaryngeal tumor and locoregional recurrence have limited success with salvage surgery. Because patients with positive margins and ECS are at high risk of relapse, adjuvant treatment should be discussed.
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Affiliation(s)
- Marc Hamoir
- Department of Head & Neck Surgery, St Luc University HospitaI and King Albert II Cancer Institute, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.
| | - Emma Holvoet
- Department of Head & Neck Surgery, St Luc University HospitaI and King Albert II Cancer Institute, Brussels, Belgium
| | - Jerôme Ambroise
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium; Center for Applied Molecular Technologies (CTMA), Université Catholique de Louvain, Brussels, Belgium
| | - Benoît Lengelé
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium; Department of Plastic and Reconstructive Surgery, King Albert II Cancer Institute & St Luc University Hospital, Brussels, Belgium
| | - Sandra Schmitz
- Department of Head & Neck Surgery, St Luc University HospitaI and King Albert II Cancer Institute, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
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Butskiy O, Rahmanian R, White RA, Durham S, Anderson DW, Prisman E. Revisiting the gastric pull-up for pharyngoesophageal reconstruction: A systematic review and meta-analysis of mortality and morbidity. J Surg Oncol 2016; 114:907-914. [PMID: 27774626 DOI: 10.1002/jso.24477] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
Gastric pull-up (GPU) is among the oldest techniques for reconstructing the pharyngoesophageal junction following cancer resection. This review examines morbidity and mortality rates following GPU pharyngoesophageal junction reconstruction from 1959 until present: 77 studies, 2,705 patients. The odds of mortality, anastomotic complications, and other complications decreased by 37.2% (95%CI = 28.0-45.3%; P < 0.0001), 8.0% (95%CI = -2.1 to 17.1%; P = 0.12), 21.0% (95%CI 3.5-35.2%; P = 0.021) per decade respectively. J. Surg. Oncol. 2016;114:907-914. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Oleksandr Butskiy
- Division of Otolaryngology-Head and Neck Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronak Rahmanian
- Division of Otolaryngology-Head and Neck Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard A White
- Statistical Consulting and Research Laboratory, Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Durham
- Division of Otolaryngology-Head and Neck Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald W Anderson
- Division of Otolaryngology-Head and Neck Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology-Head and Neck Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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León X, Rigó A, Farré N, López M, García J, de Juan J, Quer M. Prognostic significance of extracapsular spread in isolated neck recurrences in head and neck squamous cell carcinoma patients. Eur Arch Otorhinolaryngol 2016; 274:527-533. [DOI: 10.1007/s00405-016-4249-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
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Butskiy O, Anderson DW, Prisman E. Management algorithm for failed gastric pull up reconstruction of laryngopharyngectomy defects: case report and review of the literature. J Otolaryngol Head Neck Surg 2016; 45:41. [PMID: 27449235 PMCID: PMC4957331 DOI: 10.1186/s40463-016-0153-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/22/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gastric pull up remains a popular reconstructive option for pharyngoesophagectomy defects extending to thoracic inlet. Gastric necrosis is a dreaded complication of gastric pull up reconstruction and few studies report on management of this complication. MEDLINE, EMBASE, and Web of Science™ databases were searched for publications in the last 25 years on gastric pull up reconstruction following pharyngoesophagectomy. The rates of complications related to gastropharyngeal anastomosis were extracted, and methods of managing gastric necrosis were noted. Forty seven case series were identified reporting on the use of gastric pull up for reconstruction of pharyngoesophageal defects. Mortality rate varied from 0 to 33 % with a weighted average of 8.6 %. In 39 % of patients, mortality was either caused or directly related to failure of the gastropharyngeal anastomosis. The reported rate of gastric necrosis ranged from 0 to 24 % resulting in a 28 % mortality. Options for managing gastric necrosis included: temporary cervical diversion, free jejunum flap, colonic interposition, tubed radial forearm flap, deltopectoralis and pectoralis myocutaneous flaps. CASE PRESENTATION We present the first case of an anterolateral thigh flap rescue of gastric necrosis after gastric pull up reconstruction. The case report is followed by a review of literature on management of gastric pull up failures. CONCLUSION Based on the extracted information, we propose an algorithm for managing gastric pull up failure following pharyngoesophageal reconstruction.
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Affiliation(s)
- Oleksandr Butskiy
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital & University of British Columbia, Vancouver, BC, Canada.
- Gordon & Leslie Diamond Health Care Centre, 4th. Fl. 4299B-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Donald W Anderson
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital & University of British Columbia, Vancouver, BC, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital & University of British Columbia, Vancouver, BC, Canada
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Dabas S, Dewan A, Ranjan R, Dewan AK, Shukla H, Sinha R. Salvage Transoral Robotic Surgery for Recurrent or Residual Head and Neck Squamous Cell Carcinoma: A Single Institution Experience. Asian Pac J Cancer Prev 2015; 16:7627-32. [DOI: 10.7314/apjcp.2015.16.17.7627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rudmik L, An W, Livingstone D, Matthews W, Seikaly H, Scrimger R, Marshall D. Making a case for high-volume robotic surgery centers: A cost-effectiveness analysis of transoral robotic surgery. J Surg Oncol 2015; 112:155-63. [DOI: 10.1002/jso.23974] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/23/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Wenyi An
- Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
| | - Devon Livingstone
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Wayne Matthews
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Hadi Seikaly
- D ivision of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Rufus Scrimger
- Division of Radiation Oncology; Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Deborah Marshall
- Canada Research Chair; Health Services and Systems Research; Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
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Basheeth N, O'Leary G, Khan H, Sheahan P. Oncologic outcomes of total laryngectomy: Impact of margins and preoperative tracheostomy. Head Neck 2014; 37:862-9. [DOI: 10.1002/hed.23681] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/29/2013] [Accepted: 03/07/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Naveed Basheeth
- Department of Otolaryngology - Head and Neck Surgery; South Infirmary Victoria University Hospital; Cork Ireland
| | - Gerard O'Leary
- Department of Otolaryngology - Head and Neck Surgery; South Infirmary Victoria University Hospital; Cork Ireland
| | - Habib Khan
- Department of Otolaryngology - Head and Neck Surgery; South Infirmary Victoria University Hospital; Cork Ireland
| | - Patrick Sheahan
- Department of Otolaryngology - Head and Neck Surgery; South Infirmary Victoria University Hospital; Cork Ireland
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Omura G, Saito Y, Ando M, Kobayashi K, Ebihara Y, Yamasoba T, Asakage T. Salvage surgery for local residual or recurrent pharyngeal cancer after radiotherapy or chemoradiotherapy. Laryngoscope 2014; 124:2075-80. [PMID: 24676876 DOI: 10.1002/lary.24695] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/06/2014] [Accepted: 03/26/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Local residual or recurrent pharyngeal cancer after definitive radiotherapy (RT) or chemoradiotherapy (CRT) is correlated to poor prognosis. We analyzed the efficacy of salvage surgery for patients with local residual or recurrent pharyngeal cancer after RT or CRT. STUDY DESIGN Retrospective clinical study with chart review. METHODS Between 2001 and 2011, we treated 207 patients with resectable pharyngeal cancer, including 98 patients with oropharyngeal cancer (OPC) and 109 patients with hypopharyngeal cancer (HPC) who received definitive RT or CRT. Local residual or recurrence developed in 59 patients (23 with OPC; 36 with HPC), of whom 42 (18 with OPC; 24 with HPC) underwent salvage surgery. These 42 patients were investigated in this study. RESULTS The initial treatments were RT; RT with induction chemotherapy (IC); and concurrent CRT in 12, 9, and 21 patients, respectively. The median radiation dose was 70 Gy. The 3-year disease-specific survival rate after salvage surgery was 40% (median, 26 months). The significant prognostic factors were stage IV prior to initial therapy (P = .049), development of concurrent local and regional relapse (P = .02), and OPC (P = .04). CONCLUSIONS The efficacy of salvage surgery for local residual or recurrent pharyngeal cancer was limited. Oropharynx origin, stage IV prior to initial therapy, and concurrent regional relapses were significantly poor prognostic factors. Salvage surgery for HPC is worth challenging aggressively. Conversely, the indication of salvage surgery for OPCs should be carefully considered because of its low cure rate.
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Affiliation(s)
- Go Omura
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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36
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Ida S, Morita M, Hiyoshi Y, Ikeda K, Ando K, Kimura Y, Saeki H, Oki E, Kusumoto T, Yoshida S, Nakashima T, Watanabe M, Baba H, Maehara Y. Surgical Resection of Hypopharynx and Cervical Esophageal Cancer with a History of Esophagectomy for Thoracic Esophageal Cancer. Ann Surg Oncol 2014; 21:1175-81. [PMID: 24380922 DOI: 10.1245/s10434-013-3454-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Satoshi Ida
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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When is reoperative surgery not indicated for recurrent head and neck squamous cell carcinoma? Eur Arch Otorhinolaryngol 2013; 272:259-62. [DOI: 10.1007/s00405-013-2828-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
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Loevner LA, Learned KO, Mohan S, O’Malley BW, Scanlon MH, Rassekh CH, Weinstein GS. Transoral Robotic Surgery in Head and Neck Cancer: What Radiologists Need to Know about the Cutting Edge. Radiographics 2013; 33:1759-79. [DOI: 10.1148/rg.336135518] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Transoral robotic-assisted free flap reconstruction after radiation therapy in hypopharyngeal carcinoma: report of two cases. Eur Arch Otorhinolaryngol 2013; 270:2359-64. [DOI: 10.1007/s00405-013-2566-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 05/14/2013] [Indexed: 12/28/2022]
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40
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Piazza C, Taglietti V, Paderno A, Nicolai P. End-to-end versus end-to-side venous microanastomoses in head and neck reconstruction. Eur Arch Otorhinolaryngol 2013; 271:157-62. [PMID: 23605305 DOI: 10.1007/s00405-013-2496-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/11/2013] [Indexed: 11/26/2022]
Abstract
Venous thrombosis (VT) is the primary reason for microvascular free flaps (MFFs) failure. Different series have addressed the influence of venous anastomosis, end-to-end (ETE) vs. end-to-side (ETS), on this issue in head and neck (HN) microsurgery, but a consensus about the optimal technique to be adopted is still lacking. The aim of this study is to prospectively compare the venous complication rates of ETE and ETS techniques in 422 homogeneously treated patients who underwent MFF for HN oncologic defects between 2000 and 2012 at our Institution. Patients were divided into two groups: Group A (n = 269 patients) receiving an ETE and Group B (n = 153) an ETS venous anastomosis. The choice between the type of venous anastomosis was based on the several variables: availability of adequate caliber recipient veins in the neck, length and caliber of the donor vein, geometry and orientation of the vascular pedicle, and possibility to create a tensionless anastomosis. An ETE anastomosis was always preferred when feasible, while an ETS (performed on the internal jugular vein) was reserved to cases in which the abovementioned considerations contraindicated an ETE. Overall, the MFF failure rate was 3%. Among the 13 failures, five had VT (1.1%): three had received an ETE, and two an ETS. Venous anastomosis re-exploration and failure rates of the two groups were compared by the Chi-squared test showing no statistically significant differences. In conclusion, our data show how ETS venous anastomosis is a safe alternative to ETE whenever the latter cannot be properly accomplished for the previously mentioned contraindications.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Spedali Civili of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy,
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Fakhry N, Chamorey E, Michel J, Collet C, Santini L, Poissonnet G, Santini J, Dessi P, Giovanni A, Dassonville O, Bozec A. Salvage Circular Laryngopharyngectomy and Radial Forearm Free Flap for Recurrent Hypopharyngeal Cancer. Laryngoscope 2013; 123:910-5. [DOI: 10.1002/lary.23781] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 08/06/2012] [Accepted: 09/17/2012] [Indexed: 11/11/2022]
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Ho AS, Kraus DH, Ganly I, Lee NY, Shah JP, Morris LGT. Decision making in the management of recurrent head and neck cancer. Head Neck 2013; 36:144-51. [PMID: 23471843 DOI: 10.1002/hed.23227] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/22/2012] [Accepted: 11/26/2012] [Indexed: 01/28/2023] Open
Abstract
Despite substantial improvements in head and neck squamous cell carcinoma (HNSCC) treatment, the major obstacle to long-term survival remains disease recurrence. Salvage options are often limited due to prior therapy and the escalated morbidity of retreatment. The costs of treatment must be measured against the anticipated quality and quantity of life recovered, even with resectable disease. This review surveys the recurrent HNSCC literature to better guide decision making. Across multiple studies, negative prognostic factors include impaired performance status, advanced recurrent stage, brief disease-free interval, previous chemotherapy, and nonlaryngeal sites of recurrence. When possible, surgical salvage remains the principal option for durable disease control, quality of life preservation, and cure. Nonsurgical therapies have also demonstrated measurable improvements in locoregional control. Interpretation of salvage literature must be tempered by recognition of significant selection bias. The decision for salvage therapy must be individualized, with management that involves well-informed patients resulting in the best outcomes.
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Affiliation(s)
- Allen S Ho
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Künzel J, Iro H, Psychogios G, Zenk J, Koch M. Closure of defects after resection of tumors of the oral cavity and the pharynx: medium- to long-term oncologic and functional results with the myocutaneous platysma flap. Eur Arch Otorhinolaryngol 2013; 270:2537-45. [DOI: 10.1007/s00405-013-2389-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Goessler UR. Traditional transcutaneous approaches in head and neck surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc06. [PMID: 23320058 PMCID: PMC3544212 DOI: 10.3205/cto000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing.In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool.In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.
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Pruegsanusak K, Peeravut S, Leelamanit V, Sinkijcharoenchai W, Jongsatitpaiboon J, Phungrassami T, Chuchart K, Thongsuksai P. Survival and prognostic factors of different sites of head and neck cancer: an analysis from Thailand. Asian Pac J Cancer Prev 2012; 13:885-90. [PMID: 22631666 DOI: 10.7314/apjcp.2012.13.3.885] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head and neck cancers are prevalent in Thailand, in particular in the southern region of the country. However, survival with a large data set has not been reported. The purpose of the present study was to evaluate the survival figures and the prognostic factors in a cohort of patients treated in a university hospital located in the south of Thailand. PATIENTS AND METHODS Consecutive new cases of primary carcinoma of the oral cavity, oropharyx, hypopharynx and larynx, treated at Songklanagarind Hospital during 2002 to 2004, were analyzed. The 5-year overall survival rates were obtained by the Kaplan-Meier method. Prognostic factors were identified through multivariate Cox regression analysis. RESULTS A total 1,186 cases were analyzed. Two-thirds (66.6%) of the cases were at advanced stage (stage III and IV) at presentation. The five-year overall survivals for the whole cohort, oral cavity, oropharynx, hypopharynx and larynx were 24.1%, 25.91%, 19.2%, 13.4%, 38.0% respectively. Stage and treatment type were strong prognostic factors for all sites. An age ≥80 years was associated with poor survival in oral cavity and larynx cancer. CONCLUSIONS The results revealed remarkably poor outcomes of the patients in the series, indicating a strong need to increase the proportion of early stage presentations and maximize the treatment efficacy to improving outcomes. Very old patients are of particular concern for treatment care of oral cavity and larynx cancer.
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Affiliation(s)
- Kowit Pruegsanusak
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Comparison between Fasciocutaneous and Jejunum Flaps in Pharyngolaryngoesophageal Reconstruction. Plast Reconstr Surg 2011; 127:2124-2126. [DOI: 10.1097/prs.0b013e31820e92e0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takes RP, Strojan P, Silver CE, Bradley PJ, Haigentz M, Wolf GT, Shaha AR, Hartl DM, Olofsson J, Langendijk JA, Rinaldo A, Ferlito A. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck 2010; 34:270-81. [PMID: 22228621 DOI: 10.1002/hed.21613] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 01/18/2023] Open
Abstract
Squamous cell carcinoma of the hypopharynx represents a distinct clinical entity. Most patients present with significant comorbidities and advanced-stage disease. The overall survival is relatively poor because of high rates of regional and distant metastasis at presentation or early in the course of the disease. A multidisciplinary approach is crucial in the overall management of these patients to achieve the best results and maintain or improve functional results. Traditionally, operable hypopharyngeal cancer has been treated by total (occasionally partial) laryngectomy and partial or circumferential pharyngectomy, followed by reconstruction and postoperative radiotherapy in most cases. Efforts to preserve speech and swallowing function in the surgical treatment of hypopharyngeal (and laryngeal) cancer have resulted in a declining use of total laryngopharyngectomy and improved reconstructive efforts, including microvascular free tissue transfer. There are many surgical, as well as nonsurgical, options available for organ and function preservation, which report equally effective tumor control and survival. The selection of appropriate treatment is of crucial importance in the achievement of optimal results for these patients. In this article, several aspects of surgical and nonsurgical approaches in the treatment of hypopharyngeal cancer are discussed. Future studies must be carefully designed within clearly defined populations and use uniform terminology and standardized functional assessment and declare appropriate patient or disease endpoints. These studies should focus on improvement of results, without increasing patient morbidity. In this respect, technical improvements in radiotherapy such as intensity-modulated radiotherapy, advances in supportive care, and incorporation of newer systemic agents such as targeted therapy, are relevant developments.
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Affiliation(s)
- Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Salvage surgery for local recurrence after chemoradiotherapy or radiotherapy in hypopharyngeal cancer patients. Eur Arch Otorhinolaryngol 2010; 267:1765-9. [PMID: 20495926 DOI: 10.1007/s00405-010-1274-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
Abstract
This retrospective study aimed to assess the role of salvage surgery for local recurrence in hypopharyngeal cancer (HPC) patients who had received radiotherapy (RT) or concomitant chemoradiotherapy (CRT) as an initial treatment. The local recurrence rate, salvage rate after local recurrence and overall survival rate were investigated in 104 HPC patients who received treatment between 1991 and 2005. Local recurrence in the primary site was observed in 41 patients (rate, 39.4%) of whom only 12 could undergo further salvage surgery. Disease control was achieved in seven of these patients (successful salvage rate, 17.1%). The 5-year overall survival rate was 40.6% in the RT/CRT patient group and successful salvage rates for T1, T2, T3 and T4 primary disease were 33.3% (1/3), 20.0% (4/20), 16.7% (2/12) and 0% (0/6), respectively. Severe postoperative complications such as pharyngo-cutaneous fistula were seen in six patients (50.0%). Prognosis of patients with locally recurring HPC after RT/CRT is poor at any primary T-stage and the incidence of postoperative complication is relatively high. This should be taken into consideration when the initial treatment plan is decided and the choice of salvage surgery for such recurrent cases should be carefully determined.
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Kadota H, Fukushima J, Nakashima T, Kumamoto Y, Yoshida S, Yasumatsu R, Shiratsuchi H, Morita M, Komume S. Comparison of salvage and planned pharyngolaryngectomy with jejunal transfer for hypopharyngeal carcinoma after chemoradiotherapy. Laryngoscope 2010; 120:1103-8. [DOI: 10.1002/lary.20887] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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