A comparison of wound healing between irradiated and nonirradiated patients after radical neck dissection

Role of radiation therapy in carcinoma of the hypopharynx

In a series of 199 patients with hypopharyngeal carcinoma treated with irradiation, the primary tumor was controlled in 63 per cent, 54 per cent, 44 per cent and 14 per cent of T1-T4 lesions, respectively. The five-year actuarial survival for stages I, II, III and IV patients was 60 per cent, 66 per cent, 49 per cent and 18 per cent. It was significantly better in patients with tumors located at the upper hypopharynx (p = 0.024). Early lesions yielded satisfactory results with irradiation alone. Advanced tumors had poor prognosis and other treatment modalities along with irradiation should be tried.

[Complications after surgery of ENT-tumors. A comparison between preoperatively irradiated and nonirradiated patients]

Complications after preoperative high-dosage radiation of head and neck cancer are reported: 1. Preoperative radiation leads to complications in 42% compared to surgery alone in 20%. The results are statistically significant (alpha = 2%). 2. The complications after preoperative radiation are more severe (three ruptures of the carotid artery, three defects, which could only be managed by flap rotation). These results indicate the preoperative high-dosage radiation implies the risk of major surgical complications.

Morbidity and mortality of mandibular resection for malignant disease

Twenty-nine per cent of patients undergoing mandibular resection had an entirely uncomplicated postoperative course. Local complications occurred in 54 per cent and systemic complication in 35 per cent. Increasing the extent of resection or an additional procedure, such as radical neck dissection, increased the local complication rate. Operation in fully irradiated tissue produced an increase in the proportion of life-threatening complications. Systemic complications were responsible for 80 per cent of the postoperative deaths.

Complications following surgery for cancer of the larynx and hypopharynx

The hospital and office records of patients undergoing major surgery for cancer of the larynx and hypopharynx at the Washington University Medical Center, St. Louis from 1955 to 1972 were reviewed. Study parameters were correlated with the incidence of major complications and statistically analyzed to elucidate what factors contribute to increased complication rates. Abnormal margins of surgical resection were found to be significant in determining subsequent complication. Age, sex, race, site and stage of the primary tumor, and the presence of pre-treatment cervical lymph node fixation did not alter the rate of complications. Similarly, low dose preoperative irradiation, various forms of carotid artery protection, and surgical patholgic findings including the size of the tumor, number of positive cervical nodes and cellular characteristics of the tumor showed no significant effect on the rate of complications. Increased total complication rate was associated with an increased death rate. Common complications included wound infection, wound necrosis, salivary fistula, hemorrhage, and carotid artery catastrophe. Also considered were operative deaths and delayed fatal complications. The common causes and treatment of these complications are outlined and safeguards which have been valuable in a sizeable number of patients are discussed.