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Acevedo Ortiz L, Aguilera Aguilera GA, Lasierra Concellón M, Carboni Muñoz MA, Andreu Mencia L, Soteras Olle J, Garcia Gonzalez B, Galindo Ortego FJ. Comparison of Patients With Total and Salvage Laryngectomy. Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:352-8. [PMID: 34844673 DOI: 10.1016/j.otoeng.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/03/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival. METHODS The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death. RESULTS The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P = .000) and between fistula and infection (P = .000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P = .038), T4 (P = .026), lymphovascular invasion (P = .019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P = .005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P = .026). CONCLUSIONS Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.
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Ramada Rodilla JM, Calvo Cerrada B, Serra Pujadas C, Delclos GL, Benavides FG. Fiber burden and asbestos-related diseases: an umbrella review. Gac Sanit 2021; 36:173-183. [PMID: 34120777 PMCID: PMC8882348 DOI: 10.1016/j.gaceta.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022]
Abstract
Objective: What are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects. Method: An umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument. Results: We retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those > 10 μm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 μm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels < 0.1 f/ml. No reviews provided information on exposure concentrations for pulmonary fibrosis. Currently, there is limited evidence in humans to establish the causal relationship between gastrointestinal cancer and asbestos exposure. Conclusions: Banning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml.
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Affiliation(s)
- José María Ramada Rodilla
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Servei de Salut Laboral, Parc de Salut Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Center for Research in Occupational Health (CISAL-UPF), Barcelona, Spain.
| | | | - Consol Serra Pujadas
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Servei de Salut Laboral, Parc de Salut Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Center for Research in Occupational Health (CISAL-UPF), Barcelona, Spain
| | - George L Delclos
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Center for Research in Occupational Health (CISAL-UPF), Barcelona, Spain; Southwest Center for Occupational and Environmental Health, The University of Texas Health Science at Houston School of Public Health, Houston, Texas, USA
| | - Fernando G Benavides
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Center for Research in Occupational Health (CISAL-UPF), Barcelona, Spain
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Albano D, Dondi F, Paderno A, Nocivelli G, Maddalo M, Magrini SM, Nicolai P, Maroldi R, Giubbini R, Bertagna F. 18F-FDG-PET/CT in laryngeal cancer: Comparison with conventional imaging and prognostic role. Rev Esp Med Nucl Imagen Mol 2021. [PMID: 33642259 DOI: 10.1016/j.remn.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the diagnostic accuracy of staging 18F-FDG-PET/CT in laryngeal cancer, compare these results with conventional imaging (CI) and assess the value of 18F-FDG-PET/CT features to predict survival. METHODS Fifty-four patients with laryngeal squamous cell cancer and baseline 18F-FDG-PET/CT were retrospectively enrolled. The PET images were analyzed visually and semi-quantitatively by measuring several metabolic parameters. A combination of clinical follow-up/imaging follow-up and/or histopathology was taken as reference standard. Progression free survival (PFS) and disease specific survival (DSS) were computed using Kaplan-Meier curves. RESULTS All primary tumors were clearly identified by CI, and 52/54 by 18F-FDG-PET/CT with a sensitivity of 96.3%. Cervical nodal metastases were detected in 40/54 patients at 18F-FDG-PET/CT and in 34/49 patients at CI. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy on a patient-based analysis for nodal disease were 100%, 85.7%, 94.6%, 100% and 95.9% at 18F-FDG-PET/CT, and 91.4%, 85.7%, 94.1%, 80%, 89.8% at CI. Diagnostic performances of PET/CT and CI were not significantly different on a patient-based, side-by-side and level-by-level analysis. 18F-FDG-PET/CT recognized distant metastases in 7 patients allowing to an upstaging. At a median follow-up of 27 months, relapse/progression of disease occurred in 31 patients and death occurred in 32. Metabolic tumor volume (MTV T), MTV total and total lesion glycolysis (TLG) showed to be independent prognostic factors for PFS. CONCLUSIONS Both CI and PET/CT had good diagnostic performances for the staging of laryngeal cancer; baseline metabolic features (MTV and TLG) showed an important prognostic value in assessing the rate of PFS.
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Affiliation(s)
- D Albano
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italia.
| | - F Dondi
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italia
| | - A Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia and Spedali Civili Brescia, Brescia, Italia
| | - G Nocivelli
- Department of Radiology, University of Brescia and Spedali Civili Brescia, Brescia, Italia
| | - M Maddalo
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italia
| | - S M Magrini
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italia
| | - P Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia and Spedali Civili Brescia, Brescia, Italia
| | - R Maroldi
- Department of Radiology, University of Brescia and Spedali Civili Brescia, Brescia, Italia
| | - R Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italia
| | - F Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italia
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Acevedo Ortiz L, Aguilera Aguilera GA, Lasierra Concellón M, Carboni Muñoz MA, Andreu Mencia L, Soteras Olle J, Garcia Gonzalez B, Galindo Ortego FJ. Comparison of patients with total and salvage laryngectomy. Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:S0001-6519(20)30166-7. [PMID: 33485626 DOI: 10.1016/j.otorri.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival. METHODS The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death. RESULTS The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P=.000) and between fistula and infection (P=.000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P=.038), T4 (P=.026), lymphovascular invasion (P=.019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P=.005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P=.026). CONCLUSIONS Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.
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Affiliation(s)
- Laura Acevedo Ortiz
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España.
| | - Gabriel Alejandro Aguilera Aguilera
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España
| | - Marta Lasierra Concellón
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España
| | - Mariela Andrea Carboni Muñoz
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España
| | - Leandro Andreu Mencia
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España
| | - Josep Soteras Olle
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España
| | - Begoña Garcia Gonzalez
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España
| | - Francisco Javier Galindo Ortego
- Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, España; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, España
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Gallegos-Hernández JF, Díaz-Guzmán ME, Pichardo-Romero PA, Mateos-Aguilar OO, Abrego JA, Ortiz-Maldonado AL. [Evaluación funcional de deglución-aspiración en pacientes sometidos a laringectomía subtotal supracricoidea con cricohioidoepiglotopexia]. GAC MED MEX 2018; 154:645-648. [PMID: 30532113 DOI: 10.24875/gmm.18003936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known. Objective To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteinsHDL cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria. Method Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio. Results Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides Tg in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk-measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tgtriglyceride/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52). Conclusion Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.
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Affiliation(s)
| | - María Elba Díaz-Guzmán
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Pablo Antonio Pichardo-Romero
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Oscar Omar Mateos-Aguilar
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Alberto Abrego
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Alma Lilia Ortiz-Maldonado
- Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Palacios-Saucedo GC, Vázquez-Guillén JM, Rivera-Morales LG, García-Cabello R, Sánchez-Fresno EC, Montalvo-Bañuelos MS, Serna-Hernández JC, Hernández-Martínez SJ, Castelán-Maldonado EE, Zavala-Pompa Á, Amador-Patiño GI, Rodríguez-Padilla C. [Prevalencia y genotipos del virus del papiloma humano en muestras de tejido laríngeo de pacientes con cáncer de laringe del noreste de México]. CIR CIR 2018; 86:499-507. [PMID: 30361714 DOI: 10.24875/ciru.18000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antecedentes El cáncer de laringe representa el 21.7% de las neoplasias malignas de vías aerodigestivas superiores. La prevalencia del virus del papiloma humano (VPH) en el cáncer de laringe oscila entre el 0 y el 80%. Método Se incluyeron 112 muestras de tejido laríngeo de pacientes con cáncer de laringe. Se amplificó el ADN y se analizó la presencia y el genotipo del VPH mediante hibridación reversa (INNO-LiPA®). Se realizaron pruebas de ji cuadrada, Fisher y t de Student no pareada. Resultados Se incluyeron muestras de 107 hombres (95.5%) y 5 mujeres (4.5%), con una edad de 65.3 ± 10.1 años, con antecedente de tabaquismo 108 (96.4%), alcoholismo 9 (8.0%) y carcinoma epidermoide moderadamente diferenciado queratinizante 96 (85.7%). Se identificó VPH en 60 (53.5%), VPH-11 en 51 (45.5%), VPH-52 en 27 (24.1%), VPH-16 en 9 (8.0%), VPH-45 en 3 (2.6%) y coinfección por más de un genotipo en 31 (27.6%). No hubo diferencia entre pacientes con y sin infección por VPH en cuanto a edad, sexo, localización, diagnóstico histopatológico, tabaquismo ni alcoholismo (p > 0.05). Conclusiones La prevalencia de infección por VPH en el cáncer de laringe fue del 53.5%, con coinfección por más de un genotipo en el 27.6%. El genotipo más frecuente fue el VPH-11, tipo de bajo riesgo, seguido por el VPH-52, de alto riesgo oncogénico. Background Laryngeal cancer represents 21.7% of malignancies of the upper aerodigestive tract. The prevalence of the Human Papillomavirus (HPV) in laryngeal cancer ranges 0 to 80%. Methods We included 112 laryngeal tissue samples obtained from patients with laryngeal cancer. DNA was extracted and amplified by PCR. HPV presence and genotype were analyzed by the reverse hybridization INNO-LiPA® assay. Chi-square, Fisher’s and unpaired Student t tests were used. Results Samples from 107 male (95.5%) and 5 female patients (4.5%) were evaluated, aged 65.3±10.1 years, 108 with smoking history (96.4%), 9 with alcoholism history (8.0%), and in 96 the histological diagnosis was moderately differentiated keratinizing squamous cell carcinoma (85.7%). HPV was detected in 60 samples (53.5%), HPV-11 in 51 (45.5%), HPV-52 in 27 (24.1%), HPV-16 in 9 (8.0%), HPV-45 in 3 (2.6%), and coinfection by more than one genotype in 31 (27.6%). There was no difference between patients with and without HPV infection with respect to age, sex, tumor location and histology, smoking and alcoholism history (p>0.05). Conclusions The prevalence of HPV infection in laryngeal cancer was 53.5% with coinfection with more than one genotype in 27.6%. The most frequent genotype was HPV-11, an oncogenic low-risk genotype, followed by HPV-52, a high-risk genotype.
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Affiliation(s)
- Gerardo C Palacios-Saucedo
- División de Investigación en Salud, Departamento de Otorrinolaringología y Departamento de Anatomía Patológica, Unidad Médica de Alta Especialidad Hospital de Especialidades No. 25, Instituto Mexicano del Seguro Social (IMSS), Monterrey
| | - José M Vázquez-Guillén
- Laboratorio de Inmunología y Virología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza
| | - Lydia G Rivera-Morales
- Laboratorio de Inmunología y Virología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza
| | - Ricardo García-Cabello
- División de Investigación en Salud, Departamento de Otorrinolaringología y Departamento de Anatomía Patológica, Unidad Médica de Alta Especialidad Hospital de Especialidades No. 25, Instituto Mexicano del Seguro Social (IMSS), Monterrey
| | - Ethel C Sánchez-Fresno
- División de Investigación en Salud, Departamento de Otorrinolaringología y Departamento de Anatomía Patológica, Unidad Médica de Alta Especialidad Hospital de Especialidades No. 25, Instituto Mexicano del Seguro Social (IMSS), Monterrey
| | - Martha S Montalvo-Bañuelos
- Departamento de Foniatría, Hospital General de Zona No. 6, IMSS, San Nicolás de los Garza, Nuevo León, México
| | - Julio C Serna-Hernández
- División de Investigación en Salud, Departamento de Otorrinolaringología y Departamento de Anatomía Patológica, Unidad Médica de Alta Especialidad Hospital de Especialidades No. 25, Instituto Mexicano del Seguro Social (IMSS), Monterrey
| | - Silvia J Hernández-Martínez
- División de Investigación en Salud, Departamento de Otorrinolaringología y Departamento de Anatomía Patológica, Unidad Médica de Alta Especialidad Hospital de Especialidades No. 25, Instituto Mexicano del Seguro Social (IMSS), Monterrey
| | - Edmundo E Castelán-Maldonado
- División de Investigación en Salud, Departamento de Otorrinolaringología y Departamento de Anatomía Patológica, Unidad Médica de Alta Especialidad Hospital de Especialidades No. 25, Instituto Mexicano del Seguro Social (IMSS), Monterrey
| | - Ángel Zavala-Pompa
- Laboratorio de Inmunología y Virología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza
| | - Gustavo I Amador-Patiño
- Laboratorio de Inmunología y Virología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza
| | - Cristina Rodríguez-Padilla
- Laboratorio de Inmunología y Virología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza
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García-León FJ, García-Estepa R, Romero-Tabares A, Gómez-Millán Borrachina J. Treatment of advanced laryngeal cancer and quality of life. Systematic review. Acta Otorrinolaringol Esp (Engl Ed) 2017; 68:212-9. [PMID: 28351474 DOI: 10.1016/j.otorri.2016.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/28/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The objective was the comparison of the quality of life in patients with advanced laryngeal cancer treated with organ preservation versus surgical treatment. METHODS We performed a systematic review in the databases MedLine, EMBASE, and PubMed (2014 1991) and Web of Science (2012 - 2014). The search terms were: Laryngeal cancer, organ preservation, chemotherapy, laryngectomy, treatment outcomes and quality of life. Systematic reviews, meta-analysis, reports of health technology assessment and comparative studies with control group, published in Spanish, French or English were included. The selection and quality assessment was made by two researchers. The criteria of the Cochrane Collaboration were used to assess the risk of bias and Scottish Intercollegiate Guidelines Network (SIGN) for the level of evidence. RESULTS Of the 208 studies identified in the search, three were included a clinical trial and two observational studies, with a total of 211 patients. Quality and level of evidence was low. The results were contradictory, on occasion they favoured surgery, and on other occasions chemotherapy, but in general there were no statistical differences between the treatments. The studies were heterogeneous, with different methodology, undersized, limitations in quality with high risk of bias and use of different measurement scales. CONCLUSIONS There are not enough studies of quality to establish differences in the quality of life in patients with advanced laryngeal cancer according to the treatment received.
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Gallegos-Hernández JF, Cruz-Esquivel I, Ortiz-Maldonado AL, Minauro-Muñoz GG, Arias-Ceballos H, Pichardo-Romero P. [Laryngeal conservative surgery in patients candidates for combined treatment with chemo-radiotherapy]. CIR CIR 2015; 84:96-101. [PMID: 26707250 DOI: 10.1016/j.circir.2015.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/18/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The standard of care for advanced-stage laryngeal cancer is combined treatment (chemo-radiotherapy). However, the complications with this treatment are not few, mainly in swallowing. Conservative laryngeal surgery remains an effective alternative for cancer control without the complications of chemo-radiotherapy. MATERIAL AND METHODS Retrospective study was conducted on patients with laryngeal cancer cT3, cN0 with paraglottic infiltration, fixation of the vocal cord, minimal invasion of the hyo-thyroepiglottic space, but with normal arytenoid mobility and no sub-glottic extension, were treated with subtotal supracricoid laryngectomy. Complications, sequels of treatment, and local recurrence were evaluated. Bronchial aspiration was studied with radioactive swallow. RESULTS There were 25 patients, 22 with negative surgical margins, one had tumour contact with the surgical margins, and 2 were positive. Two patients received postoperative radiotherapy. The mean decannulation was 15 days and removal of nasogastric tube 25 days. During the mean follow-up of 26 months, none of the patients had tumour recurrence or required conversion to total laryngectomy. In all patients swallowing has been normal and none required permanent or temporary tracheotomy or definitive gastrostomy. The voice is considered intelligible in all patients. Radioactive swallow showed aspiration in 15/25 patients, with none being clinically relevant. There were postoperative complications in 5 patients, and 4 patients required re-intervention but no conversion to total laryngectomy. CONCLUSION Conservative surgery is an effective surgical-alternative to chemo-radiotherapy in patients with locally advanced laryngeal cancer, providing oncological control, acceptable complications and minimal sequels. Although most patients have aspiration, this does not affect functional status.
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Affiliation(s)
- José Francisco Gallegos-Hernández
- Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México.
| | - Iván Cruz-Esquivel
- Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
| | - Alma Lilia Ortiz-Maldonado
- Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
| | - Gerardo Gabriel Minauro-Muñoz
- Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
| | - Héctor Arias-Ceballos
- Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
| | - Pablo Pichardo-Romero
- Departamento de Medicina Nuclear, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
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García-Sánchez M, Romero-Durán E, Mantilla-Morales A, Gallegos-Hernández JF. [Histopathological evaluation of the subtotal laryngectomy specimen]. CIR CIR 2015; 83:537-42. [PMID: 26159367 DOI: 10.1016/j.circir.2015.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 10/07/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors. OBJECTIVE To highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy. CONCLUSION The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen.
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Affiliation(s)
- Manuel García-Sánchez
- Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social, México D.F., México
| | - Elizabeth Romero-Durán
- Departamento de Patología, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
| | - Alejandra Mantilla-Morales
- Departamento de Patología, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
| | - José Francisco Gallegos-Hernández
- Departamento de Patología, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México.
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