Cees A. Meeuwis

Psychosocial and physical correlates of survival and recurrence in patients with head and neck carcinoma

Studies that have examined correlations between psychosocial factors and survival in cancer patients do not permit any definitive conclusions. To the authors knowledge, to date no study has examined the relation between medical as well as quality of life variables and survival in head and neck carcinoma patients. The current study focused on the complex interactions among psychosocial, medical, behavioral, and demographic variables as they relate to prognosis in these patients.

Is the pectoralis myocutaneous flap in intraoral and oropharyngeal reconstruction outdated

METHODSnOur experience with 224 immediate pectoralis major myocutaneous flap reconstructions in patients with carcinomas of the oral and oropharyngeal cavities is presented.nnnRESULTSnAlthough flap-related complications developed in 53% of the patients, all flaps survived, and we had no major skin paddle loss. The incidence of reoperation due to flap-related complications was 2%. All other complications were minor and did not affect the length of hospitalization. Analysis showed no significant risk factors for the development of complications. Because of fistula formation, infection, or metal exposure, plate removal was necessary in 10% of the AO fixation plates used in cases of mandibular swing. This occurred in 68% of the anterior and 22% of the lateral mandibular reconstructions performed with a reconstruction plate (P < 0.05).nnnCONCLUSIONSnWe conclude that a reconstruction plate is unsatisfactory for anterior mandibular continuity reconstruction and debatable for lateral mandibular reconstruction. At present, anterior defects are reconstructed with free vascularized osteocutaneous flaps that should probably also be used for lateral mandibular reconstruction. Furthermore, in a large number of series, it is reported that free flaps also have high complication rates and 5-10% flap loss. As all pectoralis major flaps survived in our series, it still remains a good choice in intraoral and oropharyngeal reconstruction when there is no necessity to reconstruct bone.

CO2-laser treatment of recurrent glottic carcinoma

Evaluation of the results of CO2 laser treatment of recurrent glottic carcinoma after radiotherapy.

Prognostic index for patients with parotid carcinoma: external validation using the nationwide 1985-1994 Dutch Head and Neck Oncology Cooperative Group database.

Validation of the prognostic indices for the recurrence‐free interval of patients with parotid carcinoma, the development of which was described in a previous report, is needed to be confident of their generalizability and justified prospective use.

Resection margins in oral cancer surgery: Room for improvement

The purpose of this review was to identify publications on resection margins in oral cancer surgery and compare these with the results from 2 Dutch academic medical centers. Eight publications were considered relevant for this study, reporting 30% to 65% inadequate resection margins (ie, positive and close margins), compared to 85% in Dutch centers. However, clinical outcome in terms of overall survival and recurrence seemed comparable. The misleading difference is caused by lack of unanimous margin definition and differences in surgicopathological approaches. This prevents comparison between the centers. Data from Dutch centers showed that inadequate resection margins have a significantly negative effect on local recurrence, regional recurrence, distant metastasis, and overall survival. These results confirm the need for improvement in oral cancer surgery. We underline the need for consistent protocols and optimization of frozen section procedures. We comment on development of optical techniques for intraoperative assessment of resection margins.

The Blom-Singer tracheostoma valve as a valuable addition in the rehabilitation of the laryngectomized patient.

Prosthesis-assisted tracheo-esophageal speech has proven its value in post-laryngectomy voice rehabilitation, although manual occlusion of the tracheostoma during speech is necessary. In contrast a tracheostoma valve enables hands-free speech. We have now had experience with 30 patients using the Blom-Singer tracheostoma valve for more than 6 months and have found that most patients prefer prosthesis-assisted speech with the tracheostoma valve. Measurement of several speech parameters with digital and valve occlusion of the tracheostoma did not show any significant differences between the two speaking conditions. Problems included maintenance of an airtight seal, outward forcing of the valve diaphragm during forced expiration and subjective increased airflow resistance.

High complication risk of salvage surgery after chemoradiation failures

Abstract Conclusions: Although organ preservation can be achieved with chemoradiation protocols for laryngeal or pharyngeal cancers, salvage surgery is accompanied by high complication rates. Objectives: To determine the rate of complications associated with salvage surgery after chemoradiation for laryngeal and pharyngeal cancers. Methods: A multicenter retrospective study was performed of 24 patients treated with total laryngectomy combined with total or partial pharyngectomy between 1995 and 2004 who had previously been treated with chemoradiation. The main outcome measures were early and late complication rates. Quality of life analysis was determined by two questionnaires. Results: The complication rate after salvage surgery was 92% in the direct postoperative period. The most frequent complication was pharyngocutaneous fistula formation. Narrowing of the esophagus and tracheostoma were the most common late sequelae. The quality of life, measured at least 2 years after salvage surgery, showed a social dysfunctioning.

Wound healing of cartilage structures in the head and neck region.

This study was performed to determine the various processes involved in the behaviour of hyaline cartilage during the wound healing period after trauma or surgery of vulnerable structures like the nasal septal cartilage and the cricoid. The results of different procedures (perpendicular and parallel to the cartilage surface) in young and young-adult animals were analyzed: septal incision at different locations (young-old), cricoid split (young-old), suturing cartilage, closing defects with autologous cartilage (young), biomaterials (young) and newly engineered cartilage in 4- and 24-week-old rabbits (series of ten animals). Cartilage of the young rabbit and child have similar hyaline cartilage with a varying distribution in thickness. Thinner areas are more susceptible to malformations. Incisions through younger cartilage give rise to some new cartilage formation covered by a new layer of perichondrium: through older, differentiated cartilage the incision causes superficial but permanent necrosis. Edges of cut cartilage mostly do heal by formation of fibrous junctions. This forms a weak spot, sensitive to deviations. The same fate goes for the healing between the autologous graft and the surrounding pre-existent cartilage. Trauma parallel to the surface, leads to inconsistent quantity of neocartilage. With ageing the wound healing and regenerative capacities decrease. In general, biomaterials are less accepted by the surrounding tissues and would impede further growth. Only newly engineered, and thus less differentiated (younger) cartilage of hyaline nature, appeared to be well accepted at the interface with the edges of a cartilage defect. There are indications that the release of growth factors might play a role in cartilage wound healing. In the child as well as the adult, wound healing of hyaline cartilage structures is incomplete, and surgery remains experimental surgery. The clinical implications of gradual loss of the regenerative capacity of hyaline cartilage should be further investigated.

Macrophage and dendritic cell infiltration in head and neck squamous-cell carcinoma; an immunohistochemical study

A study was undertaken to help us reach a better understanding of the tumor-infiltrating pattern of lymphoid cells and in particular of monocyte-derived cells, namely the CD68+, acid-phosphatase-expressing scavenger macrophages and the MHC-class-II- and S100-antigen-presenting dendritic cells in head and neck squamous-cell carcinoma. In the stroma of the tumors distinctive small fields of lymphocytes were found, the T cell areas of these fields being intermingled with dendritic cells. Intra-epithelial dendritic cell infiltration was low. The infiltrative pattern of macrophages was similar to patterns described in earlier studies with substantial stromal invasion and inconsistent intra-epithelial invasion, but small granuloma-like structures of CD68+ macrophage-like cells, found in the stroma of tumors, have not been reported before. The histochemical localization of the tumor-infiltrated dendritic cells and macrophages supports the view that the former cells are involved in the sensitization to tumor antigens, whereas the latter cells are involved in tumor cytotoxicity/scavenging of tumor cell debris. Although it has been shown in the past that transmembranal (TM) factors (p15E-like factors) present in the serum and tumor of patients with cancer of the head and neck have suppressive effects on monocyte/macrophage/dendritic cell function, a relationship between the intensity of epithelial staining for TM factors and the infiltrative pattern of monocytes/macrophages/dendritic cells could not be demonstrated.

Early and long-term morbidity after total laryngopharyngectomy

To determine the early and long-term morbidity of patients treated with a total laryngopharyngectomy and reconstruction using a jejunum interposition or gastric pull-up procedure. It is a retrospective study; and it is conducted in tertiairy referral center. Sixty-three patients were included in whom 70 reconstructions were performed (51 jejunum interpositions and 19 gastric pull-up procedures) between 1990 and 2007. The studied parameters were success rate of the reconstruction, early and long-term complication rate, and functional outcome including quality of life. Subjective quality of life analysis was determined by two questionnaires: the EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, and the EORTC-Head and Neck (H & N 35). The success rates were 84 and 74%, respectively. The procedures were associated with a high complication rate (63% after jejunum interposition and 89% after gastric pull-up), and a lengthy rehabilitation. Surviving patients were found to have a good long-term quality of life. Complete oral intake was achieved in 97%, and speech rehabilitation in 95%. These procedures are associated with significant morbidity, high complication rates, lengthy rehabilitation, but a good long-term quality of life.