G. Gitti

Supracricoid partial laryngectomy as salvage surgery for radiation therapy failure

The main concern in the treatment of laryngeal carcinomas is tumor control with preservation of laryngeal functions. We believe that salvage supracricoid partial laryngectomy (SPL) should be carefully considered in selected cases of radiotherapy failure, because it can offer the possibility of achieving adequate tumor control with preservation of laryngeal functions.

Infrahyoid flap reconstruction of oral cavity and oropharyngeal defects in elderly patients with severe general comorbidities

In current practice, surgeons frequently deal with elderly patients who have severe medical comorbidities.

Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

The goal of this study was to identify host and tumour factors associated with postoperative pneumonia (PP) in a selected population of laryngeal cancer patients, treated by partial laryngectomy in 20 years at our Institution and to assess its potential prognostic impact. Clinical records of 416 consecutive patients were retrospectively reviewed. Tobacco consumption, body mass index (BMI), previous pulmonary disease, age, sex, preoperative blood gas analysis values, tumour stage and type of surgery were tested as potential risk factors for PP. Finally, the prognostic impact of these variables, including PP, in terms of disease-free and actuarial survival by Kaplan-Meier and Cox analyses were evaluated. PP developed in 73 patients (16.8%). We identified two groups of patients: 26 patients experienced an early PP within the first 7-9 days after surgery, whilst 44 experienced an ab ingestis PP following attempts of oral food intake restoration, three patients died for PP related sepsis. At multivariate Cox analysis, age older than 60 years and BMI greater than 30 were statistically associated with early PP; whereas male gender and laryngectomy with neck dissection were statistically related to a higher risk of ab ingestis PP. Interestingly, the occurrence of early PP was a negative independent prognostic factor for 5-years disease-free and actuarial survival (p=0.049 and p=0.001, respectively). The occurrence of early-onset pneumonia in laryngeal cancer patients selected for conservative laryngectomies is predictable and associated with poor clinical outcome.

Risk Factors for Multiple Malignancies in the Head and Neck

Objective To define the prognostic role of multiple epidemiological, clinical, and biological factors for the development of multiple malignancies (MM) in patients with head and neck cancer (HNC). Study Design Historical cohort study. p53 gene status, microsatellite instability (MSI) of the index tumor, and inherited chromosome fragility (CF) were studied. Setting Ninety-six consecutive patients affected by primary HNC, between January 1987 and October 1991, who were eligible for curative radiation therapy were followed up. Subjects and Methods p53 gene status, MSI, and CF in 96 curative radiotherapy-treated patients were correlated with the risk for MM. Results Multiple malignancies occurred in 28.9%. Microsatellite instability (P = 0.05), CF (P < 0.01), and smoking after treatment of the index tumor (P = 0.02) were correlated with an increased risk of MM. Conclusion Genetic susceptibility may play a central role for MM development in patients with HNC.