Hugo Fontan Köhler

Surgical treatment of paragangliomas of the carotid bifurcation: Results of 36 patients

Paragangliomas of the carotid bifurcation are rare and usually benign neoplasms arising from the carotid body chemoreceptors. The aim of this retrospective study was to report long‐term results of carotid bifurcation paragangliomas treated in a single institution over a period of 20 years. The following variables are described: age, sex, localization, diagnostic workup, operative procedure, complications, proportion and characteristics of malignant tumors, and cure rates.

The prognosis of N2b and N2c lymph node disease in oral squamous cell carcinoma is determined by the number of metastatic lymph nodes rather than laterality: evidence to support a revision of the American Joint Committee on Cancer staging system.

A study was conducted to assess for prognostic heterogeneity within the N2b and N2c classifications for oral cancer based on the number of metastatic lymph nodes and to determine whether laterality of neck disease provides additional prognostic information.

Antioxidantes enterais em lesões de isquemia e reperfusão em ratos

OBJECTIVE To evaluate the role of pre-treatment with dietary antioxidants in an experimental model of intestinal injury of ischemia-reperfusion (I/R) in rats. METHODS Ninety adult male Wistar rats were used. An intestinal segment was isolated based on its vascular pedicle. A control biopsy was performed and the pedicle was sectioned and sutured again, ensuring a time of 60 minutes of ischemia followed by reperfusion. Sequential biopsies were performed at the end of the ischemic period and every 15 minutes during reperfusion. The treatment consisted of saline, vitamin C, vitamin E or a combination of the latter two. Quantitative and qualitative assessments of the biopsies were performed. RESULTS The groups treated with vitamin E alone or vitamin E combined with vitamin C showed a statistically significant attenuation of ischemia-reperfusion, with reduced loss of height of the villi and lower neutrophilic infiltration at the end of the study when compared to the control and vitamin C-exclusive groups. CONCLUSION In this experimental model of ischemia-reperfusion, pre-treatment with vitamin E attenuated the I/R injury in the small intestine of Rats, demonstrated by reduced loss of height of the villi and the attenuation of neutrophil infiltration.

The origin of regional failure in oral cavity squamous cell carcinoma with pathologically negative neck metastases.

IMPORTANCE Squamous cell carcinoma of the oral cavity (OSCC) is a common malignant tumor worldwide. OBJECTIVE To determine if regional failure in patients with OSCC and pathologically negative neck nodes (pN-) is due to an incomplete sampling procedure during surgery. DESIGN, SETTING, AND PARTICIPANTS We retrospectively reviewed the medical records of 2258 patients from 11 cancer centers worldwide who underwent neck dissection for OSCC (1990-2011) and who were pN-. Of those, 345 had clinical evidence of nodal metastases (cN+) on radiologic workup. The neck specimens were available for reanalysis in 193 patients. Survival rates were calculated using the Kaplan-Meier graphs and analyzed by multivariable analysis. MAIN OUTCOMES AND MEASURES Five-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). RESULTS Resectioning and analysis of the neck dissection specimens in the cN+/pN- subgroup revealed false-negative results in 29 (15%) of 193 patients. The negative predictive value of the initial pathologic examination was 85%. The 5-year OS and DSS in the cN-/pN- group were 77.6% and 87.2%, respectively. The 5-year OS and DSS of the cN+/pN- group were 62.6% and 78.5%, respectively (P < .001). In multivariable analysis, cN+ classification was significantly associated with poor OS (hazard ratio [HR], 1.7; 95% CI, 1.1-3.8; P = .03) and poor DSS (HR, 1.46; 95% CI, 1.1-4.1; P = .04). A cN+ classification was associated with lower DFS (66.3% vs 76.2%; P = .05) and lower regional recurrence-free survival (68.6% vs 78.8%; P = .02) but not with local (P = .20) or distant recurrence (P = .80). CONCLUSIONS AND RELEVANCE Pathologic staging underestimates the incidence of nodal metastases in cN+ disease. After correction for pathologically missed nodal metastases, radiologic evidence of neck nodes is an independent predictor of outcome, suggesting that traditional sampling during surgery might miss metastases, and this fact might explain the origin of treatment failure in these patients.

Prognostic impact of the level of neck metastasis in oral cancer patients

UNLABELLED Neck staging in oral cancer depends on the number of compromised nodes, their size and side of occurrence. OBJECTIVE This paper aims to evaluate risk factors for metastatic nodes in levels IV/V and their prognostic impact on patients with oral carcinoma. METHOD Retrospective study. INCLUSION CRITERIA pathologists diagnosis of squamous cell carcinoma, primary tumor in the lower oral cavity, no extension into extraoral sites, no previous treatment, synchronous neck dissection and presence of metastatic nodes. Risk factors for metastasis were evaluated through logistic regression and disease-specific survival and recurrence by survival analysis. Classificatory analysis was performed through recursive partitioning. RESULTS 307 patients met the inclusion criteria. Univariate logistic regression identified pN stage, vascular invasion, and multiple metastatic nodes as risk factors for metastases in levels IV/V. Multivariate analysis found vascular invasion and multiple metastatic nodes were significant. Survival analysis revealed pT, pN, neural infiltration, vascular invasion, number of metastatic nodes, metastases in levels IV/V, and node ratio were significant factors. In multivariate survival analysis, pT, pN, vascular invasion and metastases in levels IV/V were significant. Classificatory analysis showed that pN is non-significant in patients with level IV/V metastases. CONCLUSION The occurrence of metastases in levels IV/V was significant for disease-specific survival.

The role of adjuvant treatment in early-stage oral cavity squamous cell carcinoma: An international collaborative study: Treatment of Early Squamous Cell Carcinoma

Up to half of patients with oral cavity squamous cell carcinoma (OCSCC) have stage I to II disease. When adequate resection is attained, no further treatment is needed; however, re‐resection or radiotherapy may be indicated for patients with positive or close margins. This multicenter study evaluated the outcomes and role of adjuvant treatment in patients with stage I to II OCSCC.

Who are the low-risk patients that could benefit from watch-and-wait regarding the neck?

CONTEXT AND OBJECTIVE The management of clinically negative neck is controversial, with an ongoing debate on the indication criteria and prognostic impact of different types of therapy. The aim here was to compare the results from neck dissection and watch-and-wait, among oral cancer patients who, clinically, did not show any evidence of neck metastasis. DESIGN AND SETTING Retrospective analysis in a tertiary cancer center hospital. METHODS Patients with epidermoid oral carcinoma were assessed. The inclusion criteria were: primary tumor restricted to the oral/oropharyngeal cavity, no previous treatment, surgical treatment as the first option, clinical/radiological stage N0 and no distant metastasis. RESULTS Two hundred and sixty-two patients were analyzed. The length of follow-up ranged from four to 369.6 months and, at the end, 118 patients were alive, 53 had died due to cancer, 84 had died from other causes and 7 had died after the operation. Among the patients who underwent neck dissection, lymphatic vascular embolization (P = 0.009) and tumor thickness (P = 0.002) were significant for regional recurrence, while for the watch-and-wait group, only tumor thickness was significant (P = 0.018). Through recursive partitioning, the patients without adverse prognostic factors and tumor thickness < 2 mm presented compatible results in the two groups. CONCLUSION Elective neck dissection seems to be the best treatment option. Patients who are eligible for watch-and-wait constitute a small group that, ideally, is categorized according to the postoperative pathological findings.

Impact of modified radical neck dissections on the number of retrieved nodes, recurrence and survival

UNLABELLED Neck dissection is an integral part of head and neck tumors. Throughout its history, it has undergone changes looking for an improvement in functional outcome without loss of oncologic efficiency. AIM Demonstrate that the modified radical neck dissection have an oncologic results comparable to classical radical dissection. MATERIALS AND METHODS We included patients with squamous cell carcinoma of the lower floor of the mouth and oropharynx, who underwent radical classic or modified neck dissection. We excluded from this analysis those patients who had undergone previous treatment or extended neck dissection. STUDY DESIGN Retrospective study, involving an institution. RESULTS We identified 481 patients who met the inclusion criteria, corresponding to 521 dissections. The average number of lymph nodes dissected was 44.92 (SD 16:45) lymph nodes to the RCT, 44.16 (SD 15.76) for the MRND + XI and 56.02 (SD 22.91) for the ECRM IJV + XI. The ANOVA indicated a statistically significant difference between groups (p<0.001). The type of neck dissection was not significant for regional recurrence or disease-specific survival. CONCLUSION The use of modified neck dissection has no significant impact on the pathological staging, disease-free survival or disease-specific survival.

The prognosis of N2b and N2c lymph node disease in oral squamous cell carcinoma is determined by the number of metastatic lymph nodes rather than laterality

A study was conducted to assess for prognostic heterogeneity within the N2b and N2c classifications for oral cancer based on the number of metastatic lymph nodes and to determine whether laterality of neck disease provides additional prognostic information.

A critical appraisal of different survival techniques in oral cancer patients

The Cox model is the preferred survival analysis technique. We compare parametric techniques with the Cox model. 709 consecutive patients treated at a single institution. Univariate survival analysis was performed using the Cox model and parametric models. Significant factors were used to perform the multivariate analysis. The Cox model identified T stage, N stage, tumor thickness, and lymphatic embolization as significant in multivariate analysis. Non-proportional hazards were demonstrated for post-operative radiotherapy and vascular invasion. In the exponential model, T stage, N stage, post-operative radiotherapy, and tumor thickness were significant. The Weibull model identified T stage, N stage, ASA score, post-operative radiotherapy, and vascular invasion as significant. Both lognormal and generalized gamma models identified T stage, N stage, post-operative radiotherapy, tumor thickness, and vascular invasion as significant. Martingale and Cox-Snell residuals were tested. Internal validation confirmed the failure of the Cox model to correctly identify all significant covariates. In conclusion, parametric models may perform better than Cox model at identifying prognostic factors in certain circumstances and should be tested.