Jossi Ledo Kanda

End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas

Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients.

Perioperative frozen section examination in parotid gland tumors

CONTEXT The minimal recommended surgical approach to parotid tumors is partial parotidectomy with resection of the superficial lobe of the gland. Histologic diagnosis prior to surgery is not possible, as incisional biopsies are contraindicated due to the possibility of facial nerve injury or incomplete tumor resection. Thus, the biopsies tend to be perioperative. OBJECTIVE To compare the results of frozen section examination with the definitive pathological diagnosis. DESIGN Accuracy study by retrospective analysis. SETTING Head and Neck Surgery Service of Heliópolis Hospital, São Paulo, Brazil. SAMPLE 153 cases of parotid gland tumors treated between 1977 and 1994. DIAGNOSTIC TEST Frozen section and pathological diagnosis. MAIN MEASUREMENTS Sensibility and specificity of the frozen section examination. RESULTS Frozen section study diagnosed 19 (12.4%) malignant and 127 (83.7%) benign tumors. Sensitivity of the frozen sections for malignancy was 61.5% (95% CI 54 to 69%) and specificity was 98% (95% CI 94 to 100%), and this result is comparable to the literature. CONCLUSIONS We consider that frozen section examination for salivary gland tumors is not sufficient on its own for deciding on the best management. Their interpretation must be correlated with clinical and intraoperative findings, in association with the surgeons experience.

Head and neck squamous cell carcinoma in childhood

BACKGROUND Squamous cell carcinoma (SCC) of the head and neck region is rare in young patients and even less frequent in children 15 years or younger children. The patients reported in the literature are isolated cases and their management is always difficult because there is no large experience or a convincing theory to support treatment decisions for every child. PROCEDURES AND RESULTS Four patients aged 15 years or younger were treated for SCC of head and neck between 1977 and 1995 at the Head and Neck Service of Heliópolis Hospital, São Paulo, Brazil, and with this paper we are reporting our experience with their treatment, including a genetic investigation in two cases (immunohistochemical analysis using monoclonal antibodies against p53 and c-erbB-2 oncogenes). These patients had no history of tobacco or ethanol abuse and no history of cancer in their families. Many authors attribute an unusual aggressiveness to SCC in childhood, with propensity to locoregional recurrence and high death rates and therefore, propose aggressive multidisciplinary therapy. Our cases, with the exception of one, had an early diagnosis and were treated using the same method we use for adults; the results were very good. CONCLUSIONS We recommend for these cases the same protocol as for older patients. In these cases, however, the primary lesion is resected with a safety margin which is usually 2 to 3 mm larger than usual safety margins and selective neck dissection is routinely indicated. This management is adopted in an attempt to avoid postoperative irradiation which may prove to be dangerous in the future for young patients. On the other hand, we recognize that due to a small number de patients, definitive treatment recommendations cannot be made at this time.

Serum and salivary macrophage migration inhibitory factor in patients with oral squamous cell carcinoma.

The overexpression of macrophage migration inhibitory factor (MIF) has been identified in a variety of tumors and the investigation of its molecular mechanisms in tumor progression is a key topic of research. The present study aimed to investigate MIF as a potential marker for disease control or recurrence, and to assess the association between serum and salivary MIF and the clinicopathological characteristics of patients with oral squamous cell carcinoma (OSCC). Serum and salivary samples were collected prior to and following the surgical treatment of 50 patients with OSCC. MIF concentrations were assessed by enzyme-linked immunosorbent assay and the adopted level of statistical significance was P<0.05. The results revealed that serum MIF concentrations were significantly reduced following tumor resection in OSCC patients. Furthermore, higher preoperative salivary MIF concentrations were observed in patients with larger tumors and in those who succumbed to the disease. In conclusion, high salivary and serological MIF concentrations were identified in patients with OSCC. Nevertheless, only serological MIF concentrations may be considered as a potential marker for the early detection of OSCC recurrence once the salivary levels, prior and following treatment, do not show any significant differences.

TOTAL THYROIDECTOMY WITH ULTRASONIC SCALPEL: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL

The ultrasonic scalpel is a recently introduced device in head and neck surgery. Total thyroidectomy is the most common endocrine procedure performed by surgeons.

Diabetes mellitus, metformin and head and neck cancer

INTRODUCTION Diabetes mellitus (DM (Diabetes Mellitus)) is directly associated with some cancers. However, studies on the association between diabetes mellitus and head and neck cancer (HNC (Head and Neck Cancer)) have rendered controversial results. The objective of this study was to evaluate the association between DM and HNC, as well as the impact of metformin use on the risk of HNC. MATERIAL AND METHODS This case-control study was conducted within the framework of the Brazilian Head and Neck Genome Project in 2011-2014. The study included 1021 HNC cases with histologically confirmed squamous cell carcinoma of the head and neck admitted to five large hospitals in São Paulo state. A total of 1063 controls were selected in the same hospitals. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression. RESULTS Diabetic participants had a decreased risk of HNC (OR=0.68; 95% CI: 0.49-0.95) than non-diabetic participants, and this risk was further decreased among diabetic metformin users (OR=0.54; 95% CI: 0.29-0.99). Diabetic metformin users that were current smokers (OR=0.13; 95% CI: 0.04-0.44) or had an alcohol consumption of >40g/day (OR=0.31; 95% CI: 0.11-0.88) had lower risk of HNC than equivalent non-diabetic participants. CONCLUSION The risk of HNC was decreased among diabetic participants; metformin use may at least partially explain this inverse association.

The value of therapeutic planning and the degree of experience of the surgical team on the results of cancer treatment of the larynx and hypopharynx

This is a prospective study supported by 170 cases of epidermoid carcinoma of the larynx or hypopharynx, treated during the period from January of 1981 to January of 1988, at the Head and Neck Surgery Service of the Heliópolis Hospital Complex, São Paulo. The objective of this project was to evaluate the importance of surgeon experience with regard to the rates of post-operative complications and the rates of relapse and survival. The results of the 8 surgical specialists who integrate the permanent staff at the institute and who different varying degrees of experience with regard to time spent exercising their specialties were compared. The results obtained did not show a significant difference among the various surgeons, and this uniformity is explained by the fact that all the therapeutic planning was elaborated through consensus of the whole group, and this could have minimized the effect of experience of a surgeon responsible for the operation. The authors emphasize the importance of pre-operative evaluation for good results and propose that it is in the direction of complete mastery of preliminary work in the area that programs for the formation of new specialists should be directed.

Tumores malignos de cabeça e pescoço em pacientes com menos de 18 anos de idade

A conduta ideal para os pacientes menores de 18 anos portadores de tumores malignos da regiao de cabeca e pescoco nao e uniforme nos escassos relatos de literatura. Com o objetivo de mostrar e discutir a experiencia no atendimento de cinquenta casos tratados no Servico de Cirurgia de Cabeca e Pescoco do Complexo Hospitalar Heliopolis, no periodo de 1978 a 1994, os autores procederam a uma analise retrospectiva de sua casuistica. Os tipos histologicos mais frequentes foram os derivados da linhagem epitelial, 24 casos (48%) e, entre eles, o carcinoma mucoepidermoide. Entre os tumores derivados do tecido mensequimal, os mais frequentes foram o rabdomiossarcoma e os linfomas. A cavidade oral foi o sitio mais frequentemente acometido (15 casos, 30%). Entre todos os pacientes, apenas 21 (42%) estavam vivos e sem evidencia de doenca em atividade por um periodo que variou de seis meses a 18 anos. Quatorze (28%) pacientes morreram em decorrencia de doenca nao controlada apos um periodo que variou de dez dias a dois anos a contar da data do final do tratamento. De quatorze (28%) pacientes nao pudemos obter informacoes atualizadas de suas condicoes e foram considerados perdidos de seguimento. Estes tumores nao devem ser vistos como neoplasias de adultos localizadas em pacientes pediatricos; devem ser estudados e abordados como uma doenca que apresenta caracteristicas proprias e que exigem, como no adulto, que a primeira intervencao para o diagnostico ou para o tratamento nao seja intempestiva e, de fato, tenha resolubilidade.