R.J.J. van Es

A prospective study on prognostic factors for free-flap reconstructions of head and neck defects

The purpose of this study is to examine a cohort of patients with free-flap reconstruction prospectively and to identify the prognostic factors for postoperative medical and surgical complications. All 150 patients required a free-flap reconstruction after ablative surgery for a defect in the head and neck area. Medical complications and major surgical complications were correlated with patient factors. An ASA score of 3 and male gender were statistically significant prognostic factors for medical complications. The ASA scoring system is a slightly better prognostic factor for medical complications than Charlson comorbidity stage on forward logistic regression analysis. Female gender and an operation time exceeding 10h were statistically significant prognostic factors for major surgical complications.

The VX2 carcinoma in the rabbit auricle as an experimental model for intra-arterial embolization of head and neck squamous cell carcinoma with dextran microspheres

A head and neck cancer model is developed using the VX2 carcinoma cell line injected s.c. in both ears of New Zealand White (NZW) rabbits. The study is focused on the effects of intra-arterial embolization of the carcinomas with a new type of dextran hydrogel microspheres. During the phase of exponential growth the tumour-surface doubling-time was 7.1 ± 2.0 days. Standard deviation in growth of the tumours was significantly larger between separate animals than between tumours growing in the left and right auricle of each individual animal (2.0 versus 0.65 days). A fresh cell suspension containing at least 10.106 vital tumour cells was necessary to yield a tumour-take of 85%. The caudal auricular artery perfuses the caudal half of the external ear and is very suitable for macroscopic cannulation. Histological evaluation shows, that the use of dextran hydrogel micro spheres of at least 25 μm in combination with ligation of non-tumour perfusing branches of the central auricular artery yields diffuse embolization of the VX2 carcinoma. This tumour model can be of use in further studies to optimize particle size and dosage for embolization as well as to evaluate the effect of different anti-neoplastic drugs, slowly released by controlled degradation of dextran microspheres.

Watchful waiting of the neck in early stage oral cancer is unfavourable for patients with occult nodal disease

For cT1/2N0 oral squamous cell carcinoma (OSCC), treatment of the neck is a matter of debate. Two treatment strategies were evaluated in this study: selective neck dissection (SND) and watchful waiting (WW). One hundred and twenty-three SND patients and 70 WW patients with cT1/T2N0M0 OSCC of the tongue, floor of mouth, or buccal mucosa were analysed retrospectively. Extracapsular spread (ECS), 3-year overall survival (OS), and disease-specific survival (DSS) were determined. Twenty-nine percent of SND patients and 13% of WW patients had occult nodal disease. WW-N+ patients showed thicker tumours as compared to WW-N0 patients (5mm vs. 2mm, P=0.02). WW-N+ patients showed significantly more ECS as compared to SND-N+ patients (56% vs. 14%, P=0.016) and had a significantly worse 3-year DSS than SND-N+ patients (56% vs. 82%, P=0.02). For T1 OSCCs, a watchful waiting policy is acceptable if tumour thickness proves to be <4mm. Otherwise, an additional treatment of the neck is advised, since WW-N+ patients show more ECS, with a worse DSS than SND-N+ patients.

Nieuwe onderzoeksmethoden om occulte halskliermetastasen van mondkanker op te sporen

Orale plaveiselcelcarcinomen (OPCC) ontstaan vanuit de slijmvliezen van de mond en metastaseren bij voorkeur naar de regionale lymfeklieren in de hals. De aanwezigheid van halskliermetastasen is een belangrijke prognostische factor en bepalend voor de klinische behandeling.