Terence Pires de Farias

Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth.

A retrospective study was undertaken of patients with T1N0M0 squamous cell carcinoma of the oral tongue and floor of the mouth who underwent surgical treatment between 1985 and 1995. Evaluation of two groups of patients (neck dissection versus observation) was made according to the management of the neck. Results were obtained regarding the presence of occult metastases, recurrence in the neck, treatment failure, results of salvage treatment, and disease-free survival. Forty-nine patients underwent surgical treatment: 25 resection of primary and 24 resection plus neck dissection. Overall incidence of regional metastases was 24.5%. Eight patients (16%) developed recurrence of the disease. Seven (14%) had regional recurrences (including 1 with distant metastases) and 1(2%) had local recurrence. Twenty-four percent of patients from the resection of primary group developed neck recurrences in comparison with 4% of the resection plus neck dissection group (P = 0.05). Overall salvage rate was 37.5%. Second primary tumors developed in 16% of patients. Patients who underwent elective neck dissection had a 23% higher disease-free survival rate compared with those who underwent resection of the tumor alone (P = 0.03). The findings of this study stress the importance of control of the neck in early oral cancer. Elective neck dissection significantly improved regional control of the disease.

Relevance of Skip Metastases for Squamous Cell Carcinoma of the Oral Tongue and the Floor of the Mouth

OBJECTIVE: To analyze the therapeutic implications of the distribution of neck metastases (NM) in patients with squamous cell carcinoma (SCC) of the tongue and the floor of the mouth (FOM). PATIENTS AND METHODS: From January 1987 through December 1997, 339 previously untreated patients with T1-2 N0 M0 SCC of the tongue and the FOM underwent primary surgical treatment in our institution. A retrospective review of the pathology reports and outcome of these patients was made to ascertain the prevalence and distribution of NM. Patients were grouped by clinical neck status at the time of neck dissection: elective neck dissection (END) in the NO neck and subsequent therapeutic dissection (STD) in the neck observed which converted clinically to N+ or regional recurrences after END. All patients were classified according to the American Joint Committee on Cancer (AJCC)/UICC 2002 TNM classification. RESULTS: All patients underwent surgical treatment of the primary cancer and had negative margins at frozen section. Overall incidence of NM was 41.3%. Twenty-seven point eight percent of T1 N0 M0 and 48.2% of T2 N0 M0 patients developed NM (P = .0004). Occult neck metastases occurred in 24.1% of patients. Clinically, N+ metastases occurred in 23.6% of patients. The overall incidence of NM in levels IV and V was 8.5%. Neck level IV nodes were involved in only 1.5% of patients in the END group versus 23.7% in the STD group (P < 0.001). Level V was always associated to nodal metastases in other neck levels. Only 2% of patients in our study presented “skip metastases” in the neck. CONCLUSIONS: Neck levels I and II were at great risk for the development of NM (46.9% and 75.3% respectively). Levels IV (6.5%) and V (2%) were rarely involved in our group of patients. The results found in this study support the indication of supraomohyoid neck dissection for N0 and a more comprehensive neck dissection (levels I-V) for N+ patients in Stage I-II SCC of the tongue and FOM. EBM rating: C-4

Supracricoid Laryngectomy with CHEP: Functional Results and Outcome:

OBJECTIVES: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. STUDY DESIGN: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.

Predictors of Postoperative Complications, Prolonged Length of Hospital Stay, and Short-Term Mortality in Elderly Patients with Malignant Head and Neck Neoplasm

Purpose: To identify and assess predictors of short-term outcomes and a prolonged length of hospital stay after head and neck cancer surgery in older-old and oldest-old patients. Procedures: Patients aged ≥75 years with head and neck cancer undergoing surgery at the Brazilian National Cancer Institute from January to December 2011 were assessed regarding postoperative complications, mortality, and length of hospital stay. Results: Over the study period, 67 patients with head and neck cancer underwent surgery, 44.8% of whom developed complications within 30 days of surgery, surgical site and respiratory infections (29.9 and 20.9%, respectively) being the most common. The mean length of hospital stay was 7 days (range: 2-26). In multivariate analysis, previous radiotherapy, dependence in instrumental activities of daily living, and low serum hemoglobin (≤13.2 g/dl) were predictors of complications. In addition, the presence of at least 1 clinical or surgical complication, smoking, and an arm circumference ≤25 cm were independent predictors of a prolonged length of hospital stay. Conclusions: Complications after head and neck cancer surgery in the elderly are common and related to the prolonged length of hospital stay, both being influenced by previous radiotherapy, smoking, functional dependence in instrumental activities of daily living, and nutritional conditions. Such predictors should be considered in a preoperative assessment of elderly patients as these are modifiable risk factors.

Use of prototyping in preoperative planning for patients with head and neck tumors.

Prototyping technologies for reconstructions consist of obtaining a 3‐dimensional model of the object of interest. Solid models are constructed by the deposition of materials in successive layers. The purpose of this study was to perform a double‐blind, randomized, prospective study to evaluate the efficacy of prototype use in head and neck surgeries.

Surgical management of parapharyngeal ganglioneuroma: case report and review of the literature.

Parapharyngeal ganglioneuroma is a rare benign tumor, with fewer than 40 cases having been reported in the literature. We report a case of parapharyngeal ganglioneuroma in a child, including the presentation, diagnostic testing, treatment, outcome and a review of the literature. The patient presented with a large cervical mass arising from the cervical sympathetic chain. Complete excision of the ganglioneuroma was possible via a transcervical dissection approach without mandibulotomy. Clinical follow-up was conducted, and no recurrence has been observed to date.

Reconstrução tridimensional da face nos tumores avançados com invasão da fossa craniana anterior

BACKGROUND: The analysis of the surgical indications and the follow-up, stressing the surgical complications and efficiency of a team approach for the advanced tumors involving the anterior skull base are the purpose of the present study. METHODS: The authors present a retrospective evaluation of 46 patients who underwent resections of advanced tumors involving the anterior skull base, which were reconstructed with free flaps from May, 1990 to July, 2002. Those patients have been treated by the skull base surgical team of INCA. RESULTS: The commonest resected structures were: the orbit (76.5%), maxilar sinus (76.5%), sphenoidal sinus (63.8%), nasal cavity walls (59.5%) and palate (42.5%). The dura-mater was involved in 32,6% of the patients. Free-flap reconstructions employing the rectus abdominis muscle flaps were the leading procedure in 93.5% of patients. The successful rate of the free-tissue transfer was 97.8%. Complications occurred in 58,6% of patients, the most frequent were: local infection (21.7%), cerebrospinal fluid leakage (15.3%), meningitis(6.5%) and hematoma (6.5%). CONCLUSIONS: The microvascular free-tissue transfer reconstruction allows more extensive resections of those tumors with safety borders, presenting acceptable complication rates, offering the patients a better quality of life, longer life expectance with low incidence of recurrent disease.

Laringectomia supracricóide (chep) para câncer glótico

BACKGROUND: Our objective was to assess whether Supracricoid Laryngectomy with CricoHiodoEpiglottoPexy (CHEP) could successfully achive cure preserving voice in the treatment of glottic laryngeal cancer. METHODS: A retrospective analysis has been carried out between 1996 through 1999. We classified 18 patients as T2N0M0 and 32 patients as T3N0M0. Fourty one patients underwent selective bilateral lateral neck dissection, four had unilateral neck dissection and five patients had the neck undissected. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Ten patients had postoperative complications, two treated with total laryngectomy. The remained 48 patients maintained normal airway, swallowing and speech. Three patients in the neck dissection group presented occult neck metastasis. Four patients had recurrences, three of them were local. Two patients treated with total laryngectomy are alive without disease, and another had advanced recurrence and died. One patient had neck recurrence and was treated with radical neck dissection plus radiotherapy and died from the disease. Two patients presented a second tumor in the oropharynx. One of them was treated with palliative radiotherapy and died and the other had surgical resection and is alive without disease. Three years disease free survival was 88% for T2 and 72% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer, regarding the extension of the disease. The incidence of complications required completion laryngectomy which did not compromise the functionality of this technique. Survival is comparable to patients submitted to total laryngectomy and near-total laryngectomy, regarding the extension of the lesion.

Carcinoma papilífero de alto risco da glândula tireóide: influência dos fatores prognósticos em 126 pacientes

OBJETIVO: Este trabalho tem como objetivo avaliar a influencia dos fatores prognosticos em portadores de carcinoma papilifero da tireoide, tratados no Hospital do Câncer (INCA-RJ). METODO: Com base em testes estatisticos (Wilcoxon e Cox) foram analisados 126 prontuarios de pacientes atendidos no periodo de 1986 a 1994, portadores de carcinoma papilifero da tireoide, pertencentes ao grupo de alto risco, segundo os fatores de risco do carcinoma diferenciado da tireoide, considerando uma sobrevida de dez anos livre de doenca. RESULTADOS: Observou-se que 104 pacientes eram mulheres (83%); a idade variou de sete a 79 anos, media de 40 anos; invasao capsular ocorreu em 15% (18/126); houve metastase regional em 38% (47/126) e metastase a distância em 11% (13/126). A sobrevida em dez anos livre de doenca foi de 81% para os pacientes com menos de 45 anos, e de 76% para os mais idosos: p = 0,0008 (analise univariada) e p = 0,01 (analise multivariada). Dos pacientes que tinham invasao capsular, 72% viveram dez anos, assim como 60% dos que tinham metastase regional, e 28% dos que apresentavam metastase a distância. CONCLUSOES: A utilizacao dos fatores de risco no carcinoma papilifero da tireoide e valida mesmo para doenca avancada, sendo tambem de grande importância na projecao do prognostico e do futuro desenvolvimento da doenca.

Tracheostomy: Conventional Technique

Tracheostomy, a term derived from two Greek words meaning “to cut the trachea,” is a procedure known for approximately 3500 years.