Xavier León Vintró

Colgajo de pectoral mayor: evolución de su uso en la era de los colgajos microanastomosados

Introduccion La cirugia oncologica de cabeza y cuello ha ido avanzando a medida que se ha podido ofrecer una reconstruccion adaptada al acto quirurgico. En los ultimos 30 anos se han desarrollado 2 tecnicas fundamentales: el colgajo pediculado de pectoral mayor (CMPM) y los colgajos microanastomosados. El CMPM tuvo un papel preeminente en los anos ochenta, y con posterioridad su uso disminuyo de forma progresiva a favor de los colgajos microanastomosados. Material y metodo Se realizo una revision de 351 actos reconstructivos en 317 pacientes en los que se llevo a cabo 275 CMPM y 76 colgajos libres. Analizamos la edad, el sexo, el tipo de colgajo, la indicacion y el ano de la cirugia. Resultados De los colgajos revisados: el 34 % fueron de reconstruccion de hipofaringe; el 33 %, de orofaringe; el 21 %, de reparacion de partes blandas, y el 12 %, de reparacion de fistulas faringocutaneas. La incorporacion en el uso de colgajos libres a partir del ano 2001 ha supuesto en nuestro centro el incremento en el uso de procedimientos reconstructivos, asi como la sustitucion para una serie de indicaciones del CMPM por colgajos microanastomosados. Conclusiones En la era de los colgajos libres, creemos que el CMPM sigue manteniendo un lugar privilegiado para la reconstruccion de la hipofaringe y defectos de la region cervical. Sin embargo, actualmente, en determinadas localizaciones, como la cavidad oral y la orofaringe y en defectos de las partes blandas faciales, preferimos el uso de colgajos microanastomosados para la reconstruccion.

Pectoralis Major Flaps. Evolution of Their Use in the Age of Microvascularized Flaps

Abstract Introduction Oncological head and neck surgery has progressed with the possibility of adapting reconstruction to the surgery effected. In the last 30 years, 2 basic techniques have been developed: the pectoralis major myocutaneous flaps (PMMF) and microvascularized flaps. PMMF had a leading role in reconstruction surgery during the 1980s, but this has subsequently diminished in favour of microvascularized flaps. Material and method A review was conducted on 351 reconstructive surgeries in 317 patients, of which 275 were PMMF and 76 free flaps. We analyzed age, gender, flap type, indication, and year of the surgery in all cases. Results 34% of the revised flaps were used for reconstruction of the hypopharynx, 33% for the oropharynx, 21% for soft tissues, and 12% for the repair of pharyngealcutaneous fistulae. At our hospital, the introduction of the free flap technique from 2001 on has led to an increase in the use of reconstructive procedures as well as the replacement of PMMF by microvascularized flaps in a number of indications. Conclusions In this age of microvascularized flaps, we believe that PMMF still has a privileged role in the repair of hypopharynx and cervical lesions. However, in such locations as the oral cavity or oropharynx and in facial soft tissue reconstruction we prefer the use of microvascularized flaps.

Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker

INTRODUCTION Zenkers diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years. MATERIAL AND METHOD A retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO(2) laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed. RESULTS The endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90 min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36 hours after open surgery and 24h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach. CONCLUSIONS The combined endoscopic approach offers good results in patients with symptomatic Zenkers diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible.

Expresión de Heat Shock Protein-90 (HSP-90) como factor predictor de la respuesta a radioterapia en pacientes con tumores de cabeza y cuello

INTRODUCTION AND OBJECTIVES HSP-90 is an intracellular protein that protects the cell from environmental stress situations. The overexpression of HSP-90 isoforms could serve as a mechanism of resistance to radiotherapy for tumour cells. We studied this effect in a sample of head and neck tumours. METHODS We included 87 patients diagnosed with oral cavity, oropharynx, larynx and hypopharynx tumours. We studied the expression of the HSP-90 isoforms by real-time PCR on pre-treatment biopsy samples. We analysed the relationship between HSP-90 expression levels and local relapse of the tumour with CRT decision trees. RESULTS The expression levels of the inducible citosolic isoform (HSP90AA) allowed the definition of 2 groups of patients with different rates of local relapse. The group with a low expression level showed a 2.9% local relapse rate, while the group with a high expression level showed a 38.2% rate. Survival curves showed differences in time to local relapse for both groups of patients. These differences did not reach statistical significance. CONCLUSIONS Radiotherapy response was related to expression levels of HSP-90 in a sample of head and neck cancer patients. This result could prove useful in the selection of treatments for this group of patients.

Tratamiento quirúrgico de los carcinomas escamosos de cabeza y cuello en España durante el periodo 2006-2011

INTRODUCTION AND OBJECTIVES Surgery is one of the basic pillars in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to analyse the current state of the use of surgery in patients with HNSCC in Spain. METHODS Retrospective review of the hospital discharge reports of the patients with HNSCC treated surgically during the 2006-2011 period in Spain. We obtained the data from the Minimum Basic Data Set during the hospital discharge. RESULTS We obtained information on 26,629 hospital discharges, with a total of 27,937 surgical procedures. Overall, in our country about half of the patients with HNSCC receive surgical treatment of the primary tumour location. There were no significant changes in the number of surgical procedures throughout the study period. There was a smooth downward trend in the number and percentage of surgeries carried out in male patients, and a significant increase in those carried out in female patients throughout the study period. Among the total of surgical procedures, 15.7% were carried out in hospitals with a low level of complexity, 32.2% in hospitals with an intermediate complexity and 52.1% in centres of high complexity. CONCLUSIONS Surgery is one essential pillar in the treatment of patients with HNSCC. In Spain about half of the patients with HNSCC receive surgical treatment for the primary location of the tumour.