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Penêda JF, Fernandes J, Monteiro E. Pharyngocutaneous Fistula Following Total Laryngectomy: a High-Volume Tertiary Centre Series. Indian J Surg Oncol 2023; 14:742-748. [PMID: 37900634 PMCID: PMC10611653 DOI: 10.1007/s13193-023-01765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/29/2023] [Indexed: 10/31/2023] Open
Abstract
Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding risk factors for fistula development. A standard score for fistula prediction is lacking. Study population included all patients submitted to total laryngectomy (with or without pharyngectomy) due to laryngeal or hypopharyngeal tumours, occurring between January 1st, 2012, and December 31st, 2016. Patient demographics were recorded as well as disease and treatment variables. Statistical analysis was performed using the IBM SPSS Statistics 25®. A previously described predictive model for fistula occurrence was applied. A total of 212 patients were included, the vast majority with advanced local disease (97.5%). Only 10% were submitted to rescue surgery. Fistula incidence was 39.9%. Our rates of locally advanced tumours, with extensive hypopharyngeal involvement, were higher than in most series. Age, tumour location, diabetes, previous chemoradiotherapy, advanced local and regional disease, extensive pharyngectomy, flap reconstruction, manual suture and low post-operative albumin level were associated to fistula occurrence on univariate analysis. Only salvage surgery and advanced local disease remained significant on multivariate analysis. An adapted Cecatto score correlated with fistula occurrence but has not achieved statistical significance. Predictive models for fistula occurrence are lacking. Cecatto score showed promising results in our population but large multicentric studies are necessary for cut-off adjustments.
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Affiliation(s)
- José Ferreira Penêda
- Otorhinolaryngology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - João Fernandes
- Otorhinolaryngology Department, Instituto Português de Oncologia do Porto–Francisco Gentil (IPOP FG), Porto, Portugal
| | - Eurico Monteiro
- Otorhinolaryngology Department, Instituto Português de Oncologia do Porto–Francisco Gentil (IPOP FG), Porto, Portugal
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2
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Casanueva R, López F, García-Cabo P, Álvarez-Marcos C, Llorente JL, Rodrigo JP. Oncological and functional outcomes of transoral laser surgery for hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2023; 280:829-837. [PMID: 36056169 PMCID: PMC9849286 DOI: 10.1007/s00405-022-07622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/16/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgical resection or radiotherapy (RT) are standard approaches for early-staged hypopharyngeal squamous cell carcinoma (HPSCC). Transoral laser microsurgery (TOLMS) seems to provide good oncological and functional results with few local complications. The aim of our study was to analyze the outcomes of TOLMS, with or without neck dissection or RT, in the treatment of HPSCC in a tertiary referral center. METHODS A retrospective study was conducted in patients with early T-category (T1-T2) HPSCC treated by TOLMS. RESULTS A total of 34 patients were included in the study. The series includes 17 (50%) T1 and 17 (50%) T2 classified tumors. The 5-year overall survival and disease-specific survival rates were 51% and 66%, respectively, with a 5-year local control rate of 92%. All patients reassumed oral diet and none of them had a tracheostomy at the end of the follow-up. CONCLUSIONS TOLMS offers an effective treatment option in terms of oncologic control and function preservation in locally circumscribed HPSCC.
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Affiliation(s)
- Rodrigo Casanueva
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, 33011, Oviedo, Spain
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, 33011, Oviedo, Spain.
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid, Spain.
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.
| | - Patricia García-Cabo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - César Álvarez-Marcos
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - José Luis Llorente
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Avenida de Roma, s/n, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
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3
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Nursing Observation on the Clinical Efficacy and Toxicity of Lobaplatin Compared with Cisplatin in the Treatment of Locally Advanced Hypopharyngeal Carcinoma Based on Intelligent CT Imaging. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9982888. [PMID: 34306603 PMCID: PMC8266440 DOI: 10.1155/2021/9982888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/12/2021] [Accepted: 06/24/2021] [Indexed: 01/31/2023]
Abstract
With the acceleration of people's life rhythm, the incidence of hypopharyngeal cancer has generally increased. This study mainly explores the clinical efficacy and toxicity of lobaplatin compared with cisplatin in the treatment of locally advanced hypopharyngeal carcinoma based on intelligent CT imaging. Group A received lobaplatin combined with docetaxel induction chemotherapy for 2 cycles after cisplatin combined with intensity-modulated radiotherapy. Lobaplatin was added to the patient, then, 200 ml of 5% glucose was added, and the patient was injected intravenously for 1.8 hours. After 2 cycles of induction chemotherapy, simultaneous lobaplatin chemotherapy was performed every week for 5 weeks (10 mg/week), and the efficacy was evaluated after 4 consecutive courses of treatment. Group B received cisplatin combined with docetaxel induction chemotherapy after 2 cycles of cisplatin combined with intensity-modulated radiotherapy. Group C was the control group and was not treated with cisplatin or docetaxel. Stomach protection treatment was given in time throughout the treatment process. All patients underwent normal CT (NCCT) and enhanced CT (CECT) examinations before treatment. We extracted 5 mm plain scan CTQNCCT and enhanced CT (CECT) digital DICOM images from the PACS system for omics feature selection. Toxic and side effects are rated in different degrees according to the evaluation criteria of the National Cancer Institute (NCD) common adverse events. Blood routine and liver and kidney function tests were checked every week, and the medication was stopped immediately if there is a serious reaction. In addition, in vitro cell culture was set up to test the inhibitory effect of cisplatin and lobaplatin on the proliferation of cancer cells. The incidence of digestive tract reaction was 13.0% in the A plan group and 58.3% in the B plan group. The A group was lower than the B group, and the difference was statistically significant (P=0.001 < 0.05). Compared with cisplatin, lobaplatin has a milder gastrointestinal reaction, and there is no common hepatic and renal toxicity of cisplatin. This study is helpful to provide guidance for the clinical efficacy of locally advanced hypopharyngeal cancer treatment.
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4
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Royston KJ, Adedokun B, Olopade OI. Race, the microbiome and colorectal cancer. World J Gastrointest Oncol 2019; 11:773-787. [PMID: 31662819 PMCID: PMC6815924 DOI: 10.4251/wjgo.v11.i10.773] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 02/05/2023] Open
Abstract
In the past decade, more cancer researchers have begun to understand the significance of cancer prevention, which has prompted a shift in the increasing body of scientific literature. An area of fascination and great potential is the human microbiome. Recent studies suggest that the gut microbiota has significant roles in an individual's ability to avoid cancer, with considerable focus on the gut microbiome and colorectal cancer. That in mind, racial disparities with regard to colorectal cancer treatment and prevention are generally understudied despite higher incidence and mortality rates among Non-Hispanic Blacks compared to other racial and ethnic groups in the United States. A comprehension of ethnic differences with relation to colorectal cancer, dietary habits and the microbiome is a meritorious area of investigation. This review highlights literature that identifies and bridges the gap in understanding the role of the human microbiome in racial disparities across colorectal cancer. Herein, we explore the differences in the gut microbiota, common short chain fatty acids produced in abundance by microbes, and their association with racial differences in cancer acquisition.
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Affiliation(s)
- Kendra J Royston
- Division of Hematology Oncology, University of Chicago, Chicago, IL 60637, United States
| | - Babatunde Adedokun
- Center for Clinical Cancer Genetics and Global Health Department of Medicine, University of Chicago, Chicago, IL 60637, United States
| | - Olufunmilayo I Olopade
- Division of Hematology Oncology, University of Chicago, Chicago, IL 60637, United States
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Smee R, Williams JR, Kotevski DP. Surgery is not the only determinant of an outcome in patients with hypopharyngeal carcinoma. Head Neck 2019; 41:1165-1177. [PMID: 30791162 DOI: 10.1002/hed.25496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/19/2018] [Accepted: 07/05/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the outcomes in patients treated for hypopharyngeal carcinoma in a single-center and the importance of considering how patient factors influence outcomes. METHODS A retrospective review was conducted on patients who were seen at the Prince of Wales Hospital from 1968 to 2015. Kaplan-Meier and Cox regression analyses were performed for each patient and treatment factor to investigate outcomes of local control, cancer-specific survival (CSS), and ultimate local control. RESULTS Three hundred thirty patients were analyzed. Significant multivariate predictors for improved local control and CSS were fitness for surgery, cancer operability, surgery with adjuvant radiotherapy, no treatment interruptions (P < .05). Five-year local control (84%), CSS (50%), and ultimate local control (84%) rates were significantly higher in patients treated surgically with adjuvant radiotherapy, compared to single modality treatment (P < .05). CONCLUSION Patient factors influence the outcomes experienced by patients with hypopharyngeal carcinoma.
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Affiliation(s)
- Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Randwick, New South Wales, Australia.,UNSW Clinical Teaching School, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Tamworth Base Hospital, Tamworth, New South Wales, Australia
| | - Janet R Williams
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Randwick, New South Wales, Australia.,UNSW Clinical Teaching School, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Damian P Kotevski
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Randwick, New South Wales, Australia
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The Emerging Role of Robotic Surgery among Minimally Invasive Surgical Approaches in the Treatment of Hypopharyngeal Carcinoma: Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8020256. [PMID: 30781660 PMCID: PMC6406881 DOI: 10.3390/jcm8020256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this systematic review with meta-analysis was to investigate the available literature on transoral approaches in the treatment of hypopharyngeal squamous cell carcinoma, with a special focus on transoral robotic surgery (TORS). A systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) check-list, and 15 studies were included. Five of the included studies evaluated TORS, while ten studies focused on transoral laser microsurgery (TLM) for the treatment of early or advanced stage hypopharyngeal cancer. Overall, survival rates of TLM and TORS studies, analyzed together in the cumulative meta-analysis, were 66.4% (95% confidence interval (CI) 54.3%–76.7%) at 36+ months of follow up. The TORS subgroup showed a higher cumulative survival rate (85.5%, 95% CI 55.8%–96.5%) compared to TLM (58.5%, 95% CI 46.6%–69.6%). Cumulative data showed that 29.3% (95% CI 24.0%–35.3%) of deaths were attributable to cancer. The results were similar between TLM and TORS studies. The larynx function preservation cumulative rate was 94.3% (95% CI 91.8%–96.1%). The results were similar among the two subgroups. The present review supports the use of transoral approaches in the treatment of hypopharyngeal cancer. TORS is oncologically sound and provides excellent functional results with low complication rates.
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Rodrigues J, Breda E, Monteiro E. Surgically-Treated Locoregionally Advanced Hypopharyngeal Cancer: Outcomes. Int Arch Otorhinolaryngol 2018; 22:443-448. [PMID: 30357103 PMCID: PMC6197975 DOI: 10.1055/s-0038-1641562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction
Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy.
Objective
This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors.
Methods
All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively.
Results
A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%.
Conclusion
The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively;
p
< 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups;
p
< 0.05) and vascular invasion (30.5% versus 22.5% respectively;
p
< 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively;
p
< 0.05).
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Affiliation(s)
- Jorge Rodrigues
- Department of Otorhinolaringology, Hospital da Senhora da Oliveira Guimarães EPE, Creixomil, Guimarães, Portugal.,Department of Anatomy, University of Porto, Portugal
| | - Eduardo Breda
- Department of Otorhinolaringology, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
| | - Eurico Monteiro
- Department of Otorhinolaringology, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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