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Ferrari M, Mularoni F, Taboni S, Crosetti E, Pessina C, Carobbio ALC, Montalto N, Marchi F, Vural A, Paderno A, Caprioli S, Gaudioso P, Fermi M, Rigoni F, Saccardo T, Contro G, Ruaro A, Lo Manto A, Varago C, Baldovin M, Bandolin L, Filauro M, Sampieri C, Missale F, Ioppi A, Carta F, Ramanzin M, Ravanelli M, Maiolo V, Bertotto I, Del Bon F, Lancini D, Mariani C, Marrosu V, Tatti M, Cağlı S, Yüce I, Gündoğ M, Dogan S, Anile G, Gottardi C, Busato F, Vallin A, Gennarini F, Bossi P, Ghi MG, Lionello M, Zanoletti E, Marioni G, Maroldi R, Mattioli F, Puxeddu R, Bertolin A, Presutti L, Piazza C, Succo G, Peretti G, Nicolai P. How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group. Oral Oncol 2024; 152:106744. [PMID: 38520756 DOI: 10.1016/j.oraloncology.2024.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.
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Affiliation(s)
- M Ferrari
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy.
| | - F Mularoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - S Taboni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - E Crosetti
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - C Pessina
- Radiology Unit, Sant'Antonio Hospital, University of Padova, Padova, Italy
| | - A L C Carobbio
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - N Montalto
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - F Marchi
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - A Vural
- Otorhinolaryngology Unit, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - A Paderno
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - S Caprioli
- Radiology Unit, San Martino Hospital, Genoa, Italy
| | - P Gaudioso
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - M Fermi
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - F Rigoni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - T Saccardo
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Contro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Ruaro
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - A Lo Manto
- Otorhinolaryngology Unit, Infermi Hospital, Rimini, Italy
| | - C Varago
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - M Baldovin
- Otorhinolaryngology Unit, San Martino di Belluno Hospital, Belluno, Italy
| | - L Bandolin
- Otorhinolaryngology Unit, Hospital of Santorso, Vicenza, Italy
| | - M Filauro
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - C Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Italy; Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - F Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, the Netherlands
| | - A Ioppi
- Department of Otorhinolaryngology-Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - F Carta
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Ramanzin
- Radiology Unit, Hospital of Vicenza, Vicenza, Italy
| | - M Ravanelli
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - V Maiolo
- Pediatric and Adult Cardiothoracic and Vascular, Oncohematologic and Emergency Radiology Unit (IRCCS AOUBO), University of Bologna, Italy
| | - I Bertotto
- Radiology Unit, IRCCS Istituto di Candiolo, Turin, Italy
| | - F Del Bon
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - D Lancini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - C Mariani
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - V Marrosu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - M Tatti
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - S Cağlı
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - I Yüce
- Otorhinolaryngology Unit, Erciyes University, Kayseri, Turkey
| | - M Gündoğ
- Department of Radiation Oncology, Erciyes University, Kayseri, Turkey
| | - S Dogan
- Department of Radiology, Erciyes University, Kayseri, Turkey
| | - G Anile
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - C Gottardi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - F Busato
- Unit of Radiation Oncology, Policlinico Abano, Padova, Italy
| | - A Vallin
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - F Gennarini
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - P Bossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - M G Ghi
- Unit of Medical Oncology 2, "Istituto Oncologico Veneto", Padova, Italy
| | - M Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - E Zanoletti
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - G Marioni
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
| | - R Maroldi
- Radiology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - F Mattioli
- Otorhinolaryngology Unit, University of Modena, Modena, Italy
| | - R Puxeddu
- Otorhinolaryngology Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy; King's College Hospital London, Dubai, United Arab Emirates
| | - A Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - L Presutti
- Otorhinolaryngology Unit, Azienda Ospedaliera Universitaria di Bologna IRCCS, Bologna, Italy; Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - C Piazza
- Otorhinolaryngology Unit, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - G Succo
- Otorhinolaryngology Department - Head Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy; Oncology Department, University of Turin, Turin, Italy
| | - G Peretti
- Unit of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - P Nicolai
- Otorhinolaryngology and Head and Neck Unit, Department of Neuroscience, Azienda Ospedale Università di Padova, Padova, Italy
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Crosetti E, Fantini M, Bertotto I, Bertolin A, Arrigoni G, Lorenzi A, Succo G. Current Status of Partial Laryngeal Surgery for Advanced Laryngeal Cancer: When and Why? Curr Oncol Rep 2024:10.1007/s11912-024-01516-7. [PMID: 38647994 DOI: 10.1007/s11912-024-01516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This paper aims to evaluate the evolution and current status of partial laryngeal surgery in the treatment of advanced laryngeal cancer (LC). Specifically, recent progress in the selection of both patients and tumors, together with surgical and rehabilitation innovations, have contributed to balancing oncological control with the maintenance of quality of life in naïve and radiorecurrent patients. The main aspect is represented by the recognized role of open partial horizontal laryngectomies (OPHLs) in this new era of laryngeal cancer treatment. RECENT FINDINGS Recent advancements highlight OPHLs' efficacy for conservative management of intermediate to advanced stages of LC. Innovations such as supratracheal partial laryngectomy have expanded surgical options, offering a modular approach to complex cases. Improved understanding of tumor biology, enhanced imaging techniques, and more precise preoperative planning have led to better patient outcomes, emphasizing the importance of a conservative function-preserving surgical treatment. These advancements reflect a broader trend towards individualized treatment plans that prioritize both survival and quality of life. OPHLs play an important role in current management of intermediate/advanced LC, effectively balancing oncological control with the preservation of laryngeal functions. Critical factors include meticulous patient and tumor selection, the impact of surgical and technological refinements on functional outcomes, and the necessity of a multidisciplinary approach in treatment planning. Current evidence justifies the use of these interventions in many intermediate T-stage laryngeal tumors, even at risk of upstaging on pathological examination. The oncological results, the preservation of laryngeal function and the laryngectomy-free survival achieved with OPHLs appear to be highly competitive with those of non surgical organ-preservation protocols, aiming to introduce a new standard in the LC treatment.
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Affiliation(s)
- Erika Crosetti
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Marco Fantini
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Ilaria Bertotto
- Radiology Department, Candiolo Cancer Institute - IRCCS, Candiolo, TO, Italy
| | - Andy Bertolin
- ENT Department, Vittorio Veneto Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giulia Arrigoni
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Andrea Lorenzi
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Succo
- ENT Clinic - Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy.
- Department of Oncology, University of Turin, Turin, Italy.
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Crosetti E, Succo G, Sapino S, Bertotto I, Cirillo S, Petracchini M, Fondello G, Arrigoni G, Tascone M, Piazza C, Farina D, Ravanelli M. Twenty questions from the surgeon to the radiologist to better plan an open partial horizontal laryngectomy. Front Oncol 2024; 13:1305889. [PMID: 38328437 PMCID: PMC10847842 DOI: 10.3389/fonc.2023.1305889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) represent a valuable therapeutic option for tumors of the intermediate T-category and, in selected cases, for locally advanced tumors with low-volume extra-laryngeal extension. The eligibility of patients treated with this type of surgery has increased with the introduction of the modular approach to OPHL planning. This strategy follows the introduction of the classification proposed by the European Laryngological Society, based on the extent of horizontal resection. Optimization of the selection is the result of a meticulous work-up process involving close cooperation between experienced surgeons and radiologists, followed by final quality control by pathologists. Computed tomography and magnetic resonance imaging are study methods whose pearls and pitfalls are well known, especially when performed at a high level of expertise. In this paper, based on the experience of two high-volume centers, a checklist of 20 questions addressed by the surgeon to the radiologist before planning an OPHL was proposed. Considerations regarding case selection are reported for each of the questioned parameters. A very simple question-and-answer process is easy to understand and mainly addressed by less experienced colleagues who wish to increase their knowledge and skills in performing this type of surgery.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Succo
- Oncology Department, University of Turin, Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Silvia Sapino
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Ilaria Bertotto
- Radiology Service, Candiolo Cancer Institute, Candiolo, Italy
| | - Stefano Cirillo
- Radiology Service, Mauriziano Umberto I Hospital, Turin, Italy
| | | | | | - Giulia Arrigoni
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Martina Tascone
- Head and Neck Cancer Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology—Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
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Molteni G, Nocini R, Mattioli F, Nakayama M, Dedivitis RA, Mannelli G, Crosetti E, Chiesa-Estomba CM, Sistiaga-Suarez JA, Giordano L, Galli A, Lionello M, Mercante G, Ralli M, Fermi M, Klein-Rodríguez A, Mayo-Yáñez M, Serafini E, Pirola F, Paderno A, Cambria F, Oridate N, Sano D, Boscolo-Rizzo P, Marcuzzo AV, Parrinello G, Marchi F, Saibene AM, Tucciarone M, Viscasillas G, Zeleník K, Ramos DM, Palacios-Garcia J, Tirelli G, Pellini R, Paludetti G, Galli J, Rossi G, De Vincentiis M, Cernea CR, Spriano G, Bussi M, Peretti G, Succo G, Piazza C, Bertolin A, Kowalski LP, Presutti L, Sacchetto A. Impact of lymph node ratio and number of lymph node metastases on survival and recurrence in laryngeal squamous cell carcinoma. Head Neck 2023; 45:2274-2293. [PMID: 37496499 DOI: 10.1002/hed.27471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION The aim of this study is to assess the impact of lymph node ratio (LNR) and number of positive lymph nodes (NPLN) on mortality and recurrence rates in patients with laryngeal squamous cell carcinoma. MATERIALS AND METHODS We conducted a retrospective multicenter international study involving 24 Otorhinolaryngology-Head and Neck Surgery divisions. Disease-specific survival (DSS) and disease-free survival (DFS) were evaluated as the main outcomes. The curves for DSS and DFS according to NPLN and LNR were analyzed to identify significant variations and establish specific cut-off values. RESULTS 2507 patients met the inclusion criteria. DSS and DFS were significantly different in the groups of patients stratified according to LNR and NPLN. The 5-year DSS and DFS based on LNR and NPLN demonstrated an improved ability to stratify patients when compared to pN staging. CONCLUSION Our data demonstrate the potential prognostic value of NPLN and LNR in laryngeal squamous cell carcinoma.
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Affiliation(s)
- Gabriele Molteni
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Verona, Verona, Italy
- Unit of Otolaryngology, Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Unit of Otolaryngology, Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Francesco Mattioli
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Meijin Nakayama
- Department of Otolaryngology, Yokosuka Kyosai Hospital, Yokohama, Japan
| | - Rogerio A Dedivitis
- Department of Head and Neck Surgery, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Giuditta Mannelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Erika Crosetti
- Department of Otorhinolaryngology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Carlos Miguel Chiesa-Estomba
- Department of Otorhinolaryngology - Head and Neck Surgery, Donostia University Hospital, Biodonostia Research Institute, Faculty of Medicine, Deusto University, San Sebastian, Spain
| | - Jon A Sistiaga-Suarez
- Department of Otorhinolaryngology - Head and Neck Surgery, Donostia University Hospital, San Sebastian, Spain
| | - Leone Giordano
- Department of Otolaryngology - Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Andrea Galli
- Department of Otolaryngology - Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Lionello
- Unit of Otorhinolaryngology, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Giuseppe Mercante
- Unit of Otorhinolaryngology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Alejandro Klein-Rodríguez
- Department of Otorhinolaryngology - Head and Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Miguel Mayo-Yáñez
- Department of Otorhinolaryngology - Head and Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Edoardo Serafini
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Francesca Pirola
- Unit of Otorhinolaryngology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Nobuhiko Oridate
- Department of Otolaryngology - Head and Neck Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Daisuke Sano
- Department of Otolaryngology - Head and Neck Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Paolo Boscolo-Rizzo
- Section of Otolaryngology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Section of Otolaryngology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Maria Saibene
- Unit of Otolaryngology, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Manuel Tucciarone
- Department of Otorhinolaryngology, University Hospital of Jerez, Cádiz, Spain
| | - Guillem Viscasillas
- Department of Otolaryngology - Head and Neck, Althaia, Xarxa Assitencial Universitaria de Manresa, Barcelona, Spain
| | - Karol Zeleník
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Daniel Marin Ramos
- Department of Head and Neck Surgery, Cancer Institute of São Paulo ICESP, São Paulo, Brazil
| | - Jose Palacios-Garcia
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Giancarlo Tirelli
- Section of Otolaryngology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Raul Pellini
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgia Rossi
- Unit of Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Claudio Roberto Cernea
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Giuseppe Spriano
- Unit of Otorhinolaryngology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology - Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giovanni Succo
- Unit of Otolaryngology - Head and Neck Surgery, San Giovanni Bosco Hospital, Turin, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andy Bertolin
- Unit of Otorhinolaryngology, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Livio Presutti
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Andrea Sacchetto
- Unit of Otolaryngology, Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
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Succo G, Bertolin A, Santos IC, Tascone M, Lionello M, Fantini M, de Freitas AS, Bertotto I, Sprio AE, Sanguineti G, Dias FL, Rizzotto G, Crosetti E. Partial Laryngectomy for pT4a Laryngeal Cancer: Outcomes and Limits in Selected Cases. Cancers (Basel) 2023; 15:2861. [PMID: 37345197 DOI: 10.3390/cancers15102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
A large multi-institutional case series of laryngeal cancer (LC) T4a was carried out, including 134 cases treated with open partial horizontal laryngectomies (OPHL) +/- post-operative radiation therapy (PORT). The goal was to understand better whether OPHL can be included among the viable options in selected pT4a LC patients who refuse a standard approach, represented by total laryngectomy (TL) + PORT. All 134 patients underwent OPHL type I (supraglottic), II (supracricoid), or III (supratracheal), according to the European Laryngological Society Classification. Comparing clinical and pathological stages showed pT up-staging in 105 cases (78.4%) and pN up-staging in 19 patients (11.4%). Five-year data on overall survival, disease-specific survival, disease-free survival, freedom from laryngectomy, and laryngo-esophageal dysfunction-free survival (rate of patients surviving without a local recurrence or requiring total laryngectomy and without a feeding tube or a tracheostomy) were, respectively, 82.1%, 89.8%, 75.7%, 89.7%, and 78.3%. Overall, complications were observed in 22 cases (16.4%). Sequelae were observed in 28 patients (20.9%). No patients died during the postoperative period. This large series highlights the good onco-functional results of low-volume pT4a laryngeal tumors, with minimal or absent cartilage destruction, treated with OPHLs. The level of standardization of the indication for OPHL should allow consideration of OPHL as a valid therapeutic option in cases where the patient refuses total laryngectomy or non-surgical protocols with concomitant chemo-radiotherapy.
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Affiliation(s)
- Giovanni Succo
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
- Oncology Department, University of Turin, 10124 Torino, Italy
| | - Andy Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | | | - Martina Tascone
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - Marco Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | - Marco Fantini
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | | | - Ilaria Bertotto
- Radiology Service, Candiolo Cancer Institute FPO IRCCS, Candiolo, 10060 Turin, Italy
| | - Andrea Elio Sprio
- Department of Research, ASOMI College of Sciences, 2080 Marsa, Malta
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Fernando Luiz Dias
- Brazilian National Cancer Institute, Rio de Janeiro 20230-130, RJ, Brazil
| | - Giuseppe Rizzotto
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | - Erika Crosetti
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
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6
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Bertino G, Pedretti F, Mauramati S, Filauro M, Vallin A, Mora F, Crosetti E, Succo G, Peretti G, Benazzo M. Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study. Acta Otorhinolaryngol Ital 2023; 43:S111-S122. [PMID: 37698108 PMCID: PMC10159644 DOI: 10.14639/0392-100x-suppl.1-43-2023-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 09/13/2023]
Abstract
Objectives Recurrent respiratory papillomatosis (RRP) is a benign, rare disease caused by Human Papilloma Virus (HPV) that can be divided into juvenile and adult forms. The course of the disease is variable, but is usually more aggressive in the juvenile form. The standard surgical treatment is represented by CO2 laser resection, although photoangiolytic lasers represent a valid alternative. Adjuvant therapies have been proposed for disease control in case of frequent surgical resections or spreading into the lower airways. In recent years, the development of immunotherapy led to the use of bevacizumab either intratumorally or intravenously, but the most promising therapeutic development is represented by HPV vaccination. This paper aims to present a narrative review of the literature and the experience of three different University Centres in the treatment of RRP. Methods A retrospective analysis of the clinical charts of all patients affected by laryngeal papillomatosis and treated in three different University Centres between 2002 and 2022 was performed. The following parameters were collected: sex, age at first evaluation, sites of larynx involved, HPV type, type of first surgical treatment, presence and number of recurrences, surgical treatment of recurrences, adjuvant therapies, side effects and status at last follow-up. Results Seventy-eight patients were available for evaluation. Of these, 88% had adult onset RRP (Ao-RRP) and 12% juvenile onset RRP (Jo-RRP). The glottis was the most frequently involved subsite; all patients were submitted to surgical resection with CO2 laser under general anaesthesia. Recurrences appeared in 79% of the patients, the patients who did not recur were all adults. The mean number of recurrences was 9 (range 1-110). Recurrences were more frequent in children (M = 20; range 2-110) than adults (M = 5; range 1-21). Thirty-two (52%) of the 62 patients who recurred were re-treated with CO2 laser under general anaesthesia, while office-based treatment with a photoangiolytic laser was preferred in the remaining 30 (48%) patients. Adjuvant treatments were applied in 26 patients. The analysis of the course of the disease showed that in the 9 patients with Jo-RRP, 6 (67%) were free of lesions at the last follow-up, while the other 3 (33%) had papillomas. Of the 69 patients with Ao-RRP, 53 (77%) were alive and free of disease at the last visit, 14 (21%) were alive with disease, 1 (1%) was lost at follow-up and 1 (1%) died for other disease. Severe side effects were not observed except for 2 patients, who developed posterior glottic stenosis. Conclusions Our results confirmed the literature review. RRP is a potentially aggressive disease, especially in juvenile onset. Surgical resection is still first-line treatment, but in case of multiple recurrences the use of adjuvant therapies must be taken into consideration.
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Affiliation(s)
- Giulia Bertino
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Fabio Pedretti
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Simone Mauramati
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marta Filauro
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alberto Vallin
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
- DISC, University of Genoa, Italy
| | - Francesco Mora
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
- DISC, University of Genoa, Italy
| | - Erika Crosetti
- ENT Unit, Oncology Department, University of Turin, Orbassano (Turin), Italy
| | - Giovanni Succo
- ENT Department, San Giovanni Bosco Hospital, Turin, Italy
- Oncology Department, University of Turin, Turin, Italy
| | - Giorgio Peretti
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
- DISC, University of Genoa, Italy
| | - Marco Benazzo
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Denaro N, Succo G, Ostellino O, Airoldi M, Merlano MC, Badellino S, Solinas C, Garrone O, Iorio GC. The oligometastatic setting in HNSCC: A critical review by the Rete Oncologica Piemonte e Valle d'Aosta multidisciplinary team. Crit Rev Oncol Hematol 2023; 185:103968. [PMID: 36965646 DOI: 10.1016/j.critrevonc.2023.103968] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION The oligometastatic disease is a low burden metastatic disease that might still benefit from curable treatment. Squamous cell carcinoma of the head and neck (HNSCC) is a complex group of malignancies, with high rates of loco-regional recurrences. Distant metastases are less frequent, and a single or few deposits are often observed (oligometastatic disease). The optimal management of oligometastatic HNSCC remains to be defined. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of the available evidence on the management of oligometastatic HNSCC patients, with a focus on metastasis-directed therapy (MDT), particularly stereotactic ablative radiotherapy (SABR). CONCLUSIONS in line with literature data, the multidisciplinary evaluation emerged as the key element in the management of oligometastatic HNSCC patients.
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Affiliation(s)
- Nerina Denaro
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Oliviero Ostellino
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mario Airoldi
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Carlo Merlano
- Scientific Direction, Candiolo Cancer Institute, FPO-IRCCS Candiolo, 10060 Torino, Italy
| | - Serena Badellino
- Department of Oncology, University of Torino, 10125 Torino, Italy
| | - Cinzia Solinas
- Oncology Department AOU Cagliari, Policlinico di Monserrato, Monserrato (CA) Italy
| | - Ornella Garrone
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
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Mattioli F, Serafini E, Lo Manto A, Mularoni F, Abeshi A, Lionello M, Ferrari M, Paderno A, Lancini D, Mattavelli D, Confuorto G, Marchi F, Ioppi A, Sampieri C, Mercante G, De Virgilio A, Petruzzi G, Crosetti E, Pellini R, Giuseppe S, Giorgio P, Piazza C, Molteni G, Bertolin A, Succo G, Nicolai P, Alicandri-Ciufelli M, Marchioni D, Presutti L, Fermi M. The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study. Head Neck 2023; 45:197-206. [PMID: 36250285 PMCID: PMC10092371 DOI: 10.1002/hed.27225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To retrospectively evaluate oncological outcomes in two groups of patients with pT4aN0 glottic SCC treated with total laryngectomy (TL) and neck dissection (ND) who underwent postoperative radiotherapy or exclusive clinical and radiological follow-up. METHODS It includes patients with pT4N0 glottic SCC who underwent TL and unilateral or bilateral ND with or without PORT. Divided in two comparison groups: the first group underwent adjuvant RT (TL-PORT); the second group referred to clinical and radiological follow-up (TL). RESULTS PORT was associated with a better OS while no differences were found in terms of DSS. A better local control is achieved when PORT is administered while no differences in terms of regional and distant control rates were found. Bilateral ND positively impacts on the regional control while the PNI negatively impact the regional control. CONCLUSIONS A tailored PORT protocol might be considered for pT4N0 glottic SCC treated with TL and ND, both considering the ND's extent and presence of PNI.
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Affiliation(s)
- Francesco Mattioli
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alfredo Lo Manto
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Francesca Mularoni
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedale Università di Padova, Padua, Italy
| | - Andi Abeshi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marco Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedale Università di Padova, Padua, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gennaro Confuorto
- Otolaryngology Unit, Department of Surgery, Dentistry and Paediatrics, University of Verona, Verona, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Erika Crosetti
- ENT Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital Orbassano, Turin, Italy
| | - Raul Pellini
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Spriano Giuseppe
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Peretti Giorgio
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gabriele Molteni
- Otolaryngology Unit, Department of Surgery, Dentistry and Paediatrics, University of Verona, Verona, Italy.,Department of Otolaryngology - Head and Neck Surgery, University Hospital Policlinico, Verona, Italy
| | - Andy Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedale Università di Padova, Padua, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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Crosetti E, Arrigoni G, Fantini M, Fondello G, Moniaci D, Carnino R, Succo G. Lipofilling after total parotidectomy: a useful option to prevent functional and aesthetic sequelae. Acta Otorhinolaryngol Ital 2022; 42:516-524. [PMID: 36654517 PMCID: PMC9853102 DOI: 10.14639/0392-100x-n2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023]
Abstract
Objective Parotidectomy is the main treatment for parotid tumours, but its functional and aesthetic sequelae can be very disturbing for patients. Methods 15 patients underwent total conservative parotidectomy, harvesting of a superficial musculoaponeurotic system (SMAS) flap and lipofilling between May 2014 and June 2020 for a benign parotid tumour. Aesthetic, functional sequelae and cosmetic results were assessed with the House-Brackmann scale, Luna-Ortiz's classification and a semiquantitative questionnaire. Lipofilling resorption was analysed by maxillofacial and neck MRI imaging at 2 years after surgery. The results were compared to a group of 21 patients who underwent total parotidectomy without harvesting a SMAS flap and lipofilling. Results No complications were observed. No facial defects were seen during follow-up. Post-operative MRI showed fat resorption was less than 20% in 12 patients and from 20 to 30% in 3 patients. Cosmetic satisfaction was 100% in all cases. Only 1 patient (6%) complained of Frey's syndrome. Conclusions Lipofilling is an excellent solution considering its efficacy, safety, simplicity, duration over time and economic costs. Donor site invasiveness is minimal, and reintervention is always possible. Face-lift incision and SMAS flap can improve aesthetic results and minimise the disfiguring impact of the surgical scar.
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Affiliation(s)
- Erika Crosetti
- ENT Unit, San Luigi Gonzaga Hospital, Orbassano (TO), Italy, Department of Oncology, University of Turin, Orbassano (TO), Italy,Correspondence Erika Crosetti ENT Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy, Regione Gonzole 10, 10043 Orbassano, Turin, Italy Tel. +39 011 9026463 E-mail:
| | | | | | | | - Diego Moniaci
- Vascular Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Riccardo Carnino
- Plastic Surgery Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo (TO), Italy
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10
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Fadda GL, Petrelli A, Urbanelli A, Castelnuovo P, Bignami M, Crosetti E, Succo G, Cavallo G. Risky anatomical variations of sphenoid sinus and surrounding structures in endoscopic sinus surgery. Head Face Med 2022; 18:29. [PMID: 36057720 PMCID: PMC9440488 DOI: 10.1186/s13005-022-00336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures. Methods In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP). Results The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment. Conclusion To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy.
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anastasia Urbanelli
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Insubria, Como, Italy
| | - Erika Crosetti
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
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11
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Fantini M, Crosetti E, Pizzorni N, Sprio AE, Bertolin A, Rizzotto G, Schindler A, Succo G. Voice and communication after open partial horizontal laryngectomies: A cross-sectional outcome study. Head Neck 2022; 44:2248-2256. [PMID: 35792420 DOI: 10.1002/hed.27132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The present study evaluates voice and communication after open partial horizontal laryngectomies (OPHLs), according to surgery and patient-related variables. METHODS Fifty-eight patients were included: 18 type I OPHL, 20 type II OPHL and 20 type III OPHL. Acoustic, aerodynamic, endoscopic, perceptual and self-assessment analyses were carried out. Surgery-related variables and patient-related variables were considered for the analysis. RESULTS Type I OPHL revealed the best phonatory outcomes. Type II and type III OPHL showed similar and poor results, with a highly deteriorated voice quality. A significant difference in MTP was found for patients who had both arytenoids/cricoarytenoid units preserved. Age and time from surgery showed significant correlations with voice quality after OPHLs. CONCLUSIONS Voice and communication outcomes after OPHLs are heterogeneous and might be influenced by several factors. Knowing variables with a substantial impact on phonatory outcomes may help clinicians in the preoperative decision-making process and the postoperative rehabilitative program.
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Affiliation(s)
- Marco Fantini
- Otorhinolaryngology Service, Koelliker Hospital, Turin, Italy.,Otorhinolaryngology Service, San Feliciano Hospital, Rome, Italy
| | - Erika Crosetti
- Otolaryngology Head and Neck Surgery Unit, San Luigi Gonzaga Hospital, Turin, Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Andy Bertolin
- Otolaryngology Head and Neck Surgery Unit, Ospedale Civile of Vittorio Veneto, Vittorio Veneto, Italy
| | - Giuseppe Rizzotto
- Otolaryngology Head and Neck Surgery Unit, Ospedale Civile of Vittorio Veneto, Vittorio Veneto, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giovanni Succo
- Department of Oncology, University of Turin, Turin, Italy.,Otolaryngology Head and Neck Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy
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12
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Fantini M, Crosetti E, Firino A, Gallia M, Borrelli G, Stacchini M, Ricci Maccarini A, Succo G. Phonosurgical Injection Approaches for Voice Restoration After Open Partial Horizontal Laryngectomies: A Pilot Study. J Voice 2022:S0892-1997(22)00099-6. [PMID: 35473913 DOI: 10.1016/j.jvoice.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study is to evaluate the efficacy of phonosurgical corrective approaches based on injection laryngoplasties and pharyngoplasties followed by speech therapy for voice restoration after unsatisfactory phonatory results of open partial horizontal laryngectomies. METHODS Ten patients with not satisfying phonatory results despite speech therapy after type II or type III open partial horizontal laryngectomies (OPHLs) were included. Each patient underwent a voice restoration program based on phonosurgery (injection laryngoplasty and/or injection pharyngoplasty) with hyaluronic acid and/or calcium hydroxyapatite, followed by post-surgical voice rehabilitation. Voices were recorded and analysed through spectrographic, aerodynamic, perceptual, laryngoscopic and self-assessment evaluations before the treatment (T0), after 1 month (T1) and after three months (T2). RESULTS Significant improvements in the patients voices were found between T0, T1 and T2 concerning acoustic, perceptual, aerodynamic, laryngoscopic and self assessment evaluations. CONCLUSIONS The results of the present study support phonosurgical injection procedures followed by speech therapy as an effective strategy for voice restoration after type II or type III OPHLs in selected patients.
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Affiliation(s)
- Marco Fantini
- Otorhinolaryngology Service, Koelliker Hospital, Turin, Italy; Otorhinolaryngology Service, San Feliciano Hospital, Rome, Italy.
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Arianna Firino
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Michela Gallia
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Gabriella Borrelli
- Physical Medicine and Rehabilitation Service, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Marco Stacchini
- Otorhinolaryngology Unit, Head and Neck Department, Bufalini Hospital, Cesena, Italy
| | | | - Giovanni Succo
- Otolaryngology Head and Neck Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy; Oncology Department, University of Turin, Turin, Italy
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Arrigoni G, Crosetti E, Freddi M, Piovesan A, Rossetto Giaccherino R, Succo G, Palestini N. Comparison between 2015 ATA guidelines and Italian Consensus for DTC management. A commented report. Acta Otorhinolaryngol Ital 2022; 42:41-54. [PMID: 35292787 PMCID: PMC9058931 DOI: 10.14639/0392-100x-n1572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022]
Abstract
The 2015 ATA guidelines and 2018 Italian Consensus have produced a series of generally concordant recommendations on clinical and therapeutic management of thyroid nodules and thyroid carcinoma. Currently, the goals of treatment are to achieve the highest disease-free survival rates through the best ratio between minimum invasiveness and cost/impact on quality of life. By analysis and comparison of the ATA Guidelines and Italian Consensus, we highlighted and commented upon the key points of differentiated thyroid cancer management. Furthermore, the aim of this work is to identify and promote uniform clinical approaches among all specialists who treat differentiated thyroid cancer and represent a starting point for a consensus drafted by the Italian Society of Otolaryngology - Head and Neck Surgery.
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Crosetti E, Succo G, Battiston B, D'Addabbo F, Tascone M, Maldi E, Bertotto I, Berrone M. Surgical Margins After Computer-Assisted Mandibular Reconstruction: A Retrospective Study. Front Oral Health 2022; 2:806477. [PMID: 35098211 PMCID: PMC8793010 DOI: 10.3389/froh.2021.806477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: The use of virtual surgical planning in head and neck surgery is growing strongly. In the literature, its validity, accuracy and clinical utility for mandibular reconstruction are widely documented. Virtual planning of surgical bone resection and reconstruction takes place several days before surgery and its very sensitive nature can negatively affect an intervention aimed at maximum precision in term of oncological safety. Methods: The study focuses on a retrospective evaluation of the surgical margins in 26 consecutive cases with oral cavity malignancy and who underwent computer-assisted mandibular resection/reconstruction guided by the different types of bone, periosteal and peri-mandibular tissue involvement. The goal was to analyze the strategic and technical aspects useful to minimize the risk of positive or close margins and to vary the reconstructive strategy in the case of intraoperative findings of a non-radical planned resection. Results: No intraoperative or perioperative complications occurred. In 20 patients, virtual surgical planning permitted mandibular reconstruction to be performed using composite fibular free flaps, characterized by high accuracy and negative bone margins. In the remaining 6 patients, also virtually planned but otherwise reconstructed due to poor general condition (advanced age, severe comorbidity), negative bone margins were obtained. Intraoperative enlargement of the resection was carried out in one case and positive soft tissue margins were observed in another case. Conclusion: The results were satisfactory in terms of oncological radicality and precision. The functional benefits and reduction in operating times, previously demonstrated in other articles also by the authors, seem to justify the side effects related to the risk of modifying the planned surgery. During virtual planning, the surgeons must bear in mind that an unexpected progression of the tumor or a limited planned resection will entail modifying the extent of the resection intraoperatively and nullifying the virtual planning on which the reconstruction was based. Further investigations are necessary to clarify all aspects of virtual surgical planning in this setting.
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Affiliation(s)
- Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Giovanni Succo
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology, Hand and Microsurgery Unit, Orthopedic and Trauma Centre, Azienda Ospedaliero Universitaria (AOU) Città Della Salute e Della Scienza, Turin, Italy
| | | | - Martina Tascone
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Elena Maldi
- Pathology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
| | - Mattia Berrone
- Head Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per - l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Candiolo, Italy
- Department of Oncology, University of Turin, Orbassano, Italy
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Crosetti E, Tascone M, Arrigoni G, Fantini M, Succo G. Impact of COVID-19 restrictions on hospitalisation and post-operative rehabilitation of head and neck cancer patients. Acta Otorhinolaryngol Ital 2021; 41:489-495. [PMID: 34928262 PMCID: PMC8686804 DOI: 10.14639/0392-100x-n1604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022]
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16
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Crosetti E, Arrigoni G, Caracciolo A, Tascone M, Manca A, Succo G. VITOM-3D-assisted retroauricular neck surgery (RANS-3D): preliminary experience at Candiolo Cancer Institute. Acta Otorhinolaryngol Ital 2021; 41:419-431. [PMID: 34734577 PMCID: PMC8569660 DOI: 10.14639/0392-100x-n1293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
Objective The recent introduction of 3D exoscopic surgery has engendered interesting technical improvements in head and neck surgery. The main goal of this study was to describe the application of 3D exoscopic technology on a wide range of pathologies of the neck, benign and malignant, through a minimally invasive retroauricular approach. Methods In the period January-December, 2019, 40 consecutive patients underwent neck surgery with a retroauricular approach, enhanced by using a 3D exoscope at the Head and Neck Oncological Unit of Candiolo Cancer Institute. Results Data regarding time to drain removal, length of hospitalisation, degree of pain experienced, need for opioid drugs during hospitalisation and after discharge, and intra-operative and post-operative complications were collected. All patients were followed for a minimum of 90 days with possible complications evaluated at each post-operative visit. Post-operative outcomes were evaluated at 3 months after surgery. Conclusions The current study indicates that VITOM-3D-assisted retroauricular neck surgery (RANS-3D) may be an interesting approach for neck surgery. The hybrid execution of neck dissection under direct and exoscopic vision represents a valid alternative to video-assisted endoscopic- and robot-assisted techniques.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giulia Arrigoni
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Alessandra Caracciolo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Martina Tascone
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Andrea Manca
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Orbassano (TO), Italy
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Fantini M, Crosetti E, Affaniti R, Sprio AE, Bertotto I, Succo G. Preoperative prognostic factors for functional and clinical outcomes after open partial horizontal laryngectomies. Head Neck 2021; 43:3459-3467. [PMID: 34405480 DOI: 10.1002/hed.26845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In minority of cases, the clinical recovery of the neolarynx after open partial horizontal laryngectomies (OPHLs) can be challenging, possibly affecting the final functional outcome. METHODS One hundred and twenty-three patients who underwent OPHLs were selected. A series of clinical preoperative independent variables were considered. All patients were monitored for the following dependent outcome variables: sequelae; need for percutaneous endoscopic gastrostomy positioning; days before tracheal cannula removal and nasogastric tube removal; and length of hospital stay. Univariate and multivariate logistic regression analyses were performed to identify significant associations between preoperative clinical variables and outcomes variables. RESULTS Multivariate analysis confirmed age, cT classification, body mass index, and smoking habits as significant prognostic factors for worse functional and clinical recovery outcomes. CONCLUSIONS Knowing what variables are significantly associated with worse clinical and functional outcomes can guide clinicians in defining the best surgical choice not only from an oncological perspective, but also for a better postoperative recovery.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Riccardo Affaniti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy.,Oncology Department, University of Turin, Orbassano (TO), Italy
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Crosetti E, Arrigoni G, Manca A, Fantini M, Caracciolo A, Sardanapoli F, Succo G. VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab. ACTA ACUST UNITED AC 2021; 40:343-351. [PMID: 33299224 PMCID: PMC7726639 DOI: 10.14639/0392-100x-n0757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022]
Abstract
Objective The recent introduction of 3D exoscopic surgery has allowed interesting technical improvements in head and neck surgery resulting in technical solutions that are also applicable to neck dissection. The aim is to replace robotic surgery while minimising the costs of the procedure. Methods Based on these considerations, we conducted a preclinical investigation in the cadaver lab focused on approaching conventional neck dissection using a retroauricular incision, and evalute the applications and usefulness of the Storz 3D Exoscopic System at different stages of the surgical procedure. The acronym RAND-3D (3D exoscopic surgery) was coined to describe the application of this optical tool in neck dissection. Results The current study in the cadaver lab indicates that RAND-3D is an acceptable alternative operating technique in performing neck dissection by a retroauricular approach. Technically feasible and safe, this technique assures a complete compartment-oriented dissection without damaging major vascular or nervous structures. Conclusions This approach can be used in selected cases with a clear cosmetic benefit and represents a valid alternative to endoscopic- and robotic-assisted neck dissection.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giulia Arrigoni
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Andrea Manca
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Alessandra Caracciolo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Francesco Sardanapoli
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Orbassano (TO), Italy
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Bertolin A, Lionello M, Ghizzo M, Barbero E, Crosetti E, Rizzotto G, Succo G. Modular approach in OPHL: are there preoperative predictors? ACTA ACUST UNITED AC 2021; 40:352-359. [PMID: 33299225 PMCID: PMC7726649 DOI: 10.14639/0392-100x-n0782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
Abstract
Objective Open partial horizontal laryngectomies (OPHLs) nowadays represent the first line surgical choice for the conservative treatment of locally intermediate and selected advanced stage laryngeal cancers. Among the peculiarities of OPHLs, there is the possibility of intraoperatively modulating the procedure. It would be useful for the surgeon to recognise preoperative endoscopic and radiological factors that can predict the possibility to modulate the laryngectomy. Methods The present study retrospectively reviewed a cohort of 72 patients who underwent OPHL for glottic LSCC, in order to identify preoperative (endoscopic and radiological) parameters that are able to predict modulation surgery. Results The hypoglottic extension of the glottic tumour was the preoperative finding that was most informative in predicting OPHL modulation. However, it had no significant impact on oncological outcomes. Conclusions Patients affected by tumours with hypoglottic extension and eligible for OPHL type II should be preoperatively informed about the possibility of an intraoperative switch towards OPHL type III.
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Affiliation(s)
- Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
| | | | - Marco Ghizzo
- Otolaryngology Unit, Vittorio Veneto Hospital, Italy
| | - Emanuela Barbero
- Otorhinolaryngology Service, University of Eastern Piedmont, Novara, Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | | | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Orbassano (TO), Italy
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Fadda GL, Martino F, Andreani G, Succo G, Catalani M, Di Girolamo S, Cavallo G. Definition and management of invasive fungal rhinosinusitis: a single-centre retrospective study. ACTA ACUST UNITED AC 2021; 41:43-50. [PMID: 33746222 PMCID: PMC7982758 DOI: 10.14639/0392-100x-n0848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022]
Abstract
Objectives The purpose of this study was to correlate acute invasive fungal rhinosinusitis (AIFRS) and chronic invasive fungal rhinosinusitis with underlying diseases, aetiological microorganisms, clinical symptoms, radiological findings, and surgical and medical treatment to determine the subset of patients who require more accurate diagnostic investigation and to prevent irreversible complications. Methods This retrospective monocentric study included 17 patients who underwent endoscopic sinus surgery evaluated by paranasal computed tomography and magnetic resonance imaging. Age, sex and symptoms, and location of the invasive fungal infection and the causative fungus were analysed. Results In total, 4 patients were affected by the AIFRS form, and 13 by the chronic form. Diabetes mellitus was reported in 41.17% of cases, and haematological diseases in 23.52%. The maxillary sinuses were involved in 47.05% of cases and sphenoidal sinuses in 52.94%; Aspergillus fumigatus was the fungus in 76.47% of cases, and Zygomycetes in 23.53%. Conclusions An understanding of the different types of fungal sinusitis and knowledge of their features play a crucial role in reaching prompt diagnosis and initiation of appropriate therapy, which is essential to avoid a protracted or fatal outcome.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federica Martino
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.,Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giovanni Succo
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.,Oncology Dept. University of Turin, Italy; 6 Department of Otolaryngology, Humanitas Cellini, Turin, Italy
| | - Maurizio Catalani
- Oncology Dept. University of Turin, Italy; 6 Department of Otolaryngology, Humanitas Cellini, Turin, Italy
| | - Stefano Di Girolamo
- Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Cavallo
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Crosetti E, Arrigoni G, Sprio AE, Succo G. "Fistula Zero" Project After Total Laryngectomy: The Candiolo Cancer Institute Experience. Front Oncol 2021; 11:690703. [PMID: 34239804 PMCID: PMC8258249 DOI: 10.3389/fonc.2021.690703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Pharyngocutaneous fistula (PCF) is a troublesome complication after total laryngectomy. The “Fistula zero” project aims to reduce the number of PCF by following a detailed protocol based on three fundamental key points. Materials and Methods The Fistula zero project included 77 patients who underwent total laryngectomy in the period from January 2019 to December 2020. The protocol consisted of three main aspects: the systematic placement of a Har-El salivary bypass tube, the continuous horizontal watertight pharyngeal suture using a barbed suture, onlay insetting of a pedicled flap in pre-treated patients. Results One case of PCF (1.3%) and three small blind fistulas (3.9%) were observed in this series. The mean length of hospitalization was 18 days. Conclusion Pharyngocutaneous fistula (PCF) prolongs hospitalization and delays adjuvant treatments. Thanks to a strict adherence to the protocol, it was possible to reduce PCF rates, avoiding lengthy hospitalization and additional surgical procedures.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia - IRCCS (FPO-IRCCS), Candiolo, Italy
| | - Giulia Arrigoni
- Head and Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia - IRCCS (FPO-IRCCS), Candiolo, Italy
| | - Andrea Elio Sprio
- Department of Biomedical and Clinic Sciences, University of Turin, Orbassano, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia - IRCCS (FPO-IRCCS), Candiolo, Italy.,Department of Oncology, University of Turin, Orbassano, Italy
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22
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Fadda GL, Petrelli A, Martino F, Succo G, Castelnuovo P, Bignami M, Cavallo G. Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations. Am J Rhinol Allergy 2021; 35:871-878. [PMID: 34039073 DOI: 10.1177/19458924211020549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. OBJECTIVE To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation.Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). RESULTS The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. CONCLUSIONS According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Federica Martino
- Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Succo
- FPO IRCCS, Head and Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.,Oncology Department, University of Turin, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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Berrone M, Lajolo C, De Corso E, Settimi S, Rupe C, Crosetti E, Succo G. Cooperation between ENT surgeon and dentist in head and neck oncology. ACTA ACUST UNITED AC 2021; 41:S124-S137. [PMID: 34060528 PMCID: PMC8172104 DOI: 10.14639/0392-100x-suppl.1-41-2021-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/08/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Mattia Berrone
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Carlo Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy.,School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio De Corso
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Stefano Settimi
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Cosimo Rupe
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Turin, Italy
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Gorphe P, Grandbastien B, Dietz A, Duvvuri U, Ferris RL, Golusinski W, Holsinger FC, Hosal S, Lawson G, Mehanna H, Paleri V, Shaw R, Succo G, Leemans CR, Simon C. Safety and Feasibility of Surgery for Oropharyngeal Cancers During the SARS-CoV-2-Pandemic. Front Oncol 2021; 11:651123. [PMID: 33842364 PMCID: PMC8024687 DOI: 10.3389/fonc.2021.651123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Bruno Grandbastien
- Department of Hospital Preventive Medicine, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland
| | - Floyd Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, United States
| | - Sefik Hosal
- Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey
| | - George Lawson
- ENT and Head and Neck Surgery Department, CHU UCL Namur- Site Godinne, Namur, Belgium
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust, London, United Kingdom
| | - Richard Shaw
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, United Kingdom.,Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Giovanni Succo
- Department of Oncology, University of Turin, Turin, Italy.,Head and Neck Oncology Unit, Candiolo Cancer Institute - FPO IRCCS, Candiolo, Italy
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Center, VU University, Amsterdam, Netherlands
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
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Fantini M, Succo G, Tascone M, Borrelli G, Pisanu G, Crosetti E. Spontaneous Vocal Fold Polyps Remission after Lockdown for Covid-19 Pandemic: Does Vocal Load Matter? J Voice 2021:S0892-1997(21)00103-X. [PMID: 33771429 PMCID: PMC7959267 DOI: 10.1016/j.jvoice.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/23/2022]
Abstract
Objective During the Italian lockdown for Covid-19 emergency, due to stay-at-home orders, many people experienced an unusual period of voice rest. The present case series aims at reporting the spontaneous regression of some vocal fold polyps during the Italian lockdown for SARS-CoV2 pandemic. Methods Five patients with voice complaints presenting to a tertiary referral center and diagnosed with vocal fold polyps before the lockdown were included. Because of the lockdown restrictive measures, planned elective surgical procedures were suspended. The patients were re-assessed immediately after lockdown. Multidimensional voice assessments were conducted before and after the lockdown period through laryngostroboscopies, perceptual voice evaluations, electroacoustic analysis and self assessments. Results The patients included in the present case series experienced a complete or nearly complete remission of symptoms. Videolaryngostroboscopies documented a complete or nearly complete regression of the polyps. Voices considerably improved both perceptually and electroacoustically. Self assessments showed a reduction of voice-related complaints. Conclusions The present study suggests that daily vocal load reduction may play a critical role in the conservative management of vocal fold polyps.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy.
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy; Oncology Dept., University of Turin, Turin, Italy
| | - Martina Tascone
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy
| | - Gabriella Borrelli
- Physical Medicine and Rehabilitation Service, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuliana Pisanu
- Phoniatric Rehabilitation Service, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy
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26
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Muscatello L, Piazza C, Peretti G, Marchi F, Bertolin A, Crosetti E, Leopardi G, Lenzi R, Manca L, Matteucci J, Pellini R, Petruzzi G, Presutti L, Sarno A, Succo G, Valerini S, Rizzotto G. Open partial horizontal laryngectomy and adjuvant (chemo)radiotherapy for laryngeal squamous cell carcinoma: results from a multicenter Italian experience. Eur Arch Otorhinolaryngol 2021; 278:4059-4065. [PMID: 33599842 DOI: 10.1007/s00405-021-06651-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/27/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the functional and oncologic outcomes of adjuvant (chemo)radiation [(C)RT] after open partial horizontal laryngectomies (OPHLs). METHODS Multicenter retrospective evaluation of 130 patients (116 males, 14 females) submitted between 1995 and 2017 to OPHL Types II and III for laryngeal cancer and receiving adjuvant (C)RT for one or more of the following risk factors at histopathologic examination of the surgical specimen: pT4a and/or > pN2a categories, close/positive resection margins, or presence of both perineural (PNI) and lympho-vascular invasion (LVI). The primary study endpoints were evaluation of the presence of tracheostomy and/or gastrostomy at last follow-up, and calculation of laryngo-esophageal dysfunction-free survival (LEDFS). RESULTS Mean age of the study cohort was 60.8 ± 8.9 years (median, 62; interquartile range [IQR], 13). Mean follow-up was 50.7 ± 39.4 months (range 24-188; median, 38; IQR, 51). Adjuvant therapy consisted of CRT in 53 (41%) patients, and RT alone in 77 (59%). Five-year LEDFS was 85%. Overall survival was 71.5%, while 13% of patients remained tracheostomy- and 3% gastrostomy-dependent at the last follow-up. The only significant variable in predicting survival (p = 0.020) was tracheostomy dependence: it was maintained in 7.5% of subjects after OPHL Type II and in 34% of those submitted to OHPL Type III (p < 0.001). CONCLUSIONS In selected patients affected by advanced laryngeal cancer, OPHLs Type II and III have a relatively good laryngeal safety profile and provide favorable oncologic outcomes even in case of need for adjuvant (C)RT.
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Affiliation(s)
- Luca Muscatello
- Unit of Otorhinolaryngology, Azienda USL Toscana Nord Ovest, Versilia Hospital, Camaiore (LU), Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Andy Bertolin
- Otolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Gianluca Leopardi
- Unit of Otorhinolaryngology, Azienda USL Toscana Centro, San Giuseppe Hospital, Empoli (FI), Italy
| | - Riccardo Lenzi
- Unit of Otorhinolaryngology, Azienda USL Toscana Nord Ovest, Apuane Hospital, Via E. Mattei 31, 54100, Massa, Italy.
| | - Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Mathematics, University of Pisa, Pisa, Italy
| | - Jacopo Matteucci
- Unit of Otorhinolaryngology, Azienda USL Toscana Nord Ovest, Apuane Hospital, Via E. Mattei 31, 54100, Massa, Italy
| | - Raul Pellini
- Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Livio Presutti
- Department of Otolaryngology, Head and Neck Surgery, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Antonio Sarno
- Unit of Otorhinolaryngology, Azienda USL Toscana Centro, Santo Stefano Hospital, Prato, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Sara Valerini
- Department of Otolaryngology, Head and Neck Surgery, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Giuseppe Rizzotto
- Otolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2020; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany.,Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.,Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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28
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Fantini M, Gallia M, Borrelli G, Pizzorni N, Ricci Maccarini A, Borragan Torre A, Schindler A, Succo G, Crosetti E. Substitution Voice Rehabilitation After Open Partial Horizontal Laryngectomy Through the Proprioceptive Elastic Method (PROEL): A Preliminary Study. J Voice 2020; 36:291.e1-291.e7. [PMID: 32553498 DOI: 10.1016/j.jvoice.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim was to investigate the efficacy of the Proprioceptive Elastic Method (PROEL) in the rehabilitation of the substitution voice after open partial horizontal laryngectomy (OPHL). STUDY DESIGN Prospective outcome study. METHODS Fifteen patients surgically treated by OPHL type II or type III for laryngeal cancer were recruited (experimental group). Each patient underwent a specific program of voice rehabilitation based on the PROEL method with the same speech and language pathologist. Acoustic-aerodynamic analysis: maximum phonation time (MPT); spectrographic classification (Titze's modified classification), perceptual analysis (INFVo rating scale) and self-assessments (SECEL questionnaire) were performed before the treatment (T0), after 3 months of rehabilitation (T1), and at the end of the 6-month rehabilitation program (T2). A control sample of other 15 patients who underwent OPHL type II or type III and who underwent a standard perioperative rehabilitation was randomly extracted from an historical database and compared to the experimental group. RESULTS Significative voice improvements between T0-T1 and T2 were found for acoustic, aerodynamic, perceptual, and self-assessments analysis in the experimental group. Significative differences were found between the experimental group at T2 and the control sample for aerodynamic, self-assessment, and perceptual analysis. CONCLUSIONS The results of the present study support PROEL method as an effective approach for substitution voice rehabilitation after OPHL type II and III. Randomized controlled trials on larger groups of patients are needed in future in order to compare PROEL with other rehabilitative approaches.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy.
| | - Michela Gallia
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Gabriella Borrelli
- Otorhinolaryngology Service, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | | | | | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy; Oncology Department, University of Turin, Turin, Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
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Abstract
Amyloidosis is a heterogeneous group of diseases characterized by the extracellular deposition of insoluble proteins whose pathogenesis is not yet fully understood. The deposition of amyloid proteins can be systemic or localized, idiopathic or related to systemic diseases, mostly multiple myeloma or chronic inflammatory diseases. Localized head and neck amyloidosis is a rare entity, mainly involving the larynx. Given the rarity of the disease and the absence of a lasting follow-up protocol, there is no standard treatment defined for localized amyloidosis. We report a rare case of localized nasopharyngeal amyloidosis, treated with complete transoral resection and confirmed by histological examination.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Andrea Manca
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Elena Maldi
- Pathology Unit, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Torino, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy.,Department of Oncology, University of Turin, Orbassano, Torino, Italy
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30
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Abstract
Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is almost completely reserved to a few referral centers that deal with a large proportion of this pathology. Practice on human specimens is not always possible for ethical, economic, or availability reasons. The aim of this study is to provide a reproducible method for the organization of a laryngeal laboratory on ex vivo animal models where it is possible to approach, learn, and refine laryngeal techniques. Porcine and ovine larynges are ideal, affordable, models to simulate laryngeal surgery given their similarity to the human larynx in their anatomical layout and tissue composition. Herein, the surgical steps of transoral laser surgery, open partial horizontal laryngectomy, and total laryngectomy are reported. The merging of endoscopic and exoscopic views guarantees an inside-out perspective, which is vital for the comprehension of the complex laryngeal anatomy. The method was successfully adopted during three sessions of a dissection course "Lary-Gym". Further perspectives on robotic surgical training are described.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS
| | - Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS
| | - Davide Lancini
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia;
| | - Andrea Manca
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS; Department of Oncology, University of Turin
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31
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Crosetti E, Arrigoni G, Manca A, Caracciolo A, Bertotto I, Succo G. 3D Exoscopic Surgery (3Des) for Transoral Oropharyngectomy. Front Oncol 2020; 10:16. [PMID: 32082996 PMCID: PMC7006030 DOI: 10.3389/fonc.2020.00016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022] Open
Abstract
Over the past three decades, the incidence of oropharyngeal squamous cell carcinoma has increased, primarily related to the spread of human papillomavirus. Treatment has always been preferentially unimodal (surgery or radiotherapy) for early stage disease and multimodal (surgery with adjuvant therapy or concomitant chemoradiotherapy) for advanced stages. Recently, the surgical approach has gained renewed interest due to the morbidity of non-surgical treatments and also to technical innovations. We have coined the term 3Des (3D exoscope surgery) to describe the use of the 3D Vitom Exoscope System for transoral surgery of oropharyngeal cancers. During the period from June 2017 to May 2018, 10 patients with oropharyngeal cancer were treated by oropharyngeal surgery with the 3Des approach at FPO IRCCS Institute of Candiolo. The aim of the present prospective study was to evaluate the utility of 3Des for the treatment of early-stage oropharyngeal cancer. 3Des could represent a viable alternative to the operating microscope and robotic surgery thanks to its excellent ability to provide 3D visual information, depth of field, magnification, image contrast, color imaging, and low running costs. It promises great utility in the learning process, with the possibility of recording in high definition.
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Affiliation(s)
- Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Giulia Arrigoni
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Andrea Manca
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Alessandra Caracciolo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Ilaria Bertotto
- Radiology Unit, Surgery Department, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Orbassano, Italy
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32
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Crosetti E, Bertolin A, Molteni G, Bertotto I, Balmativola D, Carraro M, Sprio AE, Berta GN, Presutti L, Rizzotto G, Succo G. Patterns of recurrence after open partial horizontal laryngectomy types II and III: univariate and logistic regression analysis of risk factors. ACTA ACUST UNITED AC 2020; 39:235-243. [PMID: 31501615 PMCID: PMC6734199 DOI: 10.14639/0392-100x-2409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/11/2019] [Indexed: 11/23/2022]
Abstract
In choosing the best surgical treatment (total or partial laryngectomy) for patients affected by laryngeal squamous cell carcinoma (SCC), it is still necessary to identify a link between prognostic factors and oncological outcomes. A retrospective analysis of clinical outcomes of 819 patients affected by laryngeal cancer who underwent OPHL type II and III between 1995 to 2014 was carried out. Focusing on recurrence and its site (local, regional or distant), our cohort has been divided in two groups: patients showing recurrence (n = 108) vs those without recurrence (n = 711). Thirteen clinical-pathological parameters have been studied by univariate and multivariate analysis to identify possible correlations between recurrence and oncological outcomes (overall survival (OS), disease free survival (DFS), disease specific survival (DSS), laryngectomy free survival (LSF), laryngectomy free freedom (FFL). In multivariate analysis, we found 4 negative prognostic factors for recurrence: site of tumour (> supraglottic), cartilage invasion (> if present), perineural invasion (> if present) and type of OPHL (> in OPHL type III). The knowledge and detection of negative prognostic factors for the risk of recurrence (pN classification, cartilage involvement, perineural invasion, and thus the type of surgical treatment adopted) could increase the already well-established potentiality of OPHLs in treating cases with a safe indication after careful discussion in the tumour board.
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Affiliation(s)
- E Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO IRCCS, Candiolo (TO), Italy
| | - A Bertolin
- Otolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto (TV) Italy
| | - G Molteni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Italy
| | - I Bertotto
- Radiology Service, Candiolo Cancer Institute - FPO IRCCS, Candiolo (TO), Italy
| | - D Balmativola
- Pathology Service, Candiolo Cancer Institute - FPO IRCCS, Candiolo (TO), Italy
| | - M Carraro
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO IRCCS, Candiolo (TO), Italy
| | - A E Sprio
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - G N Berta
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - L Presutti
- Otolaryngology Service, Head and Neck Dept., Policlinico Hospital, University of Modena, Italy
| | - G Rizzotto
- Otolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto (TV) Italy
| | - G Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO IRCCS, Candiolo (TO), Italy.,Oncology Dept. University of Turin, Italy
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Nakayama M, Orosco RK, Holsinger FC, Spriano G, Succo G, De Virgilio A, Oridate N. Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy. Ann Otol Rhinol Laryngol 2019; 129:273-279. [DOI: 10.1177/0003489419885139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics. Methods: Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture). Results: EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques. Conclusions: EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.
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Affiliation(s)
- Meijin Nakayama
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Ryan K. Orosco
- Division of Head and Neck Surgery, University of California San Diego, La Jolla, CA, USA
| | - F. Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Rozzano and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giovanni Succo
- Oncology Department, University of Turin and Head and Neck Oncology Unit, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Rozzano and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Nobuhiko Oridate
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
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Mozzanica F, Scarponi L, Rota M, Succo G, Crosetti E, Guzzo M, Bossi P, Piazza C, Ottaviani F, Schindler A. Psychometric properties of the Italian version of the Speech Handicap Index. Disabil Rehabil 2019; 43:1307-1312. [DOI: 10.1080/09638288.2019.1655595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- ENT Unit, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Letizia Scarponi
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Martina Rota
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Succo
- Head/Neck Oncology Service, Department of Oncology, University of Turin, FPO IRCCS-Candiolo Cancer Institute, Turin, Italy
| | - Erika Crosetti
- Head/Neck Oncology Service, Department of Oncology, University of Turin, FPO IRCCS-Candiolo Cancer Institute, Turin, Italy
| | - Marco Guzzo
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Francesco Ottaviani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- ENT Unit, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
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35
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Pizzorni N, Crosetti E, Santambrogio E, de Cillis G, Bertolin A, Rizzotto G, Fantini M, Succo G, Schindler A. The Penetration-Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis. Dysphagia 2019; 35:261-271. [PMID: 31161405 DOI: 10.1007/s00455-019-10025-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/06/2019] [Accepted: 05/25/2019] [Indexed: 11/25/2022]
Abstract
A standard for assessing swallowing function after open partial horizontal laryngectomy (OPHL) is still not established. The variability in the measures used to investigate swallowing functional outcomes after OPHL limits the communication among clinicians and the possibility to compare and combine results from different studies. The study aims to adapt the PAS to the altered anatomy after OPHLs using fiberoptic endoscopic evaluation of swallowing (FEES) and to test its reliability. To adapt the PAS, two landmarks were identified: the entry of the laryngeal vestibule and the neoglottis. Ninety patients who underwent an OPHL were recruited (27 type I, 31 type II and 32 type III). FEES was performed and video-recorded. Two speech and language therapists (SLTs) independently rated each FEES using the PAS adapted for OPHL (OPHL-PAS). FEES recordings were rated for a second time by both SLTs at least 15 days from the first video analysis. Inter- and intra-rater agreement was assessed using unweighted Cohen's kappa. Overall, inter-rater agreement of the OPHL-PAS was k = 0.863, while intra-rater agreement was k = 0.854. Concerning different OPHL types, inter- and intra-rater agreement were k = 0.924 and k = 0.914 for type I, k = 0.865 and k = 0.790 for type II, and k = 0.808 and k = 0.858 for type III, respectively. The OPHL-PAS is a reliable scale to assess the invasion of lower airway during swallowing in patients with OPHL using FEES. The study represents the first attempt to define standard tools to assess swallowing functional outcome in this population.
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Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Elena Santambrogio
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giada de Cillis
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Andy Bertolin
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Giuseppe Rizzotto
- Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy
| | - Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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Fadda GL, D'Eramo A, Gned D, Succo G, Galizia A, Cavallo G. An unusual case of complicated rhinosinusitis of the sphenoid sinus involving the cavernous sinus and skull base: Endoscopic sinus surgery and medical therapy. SAGE Open Med Case Rep 2019; 7:2050313X19852885. [PMID: 31205718 PMCID: PMC6537237 DOI: 10.1177/2050313x19852885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Abstract
Isolated sphenoid sinus diseases are generally asymptomatic and relatively uncommon with the potential for serious complications. Patients with this condition should be monitored closely and treated aggressively and either diagnostic or therapeutic intent is often indicated. In the management of a complex, life-threatening condition that involves many different fields of expertise, the otolaryngologist plays a key role in orchestrating different specialists and gaining direct access to the affected area, thus taking the first and essential step towards diagnosis and therapy. Because of the superiority of computed tomography in defining the bony margins and the superior soft tissue resolution of magnetic resonance imaging, these two techniques should be used in a complementary manner in the evaluation of isolated sphenoid sinus disease in addition to mapping the lesion better and identifying intracranial and intraorbital extent. We report an unusual case of isolated rhinosinusitis of the sphenoid sinus involving the cavernous sinus, pterygoid fossae and masticatory space in an immunocompetent patient.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy.,ENT Department, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Anna D'Eramo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Dario Gned
- Department of Radiology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Turin, Italy
| | - Andrea Galizia
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
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Succo G, Crosetti E. Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs. Front Oncol 2019; 9:408. [PMID: 31192120 PMCID: PMC6540733 DOI: 10.3389/fonc.2019.00408] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022] Open
Abstract
The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.
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Affiliation(s)
- Giovanni Succo
- Oncology Department, University of Turin, Turin, Italy.,Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
| | - Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Turin, Italy
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Crosetti E, Fantini M, Maldi E, Balmativola D, Succo G. Open partial horizontal laryngectomy using CO 2 fiber laser. Head Neck 2019; 41:2830-2834. [PMID: 31066480 DOI: 10.1002/hed.25797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/14/2019] [Accepted: 04/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The application of CO2 fiber laser technology to ENT surgery has led to new interesting scenarios, both in endoscopic and in open surgical approaches. METHODS The current video shows three examples of open partial horizontal laryngectomies (OPHLs) performed using CO2 fiber laser for resection procedures. RESULTS CO2 fiber laser helped the surgeon in improving the accuracy of resection and the quality of surgical margins on specimen. The low thermal damage on tissues resulted in minor postoperative edema and a fast recovery of laryngeal function. CONCLUSIONS In our experience, the application of CO2 fiber laser showed some very useful features for performing OPHLs: a high cutting precision with very low tissue damage, the possibility of delivering energy without touching the organ, a modulable power for the various surgical steps, a very good maneuverability of the fine fiber holder during the procedure allowing the surgeon to "draw" the resection with a great accuracy.
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Affiliation(s)
- Erika Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Marco Fantini
- Oncology Department, University of Turin, Orbassano, Italy
| | - Elena Maldi
- Pathology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Davide Balmativola
- Pathology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy.,Oncology Department, University of Turin, Orbassano, Italy
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39
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Bertolin A, Lionello M, Ghizzo M, Cena I, Leone F, Valerini S, Mattioli F, Crosetti E, Presutti L, Succo G, Rizzotto G. Salvage open partial horizontal laryngectomy after failed radiotherapy: A multicentric study. Laryngoscope 2019; 130:431-436. [PMID: 31046149 DOI: 10.1002/lary.27959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The primary aim of the present study was to report our multi-institutional experience in surgical salvage with open partial horizontal laryngectomies (OPHL) after failed radiotherapy (RT) for laryngeal squamous cell carcinoma (LSCC). Secondary aims were to analyze the prognostic meaning of the main clinical and pathological parameters in relation to the oncologic outcome and to compare our results with the available literature. STUDY DESIGN A retrospective multicenter analysis of surgical oncological outcomes. METHODS We retrospectively review the clinical charts of 70 recurrent LSCC patients after primary RT failure undergone salvage OPHL. RESULTS At last follow-up, 46 patients (65%) were disease-free; six (9%) were alive with disease; nine (12%) died because of the disease; and nine (12%) died without evidence of disease. The final local control, overall survival, disease-specific survival, and laryngectomy-free survival were 87%, 75%, 87%, and 91%, respectively. Twelve patients (17%) experienced postoperative complications, whereas 18 patients (25%) experienced late sequelae. In five patients (7%), decannulation was not possible because of postoperative laryngeal stenosis. CONCLUSION In selected patients, when proper selection criteria for conservation laryngeal surgery are adopted, OPHL can be considered for salvage after RT failure. LEVEL OF EVIDENCE 4 Laryngoscope, 130:431-436, 2020.
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Affiliation(s)
- Andy Bertolin
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Treviso, Italy
| | - Marco Lionello
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Treviso, Italy
| | - Marco Ghizzo
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Treviso, Italy
| | - Isida Cena
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Treviso, Italy
| | | | - Sara Valerini
- Department of Otolaryngology-Head and Neck Surgery, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Francesco Mattioli
- Department of Otolaryngology-Head and Neck Surgery, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Erika Crosetti
- Head Neck Oncology Unit Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giovanni Succo
- Head Neck Oncology Unit Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Orbassano, Italy
| | - Giuseppe Rizzotto
- Otorhinolaryngology Service, Vittorio Veneto Hospital, Treviso, Italy
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Crosetti E, Arrigoni G, Cerutti M, Succo G. Atypical Carcinoid of the Larynx. Ear Nose Throat J 2019; 99:369-370. [PMID: 31012344 DOI: 10.1177/0145561319840157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E Crosetti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy
| | - G Arrigoni
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy
| | - M Cerutti
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy
| | - G Succo
- Head Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy
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41
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Pizzorni N, Schindler A, Castellari M, Fantini M, Crosetti E, Succo G. Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study. Cancers (Basel) 2019; 11:cancers11040549. [PMID: 30999620 PMCID: PMC6520791 DOI: 10.3390/cancers11040549] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways’ invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent an OPHL type IIa with arytenoid resection were recruited. Videofluoroscopic examination of swallowing was performed. Ten spatial, temporal, and scalar parameters were analyzed. Swallowing safety and efficiency were assessed through the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Swallowing was considered unsafe or inefficient for a DIGEST safety or efficiency grade ≥2, respectively. Videofluoroscopic measurements were compared between safe vs. unsafe swallowers, and efficient vs. inefficient swallowers. Seven patients (46.7%) showed unsafe swallowing and 6 patients (40%) inefficient swallowing. Unsafe swallowers had worse laryngeal closure (p = 0.021). Inefficient swallowers presented a longer pharyngeal transit time (p = 0.008), a reduced pharyngoesophageal segment opening lateral (p = 0.008), and a worse tongue base retraction (p = 0.018 with solids and p = 0.049 with semisolids). In conclusion, swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction. The identified physio-pathological mechanisms could represent targets for rehabilitative and surgical approaches in patients with dysphagia after OPHL.
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Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20154 Milano, Italy.
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20154 Milano, Italy.
| | - Micol Castellari
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20154 Milano, Italy.
| | - Marco Fantini
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Strada Provinciale 142 km 95, 10060 Candiolo (TO), Italy.
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Strada Provinciale 142 km 95, 10060 Candiolo (TO), Italy.
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Strada Provinciale 142 km 95, 10060 Candiolo (TO), Italy.
- Department of Oncology, University of Turin, 10043 Orbassano (TO), Italy.
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Crosetti E, Caracciolo A, Arrigoni G, Delmastro E, Succo G. Barbed suture in oral cavity reconstruction: preliminary results. ACTA ACUST UNITED AC 2019; 39:308-315. [PMID: 30745594 PMCID: PMC6843584 DOI: 10.14639/0392-100x-2130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/20/2018] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to evaluate the efficacy and safety of unidirectional barbed suture (V-Loc) compared to a standard monofilament stitch (Vicryl) in suturing of a free flap to local tissue after head and neck surgery for squamous cell carcinoma of the oral cavity. Complication rates, operative closure time, length of hospitalisation and costs were evaluated. The study cohort (group A) of 20 consecutive patients reconstructed using barbed stitches for suturing was prospectively compared to a control cohort (group B) of 20 consecutive patients reconstructed using conventional vicryl stitches. All patients were affected by squamous cell carcinoma of the tongue and underwent different types of glossectomy and reconstruction with free flaps. This analysis demonstrates the efficacy of the barbed suture compared with a standard monofilament stitch in terms of lower complication rate (15% group A, 30% group B), intra-operative closure times (486 minutes group A, 517 minutes group B), and length of hospitalisation (average length of hospitalisation 14.60 days group A, 16.85 days group B). These factors coupled with the use of a lower number of stitches compared with the standard stitches may compensate the increased cost of the barbed suture. In conclusion, this study demonstrates that the use of unidirectional barbed stitches for suturing of a free flap to the recipient site reduces the complication rate, principally in terms of dehiscence and fistula incidence, and reduces intra-operative time and length of hospitalisation. Based on these results and on the literature, the use of unidirectional barbed stitches can be considered as a safe and efficient alternative to conventional stitches for suturing of free flaps to local tissue.
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Affiliation(s)
- E Crosetti
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - A Caracciolo
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - G Arrigoni
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - E Delmastro
- Division of Radiotherapy, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - G Succo
- Head and Neck Oncology Service, Oncology Deparment University of Turin, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
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Fadda GL, Succo G, Moretto P, Veltri A, Castelnuovo P, Bignami M, Cavallo G. Endoscopic Endonasal Surgery for Sinus Fungus Balls: Clinical, Radiological, Histopathological, and Microbiological Analysis of 40 Cases and Review of the Literature. Iran J Otorhinolaryngol 2019; 31:35-44. [PMID: 30783597 PMCID: PMC6368987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Paranasal sinus fungus ball (PSFB) is a non-invasive mycosis, which appears in immunocompetent patients, along with unilateral lesion. The purpose of this study was to analyse various symptoms of PSFB and its radiological, pathological, and microbiological findings. In addition, this study involved the investigation of the incidence of bacterial coinfection and surgical techniques applied for this infection and to report the modern developments in this domain. MATERIALS AND METHODS This retrospective study was carried out on 40 consecutive patients referring for PSFB treatment to the Ear, Nose, and Throat Department in San Luigi Gonzaga University Hospital, Turin, Italy, from April 2014 to 2017. Pertinent literature was reviewed and compared within the specified period. All patients were examined by preoperative computed tomography (CT) scan, and 26 (65%) patients were subjected to magnetic resonance imaging (MRI). RESULTS Totally, 33 patients (82.5%) were affected with single sinus infection, whereas most of the cases suffered from maxillary sinusitis. With regard to CT scan findings, microcalcifications were found in 32.5% of the cases; however, mucosal membrane thickening around the fungus ball (FB) was visible in contrast-enhanced CT scans. According to MRI examination, FB showed a characteristic "signal void" on T 2(42.3%). Only 7(17.5%) patients had a positive mycological culture, whereas bacterial coinfections were identified in 47.5% of the cases. Out of 40 patients, 3(7.5%) subjects had only radiological evidence of fungal colonization while having no histopathological evidence. No patient received postoperative antifungal drugs, and there were no serious complications with only one recurrence. CONCLUSION Endoscopic endonasal surgery is the treatment of choice for patients with PSFB receiving no associated local or systemic antifungal therapy. A histopathological study facilitates the confirmation of the diagnosis and exclusion of the invasive form of fungal rhinosinusitis.
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Affiliation(s)
- Gian-Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.,Corresponding Author: Department of Otorhinolaryngology, University of Turin, Orbassano, Italy. San Luigi Gonzaga Hospital. Regione Gonzole 10, Orbassano, 10043 Turin, Italy. Tel: +39-011-9026463, E-mail:
| | - Giovanni Succo
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.
| | - Paolo Moretto
- Department of Diagnostic Imaging, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
| | - Andrea Veltri
- Department of Diagnostic Imaging, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
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Ottaviani F, Schindler A, Klinger F, Scarponi L, Succo G, Mozzanica F. Functional fat injection under local anesthesia to treat severe postsurgical dysphagia, case report. Head Neck 2018; 41:E17-E21. [PMID: 30536961 DOI: 10.1002/hed.25465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/30/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we present the first application of functional fat injection performed under local anesthesia in the treatment of severe dysphagia secondary to head and neck cancer surgery. METHODS Functional fat injection was performed using a transcervical approach. Control of injection depth and site was performed through a transnasal flexible endoscope. The effect of surgery was evaluated through videofluoroscopy (VFS), Fiberendoscopic Evaluation of Swallowing (FEES), Functional Oral Intake Scale (FOIS), and Eating Assessment Tool-10 (EAT-10). RESULTS Before the functional fat injection, the patient was dependent on permanent tube feeding; the VFS and FEES revealed a severe impairment of swallowing abilities. The EAT-10 scored 26. Twelve months after surgery, the patient was on oral diet, the VFS demonstrated mild to moderate dysphagia, the FEES demonstrated aspiration only with liquids and the EAT-10 improved. CONCLUSION Functional fat injection under local anesthesia could be useful in the treatment of chronic dysphagia in selected patients.
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Affiliation(s)
- Francesco Ottaviani
- Department of Clinical Sciences and Community Health, Division of Otorhinolaryngology, San Giuseppe Hospital, IRCCS Multimedica, University of Milan, Milan, Italy
| | - Antonio Schindler
- Department of Biochemical and Clinical science "Luigi Sacco", University of Milan, Milan, Italy
| | - Francesco Klinger
- Division of Plastic and Reconstructive Surgery, IRCCS Multimedica, Milan, Italy
| | - Letizia Scarponi
- Department of Biochemical and Clinical science "Luigi Sacco", University of Milan, Milan, Italy
| | - Giovanni Succo
- Department of Oncology, Candiolo Cancer Institute FPO-IRCCS, University of Turin, Turin, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, Division of Otorhinolaryngology, San Giuseppe Hospital, IRCCS Multimedica, University of Milan, Milan, Italy.,Department of Biochemical and Clinical science "Luigi Sacco", University of Milan, Milan, Italy
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45
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Succo G, Crosetti E, Bertolin A, Piazza C, Molteni G, Cirillo S, Petracchini M, Tascone M, Sprio AE, Berta GN, Peretti G, Presutti L, Rizzotto G. Treatment for T3 to T4a laryngeal cancer by open partial horizontal laryngectomies: Prognostic impact of different pathologic tumor subcategories. Head Neck 2018; 40:1897-1908. [DOI: 10.1002/hed.25176] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 11/27/2017] [Accepted: 02/15/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Giovanni Succo
- Head and Neck Oncology Service, Oncology Department; University of Turin, Candiolo Cancer Institute - FPO; IRCCS Candiolo (To) Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Oncology Department; University of Turin, Candiolo Cancer Institute - FPO; IRCCS Candiolo (To) Italy
| | - Andy Bertolin
- Otolaryngology Service, Vittorio Veneto Hospital; Vittorio Veneto; Treviso Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Gabriele Molteni
- Otolaryngology Service, Head and Neck Department, Policlinico Hospital; University of Modena; Italy
| | - Stefano Cirillo
- Radiology Service; Mauriziano Umberto I Hospital; Turin Italy
| | | | - Martina Tascone
- Head and Neck Oncology Service, Oncology Department; University of Turin, Candiolo Cancer Institute - FPO; IRCCS Candiolo (To) Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences; University of Turin; Italy
| | | | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Livio Presutti
- Otolaryngology Service, Head and Neck Department, Policlinico Hospital; University of Modena; Italy
| | - Giuseppe Rizzotto
- Otolaryngology Service, Vittorio Veneto Hospital; Vittorio Veneto; Treviso Italy
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46
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Abstract
Small bowel metastases from squamous cell carcinoma of the head and neck are relatively rare and in some cases asymptomatic. In the case herein reported, small bowel metastasis from a laryngeal carcinoma caused a life-threatening complication. The surgical approach was effective in saving the patient's life. Death occurred for neck tumor progression without abdominal signs of secondary lesions. A review of the previously reported cases is provided.
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Affiliation(s)
- M Airoldi
- Department of Otolaryngology, University of Turin, Ospedale Molinette, Torino, Italy
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47
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Airoldi M, Pedani F, Marchionatti S, Gabriele AM, Succo G, Gabriele P, Bumma C. Carboplatin plus Taxol is an Effective Third-line Regimen in Recurrent Undifferentiated Nasopharyngeal Carcinoma. Tumori 2018; 88:273-6. [PMID: 12400975 DOI: 10.1177/030089160208800405] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Recurrent undifferentiated nasopharyngeal carcinoma is a chemosensitive disease. Few third-line treatments have been reported. Methods Twelve patients (9 males, 3 females; median age 50 years, range, 20-62) with recurrent undifferentiated nasopharyngeal carcinoma were treated with carboplatin AUC 5.5 + paclitaxel (175 mg/m2, 3-hr infusion) on day 1 every 3 weeks. All patients had been previously treated for recurrent disease with a first-line cisplatin-based chemotherapy and a second-line therapy with low-dose continous infusion 5-fluorouracil. Results Overall, 54 courses were given (median, 5; range, 2-6). Three patients (25%) obtained a partial response lasting 6, 10 and 26+ months, 1 (8.3%) a minimal response lasting 6 months, and 3 (25%) no change with a median duration of 5 months. The median survival time was 14 months for patients who had a partial or minimal response or no change, and 5 months for nonresponders. Median overall survival was 9.5 months (3-30+). The treatment was well tolerated, and toxicity was manageable. Conclusions The combination has a good pallitive role as third-line chemotherapy in recurrent undifferentiated nasopharyngeal cancer.
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Affiliation(s)
- Mario Airoldi
- Department of Medical Oncology, San Giovanni Antica Sede Hospital, Turin, Italy.
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48
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Abstract
Two cases of metachronous metastases of renal cell adenocarcinoma are reported. One case presented a solitary metastasis of the ethmoid-orbit which was resected. The patient has remained well for the following 12 months. The second case presented with a secondary to the tongue and multiple metastases elsewhere. Electrodissection achieved a good palliative result.
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Affiliation(s)
- M Airoldi
- Department of Medical Oncology, Ospedale S. Giovanni Antica Sede, Turin, Italy
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49
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Airoldi M, Gabriele AM, Gabriele P, Pedani F, Marchionatti S, Succo G, Beatrice F, Bumma C. Concomitant Chemoradiotherapy Followed by Adjuvant Chemotherapy in Parotid Gland Undifferentiated Carcinoma. Tumori 2018; 87:14-7. [PMID: 11669550 DOI: 10.1177/030089160108700103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Undifferentiated carcinoma of the parotid gland is a poor-prognosis lesion. Results in unresectable lesions, treated with radiotherapy alone, are very disappointing. Methods Six patients with T3-4 N0-1 inoperable lesions were treated with conventional radiotherapy (64-70 Gy, 2 Gy per fraction 5 times a week) and concomitant cisplatin (100 mg/m2, days 1, 22 and 43). Four weeks after radiotherapy, adjuvant chemotherapy (cisplatin, 80 mg/m2, day 1, + VP16, 100 mg/m2, days 1, 3 and 5, q = 3 weeks, for 3 cycles) was given. Results A median dose of 66 Gy (range, 64-70 Gy) was delivered, and all patients recived 3 courses of cisplatin during radiotherapy. Five of 6 patients recived all three chemotherapeutic adjuvant courses. Two months after the end of treatment, 3 CR (50%), 2 PR (33%) and 1 NC (16%) was observed. Median CR and PR duration was 26+ and 10 months, respectively. Median overall survival was 18 months. No severe acute or late toxicity was observed. Conclusions Concomitant chemoradiotherapy followed by adjuvant chemotherapy in advanced unresectable undifferentiated parotid carcinoma is feasibile and well tolerated. The high percentage of long-lasting CR is encouraging.
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Affiliation(s)
- M Airoldi
- Medical Oncology Department, San Giovanni Antica Sede Hospital Turin, Italy
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50
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Berrone M, Crosetti E, Tos PL, Pentenero M, Succo G. Fibular osteofasciocutaneous flap in computer-assisted mandibular reconstruction: technical aspects in oral malignancies. Acta Otorhinolaryngol Ital 2018; 36:469-478. [PMID: 28177329 PMCID: PMC5317125 DOI: 10.14639/0392-100x-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/23/2022]
Abstract
Virtual surgical planning technology in head and neck surgery is witnessing strong growth. In the literature, the validity of the method from the point of view of accuracy and clinical utility has been widely documented, especially for bone modelling. To date, however, with its increased use in head and neck oncology, and consequently the increased need for bone and soft tissue reconstruction, is important to carry out the virtual programme considering not only bone reconstruction but also all aspects related to the reconstruction of soft tissue using composite flaps. We describe our approach to virtual planning in the case of composite flaps. The study reports six consecutive patients with malignant disease requiring mandibular bone and soft tissue reconstruction using fibular osteocutaneous flaps. In all six patients, the resection and reconstruction were planned virtually focusing on the position of cutaneous perforator vessels in order to schedule fibula cutting guides. There were no complications in all six cases. The technique described allowed us to schedule composite fibula flaps in mandibular reconstruction virtually with good accuracy of the position of the bone segment in relation to the cutaneous paddle, important for soft tissue reconstruction. Despite the limited number of cases, the preliminary results of the study suggest that this protocol is useful in virtual programmes using composite flaps in mandibular reconstruction. Further investigations are needed.
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Affiliation(s)
- M Berrone
- Department of Oncology, Phd Program in Experimental Medicine and Therapy, University of Turin, Italy
| | - E Crosetti
- FPO IRCSS, Candiolo Cancer Institute, Head & Neck Oncology Unit, Candiolo, Turin, Italy
| | - P L Tos
- Microsurgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center CTO, Turin, Italy
| | - M Pentenero
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Italy
| | - G Succo
- Department of Oncology, Otolaryngology Unit, University of Turin, Italy
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