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Cosset T, Tonnerre D, Gorphe P, Dupret-Bories A, Dufour X, Carsuzaa F. Free-flap reconstruction methods in head-and-neck oncologic surgery: A CROSS practice survey of members of the French GETTEC Head-and-Neck Tumor Study Group. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00053-X. [PMID: 38658260 DOI: 10.1016/j.anorl.2024.04.002] [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] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To survey practices concerning the use of anticoagulants and antiplatelets in microvascular free-flap reconstruction following oncological surgery of the head and neck. METHODS A survey of practices was carried out between September 2022 and March 2023. An online questionnaire was sent to members of the French GETTEC Head-and-Neck Tumor Study Group in all French centers practicing head-and-neck cancer surgery with reconstruction using microvascular free-flaps. The questionnaire asked surgeons about their practices regarding the use of intra- and postoperative anticoagulants and antiplatelets, preoperative management of comorbidities, and prevention of postoperative complications. RESULTS Sixty-one percent of the 38 respondents (23/38) used intraoperative intravenous heparin injection, associated to flap irrigation with heparin for 76% of surgeons (29/38) and/or a heparin solution bath for 37% (14/38). Postoperative anticoagulation was used by 95% of surgeons (36/38), and antiplatelets by 40% (15/38). Postoperatively, 40% (15/38) carried out monitoring using an implantable micro-Doppler probe, associated to analysis of clinical characteristics of the flap. CONCLUSION Reconstructive surgery using microvascular free-flaps involves numerous factors that can influence success. Prospective studies, particularly concerning the management of anticoagulants, could enable a national consensus on methods for free-flap reconstruction.
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Affiliation(s)
- T Cosset
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - D Tonnerre
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - P Gorphe
- Département d'ORL et de chirurgie cervicofaciale, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Dupret-Bories
- Service ORL et chirurgie cervicofaciale et audiophonologie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - X Dufour
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - F Carsuzaa
- Service ORL, chirurgie cervicofaciale et audiophonologie, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
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Guerlain J, Marhic A, Casiraghi O, Lumbroso J, Garcia G, Breuskin I, Janot F, Temam S, Gorphe P, Moya-Plana A. Occult nodal metastases in T1-T2cN0 oral squamous cell carcinoma: Correlation between sentinel node positivity and completion neck dissection analysis. Oral Oncol 2023; 139:106338. [PMID: 36807087 DOI: 10.1016/j.oraloncology.2023.106338] [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: 12/01/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Sentinel node procedure (SN) is a standard procedure that has shown its safety and effectiveness for T1/T2 cN0 oral squamous cell carcinoma (OSCC), with completion neck dissection (CND) for patients with positive SN. The aim of this study was to characterize the nodal involvement in a cohort of SN + OSCC. MATERIALS AND METHODS Patients with T1/T2 cN0 OSCC with positive SN with CND were included in this single-center, prospective cohort study between 2000 and 2013. RESULTS 54/301 patients had at least one positive SN. In 43/54 (80 %) cases, only the SN(s) were invaded; with only one SN involved (SN+=1) in 36/54 (67 %) cases. No predictive factors of nodal involvement in the CND were found considering the followings: SN micro/macrometastases, primary tumor's depth of invasion (DOI), perineural spread, lymphovascular involvement, primary tumor location, T stage and extranodal extension. The SN micrometastatic involvement (n = 22) was significantly associated with only one SN + CND- (p = 0.017). In the group of patients with unique micrometastatic involvement in the SN (n = 20/54), there was a higher isolated nodal recurrence free time (p = 0.017). CONCLUSION 80% of T1/T2 cN0 OSCC with positive SN had no other lymph node metastases in the CND, questioning the potential benefits of this procedure. Predictive factors such as the size of the SN metastasis need to be tested to stratify the risk of positive non-SN lymph nodes leading to a personalized treatment, lowering the therapeutic morbidity while maintaining the oncologic safety.
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Affiliation(s)
- J Guerlain
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France.
| | - A Marhic
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - O Casiraghi
- Department of Pathology, Gustave Roussy Cancer Campus, Grand Paris, France
| | - J Lumbroso
- Nuclear Medicine Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - G Garcia
- Department of Medical Imaging, Gustave Roussy Cancer Campus, Grand Paris, France
| | - I Breuskin
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - F Janot
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - S Temam
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - P Gorphe
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - A Moya-Plana
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
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Bouaoud J, Benmoussa N, Hennocq Q, Honart JF, Breuskin I, Gorphe P, Casiraghi O, Classe M, Blanchard P, Janot F, Kolb F, Leymarie N, Temam S, Moya-Plana A. Locally advanced nasal pyramid squamous cell carcinoma: our 15 years' experience in a series of 35 total rhinectomies. Rhinology 2021; 58:638-640. [PMID: 33006589 DOI: 10.4193/rhin20.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J Bouaoud
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France; Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - N Benmoussa
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Q Hennocq
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - J-F Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - I Breuskin
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - P Gorphe
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - O Casiraghi
- Department of Pathology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - M Classe
- Department of Pathology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - F Janot
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - F Kolb
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif,France
| | - N Leymarie
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - S Temam
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - A Moya-Plana
- Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
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Marhic A, Guerlain J, Benmoussa N, Breuskin I, Honart JF, Janot F, Moya-Plana A, Temam S, Gorphe P. Replacement of lip-split mandibulotomy by pull-through approach for T3-4 oral carcinomas. Int J Oral Maxillofac Surg 2021; 50:1123-1130. [PMID: 33414034 DOI: 10.1016/j.ijom.2020.10.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/06/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022]
Abstract
At the study hospital, the lip-split mandibulotomy (LSM) has progressively been replaced by a pull-through (PT) approach. This study compared the outcomes of the LSM and PT approaches in a series of 192 patients with T3-T4a oral tongue and floor of the mouth squamous cell carcinoma treated over the two last decades. No difference in margin status (P = 0.254), rate of early complications (local infections) (P = 0.867), haematoma/haemorrhage (P = 0.221), delayed wound healing (P = 0.438), re-operation (P = 0.083), or Clavien-Dindo classification (P= 0.5281) was found. The LSM approach was associated with a higher rate of late complications such as pseudarthrosis (14.5% vs 0.9%; OR 17.89, P = 0.0005) and trismus (35% vs 13.8%; OR 3.32, P = 0.025), and a trend towards a higher rate of fistulas (24.6% vs 13.1%; OR 2.16, P = 0.088). The quality of life of long-term survivors (median 132 months) was similar in the two groups, with a mean QLQC30 score of 59.7 (P = 0.099) and mean MDADI score of 57.4 (P = 0.213). The 5-year local control rate was 86.4% in the PT group and 86.2% in the LSM group (P = 0.878), while the 5-year overall survival rates were 50.0% and 48.3%, respectively (P = 0.68). In our experience, replacement of LSM by a PT approach in oral carcinoma was associated with decreased rates of late complications such as pseudarthrosis, fistula, and trismus, without any difference in oncological outcomes.
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Affiliation(s)
- A Marhic
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - J Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - N Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - I Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - J-F Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - F Janot
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - A Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - S Temam
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - P Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France.
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Fanous A, Couloigner V, Gorphe P, Galmiche L, Alexandru M, Garabedian EN, Coffinet L, Blanc T, Leboulanger N, Denoyelle F. Unusual presentation of a first Branchial cleft cyst associated with an abnormal bony canal -a case report. J Otolaryngol Head Neck Surg 2020; 49:32. [PMID: 32471510 PMCID: PMC7260795 DOI: 10.1186/s40463-020-00426-5] [Citation(s) in RCA: 2] [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: 10/31/2019] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
Abstract
Background First branchial cleft anomalies are rare, accounting for only 10% of all branchial cleft anomalies. We report an even more rare and unique case of a branchial cleft cyst with features of both first and second arch derivatives. Case presentation A 6-year-old boy presented to us with a left conductive hearing loss associated with pre-tympanic keratin debris and an ipsilateral painful cervical mass. He had a past medical history of left ear surgery for presumed cholesteatoma 2 years prior and left neck abscess drainage 6 months prior. CT and MRI revealed a lesion originating in the external auditory canal and extending cervically through a bony canal located medial to the facial nerve and terminating as a parapharyngeal cyst. The complete removal was accomplished in one surgical stage consisting of three distinct steps: robotic assisted transoral resection of the pharyngeal cyst, an endaural approach and a parotidectomy approach. Conclusion We believe that our detailed description of this rare first branchial cleft cyst with pharyngeal extension, possibly a hybrid case between a first and second branchial cyst, can serve as a valuable tool to Otolaryngologists – Head and Neck Surgeons who come across a similar unusual presentations.
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Affiliation(s)
- A Fanous
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Quebec, Canada.
| | - V Couloigner
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Hôpital Necker - Enfants Malades - Paris V University, Paris, France
| | - P Gorphe
- Department of Otolaryngology - Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
| | - L Galmiche
- Pathology Department, Hôpital Necker - Enfants Malades - Paris V University, Paris, France
| | - M Alexandru
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Hôpital Necker - Enfants Malades - Paris V University, Paris, France
| | - E-N Garabedian
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Hôpital Necker - Enfants Malades - Paris V University, Paris, France
| | - L Coffinet
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Régional et Universitaire de Nancy, Hôpital Central, Nancy, France
| | - T Blanc
- Department of Pediatric Surgery, Hôpital Necker - Enfants Malades - Paris V University, Paris, France
| | - N Leboulanger
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Hôpital Necker - Enfants Malades - Paris V University, Paris, France
| | - F Denoyelle
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Hôpital Necker - Enfants Malades - Paris V University, Paris, France
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Baste Rotllan N, Auperin A, Iacob M, Sampetrean A, Bouguetta D, Mayache Badis L, Ferrand F, Casiraghi O, Blanchard P, Bidault F, Gorphe P, Temam S, Champiat S, Even C, Marabelle A. Immune-related adverse events (irAEs) and outcome in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients (pts) treated by immune-checkpoints inhibitors (ICI). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7
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Ou D, Adam J, Garberis I, Blanchard P, Nguyen F, Levy A, Casiraghi O, Leijenaar R, Gorphe P, Breuskin I, Janot F, Robert C, Lambin P, Temam S, Scoazec J, Deutsch E, Tao Y. OC-0586 Immunological contexture basis of a prognostic radiomics signature in head and neck cancers. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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Gorphe P, Jannin C. Regulatory aspects of prospective and retrospective clinical research in France in 2018. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:103-108. [DOI: 10.1016/j.anorl.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morinière S, Gorphe P, Espitalier F, Blanchard D, Fakhry N, Saroul N, Bach C, Dufour X, Fuchsmann C, Vergez S, Albert S. Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 136:3-5. [PMID: 30482707 DOI: 10.1016/j.anorl.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/28/2022]
Abstract
OBJECTIVE Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction. MATERIAL AND METHOD A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases. RESULTS Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P=0.04). CONCLUSION Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.
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Affiliation(s)
- S Morinière
- Service d'ORL et de CCF, CHU Bretonneau, 2 Bd Tonnellé, 37000 Tours, France.
| | - P Gorphe
- Service d'ORL et de CCF, IGR, 94800 Villejuif, France
| | - F Espitalier
- Service d'ORL et de CCF, CHU de Nantes, Nantes, France
| | - D Blanchard
- Service d'ORL et de CCF,CHU de Caen, Caen, France
| | - N Fakhry
- Service d'ORL et de CCF, CHU de Marseille, Marseille, France
| | - N Saroul
- Service d'ORL et de CCF, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Bach
- Service d'ORL et de CCF, Hôpital Foch, Paris, France
| | - X Dufour
- Service d'ORL et de CCF, CHU Poitiers, Poitiers, France
| | - C Fuchsmann
- Service d'ORL et de CCF, CHU Lyon, Lyon, France
| | - S Vergez
- Service d'ORL et de CCF, CHU Toulouse, Toulouse, France
| | - S Albert
- Service d'ORL et de CCF, CHU Bichat, 75877 Paris, France
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Carsuzaa F, Thariat J, Gorphe P, Atallah I, Cosmidis A, Thureau S, de Mones E, Servagi-Vernat S, Tonnerre D, Morinière S, Dugas A, Malard O, Pasquier F, Ashley B, Vergez S, Dufour X. Stratégies de prise en charge des tumeurs des voies aérodigestives supérieures de stade T1-T2 N3. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Moya-Plana A, Aupérin A, Guerlain J, Gorphe P, Casiraghi O, Mamelle G, Melkane A, Lumbroso J, Janot F, Temam S. Sentinel node biopsy in early oral squamous cell carcinomas: Long-term follow-up and nodal failure analysis. Oral Oncol 2018; 82:187-194. [DOI: 10.1016/j.oraloncology.2018.05.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/20/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023]
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Ou D, Adam J, Garberis I, Blanchard P, Nguyen F, Levy A, Casiraghi O, Gorphe P, Breuskin I, Janot F, Temam S, Scoazec J, Deutsch E, Tao Y. OC-0489: TAM and HLA class I expression in relation to HPV and clinical outcome in head and neck cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30799-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Boros A, Blanchard P, Gorphe P, Breuskin I, Even C, Nguyen F, Deutsch E, Bidault F, Janot F, Temam S, Mirghani H, Tao Y. EP-1158: Prognostic factors and role of neck dissection in N3 head and neck cancers treated with radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gorphe P, Temam S, Kolb F, Qassemyar Q. Cervical-transoral robotic oropharyngectomy and thin anterolateral thigh free flap. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:71-74. [DOI: 10.1016/j.anorl.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ou D, Adam J, Garberis I, Blanchard P, Nguyen F, Levy A, Casiraghi O, Gorphe P, Breuskin I, Janot F, Temam S, Scoazec J, Deutsch E, Tao Y. OC-0400: Prognostic impact of tumor infiltrating lymphocytes and PD-L1 expression in head and neck cancers. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Qassemyar Q, Aguilar P, Temam S, Kolb F, Gorphe P. [The thin ALT perforator flap for oropharyngeal robotic-assisted reconstruction]. ANN CHIR PLAST ESTH 2017; 62:1-7. [PMID: 28041765 DOI: 10.1016/j.anplas.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/18/2022]
Abstract
Since a few years, the transoral robotic surgery reduced the morbidity of oropharyngeal tumors excision. Large posterior tumors can now be removed without any scar visible on the face. In this context and to respect the thinness required for reconstructions at the junction of the upper aerodigestive tract, the free radial forearm flap still remains the solution of choice. However, if the transoral robotic surgery respects the anatomy and the aesthetics of patients at the visible and social area that represents the face, the forearm flap provides visible scars on the other region of social interaction that represents the upper limb. The aim of our work was to prove the feasibility and the benefits in terms of reducing sequelae when using a thin anterolateral perforator flap harvested above the plane of the superficial fascia. We present this new original method in detail and the advantages it offers to patients after surgery.
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Affiliation(s)
- Q Qassemyar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - P Aguilar
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - S Temam
- Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - F Kolb
- Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - P Gorphe
- Département de carcinologie cervico-faciale, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
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Gorphe P, Sarfati B, Janot F, Bourgain JL, Motamed C, Blot F, Temam S. Airway fire during tracheostomy. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:197-9. [PMID: 24703002 DOI: 10.1016/j.anorl.2013.07.001] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/17/2013] [Accepted: 07/16/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Twenty-five cases of airway fire during tracheostomy have been reported in the literature. The authors describe a case observed in their centre 3 years ago, discuss the causes and preventive management and propose guidelines for prevention of this complication. CASE REPORT A 66-year-old woman was intubated and ventilated with 100% oxygen during general anaesthesia for tracheostomy. On opening the trachea by monopolar diathermy, the oxygen present in the endotracheal tube caught fire, inducing combustion of the tube spreading to the lower airways. This airway fire was responsible for severe acute respiratory failure and the formation of multiple laryngotracheal stenoses. DISCUSSION Combustion of the endotracheal tube due to ignition of anaesthetic gases induced by the heat generated by diathermy is responsible for airway fire. These various phenomena are discussed. Prevention is based on safety measures and coordination of surgical and anaesthetic teams.
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Affiliation(s)
- P Gorphe
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - B Sarfati
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - F Janot
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - J L Bourgain
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - C Motamed
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - F Blot
- Service d'anesthésie, institut de cancérologie Gustave-Roussy, 94800 Villejuif, France
| | - S Temam
- Département de cancérologie cervico-faciale, institut de cancérologie Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France
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Hans S, Delas B, Gorphe P, Ménard M, Brasnu D. Transoral robotic surgery in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:32-7. [DOI: 10.1016/j.anorl.2011.06.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 06/06/2011] [Accepted: 06/28/2011] [Indexed: 11/30/2022]
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Laccourreyre O, Gorphe P, Menard MI, Cauchois R, Badoual C. [Unilateral laryngeal paralysis after intra capsular loboisthmectomy without laryngeal nerve dissection]. Rev Laryngol Otol Rhinol (Bord) 2011; 132:45-49. [PMID: 21977702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To document the incidence, outcome and variables that increase the risk for unilateral laryngeal paralysis after loboisthmectomy performed according to the intracapsular dissection technique. MATERIALS AND METHODS A retrospective analysis of an inception cohort of 317 loboisthmectomies consecutively performed at a single institution by the same surgeon during the years 2002-2007 using the intra capsular dissection without laryngeal nerve dissection, neuromonitoring and modern hemostasis techniques (Ligasure, Ultracision). The immediate and definite rate for unilateral laryngeal nerve paralysis is documented. A statistical analysis is performed for potential relation between these events and the following variables: age, gender, comorbidity, tracheal compression and intrathoracic characteristics of the thyroid lesion, side of the loboisthmectomy, etiology of the thyroid lesion (benign, malignant, hyperthyroidy), associated thyroiditis, size of the largest resected nodule and weight of the resected lobe. RESULTS The immediate unilateral laryngeal nerve paralysis incidence was 1,2%. Recovery of motion occurred by the 1st, 3rd, 5th or 9th post operative month resulting in a 0% incidence for definitive unilateral laryngeal nerve paralysis. No significant statistical relation was noted between immediate unilateral laryngeal nerve paralysis and the variables under analysis. CONCLUSION Based on the current series and the review of the medical literature, it appears that the loboisthmectomy according to the intra capsular technique without inferior laryngeal nerve identification, in patients not previously operated, performed according to is a surgical technique whose goal is to ascent the thyroid lobe and dissect the region of the nerve penetration within the larynx by the end of the resection, does not increase the risk for transient or permanent unilateral laryngeal nerve paralysis.
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Affiliation(s)
- O Laccourreyre
- Hôpital européen Georges Pompidou, Université Paris-Descartes, Faculté de Médecine, Service ORL et CCF, 20-40 rue leblanc, 75015 Paris, France.
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