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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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Marchi F, Bellini E, Ioppi A, Simoni F, Iandelli A, Filauro M, Mora F, Sampieri C, Peretti G. Enhancing quality of life in head and neck cancer patients: a comparative analysis of 3D exoscope-assisted surgery vs. traditional approaches. Front Surg 2024; 11:1358500. [PMID: 38689603 PMCID: PMC11058215 DOI: 10.3389/fsurg.2024.1358500] [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: 12/19/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction The increasing population of survivors of head and neck carcinomas is becoming more conspicuous. Consequently, the pivotal role of quality of life, particularly elucidated through the assessment of dysphagia and dysphonia, is progressively influencing the decision-making process. The current study aims to assess whether VITOM 3D could offer a comparable post-treatment quality of life to traditional approaches for patients with laryngeal cancer and oro-hypopharyngeal cancer. Methods A case series of laryngeal cancer and oro-hypopharyngeal cancer patients treated either with an exoscopic-assisted surgical setup and with conventional treatments (transoral microsurgery and radio-chemotherapy) at the Otolaryngology Unit of IRCCS San Martino Hospital, Genoa, is presented. The post-treatment quality of life of the two cohorts were compared through the administration of the University of Washington Quality of Life Questionnaire, Voiceik Handicap Index-10, M.D. Anderson Dysphagia Inventory were administrated to both cohorts of patients. Results In the laryngeal cancer group, a total of 79 patients were included. Of these, 50.1% underwent transoral exoscope-assisted surgery, while 49.9% underwent primary transoral microscopic-assisted surgical approach. No significant differences were observed in terms of the University of Washington Quality of Life Questionnaire and Voice Handicap Index-10 between the two subgroups. Conversely, in the oro-hypopharyngeal cancer group, 43 patients were included. Of these, 37.2% underwent primary transoral exoscope-assisted surgery, while 62.8% received (chemo)radiotherapy. No notable differences were reported in terms of the University of Washington Quality of Life Questionnaire and M.D. Anderson Dysphagia Inventory between the transoral exoscope-assisted surgery and (chemo)radiotherapy subgroups. Conclusions Assessments of quality of life, conducted through the University of Washington Quality of Life Questionnaire questionnaire, dysphonia evaluations using the Voice Handicap Index-10, and dysphagia assessments employing the M.D. Anderson Dysphagia Inventory questionnaire, demonstrate analogous outcomes between conventional treatment modalities and transoral interventions utilizing the 3D exoscope.
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Affiliation(s)
- Filippo Marchi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Bellini
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Ioppi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, “S. Chiara” Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Federica Simoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Mora
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Department of Otolaryngology, Hospital Cliníc, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Cliníc, Barcelona, Spain
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Iandelli A, Gabella G, Marchi F, Campagnari V, Filauro M, Sampieri C, Tsai TY, Vilaseca I, Peretti G. The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08610-3. [PMID: 38564009 DOI: 10.1007/s00405-024-08610-3] [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: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS. DATA SOURCES PubMed, EMBASE, and Cochrane Library. METHODS We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported. RESULTS Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201 months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97). CONCLUSIONS Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.
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Affiliation(s)
- Andrea Iandelli
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Giulia Gabella
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Valentina Campagnari
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy.
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy.
| | - Marta Filauro
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Claudio Sampieri
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
| | - Tsung-You Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taoyuan, Taiwan
| | - Isabel Vilaseca
- Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain
- Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Catalunya, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Giorgio Peretti
- Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
- Department of Surgical Science (DISC), University of Genova, Genoa, Italy
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Marchi F, Bellini E, Iandelli A, Sampieri C, Peretti G. Exploring the landscape of AI-assisted decision-making in head and neck cancer treatment: a comparative analysis of NCCN guidelines and ChatGPT responses. Eur Arch Otorhinolaryngol 2024; 281:2123-2136. [PMID: 38421392 DOI: 10.1007/s00405-024-08525-z] [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: 12/14/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Recent breakthroughs in natural language processing and machine learning, exemplified by ChatGPT, have spurred a paradigm shift in healthcare. Released by OpenAI in November 2022, ChatGPT rapidly gained global attention. Trained on massive text datasets, this large language model holds immense potential to revolutionize healthcare. However, existing literature often overlooks the need for rigorous validation and real-world applicability. METHODS This head-to-head comparative study assesses ChatGPT's capabilities in providing therapeutic recommendations for head and neck cancers. Simulating every NCCN Guidelines scenarios. ChatGPT is queried on primary treatments, adjuvant treatment, and follow-up, with responses compared to the NCCN Guidelines. Performance metrics, including sensitivity, specificity, and F1 score, are employed for assessment. RESULTS The study includes 68 hypothetical cases and 204 clinical scenarios. ChatGPT exhibits promising capabilities in addressing NCCN-related queries, achieving high sensitivity and overall accuracy across primary treatment, adjuvant treatment, and follow-up. The study's metrics showcase robustness in providing relevant suggestions. However, a few inaccuracies are noted, especially in primary treatment scenarios. CONCLUSION Our study highlights the proficiency of ChatGPT in providing treatment suggestions. The model's alignment with the NCCN Guidelines sets the stage for a nuanced exploration of AI's evolving role in oncological decision support. However, challenges related to the interpretability of AI in clinical decision-making and the importance of clinicians understanding the underlying principles of AI models remain unexplored. As AI continues to advance, collaborative efforts between models and medical experts are deemed essential for unlocking new frontiers in personalized cancer care.
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Affiliation(s)
- Filippo Marchi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132, Genoa, Italy
| | - Elisa Bellini
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132, Genoa, Italy.
| | - Andrea Iandelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Department of Otolaryngology-Hospital Cliníc, Barcelona, Spain
- Functional Unit of Head and Neck Tumors-Hospital Cliníc, Barcelona, Spain
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132, Genoa, Italy
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Filauro M, Caprioli S, Lovino Camerino P, Sampieri C, Conforti C, Iandelli A, Benzi P, Gabella G, Bellini E, Mora F, Cittadini G, Peretti G, Marchi F. Depth of Invasion Assessment in Laryngeal Glottic Carcinoma: A Preoperative Imaging Approach for Prognostication. Laryngoscope 2024. [PMID: 38407326 DOI: 10.1002/lary.31369] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The prognostic value of depth of invasion (DOI) in oral squamous cell cancer carcinoma and cutaneous melanoma is well established, while there is a lack of reports investigating the role of DOI in laryngeal cancer. This study aims to explore the association of glottic cancer DOI with other established pathological risk factors and nodal metastasis and evaluate the feasibility of measuring DOI preoperatively using tomographic imaging. METHODS The medical records of glottic cancer patients treated between 2015 and 2020 in a single tertiary referral center were screened retrospectively. Pathologically measured DOI (pDOI) value was also reviewed and registered. Preoperative computer tomography (CT) was used to obtain the radiological DOI (rDOI) measured by two dedicated radiologists. Their inter-rated agreement was assessed and the correlation between pDOI and rDOI was calculated. pDOI association with the main pathology report features was assessed with univariable analysis. Cox univariable and multivariable models were used to explore the role of pDOI on survival. RESULTS Ninety-one patients had pDOI data available, of which 59 also had rDOI data. A strong concordance between the two radiologists was found (concordance correlation coefficient = 0.96); rDOI and pDOI were highly and significantly correlated (R = 0.85; p < 0.001). pDOI was significantly higher in patients with perineural invasion (PNI; p < 0.001), lymphovascular invasion (LVI; p < 0.001), and nodal metastasis (p < 0.001). pDOI was associated with disease-free survival at univariable analysis (p = 0.04) while it did not show a significant impact (p = 0.10) at multivariable analysis. CONCLUSION Glottic carcinoma DOI correlates with PNI, LVI, and nodal metastasis and it can be reliably assessed in a preoperative setting using CT imaging. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Marta Filauro
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Caprioli
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genova, Genoa, Italy
| | - Paola Lovino Camerino
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Department of Otorhinolaryngology, Ospedale S. Paolo, Savona, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - Cristina Conforti
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Benzi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giulia Gabella
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Elisa Bellini
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Francesco Mora
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giuseppe Cittadini
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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Sampieri C, Marchi F, Campagnari V, Gabella G, Costantino A, Tsai TY, Vilaseca I, Peretti G, Iandelli A. Comments on: Value and role of surgical margins in transoral laser microsurgery of the larynx, literature review and clinical considerations. Eur Arch Otorhinolaryngol 2024; 281:1065-1066. [PMID: 37987828 DOI: 10.1007/s00405-023-08334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, 16100, Genoa, Italy
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Filippo Marchi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy.
| | - Valentina Campagnari
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Giulia Gabella
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Andrea Costantino
- Department of Otolaryngology-Head and Neck Surgery, AdventHealth Orlando, 410 Celebration Place, Celebration, FL, 34747, USA
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Tsung-You Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Isabel Vilaseca
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
- Translational Genomics and Target Therapies in Solid Tumors Group, Institut d́Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Catalunya, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
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De Virgilio A, Bellini E, Pace GM, Costantino A, Festa BM, Iandelli A, Russo E, Sampieri C, Peretti G, Spriano G, Marchi F. Functional outcomes of soft palate reconstruction after oncologic surgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:5177-5191. [PMID: 37620732 DOI: 10.1007/s00405-023-08191-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE The aim of this study is to analyze functional outcomes of soft palate reconstruction after oncologic surgery. METHODS This study was conducted in conformity with the PRISMA statement. A single arm meta-analysis was performed for feeding tube dependence (FTD) (primary outcome), velopharyngeal insufficiency (VPI) and hypernasality (HN) (secondary outcomes) incidences. RESULTS A total of 510 patients (males: 77.75%, n = 353/454) with a median age of 58 years (n = 480/510; 95% CI 57.0-61.0) who underwent soft palate surgical resection with primary reconstruction were included. Overall, the cumulative FTD rate was 1.55% (n = 28/510; 95% CI 0.24-3.96%), the VPI rate was 22.18% (n = 119/379; 95% CI 12.99-33.02%), and the HN rate was 33.01% (n = 88/234; 95% CI 19.03-46.61%). CONCLUSIONS Soft palate reconstruction results in a low incidence of FTD, and most patients resume a full oral diet. Both obturators, primary closure, local and free flaps seem good reconstructive options. Nevertheless, more specific postoperative functional deficiencies like VPI and HN owns higher incidences, potentially affecting the quality of the swallowing and speaking function and the patient's quality of life.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elisa Bellini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Iandelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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Sampieri C, Costantino A, Giordano GG, Dalè M, Marchi F, Iandelli A, Filauro M, Parrinello G, Pace GM, Festa BM, Spriano G, De Virgilio A, Peretti G. Predicting the need for prophylactic gastrostomy in major head and neck cancer surgery: The PEG score. Head Neck 2023; 45:3042-3052. [PMID: 37789705 DOI: 10.1002/hed.27532] [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: 05/30/2023] [Revised: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND To elaborate a preoperative score to predict the necessity of enteral nutrition at 28 days postoperatively in patients undergoing head and neck surgery. METHODS A total of 424 patients with oral cavity, oropharyngeal, laryngeal, and hypopharyngeal carcinoma were retrospectively enrolled and analyzed to identify preoperative predictors of prolonged postsurgical enteral feeding which were used to create a prediction model with an easy-to-use nomogram. RESULTS Five preoperative variables (body mass index, previous radiotherapy, preoperative dysphagia, type of surgery, flap reconstruction) were found to be independent predictive factors and were used to create a prediction model named PEG score together with the related nomogram. Accuracy, F1, and the area under the curve (AUC) were 0.74, 0.83, and 0.74. Different decision thresholds can be used to vary the sensitivity and specificity. CONCLUSIONS The PEG score showed high prediction performances for modeling the need for enteral nutrition at 28 days postoperatively. Prospective studies are needed to define a personalized nutrition protocol.
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Affiliation(s)
- Claudio Sampieri
- Department of Medical Science (DIMES), University of Genoa, Genoa, Italy
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giorgio Gregory Giordano
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michael Dalè
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Marchi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giampiero Parrinello
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giorgio Peretti
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Arzt-Gradwohl L, Annik Herzog S, Aberer W, Alfaya Arias T, Antolín-Amérigo D, Bonadonna P, Boni E, Bożek A, Chełmińska M, Ernst B, Frelih N, Gawlik R, Gelincik A, Hawranek T, Hoetzenecker W, Jiménez Blanco A, Kita K, Kendirlinan R, Košnik M, Laipold K, Lang R, Marchi F, Mauro M, Nittner-Marszalska M, Poziomkowska-Gęsicka I, Pravettoni V, Preziosi D, Quercia O, Reider N, Rosiek-Biegus M, Ruiz-Leon B, Schrautzer C, Serrano P, Sin A, Ayşe Sin B, Stoevesandt J, Trautmann A, Vachová M, Johannes Sturm G. Influencing factors on the safety and effectiveness of venom immunotherapy. J Investig Allergol Clin Immunol 2023; 35:0. [PMID: 37937715 DOI: 10.18176/jiaci.0967] [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: 11/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The safety profile of venom immunotherapy (VIT) is a relevant issue and considerable differences in safety and efficacy of VIT have been reported. The primary aim of this study was to evaluate the safety of ACE inhibitors and beta-blockers during VIT, which has already been published. For a second analysis, data concerning premedication and venom preparations in relation to systemic adverse events (AE) during the up-dosing phase and the first year of the maintenance phase were evaluated as well as the outcome of field stings and sting challenges. METHODS The study was conducted as an open, prospective, observational, multicenter study. In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. RESULTS Premedication with oral antihistamines was taken by 52.1% of patients during the up-dosing and 19.7% of patients during the maintenance phase. Taking antihistamines had no effect on the frequency of systemic AE (p=0.11) but large local reactions (LLR) were less frequently seen (OR: 0.74; 95% CI: 0.58-0.96; p=0.02). Aqueous preparations were preferentially used for up-dosing (73.0%) and depot preparations for the maintenance phase (64.5%). The type of venom preparation neither had an influence on the frequency of systemic AE nor on the effectiveness of VIT (p=0.26 and p=0.80, respectively), while LLR were less frequently seen when depot preparations were used (p<0.001). CONCLUSION Pretreatment with oral antihistamines during VIT significantly reduces the frequency of LLR but not systemic AE. All venom preparations used were equally effective and did not differ in the frequency of systemic AE.
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Affiliation(s)
- L Arzt-Gradwohl
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - S Annik Herzog
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - T Alfaya Arias
- Allergy Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - D Antolín-Amérigo
- Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
- Servicio de Alergia, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - P Bonadonna
- Allergy Unit, Verona General Hospital, Verona, Italy
| | - E Boni
- Laboratorio Unico Metropolitano, Maggiore Hospital, Bologna, Italy
| | - A Bożek
- Clinical Department of Internal Diseases, Dermatology, and Allergology, Medical University of Silesia, Zabrze, Poland
| | - M Chełmińska
- Allergology Department, Medical University of Gdańsk, Gdańsk, Poland
| | - B Ernst
- Department of Dermatology, General Hospital Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
| | - N Frelih
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - R Gawlik
- Department of Internal Medicine, Allergy, and Clinical Immunology, Silesian University of Medicine, Katowice, Poland
| | - A Gelincik
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - T Hawranek
- Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - W Hoetzenecker
- Department of Dermatology, Kepler University Hospital and Medical Faculty, Johannes Kepler University, Linz, Austria
| | - A Jiménez Blanco
- Allergy Unit, Hospital Central de la Cruz Roja. Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain
| | - K Kita
- Allergology Department, Medical University of Gdańsk, Gdańsk, Poland
| | - R Kendirlinan
- Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - M Košnik
- University Clinic of Respiratory and Allergic Diseases, Golnik and Medical Faculty Ljubljana, Slovenia
| | - K Laipold
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - R Lang
- Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Marchi
- SD Allergologia Clinica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M Mauro
- Allergy Unit, Sant´Anna Hospital, Como, Italy
| | - M Nittner-Marszalska
- Department of Internal Diseases, Pulmonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | | | - V Pravettoni
- Department of Internal Medicine, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Preziosi
- Allergy Unit, Sant´Anna Hospital, Como, Italy
| | - O Quercia
- High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Romagna, Italy
| | - N Reider
- Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Rosiek-Biegus
- Department of Internal Diseases, Pulmonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - B Ruiz-Leon
- Allergy Section of University Hospital Reina Sofia, ARADyAL Network, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - C Schrautzer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - P Serrano
- Allergy Section of University Hospital Reina Sofia, ARADyAL Network, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - A Sin
- Department of Internal Medicine, Division of Allergy and Immunology, Medical Faculty, Ege University, Izmir, Türkiye
| | - B Ayşe Sin
- Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - J Stoevesandt
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - A Trautmann
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - M Vachová
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Immunology and Allergology, University Hospital Pilsen, Czech Republic
| | - G Johannes Sturm
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
- Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
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Pistoia F, Camerino PL, Ioppi A, Picasso R, Zaottini F, Caprioli S, Mocellin D, Ascoli A, Pansecchi M, Carobbio ALC, Parrinello G, Marchi F, Peretti G, Martinoli C. High-resolution US of the facial vessels with new facial vein landmarks for reconstructive surgery and dermal injection. Eur Radiol Exp 2023; 7:49. [PMID: 37691033 PMCID: PMC10493206 DOI: 10.1186/s41747-023-00363-8] [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: 03/05/2023] [Accepted: 06/12/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Accurate knowledge of vessel anatomy is essential in facial reconstructive surgery. The technological advances of ultrasound (US) equipment with the introduction of new high-resolution probes improved the evaluation of facial anatomical structures. Our study had these objectives: the primary objective was to identify new surgical landmarks for the facial vein and to verify their precision with US, the secondary objective was to evaluate the potential of high-resolution US examination in the study of both the facial artery and vein. METHODS Two radiologists examined a prospective series of adult volunteers with a 22-8 MHz hockey-stick probe. Two predictive lines of the facial artery and vein with respective measurement points were defined. The distance between the facial vein and its predictive line (named mandibular-orbital line) was determined at each measurement point. The distance from the skin and the area of the two vessels were assessed at every established measurement point. RESULTS Forty-one volunteers were examined. The median distance of the facial vein from its predictive line did not exceed 2 mm. The facial vein was visible at every measurement point in all volunteers on the right side, and in 40 volunteers on the left. The facial artery was visible at every measurement point in all volunteers on the right and in 37 volunteers on the left. CONCLUSIONS The facial vein demonstrated a constant course concerning the mandibular-orbital line, which seems a promising clinical and imaging-based method for its identification. High-resolution US is valuable in studying the facial artery and vein. RELEVANCE STATEMENT High-resolution US is valuable for examining facial vessels and can be a useful tool for pre-operative assessment, especially when combined with the mandibular-orbital line, a new promising imaging and clinical technique to identify the facial vein. KEY POINTS • High-resolution US is valuable in studying the facial artery and vein. • The facial vein demonstrated a constant course concerning its predictive mandibular-orbital line. • The clinical application of the mandibular-orbital line could help reduce facial surgical and cosmetic procedure complications.
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Affiliation(s)
- Federico Pistoia
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy.
| | - Paola Lovino Camerino
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Alessandro Ioppi
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Riccardo Picasso
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Federico Zaottini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Simone Caprioli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Davide Mocellin
- Department of Otorhinolaryngology, Ospedale S. Paolo, Savona, Italy
| | - Alessandro Ascoli
- Department of Otorhinolaryngology, Ospedale Giovanni Borea, Sanremo, Italy
| | - Michelle Pansecchi
- Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore 1, Genoa, Italy
| | - Andrea Luigi Camillo Carobbio
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua "Azienda Ospedaliera Di Padova", 35128, Padua, Italy
| | | | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore 1, Genoa, Italy
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Marchi F, Carabelli A. Hypersensitivity to lipoic acid. Eur Ann Allergy Clin Immunol 2023. [PMID: 37671889 DOI: 10.23822/eurannaci.1764-1489.310] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
- F Marchi
- S.D. Allergology Clinic, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A Carabelli
- S.D. Allergology Clinic, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Caprioli S, Giordano GG, Pennacchi A, Campagnari V, Iandelli A, Parrinello G, Conforti C, Gili R, Giannini E, Marabotto E, Kayali S, Bianchi B, Peretti G, Cittadini G, Marchi F. Can High-Frequency Intraoral Ultrasound Predict Histological Risk Factors in Oral Squamous Cell Carcinoma? A Preliminary Experience. Cancers (Basel) 2023; 15:4413. [PMID: 37686688 PMCID: PMC10486952 DOI: 10.3390/cancers15174413] [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: 07/24/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Despite advancements in multidisciplinary care, oncologic outcomes of oral cavity squamous cell carcinoma (OSCC) have not substantially improved: still, one-third of patients affected by stage I and II can develop locoregional recurrences. Imaging plays a pivotal role in preoperative staging of OSCC, providing depth of invasion (DOI) measurements. However, locoregional recurrences have a strong association with adverse histopathological factors not included in the staging system, and any imaging features linked to them have been lacking. In this study, the possibility to predict histological risk factors in OSCC with high-frequency intraoral ultrasonography (IOUS) was evaluated. Thirty-four patients were enrolled. The agreement between ultrasonographic and pathological DOI was evaluated, and ultrasonographic margins' appearance was compared to the Brandwein-Gensler score and the worst pattern of invasion (WPOI). Excellent agreement between ultrasonographic and pathological DOI was found (mean difference: 0.2 mm). A significant relationship was found between ultrasonographic morphology of the front of infiltration and both Brandwein-Gensler score ≥ 3 (p < 0.0001) and WPOI ≥4 (p = 0.0001). Sensitivity, specificity, positive predictive value, and negative predictive value for the IOUS to predict a Brandwein-Gensler score ≥3 were 93.33%, 89.47%, 87.50%, and 94.44%, respectively. The present study demonstrated the promising role of IOUS in aiding risk stratification for OSCC patients.
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Affiliation(s)
- Simone Caprioli
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
| | - Giorgio-Gregory Giordano
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Alessia Pennacchi
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Valentina Campagnari
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Andrea Iandelli
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giampiero Parrinello
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Cristina Conforti
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Riccardo Gili
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Edoardo Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Stefano Kayali
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Giorgio Peretti
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giuseppe Cittadini
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Filippo Marchi
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
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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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Carobbio ALC, Cheng Z, Gianiorio T, Missale F, Africano S, Ascoli A, Fragale M, Filauro M, Marchi F, Guastini L, Mora F, Parrinello G, Canevari FRM, Peretti G, Mattos LS. Electric Bioimpedance Sensing for the Detection of Head and Neck Squamous Cell Carcinoma. Diagnostics (Basel) 2023; 13:2453. [PMID: 37510197 PMCID: PMC10377945 DOI: 10.3390/diagnostics13142453] [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: 05/14/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The early detection of head and neck squamous cell carcinoma (HNSCC) is essential to improve patient prognosis and enable organ and function preservation treatments. The objective of this study is to assess the feasibility of using electrical bioimpedance (EBI) sensing technology to detect HNSCC tissue. A prospective study was carried out analyzing tissue from 46 patients undergoing surgery for HNSCC. The goal was the correct identification of pathologic tissue using a novel needle-based EBI sensing device and AI-based classifiers. Considering the data from the overall patient cohort, the system achieved accuracies between 0.67 and 0.93 when tested on tissues from the mucosa, skin, muscle, lymph node, and cartilage. Furthermore, when considering a patient-specific setting, the accuracy range increased to values between 0.82 and 0.95. This indicates that more reliable results may be achieved when considering a tissue-specific and patient-specific tissue assessment approach. Overall, this study shows that EBI sensing may be a reliable technology to distinguish pathologic from healthy tissue in the head and neck region. This observation supports the continuation of this research on the clinical use of EBI-based devices for early detection and margin assessment of HNSCC.
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Affiliation(s)
- Andrea Luigi Camillo Carobbio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", 35128 Padua, Italy
| | - Zhuoqi Cheng
- Maersk Mc-Kinney Moller Institute, University of Southern Denmark, 5230 Odense, Denmark
| | - Tomaso Gianiorio
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Molecular and Translational Medicine, University of Brescia, 25125 Brescia, Italy
- Department of Head & Neck Oncology & Surgery, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066 Amsterdam, The Netherlands
| | - Stefano Africano
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Luca Guastini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | | | - Frank Rikki Mauritz Canevari
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genova, Italy
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Marchi F, Sampieri C. From data analysis to paper writing: How Artificial intelligence is changing the face of scientific literature. Oral Oncol 2023; 138:106312. [PMID: 36709707 DOI: 10.1016/j.oraloncology.2023.106312] [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] [Received: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Filippo Marchi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy.
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
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Pennacchi A, Marchi F, Delù G, Caprioli S, Peretti G. Schwannoma of the Mylohyoid Nerve: A Case Report and Review of Literature of Sublingual Schwannomas. J Maxillofac Oral Surg 2023. [DOI: 10.1007/s12663-023-01867-x] [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: 02/22/2023] Open
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17
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Ascoli A, Missale F, Giordano GG, Vallin A, Gradaschi R, Guiddo E, Schenone G, Sukkar SG, Copello F, Parrinello G, Iandelli A, Peretti G, Marchi F. Immunonutrition in major oncologic head and neck surgery: Analysis of complications, plasmatic equilibrium, and costs. Head Neck 2023; 45:449-463. [PMID: 36490206 DOI: 10.1002/hed.27270] [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: 06/22/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Malnutrition, in patients with solid tumors, is associated with a worse clinical outcome and about 40% of patients affected by head and neck cancers (HNC) are malnourished at the time of cancer diagnosis. We investigated the potential benefit of a standardized immunonutritional protocol (INP) to patients with HNC receiving major ablative surgery. METHODS An observational study was conducted enrolling 199 patients: 50 treated with the INP and 149 with standard enteral nutrition. Complication rates, need for medications, and costs were considered as outcomes. RESULTS INP played a protective role in development of major surgical complications (OR 0.23, p = 0.023), albumin administration (RR 0.38, p = 0.018), and antibiotic duration (p < 0.001) and is cost-effective in patients with moderate or severe malnutrition (-6083€ and -11 988€, p < 0.05). CONCLUSIONS Our study supports the utility of INP, and accurate nutritional screening can help to identify malnourished patients who would receive the most benefits from this protocol.
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Affiliation(s)
- Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | - Giorgio-Gregory Giordano
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Alberto Vallin
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Raffaella Gradaschi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | - Erica Guiddo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | | | - Samir Giuseppe Sukkar
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | - Francesco Copello
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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18
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Marchi F, Mollica C, Bonasia S, Robert T. Clipping and exclusion of a thoracic pial arteriovenous fistula with multiple shunting points: how I do it. Acta Neurochir (Wien) 2023; 165:983-987. [PMID: 36645489 DOI: 10.1007/s00701-022-05472-8] [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: 11/26/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Thoracic pial arteriovenous fistulas (pAVFs) are rare vascular malformations that usually consist of a single dilated pial artery connecting directly to an enlarged draining vein. Multiple shunting point thoracic pAVFs are even rarer entities causing progressive myelopathy. METHOD We present our surgical technique to identify and exclude multiple shunting point thoracic pAVF with appropriate pre-operative planning. This surgical technique is illustrated by an intraoperative video. CONCLUSION Double injection pre-operative angiography represents a helpful tool to plan the surgery. Intraoperative exposure with pedicle removal and the use of micro-Doppler improve the identification and the exclusion of a multiple shunting thoracic pAVF.
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Affiliation(s)
- F Marchi
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - C Mollica
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.
| | - S Bonasia
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - T Robert
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
- University of Southern Switzerland, USI, Via Tesserete 46, 6900, Lugano, Switzerland
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19
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Missale F, Bugatti M, Marchi F, Mandelli GE, Bruni M, Palmerini G, Monti M, Bozzola AM, Arena G, Guastini L, Boggio M, Parrinello G, Peretti G, Vermi W. The prometastatic relevance of tumor-infiltrating B lymphocytes in laryngeal squamous cell carcinoma. Clin Transl Immunology 2023; 12:e1445. [PMID: 37122496 PMCID: PMC10131296 DOI: 10.1002/cti2.1445] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives Laryngeal squamous cell carcinomas (LSCCs) typically have an excellent prognosis for stage I tumors but a significant risk of locoregional and distant recurrence for intermediate to advanced disease. This study will investigate the clinical relevance of the tumor microenvironment in a large cohort of treatment-naïve patients affected by stage II-IV LSCC. Methods Whole slide-based digital pathology analysis was applied to measure six immune cell populations identified by immunohistochemistry (IHC) staining for CD3, CD8, CD20, CD66b, CD163 and CD38. Survival analysis was performed by Cox proportional hazards models and unsupervised hierarchical clustering using the k-means method. Double IHC staining and in-situ hybridisation by RNAscope allowed further analysis of a protumoral B cell population. Results A cohort of 98 patients was enrolled and analysed. The cluster of immune-infiltrated LSCCs demonstrated a significantly worse disease-specific survival rate. We also discovered a new association between high CD20+ B cells and a greater risk of distant recurrence. The phenotypic analysis of infiltrating CD20+ B cells showed a naïve (BCL6-CD27-Mum1-) regulatory phenotype, producing TGFβ but not IL10, according to an active TGFβ pathway, as proved by positive pSMAD2 staining. Conclusion The identification of regulatory B cells in the context of LSCC, along with the activation of the TGFβ pathway, could provide the basis for new trials investigating the efficacy of already available molecules targeting the TGFβ pathway in the treatment of LSCC.
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Affiliation(s)
- Francesco Missale
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
- Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van LeeuwenhoekNederlands Kanker InstituutAmsterdamThe Netherlands
| | - Mattia Bugatti
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | | | - Maria Bruni
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
| | | | - Matilde Monti
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Anna M Bozzola
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
| | - Giorgio Arena
- ENT DivisionUniversity of Easter Pidmont – AOU Maggiore della Carità di NovaraNovaraItaly
| | - Luca Guastini
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | | | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - William Vermi
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
- Department of Pathology and ImmunologyWashington University School of MedicineMOSt. LouisUSA
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20
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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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21
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Caprioli S, Casaleggio A, Tagliafico AS, Conforti C, Borda F, Fiannacca M, Filauro M, Iandelli A, Marchi F, Parrinello G, Peretti G, Cittadini G. High-Frequency Intraoral Ultrasound for Preoperative Assessment of Depth of Invasion for Early Tongue Squamous Cell Carcinoma: Radiological-Pathological Correlations. Int J Environ Res Public Health 2022; 19:ijerph192214900. [PMID: 36429617 PMCID: PMC9690087 DOI: 10.3390/ijerph192214900] [Citation(s) in RCA: 2] [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: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 06/12/2023]
Abstract
The eighth edition of the TNM classification officially introduced "depth of invasion" (DOI) as a criterion for determining the T stage in tongue squamous cell carcinoma. The DOI is a well-known independent risk factor for nodal metastases. In fact, several experts strongly suggest elective neck dissection for tongue cancer with a DOI > 4 mm due to the high risk of early and occult nodal metastases. Imaging plays a pivotal role in preoperative assessments of the DOI and, hence, in planning the surgical approach. Intraoral ultrasound (IOUS) has been proposed for early-stage SCC of the oral tongue as an alternative to magnetic resonance imaging (MRI) for local staging. The aim of this work is to investigate the accuracy of IOUS in the assessment of the DOI in early oral SCC (CIS, pT1, and pT2). A total of 41 patients with tongue SCCs (CIS-T2) underwent a preoperative high-frequency IOUS. An IOUS was performed using a small-size, high-frequency hockey-stick linear probe. The ultrasonographic DOI (usDOI) was retrospectively compared to the pathological DOI (pDOI) as the standard reference. In patients who underwent a preoperative MRI, their usDOI, magnetic resonance DOI (mriDOI), and pDOI were compared. Specificity and sensitivity for the IOUS to predict a pDOI > 4 mm and to differentiate invasive and noninvasive tumors were also evaluated. A high correlation was found between the pDOI and usDOI, pDOI and mriDOI, and usDOI and mriDOI (Spearman's ρ = 0.84, p < 0.0001, Spearman's ρ = 0.79, p < 0.0001, and Spearman's ρ = 0.91, p < 0.0001, respectively). A Bland-Altman plot showed a high agreement between the usDOI and pDOI, even though a mean systematic error was found between the usDOI and pDOI (0.7 mm), mriDOI and pDOI (1.6 mm), and usDOI and mriDOI (-0.7 mm). The IOUS was accurate at determining the T stage (p < 0.0001). The sensitivity and specificity for the IOUS to predict a pDOI ≥4 mm were 92.31% and 82.14%, respectively, with an AUC of 0.87 (p < 0.0001). The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) for the IOUS to predict an invasive cancer were 100%, 94.7%, 60%, and 100%, respectively. The AUC was 0.8 (95% CI 0.646-0.908, p < 0.0001). The IOUS was accurate in a preoperative assessment of a pDOI and T stage, and can be proposed as an alternative to MRI in the preoperative staging of tongue SCC.
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Affiliation(s)
- Simone Caprioli
- Department of Internal Medicine (DIMI), University of Genova, Viale Benedetto XV 6, 16132 Genoa, Italy
| | - Alessandro Casaleggio
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1, 16132 Genoa, Italy
| | - Cristina Conforti
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Fabio Borda
- Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1, 16132 Genoa, Italy
| | - Martina Fiannacca
- Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1, 16132 Genoa, Italy
| | - Marta Filauro
- Department 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 Genoa, 16132 Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Andrea Iandelli
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy
| | - Filippo Marchi
- Department 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 Genoa, 16132 Genoa, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy
| | - Giorgio Peretti
- Department 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 Genoa, 16132 Genoa, Italy
| | - Giuseppe Cittadini
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
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22
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Iandelli A, Marchi F, Chen AC, Young CK, Liao CT, Tsao CK, Kang CJ, Wang HM, Chang TCJ, Huang SF. Adequacy of Disease Control by Supraomohyoid Neck Dissection in cT1/T2 Tongue Cancer. J Pers Med 2022; 12:jpm12091535. [PMID: 36143322 PMCID: PMC9505271 DOI: 10.3390/jpm12091535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Patients affected by oral tongue squamous cell carcinoma (OTSCC) underwent a supraomohyoid neck dissection (SOHND) or modified radical neck dissection (mRND) according to the clinical nodal status (cN0 vs. cN+). We investigate whether the type of neck dissection affects survival with the presence of extranodal extension (ENE) and multiple nodal metastases (MNM). Methods: We conducted a retrospective study enrolling surgically treated patients affected by cT1/T2 OTSCC and MNM or ENE. The outcomes assessed were: overall survival (OS), disease-free survival (DFS), and neck-control- and metastases-free survival (NC-MFS). Survival curves were plotted by the Kaplan–Meier method and the log-rank test. Furthermore, we conducted a multivariable analysis with the Cox regression model. Results: We included a total of 565 patients (36% cT1, 64% cT2). Of these, 501 patients underwent a SOHND, and 64 underwent an mRND. A total of 184 patients presented rpN+, with 28.7% of these in the SOHND group and 62.5% of these in the mRND group. We identified no significant differences in OS, DFS, and NC-MFS in the whole pN+ cohort, in the MNM, and the ENE subgroups. In the multivariable analysis, the type of ND did not affect OS and DFS. Conclusions: Treating cT1-2 N0/+ tongue cancer with SOHND is oncologically safe. ENE and MNM patients do not benefit from an mRND.
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Affiliation(s)
- Andrea Iandelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Branch, Yaoyuan 33302, Taiwan
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy
| | - Filippo Marchi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy
- Department of Plastic Surgery, Chang Gung Memorial, Linkou Branch, Taoyuan 333, Taiwan
| | - An-Chieh Chen
- Department of Otorhinolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Branch, Yaoyuan 33302, Taiwan
| | - Chi-Kuan Young
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial, Keelung Branch, Keelung 20401, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Branch, Yaoyuan 33302, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic Surgery, Chang Gung Memorial, Linkou Branch, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Branch, Yaoyuan 33302, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Ming Wang
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Medical Oncology, Internal Medicine, Chang Gung Memorial, Linkou Branch, Taoyuan 333, Taiwan
| | - Tung-Chieh Joseph Chang
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial, Linkou Branch, Taoyuan 333, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Branch, Yaoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gun Medical College, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3328-1200 (ext. 3968); Fax: +886-3397-9361
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23
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Huang RW, Chang KP, Marchi F, Loh CYY, Lin YJ, Chang CJ, Kao HK. The impact of depression on survival of head and neck cancer patients: A population-based cohort study. Front Oncol 2022; 12:871915. [PMID: 36091181 PMCID: PMC9453493 DOI: 10.3389/fonc.2022.871915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Depression is common among patients with head and neck cancer, thereby affecting their survival rate. However, whether close monitoring of depression affects the survival outcomes of these patients is unknown. Therefore, this study aimed to determine whether depression treatment continuity after the diagnosis of cancer affects the survival of these patients. Methods A total of 55,069 patients diagnosed with head and neck cancer in the Cancer Registration System database in Taiwan were enrolled. This cohort was followed from January 1, 2007 to December 31, 2017. Furthermore, the patients were divided into four groups, namely, “no depression,” “pre-cancer only,” “post-cancer only,” and “both before and after cancer,” on the basis of the diagnosis of depression and the duration of the follow-up period in the psychiatric clinic. Further, the Cox proportional hazard model was applied to estimate the hazard of death for the four groups. Results A total of 6,345 (11.52%) patients were diagnosed with depression in this cohort. The “pre-cancer only” group had a lower overall survival (HR = 1.18; 95% CI = 1.11–1.25) compared with the “no depression” group. Moreover, the “post-cancer only” group had better overall survival (HR = 0.88; 95% CI = 0.83–0.94) compared with the “no depression” group, especially in advanced-stage patients. Patients who were diagnosed with depression before cancer and had continuous depression treatments after the cancer diagnosis had better overall survival (HR = 0.78; 95% CI = 0.71–0.86) compared with patients who had treatment interruptions. Conclusion Patients with pre-cancer depression had poorer survival outcomes, especially those who did not receive psychiatric clinic visits after their cancer diagnosis. Nonetheless, in patients with advanced-stage cancer, depression treatment may improve overall survival.
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Affiliation(s)
- Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at, Linkou, Taiwan
| | - Kai-Ping Chang
- Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital at, Linkou, Taiwan
| | - Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at, Linkou, Taiwan
| | - Charles Yuen Yung Loh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at, Linkou, Taiwan
- Department of Plastic Surgery, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Yu-Jr Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Huang-Kai Kao, ; Chee-Jen Chang,
| | - Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at, Linkou, Taiwan
- *Correspondence: Huang-Kai Kao, ; Chee-Jen Chang,
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24
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Tsao CK, Marchi F, Kang CJ, Sampieri C, Lu YA, Huang SF, Chen YT, Giordano G, Peretti G, Parrinello G, Iandelli A, Fang TJ. Comprehensive Evaluation of Vocal Outcomes and Quality of Life after Total Laryngectomy and Voice Restoration with J-Flap and Tracheoesophageal Puncture. Cancers (Basel) 2022; 14:cancers14030544. [PMID: 35158812 PMCID: PMC8833548 DOI: 10.3390/cancers14030544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Laryngopharyngectomy is still the treatment of choice in locally advanced pharyngolaryngeal tumors not eligible for organ preservation protocols. Loss of speech capacity has been reported as one of the factors that most affect the patient-reported quality of life. Thus, the reconstructive goals are restoring the pharynx and possibly the voice in such a scenario. For decades, tracheoesophageal puncture (TEP) has allowed proper voice rehabilitation; however, TEP has a non-neglectable financial expenditure and complication rate. Therefore, we recently reported a novel flap design and surgical technique that shares the same principles of TEP, without the need to change any device over time, named J-flap. This study aimed to analyze both techniques’ subjective and objective vocal outcomes and their impact on overall and voice-related quality of life. Abstract Background: Tracheoesophageal puncture with a voice prosthesis is the gold standard for speech rehabilitation in patients that receive a laryngopharyngectomy. However, a novel surgical technique, using a tubularized anterolateral tight flap, named “J-flap,” has been demonstrated to produce adequate voice restoration. We aimed to compare the outcomes and the quality of life of patients who underwent voice rehabilitation with both techniques. Methods: We enrolled patients that underwent laryngopharyngectomy and voice restoration surgery. The control group received a tracheoesophageal puncture with a voice prosthesis, while the study group received J-flap reconstruction. A total of 20 patients received voice prosthesis rehabilitation, while 18 received J-flap reconstruction. Speech and vocal outcomes and quality of life metrics were collected. Results: The objective phonatory performances and the acoustic voice analysis did not outline a significant difference. Speech pathologists judged the consonant pronunciation in the J-flap group as less accurate (p < 0.001). The voice handicap index revealed a moderate impairment for the J-flap group (p < 0.001). Quality of life scores were higher for the voice prosthesis group. Conclusion: Voice prostheses and J-flaps share similar objective phonatory outcomes. Quality of life was more impaired in the J-flap group. In our view, these two techniques possess complementary characteristics in clinical practice, taking into account health care system regulations and patients’ social background.
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Affiliation(s)
- Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-K.T.); (F.M.); (Y.-T.C.)
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-K.T.); (F.M.); (Y.-T.C.)
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Chung-Jan Kang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
| | - Claudio Sampieri
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Yi-An Lu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
| | - Shiang-Fu Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
| | - Yu-Ting Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-K.T.); (F.M.); (Y.-T.C.)
| | - Giorgio Giordano
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giorgio Peretti
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giampiero Parrinello
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Andrea Iandelli
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
- Correspondence: (A.I.); (T.-J.F.)
| | - Tuan-Jen Fang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
- Correspondence: (A.I.); (T.-J.F.)
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25
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Iandelli A, Missale F, Laborai A, Filauro M, Marchi F, Del Bon F, Perotti P, Parrinello G, Piazza C, Peretti G. Surgical management and oncological outcome of non-squamous cell carcinoma of the larynx: a bicentric study. Eur Arch Otorhinolaryngol 2021; 279:299-310. [PMID: 34557960 PMCID: PMC8738708 DOI: 10.1007/s00405-021-07076-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
Purpose Non-squamous cell carcinoma (non-SCC) accounts for about 5% of laryngeal malignancies. Survival data are limited, and consensus on management principles is lacking. The present study reviews our experience in the surgical treatment of non-metastatic non-SCC of the larynx and compares oncological and functional outcomes in a cohort of patients affected by traditional SCC. Methods We collected data on 592 patients affected by laryngeal neoplasms. Univariate and multivariable survival analyses were performed using Cox proportional-hazards models; survival estimates were reported by hazard ratios (HR) with 95% confidence intervals (CI), and survival curves were established with the Kaplan–Meier method. Results We identified 326 patients affected by untreated SCC, while 21 had non-SCC histotypes. The non-SCC cohort was composed of 5 soft tissue sarcomas, 8 chondrosarcomas, 2 adenoid cystic carcinomas, 2 neuroendocrine carcinomas, 2 solitary fibrous tumors, 1 Kaposi’s sarcoma, and 1 malignant peripheral nerve sheath tumor. Overall survival and disease-specific survival were not significantly different according to histology (p = 0.6 and p = 0.349, respectively). The non-SCC group showed an increased risk of recurrence (HR 5.87; CI95 2.15–16.06; p < 0.001). Nonetheless, no significant difference (p = 0.31) was found at multivariable analysis between the two groups in total laryngectomy-free survival with an organ preservation rate over 5 years of 81% for the non-SCC histologies. Conclusion Non-SCC is a broad spectrum pathology, but generalized laryngeal surgical management principles are still feasible and it is possible to identify patients amenable to conservative surgical treatment without affecting survival. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-07076-x.
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Affiliation(s)
- Andrea Iandelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | - Andrea Laborai
- Unit of Otorhinolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Pietro Perotti
- Unit of Otorhinolaryngology-Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | | | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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26
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Chiu TH, Marchi F, Huang SF, Kang CJ, Liao CT, Hung SY, Cheong DCF, Tsao CK. Midline versus paramedian mandibulotomy for tongue cancer surgery: analysis of complications. Int J Oral Maxillofac Surg 2021; 51:724-731. [PMID: 34535350 DOI: 10.1016/j.ijom.2021.08.023] [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: 02/03/2021] [Revised: 06/27/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022]
Abstract
Midline and paramedian mandibulotomies both have distinct anatomical and surgical strengths. A retrospective study was performed at Chang Gung Memorial Hospital, Linkou Branch between 2014 and 2019 to investigate how the osteotomy site (midline (n = 221) or paramedian (n = 44)) and type (straight, notched, or stair-stepped) affect postoperative and post-radiotherapy complications in patients undergoing wide excision of tongue cancer with flap reconstruction. Midline mandibulotomies were predominantly of the straight osteotomy type, while paramedian mandibulotomies were mostly notched type (P < 0.001). Comparably low elective tooth extraction rates were found in both approaches (P = 0.556). Paramedian mandibulotomy showed a higher osteoradionecrosis rate (P = 0.026), but there was no significance in the sub-analysis of individual types. Paramedian sites were associated with more early infection (P = 0.036) and plate exposure (P = 0.036) than midline sites with the straight osteotomy type, but complication rates did not differ significantly for the notched and stair-stepped types. Paramedian sites (P = 0.020) and notched types (P = 0.006) were associated with higher odds of osteoradionecrosis in the univariable logistic regression analysis, but only the notched type remained significant in the multivariable analysis (P = 0.048). In conclusion, paramedian sites increased the rate of osteoradionecrosis, and correlation with the osteotomy type resulted in more osteoradionecrosis in notched types and more complications in straight paramedian mandibulotomies.
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Affiliation(s)
- T-H Chiu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - F Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - S-F Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, and Chang Gung University, Taipei, Taiwan
| | - C-J Kang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, and Chang Gung University, Taipei, Taiwan
| | - C-T Liao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, and Chang Gung University, Taipei, Taiwan
| | - S-Y Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - D C-F Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - C-K Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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27
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Tsai TY, Iandelli A, Marchi F, Huang Y, Tai SF, Hung SY, Kao HK, Chang KP. The Prognostic Value of Lymph Node Burden in Oral Cavity Cancer: Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:88-95. [PMID: 34089539 DOI: 10.1002/lary.29674] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Lymph node burden has been proposed to estimate the cumulative adverse effect of nodal metastasis. In this study, a meta-analysis was conducted to evaluate the prognostic value of lymph node burden in oral cavity squamous cell carcinoma. STUDY DESIGNS Systemic review and meta-analysis. METHODS PubMed, EMBASE and the Cochrane Library as well as manual searches were performed until April 2020. The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival were extracted and pooled. RESULTS Eleven included studies were published between 2009 and 2019. The cumulative number of patients was 20,607 (range 35-14,554). Extranodal extension was adjusted or evaluated in all of the studies. The meta-analysis indicated that a higher lymph node burden was significantly related to worse overall survival (HR 2.62, 95% CI 2.12-3.25), worse disease-specific survival (HR 3.14, 95% CI 1.85-5.33) and worse disease-free survival (HR 2.30, 95% CI 1.62-3.26). The highest hazard ratio was observed when the cutoff value was 3 for overall survival, 3 for disease-specific survival, and 4 for disease-free survival. The hazard ratio showed an upward trend before the cutoff value of 3 but no significant incremental change when the cutoff exceeded 3. CONCLUSIONS In oral squamous cell carcinoma, lymph node burden is an independent prognosticator for survival outcomes. However, more prospective or high-quality studies are required to determine the optimal cutoff. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Tsung-You Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Andrea Iandelli
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Filippo Marchi
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yenlin Huang
- Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shiao-Fwu Tai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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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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Balasubramanian D, Subramaniam N, Missale F, Marchi F, Dokhe Y, Vijayan S, Nambiar A, Mattavelli D, Calza S, Bresciani L, Piazza C, Nicolai P, Peretti G, Thankappan K, Iyer S. Predictive nomograms for oral tongue squamous cell carcinoma applying the American Joint Committee on Cancer/Union Internationale Contre le Cancer 8th edition staging system. Head Neck 2021; 43:1043-1055. [PMID: 33529403 DOI: 10.1002/hed.26554] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/26/2020] [Revised: 10/13/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nomograms applying the 8th edition of the TNM staging system aimed at predicting overall (OS), disease-specific (DSS), locoregional recurrence-free (LRRFS) and distant recurrence-free survivals (DRFS) for oral tongue squamous cell carcinoma (OTSCC) are still lacking. METHODS A training cohort of 438 patients with OTSCC was retrospectively enrolled from a single institution. An external validation set of 287 patients was retrieved from two independent institutions. RESULTS Internal validation of the multivariable models for OS, DSS, DRFS and LRRFS showed a good calibration and discrimination results with optimism-corrected c-indices of 0.74, 0.75, 0.77 and 0.70, respectively. The external validation confirmed the good performance of OS, DSS and DRFS models (c-index 0.73 and 0.77, and 0.73, respectively) and a fair performance of the LRRFS model (c-index 0.58). CONCLUSIONS The nomograms herein presented can be implemented as useful tools for prediction of OS, DSS, DRFS and LRRFS in OTSCC.
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Affiliation(s)
- Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Narayana Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Genova, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Yogesh Dokhe
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Smitha Vijayan
- Department of Pathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Ajit Nambiar
- Department of Pathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Big & Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Lorenzo Bresciani
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, Milan, 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
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Genova, Genoa, Italy
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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30
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Chiu TH, Marchi F, Huang SF, Kang CJ, Liao CT, Hung SY, Cheong DCF, Tsao CK. Complication analysis of three different designs of temporary mandibulotomy in tongue cancer treatment. Head Neck 2020; 43:909-919. [PMID: 33289212 DOI: 10.1002/hed.26553] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/13/2020] [Accepted: 11/10/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mandibulotomy helps access posterior oral cavity tumors. If osteotomy designs affect postoperative and postradiotherapy complications, needs to be tested clinically. METHODS Two hundred and eighteen patients who underwent midline mandibulotomy for primary tongue cancer wide excision and flap reconstruction at Chang Gung Memorial Hospital during 2014-2019. RESULTS There were 114 straight, 54 notched, and 50 stair-stepped osteotomy cases. Stair-stepped osteotomy had less advanced tumor stages (P = .009) and notched osteotomy more common single-plate fixations (P = .012). The former showed higher mandibular heights (P = .000) and more intact midline teeth (P = .011) than notched and straight ones. Straight osteotomy cases showed lower early infection rates (P = .039). Single-plate fixation was related to more flap dehiscence (P = .001) and oro-cutaneous fistulas (P = .035). CONCLUSIONS Complex osteotomy does not offer long-term benefits in midline mandibulotomies for primary tongue cancers and has higher early infections. Single-plate fixation increases postoperative complications.
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Affiliation(s)
- Ting-Han Chiu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - David Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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31
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Marchi F, Kang SC, Cheong DCF, Hung SY, Wang SH, Chiu TH, Chen YT, Tsao CK. The Benefits of the Supercharged Ileocolic Flap in Patients Who Underwent Total Esophagectomy and Gastrectomy. J Reconstr Microsurg 2020; 37:475-485. [PMID: 33202456 DOI: 10.1055/s-0040-1719046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients who undergo total esophagectomy and gastrectomy present a challenging scenario for reconstructive surgeons. Several techniques have been described. However, the best choice is still a matter of debate. We aim to report our experience with the supercharged ileocolic flap, then to compare the long-term functional outcomes in cancer and caustic injury patients. We investigate the safest route of transposition and demonstrate the importance of supercharging the flap. Last, we perform a literature review to compare our results with the ones reported in the literature. METHODS A total of 36 patients underwent the supercharged ileocolic flap procedure. The details reviewed included the type of defect, flap characteristic, route of transposition, complications, patient survival, and swallowing evaluation. Survival and long-term function preservation were considered as the main outcomes. A secondary end-point was the identification of the safest route of transposition. We extracted the pertinent literature on supercharged bowel flaps from 1995 to July 2020 RESULTS: All flaps survived; only two flaps were partially lost. Thirty-three percent of the cohort experienced postoperative complications; the most common was leakage of the cervical anastomosis (17%), followed by neck wound infection (8%). The 5-year dysphagia-free survival rate was 87% in corrosive injury patients and 78% in cancer patients. The mean time to be free from dysphagia after surgery was 25.12 ± 4.55 months for corrosive patients and 39.56 ± 9.45 months for cancer patients (p = 0.118). The safest route of transposition was retrosternal extra-mediastinal. From the literature review, the data from 11 studies were extracted. CONCLUSION The supercharged ileocolic flap is a robust option for total esophageal replacement when the stomach is not available and the retrosternal route is the safest for transposition. The functional outcomes are excellent, with acceptable morbidity and a good life expectancy, either in cancer and noncancer patients. Supercharging the flap is recommended.
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Affiliation(s)
- Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.,Department of Otorhinolaryngology, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Shih Ching Kang
- Department of Trauma and Emergency Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - David Chon Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Shao Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Szu Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Ting Han Chiu
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Yu Ting Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan
| | - Chung Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Filauro M, Missale F, Marchi F, Iandelli A, Carobbio ALC, Mazzola F, Parrinello G, Barabino E, Cittadini G, Farina D, Piazza C, Peretti G. Intraoral ultrasonography in the assessment of DOI in oral cavity squamous cell carcinoma: a comparison with magnetic resonance and histopathology. Eur Arch Otorhinolaryngol 2020; 278:2943-2952. [PMID: 33084951 PMCID: PMC8266699 DOI: 10.1007/s00405-020-06421-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
Objective The first-line therapeutic approach for oral cavity squamous cell carcinoma (OCSCC) is complete surgical resection. Preoperative assessment of depth of invasion (cDOI) is crucial to plan the surgery. Magnetic resonance (MR) and intraoral ultrasonography (IOUS) have been shown to be useful tools for assessment of DOI. The present analysis investigates the accuracy of MR and IOUS in evaluating DOI in OCSCC compared to histological evaluation (pDOI). Materials and methods Forty-nine previously untreated patients with cT1-T3 OCSCC were reviewed. Nine patients were staged with MR alone, 10 with IOUS alone, and 30 with both MR and IOUS. Results Mean difference between cDOIMR and pDOI values of 0.2 mm (95% CI − 1.0–1.3 mm) and between cDOIIOUS and pDOI of 0.3 mm (95% CI − 1.0–1.6 mm). Spearman R between cDOIMR and pDOI was R = 0.83 and between cDOIIOUS and pDOI was R = 0.76. Both radiological techniques showed high performance for the correct identification, with the optimum cut-off of 5 mm, of patients with a pDOI ≥ 4 mm and amenable to a neck dissection, with an AUC of 0.92 and 0.82 for MR and IOUS, respectively. Conclusion Both examinations were valid approaches for preoperative determination of DOI in OCSCC, although with different cost-effectiveness profiles and indications. Electronic supplementary material The online version of this article (10.1007/s00405-020-06421-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marta Filauro
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Francesco Missale
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Filippo Marchi
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Andrea Iandelli
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Andrea Luigi Camillo Carobbio
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy. .,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
| | - Francesco Mazzola
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | | | - Emanuele Barabino
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Diagnostic Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Giuseppe Cittadini
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Diagnostic Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
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Marchi F, Deek NFAL. Challenging the Orthodoxy of Mandibular Reconstructions Comparing Functional Outcomes in Osseous versus Soft Tissue Reconstructions of the Posterolateral Mandible. J Reconstr Microsurg 2020; 36:e5-e6. [DOI: 10.1055/s-0040-1714430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Nidal F. AL Deek
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
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Marchi F, Missale F, Sampieri C, Filauro M, Iandelli A, Parrinello G, Incandela F, Smeele LE, van den Brekel MWM, Del Bon F, Nicolai P, Piazza C, Peretti G. Laryngeal Compartmentalization Does Not Affect the Prognosis of T3-T4 Laryngeal Cancer Treated by Upfront Total Laryngectomy. Cancers (Basel) 2020; 12:cancers12082241. [PMID: 32796540 PMCID: PMC7463701 DOI: 10.3390/cancers12082241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/07/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/15/2023] Open
Abstract
A picture is emerging in which advanced laryngeal cancers (LCs) are potentially not homogeneous and may be characterized by subpopulations which, if identified, could allow selection of patients amenable to organ preservation treatments in contrast to those to be treated with total laryngectomy (TL). This work aims to analyze a multicentric cohort of T3-T4a LCs treated by upfront TL, investigating the clinical and pathological features that can best predict oncologic outcomes. A total of 149 previously untreated patients who underwent TL for T3-T4a LC at four institutions were analyzed. Survival and disease-control were considered as the main outcomes. A secondary end-point was the identification of covariates associated with nodal status, investigating also the tumor thickness. T and N categories were significantly associated with both overall and disease-specific survival. The number of positive nodes and tracheal involvement were associated with loco-regional failure; post-cricoid area invasion and extra-nodal extension with distant failure. Posterior laryngeal compartment involvement was not a significant prognostic feature, by either univariable and multivariable analyses. These results support the conclusion that laryngeal compartmentalization has no impact on survival in patients treated by upfront TL and the current TNM staging system remains a robust prognosticator in advanced LC.
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei 33305, Taiwan
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Molecular and Translational Medicine, University of Brescia, 25100 Brescia, Italy
| | - Claudio Sampieri
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Andrea Iandelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taoyuan 33305, Taiwan
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, 20133 Milan, Italy; (F.I.); (C.P.)
| | - Ludwig E. Smeele
- Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066 Amsterdam, The Netherlands; (L.E.S.); (M.W.M.v.d.B.)
| | - Michiel W. M. van den Brekel
- Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066 Amsterdam, The Netherlands; (L.E.S.); (M.W.M.v.d.B.)
| | - Francesca Del Bon
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Brescia, 25123 Brescia, Italy;
| | - Piero Nicolai
- Section of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences, University of Padua, Via Giustiniani, 2-35128 Padua, Italy;
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, 20133 Milan, Italy; (F.I.); (C.P.)
- Department of Oncology and Oncohematology, University of Milan, 20122 Milan, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (F.M.); (F.M.); (M.F.); (A.I.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
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Marchi F, Al Deek NF. Re: Patient-specific soft tissue reconstruction: an IDEAL stage I report of hemiglossectomy reconstruction and introduction of the PANSOFOS flap: considerations in personalised surgical planning for soft tissue reconstruction of head and neck defects. Br J Oral Maxillofac Surg 2020; 58:1210-1211. [PMID: 32758376 DOI: 10.1016/j.bjoms.2020.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Nidal F Al Deek
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Mazzola F, Tomasoni M, Mocellin D, Dalè M, Iandelli A, Carobbio A, Marchi F, Filauro M, Petruzzi G, Massa B, Facchetti M, Battocchio S, Marandino F, Lombardi D, Pichi B, Pellini R, Nicolai P, Peretti G. A multicenter validation of the revised version of the Milan system for reporting salivary gland cytology (MSRSGC). Oral Oncol 2020; 109:104867. [PMID: 32593953 DOI: 10.1016/j.oraloncology.2020.104867] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/30/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fine-needle aspiration cytology (FNAC) is a basic step in the diagnosis of salivary gland tumors that have a wide variety of histological types. The recent Milan system for reporting salivary gland cytopathology (MSRSGC) can correlate the risk of malignancy with precise cytological features. A revised version was recently proposed to improve the surgical relevance and facilitate uniform management. MATERIAL AND METHODS A multicenter study retrospectively used the original and revised MSRSGC criteria to classify a series of patients who received surgery after FNAC. RESULTS We enrolled 503 patients from three tertiary centers. The risk of malignancy for the MSRSGC resulted 19.5% in cat. I, 14.3% in cat. II, 17.6% in cat. III, 3.6% in cat. IVa, 24.6% in cat. IVb, 66.7% in cat. V, and 96.8% in cat. VI. The results from the revised MSRSGC were consistent with the original values. CONCLUSION The MSRSGC is a promising classification system. In our opinion, the revised version of the MSRSGC supplements FNAC with some crucial clinical information and can better identify the appropriate treatment in each category.
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Affiliation(s)
- F Mazzola
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy; Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy.
| | - M Tomasoni
- Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - D Mocellin
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - M Dalè
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - A Iandelli
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - A Carobbio
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - F Marchi
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - M Filauro
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy; Department of Experimental Medicine (DIMES), University of Genoa, Via Leon Battista Alberti, 2, 16132, Genoa, Italy
| | - G Petruzzi
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - B Massa
- Cyto-Histopathological Unit and Pathology Unit, Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - M Facchetti
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - S Battocchio
- Unit of Pathology, Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - F Marandino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - D Lombardi
- Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1 - 25123, Brescia, Italy
| | - B Pichi
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - R Pellini
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - P Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Via Giustiniani, 2 - 35128 Padua, Italy
| | - G Peretti
- Unit of Otorhinolaryngology and Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
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Marchi F, Al Deek NF. Double free flaps for oromandibular defects: It is much more than bone length and surface area. Oral Oncol 2020; 109:104730. [PMID: 32416970 DOI: 10.1016/j.oraloncology.2020.104730] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Nidal F Al Deek
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Marchi F, Al Deek NF. Letter to Editors Regarding, "Assessment of fibula flap with flexor hallucis longus's effect on head & neck tumor patients' quality of life and function of donor site": Ethics, Surgical Technique, and QoL Measures. Oral Oncol 2020; 104:104620. [PMID: 32122761 DOI: 10.1016/j.oraloncology.2020.104620] [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] [Received: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Nidal F Al Deek
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
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Marchi F, Filauro M, Iandelli A, Carobbio ALC, Mazzola F, Santori G, Parrinello G, Canevari FRM, Piazza C, Peretti G. Magnetic Resonance vs. Intraoral Ultrasonography in the Preoperative Assessment of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2020; 9:1571. [PMID: 32117789 PMCID: PMC7010633 DOI: 10.3389/fonc.2019.01571] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 10/16/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Preoperative assessment is critical to decide the most adequate surgical strategy for oral squamous cell carcinoma (SCC). Magnetic resonance (MR) and intraoral ultrasonography (US) have been reported to be of great value for preoperative estimation of depth of invasion (DOI) and/or tumor thickness (TT). This review aims to analyze the accuracy of MR and intraoral US in determining DOI/TT in oral SCC, by assuming histological evaluation as the reference method. Methods: The procedure was conducted following the modified 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We performed a systematic search of papers on PubMed, Scopus, Web of Science, and Cochrane Library databases until July 31st, 2019. For quantitative synthesis, we included nine studies (487 patients) focused on MR, and 12 (520 patients) focused on intraoral US. The Pearson correlation coefficient (r) between DOI/TT evaluated with MR or intraoral US was assumed as effect size. A meta-analysis (MA) for each study group (MR and US) was performed by using the random-effects models with the DerSimonian–Laird estimator and r-to-z transformation. Results: In the MA for MR studies, a high heterogeneity was found (I2 = 94.84%; Q = 154.915, P < 0.001). No significant risk of bias occurred by evaluating funnel plot asymmetry (P = 0.563). The pooled (overall) r of the MR studies was 0.87 (95% CI from 0.82 to 0.92), whereas the pooled r-to-z transformed was 1.44 (95% CI from 1.02 to 1.85). In the MA for US studies a high heterogeneity was found (I2 = 93.56%; Q = 170.884, P < 0.001). However, no significant risk of bias occurred (P = 0.779). The pooled r of the US studies was 0.96 (95% CI from 0.94 to 0.97), whereas the pooled r-to-z transformed was 1.76 (95% CI from 1.39 to 2.13). These outputs were confirmed in additional MA performed by enrolling only MR (n = 8) and US (n = 11) studies that evaluated TT. Conclusions: MR and intraoral US seem to be promising approaches for preoperative assessment of DOI/TT in oral SCC. Remarkably, a higher pooled r and r-to-z transformed were observed in the intraoral US studies, suggesting that this approach could be more closely related to histopathological findings.
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Affiliation(s)
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | | | | | | | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | | | - Frank Rikky Mauritz Canevari
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Mariani M, Cerillo AG, Maffei S, Marchi F, Benedetti G, Zezza L, Cerone E, Paradossi U, Sorbo S, Pizzino F, Chiappino S, Trianni G, Al Jabri A, Ravani M, Berti S. 1634 3D transoesofageal echocardiography in detection of anterior leaflet laceration during mitraclip implantation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
MitraClip is a percutaneous way of treatment of mitral regurgitation. Recent trials demonstrate its value in modifying prognosis of patients with functional mitral regurgitation. During MitraClip implant imaging with 3D TEE is mandatory to guide the procedure and monitoring the results. Unfortunately, laceration of mitral leaflets is a well-described complication of Percutaneous Mitral valve repair by implantation of MitraClip. 3D TEE can be useful even to detect complication of the procedure and in particular leaflets lacerations. Here we describe a case where 3D TEE was capable to recognize and visualize a laceration in the anterior leaflet (AL) and we assume some mechanisms leading to this complication.
Methods
An 83 years old man with post-ischemic severe functional mitral regurgitation underwent to MitraClip implantation. The mitral valve shows a severe tenting and annulus was deformed and dilated.
The procedure was performed under fluoroscopic and 3D TEE guidance (Philips iE33). Due to the large central regurgitation and large coaptation gap, we decide to implant MitraClip XTR, this is the larger device 5 mm longer.
Results
A single MitraClip XTR was implanted in the central scallop (A2-P2) in the region of the larger jet, after device positioning a further jet was detected in the region of implant and the original jet was unchanged.
Using 3D color complete volume and X-plane reconstructions we recognize that the jet originates between the clip and the basal aspects of AL. Without color Doppler in 3D zoom and X plane reconstruction, a continuum solution was suspected in the body of AL but the shadow of the delivery system partially masked the region. After removal of the device, perforation of AL was clearly depicted also with 3D zoom without color Doppler. The patient was surgically treated and inspection confirmed the laceration and shows a worn thin AL. The laceration of AL can be caused by the tension on a thinned tissue carried out by the large device. The severe tethering and annular dilatation with a marked distance between anterior and posterior leaflet at the tip of the device may have been a determinant factor in the tear occurrence.
Conclusion
3D TEE can clearly depict lacerations of leaflets during MitraClip implantation. Preoperative extensive analysis of valve geometry and inspection of leaflets searching for a thinned region can avoid intraoperative complications. The distance between leaflets at the expected tips of the MitraClip can be a predictive parameter of tension applied on the leaflets and of the risk of tearing.
Abstract 1634 Figure. Image 1
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Affiliation(s)
- M Mariani
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - A G Cerillo
- Careggi University Hospital (AOUC), Florence, Italy
| | - S Maffei
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - F Marchi
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - G Benedetti
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - L Zezza
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - E Cerone
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - U Paradossi
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - S Sorbo
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - F Pizzino
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - S Chiappino
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - G Trianni
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - A Al Jabri
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - M Ravani
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
| | - S Berti
- Tuscany Foundation Gabriele Monasterio, Massa, Italy
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Marchi F, Missale F, Incandela F, Filauro M, Mazzola F, Mora F, Paderno A, Parrinello G, Piazza C, Peretti G. Prognostic Significance of Peripheral T-Cell Subsets in Laryngeal Squamous Cell Carcinoma. Laryngoscope Investig Otolaryngol 2019; 4:513-519. [PMID: 31637295 PMCID: PMC6793599 DOI: 10.1002/lio2.304] [Citation(s) in RCA: 15] [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: 04/13/2019] [Revised: 07/18/2019] [Accepted: 08/10/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives The role of the immune system in head and neck squamous cell carcinoma is controversial. The aim of our study was to analyze full blood counts and distribution of T cell subsets in patients affected by laryngeal squamous cell cancer (LSCC) and their association with clinical variables and survival. Study design Retrospective study. Methods We analyzed the levels of platelets, lymphocytes, and neutrophils, as well as the CD4+, CD8+, and CD3+ T‐cell subpopulations by cytofluorometry in LSCC patients. A cohort of healthy patients was used as control group. The disease‐specific survival (DSS) was considered as survival outcome. Results Sixty‐five LSCC patients and 48 controls were enrolled. In LSCC patients, neutrophils were higher than in the healthy group (P < .0001). The neutrophil‐to‐lymphocyte ratio (NLR) and the platelet‐to‐lymphocyte ratio (PLR) were both higher in LSCC patients (P < .0001). In patients treated for recurrent disease, the CD8+/CD3+ ratio was increased (P = .02), while the CD4+/CD8+ (P = .03) and CD4+/CD3+ (P = .04) ratios were lower. In patients with lymph node metastases, leukocytes (P = .03), CD3+ (P = .04), and CD4+ (P = .0098) were all higher. Among Stages III‐IV patients, low lymphocyte and low leukocyte count were associated with worse DSS. Conclusion Our data demonstrate that NLR and PLR are significantly increased in LSCC. Lower CD4+/CD8+ and CD3+/CD8+ ratios are related to recurrent disease and a higher level of CD3+ and CD4+ is associated with nodal metastasis. Level of Evidence 4
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino Genoa Italy.,Department of Otorhinolaryngology, Head and Neck Surgery University of Genoa Genoa Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino Genoa Italy.,Department of Otorhinolaryngology, Head and Neck Surgery University of Genoa Genoa Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan University of Milan Milan Italy
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino Genoa Italy.,Department of Otorhinolaryngology, Head and Neck Surgery University of Genoa Genoa Italy
| | - Francesco Mazzola
- IRCCS Ospedale Policlinico San Martino Genoa Italy.,Department of Otorhinolaryngology, Head and Neck Surgery University of Genoa Genoa Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino Genoa Italy.,Department of Otorhinolaryngology, Head and Neck Surgery University of Genoa Genoa Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology, Head and Neck Surgery University of Brescia Brescia Italy
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino Genoa Italy.,Department of Otorhinolaryngology, Head and Neck Surgery University of Genoa Genoa Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan University of Milan Milan Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino Genoa Italy.,Department of Otorhinolaryngology, Head and Neck Surgery University of Genoa Genoa Italy
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Giordano L, Di Santo D, Bondi S, Marchi F, Occhini A, Bertino G, Grammatica A, Parrinello G, Peretti G, Benazzo M, Nicolai P, Bussi M. The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience. ACTA ACUST UNITED AC 2019; 38:497-503. [PMID: 30623895 PMCID: PMC6325652 DOI: 10.14639/0392-100x-1794] [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: 09/06/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
The supraclavicular artery island flap (SCAIF) is a thin and pliable pedicled flap that is easy and quick to harvest. Thanks to its particular features and high reliability, it is best indicated for the elderly or most fragile patients. SCAIF is very versatile, as it can be used for reconstruction of oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. We began using this flap in four Italian tertiary referral centres, with several indications, both as first treatment and as salvage surgery. The aim of the study was to demonstrate the easy reproducibility of the flap among four different centres. A series of 28 patients underwent head and neck reconstructions with SCAIF with no recorded complications during flap harvesting. After the very first cases, harvesting time was approximately 45 minutes; 24 patients had successful flap integration at the recipient site, while the remaining 4 suffered from partial flap necrosis, two of whom needed revision surgery. Other minor complications were reported at the recipient site, always at the most distal and most delicate portion of the flap. Donor site was always closed primarily, with only three cases of partial suture dehiscence. We only selected the most fragile patients for SCAIF reconstruction, such as the elderly or those with one or more comorbidities; for this reason, we reported some serious systemic complications and one intraoperative death. SCAIF is an easy reproducible flap, with multiple possible indications. Its use as an alternative to free flaps in the head and neck region is nowadays under discussion. Its use should be encouraged among head and neck surgeons thanks to its various advantages.
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Affiliation(s)
- L Giordano
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - D Di Santo
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - S Bondi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - F Marchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - A Occhini
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - G Bertino
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - A Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - G Parrinello
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - G Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - P Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - M Bussi
- Otolaryngology Service, Head and Neck Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Marchi F, Filauro M, Missale F, Parrinello G, Incandela F, Bacigalupo A, Vecchio S, Piazza C, Peretti G. A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases. Cancers (Basel) 2019; 11:E717. [PMID: 31137671 PMCID: PMC6562846 DOI: 10.3390/cancers11050717] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022] Open
Abstract
The optimal treatment for T3 laryngeal carcinoma (LC) is still a matter of debate. Different therapeutic options are available: Transoral laser microsurgery (TLM), open partial horizontal laryngectomies (OPHLs), total laryngectomy (TL), and organ preservation protocols (radiation therapy (RT) or chemo-radiation (CRT)). This study aimed to retrospectively evaluate oncologic outcomes of 104 T3 LCs treated by surgery or non-surgical approaches from January 2011 to December 2016 at a single academic tertiary referral center. Each case was evaluated by a multidisciplinary team (MDT) devoted to the management of head and neck cancers. We divided the cohort into two subgroups: Group A, surgical treatment (TLM, OPHLs, TL) and Group B, non-surgical treatment (RT, CRT). For the entire cohort, two- and five-year overall survival (OS) rates were 83% and 56%, respectively. The two- and five-year disease-free survival (DFS) rates were 75% and 65%, and disease-specific survival rates were 93% and 70%, respectively. The N category was a significant independent prognosticator for OS (p = 0.02), whereas Group B was significantly and independently associated with DFS (HR 4.10, p = 0.006). Analyzing laryngo-esophageal dysfunction-free survival as an outcome, it was found that this was significantly lower in higher N categories (p = 0.04) and in cases that underwent non-surgical treatments (p = 0.002). Optimization of oncologic outcomes in T3 LCs may be obtained only by a comprehensive MDT approach, considering that different treatment options have heterogenous toxicity profiles and indications.
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Almalina Bacigalupo
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Radiation Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Stefania Vecchio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
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Bertulli L, Marchi F, Scarone P. Traitement chirurgical des fractures traumatiques luxées de la colonne cervicale inférieure et de la jonction cervicothoracique avec la TDM intraoperatoire AIRO®. Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.034] [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: 11/30/2022]
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Bacigalupo A, Belgioia L, Tornari E, Vecchio S, Filauro M, Marchi F, Peretti G, Corvò R. PO-052 T3 Laryngeal SCC: a mono- institutional retrospective analysis of different therapeutic approaches. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30218-x] [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: 10/27/2022]
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Del Bon F, Piazza C, Lancini D, Paderno A, Bosio P, Taboni S, Morello R, Montalto N, Missale F, Incandela F, Marchi F, Filauro M, Deganello A, Peretti G, Nicolai P. Open Partial Horizontal Laryngectomies for T3⁻T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization. Cancers (Basel) 2019; 11:cancers11030289. [PMID: 30832209 PMCID: PMC6468624 DOI: 10.3390/cancers11030289] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/22/2019] [Revised: 02/23/2019] [Accepted: 02/24/2019] [Indexed: 01/16/2023] Open
Abstract
Open partial horizontal laryngectomies (OPHLs) are well-established and oncologically safe procedures for intermediate–advanced laryngeal cancers (LC). T–N categories are well-known prognosticators: herein we tested if “anterior” vs. “posterior” tumor location (as defined in respect to the paraglottic space divided according to a plane passing through the arytenoid vocal process, perpendicular to the ipsilateral thyroid lamina) may represent an additional prognostic factor. We analyzed a retrospective cohort of 85 T3–4a glottic LCs, treated by Type II or III OPHL (according to the European Laryngological Society classification) from 2005 to 2017 at two academic institutions. Five-year overall survival (OS), disease-specific survivals (DSS), and recurrence-free survivals (RFS) were compared according to tumor location and pT category. Anterior and posterior tumors were 43.5% and 56.5%, respectively, 78.8% of lesions were T3 and 21.2% were T4a. Five-year OS, DSS, and RFS for T3 were 74.1%, 80.5%, and 63.4%, respectively, and for T4a 71.8%, 71.8%, and 43%, respectively (p not significant). In relation to tumor location, the survival outcomes were 91%, 94.1%, and 72.6%, respectively, for anterior tumors, and 60.3%, 66.3%, and 49.1%, respectively, for posterior lesions (statistically significant differences). These data provide evidence that laryngeal compartmentalization is a valid prognosticator, even more powerful than the pT category.
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Affiliation(s)
- Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Davide Lancini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Paolo Bosio
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Taboni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Riccardo Morello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Nausica Montalto
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Francesco Missale
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Filippo Marchi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Marta Filauro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Alberto Deganello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa-IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Balasubramanian D, Subramanian N, Marchi F, Camillo Carobbio A, Missale F, Thankappan K, Iyer S. Induction chemotherapy in sinonasal malignancies: A review of literature. J Head Neck Physicians Surg 2019. [DOI: 10.4103/jhnps.jhnps_6_20] [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: 01/04/2023] Open
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Piazza C, Filauro M, Paderno A, Marchi F, Perotti P, Morello R, Taboni S, Parrinello G, Incandela F, Iandelli A, Missale F, Peretti G. Three-Dimensional Map of Isoprognostic Zones in Glottic Cancer Treated by Transoral Laser Microsurgery as a Unimodal Treatment Strategy. Front Oncol 2018; 8:175. [PMID: 29872643 PMCID: PMC5972218 DOI: 10.3389/fonc.2018.00175] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/05/2018] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction The Union for International Cancer Control–American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone. Methods We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology—Head and Neck Surgery, Universities of Genoa and Brescia, Italy. All patients had at least 2 years of follow-up. Clinical, radiological, surgical, and histopathological data were reviewed and tumors divided into six subcategories: I, pT1a not involving the anterior commissure (AC); II, pT1b involving the AC; III, pT2 extending superficially to the supraglottis or the subglottis; IV, pT2 infiltrating the vocal muscle; V, pT3 involving the anterior paraglottic space; VI, pT2 or pT3 with vertical extension across the AC with/without involvement of the pre-epiglottic space. Recurrence-free survival (RFS), local control with laser alone (LCL), and organ preservation (OP) were defined as the primary oncologic outcomes. Results The 2, 5, and 10-year RFS for the entire series were 85.7, 80.3, and 73.8%, LCL rates 93.8, 92.1, and 89.6%, and OP rates 96.8, 95.9, and 93.5%, respectively. However, when comparing the rates of RFS, LCL, and OP for each subcategory, important differences emerged. In particular, subcategories V and VI showed a significantly increased risk of local recurrence [hazard ratio (HR) = 9.2 and 13.3, respectively]. These subcategories also had a significantly reduced probability to achieve LCL (HR: 73.6 and 93.5, respectively) and OP (HR: 6.4 and 8.1, respectively). Conclusion The present classification in subcategories allows introducing the concept of a three-dimensional map of isoprognostic zones in glottic SCC treated by TLM alone as a useful tool in its management by a multidisciplinary tumor board.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Marta Filauro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Riccardo Morello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Andrea Iandelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Missale
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
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Filauro M, Paderno A, Perotti P, Marchi F, Garofolo S, Peretti G, Piazza C. Role of narrow-band imaging in detection of head and neck unknown primary squamous cell carcinoma. Laryngoscope 2018; 128:2060-2066. [DOI: 10.1002/lary.27098] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/27/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Marta Filauro
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Sabrina Garofolo
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, Italian Research Hospital Foundation, National Cancer Institute of Milan; University of Milan; Milan Italy
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Fiz I, Mazzola F, Fiz F, Marchi F, Filauro M, Paderno A, Parrinello G, Piazza C, Peretti G. Impact of Close and Positive Margins in Transoral Laser Microsurgery for Tis-T2 Glottic Cancer. Front Oncol 2017; 7:245. [PMID: 29085805 PMCID: PMC5650697 DOI: 10.3389/fonc.2017.00245] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 07/14/2017] [Accepted: 09/29/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Transoral laser microsurgery (TLM) represents one of the most effective treatment strategies for Tis–T2 glottic squamous cell carcinomas (SCC). The prognostic influence of close/positive margins is still debated, and the role of narrow band imaging (NBI) in their intraoperative definition is still to be validated on large cohort of patients. This study analyzed the influence of margin status on recurrence-free survival (RFS) and disease-specific survival (DSS). Methods We retrospectively studied 507 cases of pTis–T1b (Group A) and 127 cases of pT2 (Group B) glottic SCC. We identified the following margin status: negative (n = 232), close superficial (n = 79), close deep (CD) (n = 35), positive single superficial (n = 146), positive multiple superficial (n = 94), and positive deep (n = 48) and analyzed their impact on RFS and DSS. Close margins were defined by tumor-margin distance <1 mm. Pre-TLM margins were defined by white light in 323 patients, whereas NBI was employed in 311 patients. Results In Group A, DSS and RFS were reduced in positive multiple superficial and positive deep margins (DSS = 96.1 and 97%, both p < 0.05; RFS = 72%, p < 0.001 and 75.8%, p < 0.01). In Group B, DSS was reduced in positive multiple superficial margins (82.4%, p < 0.05). RFS was reduced in positive single superficial, positive multiple superficial, and positive deep margins (62.5, 41.2, and 53.3%, p < 0.01). In the entire population, RFS was reduced in CD margins (77.1%, p < 0.05). Use of NBI led to improvement in RFS and DSS. Conclusion The study indicates that close and positive single superficial margins do not affect DSS. By contrast, all types of margin positivity predict the occurrence of relapses, albeit with different likelihood, depending on stage/margin type. CD margins should be considered as a single risk factor. Use of NBI granted better intraoperative margins definition.
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Affiliation(s)
- Ivana Fiz
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, Katharinenhospital, Stuttgart, Germany
| | - Francesco Mazzola
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum Tuebingen, Tuebingen, Germany.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Marta Filauro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, Fondazione IRCCS - National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
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