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Biomedical subjects

G A Croll

Publications and source records attributed to G A Croll.

10 recordsLinked to original sources
PubMed1994

Free vascularized jejunum interposition for pharyngoesophageal reconstruction after total laryngopharyngectomy.

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T3 carcinoma, 15 patients T4 and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The post-operative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.

Adult↗
PubMed1993

[Uni- and multivariate analysis of prognostic factors in T3 laryngeal cancers].

In 511 patients with T3N0-3M0 laryngeal carcinoma, 24 possible prognostic factors were analysed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnoea, and dysphagia, previous tracheotomy, tumour extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumour and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension were also evaluated. Univariate analysis revealed prognostic significance on survival for tumour extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy). In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumour, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.

Adult↗
PubMed1993

T3 laryngeal cancer, primary surgery vs planned combined radiotherapy and surgery.

The Dutch Co-operative Head and Neck Oncology Group performed a retrospective, nationwide study of laryngeal cancer between 1975 and 1984. The results for T3 laryngeal cancer treated with primary laryngectomy (n = 137) with post-operative radiotherapy when indicated or planned combined (pre-operative) radiotherapy with laryngectomy (n = 113) are analysed. The disease-free survival independent prognostic factors were treatment modality (planned combined treatment fared better, P = 0.001), incomplete resection of disease (P = 0.006), positive lymph nodes in the neck dissection specimen (P = 0.03) and poor differentiation (P = 0.04). Local control (95% vs. 85%, P = 0.01) as well as regional control (96% vs. 79%, P = 0.0001) was improved in the combined group compared with the primary laryngectomy group. Regional control was 69% for N0 patients if the neck nodes were not treated electively, compared with 98% for the planned combined treatment group. It is concluded that elective treatment of the neck nodes in T3 laryngeal cancer is mandatory. Radiotherapy is preferred, since as well as regional control, local control will also improve.

Female↗
PubMed1992

Prognostic factors for survival in patients with T3 laryngeal carcinoma.

In a total of 511 patients with T3,N0-3,M0 laryngeal carcinoma, 24 possible prognostic factors were analyzed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnea, and dysphagia, previous tracheotomy, tumor extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumor and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension ware also evaluated. In a univariate analysis for the whole group, tumor extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy) were considered to be prognostic factors of corrected actuarial survival. In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumor, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.

Adult↗
PubMed1991

Magnetic resonance imaging vs palpation of cervical lymph node metastasis.

In a series of 100 patients with head and neck carcinoma, the preoperative histopathologic findings of palpation and magnetic resonance imaging were compared with regard to both laterality and lymph node level (I through V). The overall error for palpation in detecting affected sides was 32%. Gadolinium-enhanced magnetic resonance images reliably upgraded 60% of the clinically negative necks, the overall error of magnetic resonance imaging being 16%. However, for both modalities, the sensitivity per level was too low to allow for selective neck dissections in case of only one positive level. These findings show that apart from primary tumor grading, magnetic resonance imaging can improve the preoperative grading of cervical lymph nodes. In selected cases, this may change the treatment plan to a "wait-and-see" policy or a more conservative type of neck dissection.

Aged↗
PubMed1989

Primary radiotherapy with surgery in reserve for advanced laryngeal carcinoma. Results and complications.

A retrospective study of a selected group of 58 patients with T3 and T4 squamous cell carcinomas of the larynx presenting between 1974 and 1984 was undertaken. These patients were treated primarily with radical radiotherapy and salvage surgery in reserve. The aim of this study was to examine survival, recurrence rate and the complications after salvage surgery. In 30 patients the tumor was classified as a T3 and in 28 as a T4. In 14 patients (24%) nodal disease in the neck was present prior to the radiotherapy. Follow-up in all patients continued for at least 3 years or until death. Nineteen patients (33%) developed locally recurrent tumor and five (9%) developed nodal metastases to the neck. The recurrence in almost every patient was detected within 2 years after completion of the irradiation. Thirty patients (52%) are alive of whom 29 have no evidence of disease. Of these 30 patients 22 (73%) have their larynx intact and functioning. The 5-year adjusted acturial survival for the whole group of patients is 73%, for the T3N0 group 87% and for the T4N0 group 75%. Patients with nodal disease responded poorly. After salvage surgery severe postoperative complications developed in 37% of the patients. There were no deaths following salvage surgery.

Adult↗
PubMedDate not supplied

Vertical partial laryngectomy for recurrent glottic carcinoma after irradiation.

Vertical partial laryngectomy after a full course of irradiation was performed in 26 patients as salvage surgery for recurrent or residual glottic carcinoma. An excellent cure rate and conservation of function was obtained, while complications were few. A prerequisite for this type of surgery is a limited extent and infiltration of the recurrent local tumor growth. As the great majority of local recurrence appears within the first 2 years after radiotherapy, frequent follow-up during this period is stressed for early detection of a recurrence.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Detection and characterization of metastatic cervical adenopathy by MR imaging: comparison of different MR techniques.

Thirty-five patients scheduled to undergo a neck dissection for squamous cell carcinoma of the head and neck were evaluated preoperatively by magnetic resonance (MR) imaging. Axial and occasionally sagittal and coronal images were obtained. To define the most reliable technique to detect cervical lymph node metastasis, we compared several MR pulse sequences with and without Gd-DTPA administration to histopathologic findings in the neck dissection specimens. T1-weighted spin echo combined with T2-weighted gradient recalled echo (GE) sequences were found to be more useful than any other combination of pulse sequences in localizing lymph nodes. On T2-weighted GE images, lymph nodes were depicted with intermediate to high signal intensity in contrast to low signal muscular and fatty tissue. Gadolinium DTPA enhanced T1-weighted GE images reliably depict central lymph node necrosis, the most specific criterion for lymph node metastasis.

Adult↗