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Biomedical subjects

H Laccourreye

Publications and source records attributed to H Laccourreye.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Inoperable tracheal and cricoid-tracheal stenoses. Results of laser therapy and prolonged calibration].

Palliative desobstruction was performed with laser and a Montgomery T tube in 11 patients with tracheal or cricotracheal stenosis. Surgery was theoretically indicated for these long thick stenotic areas with underlying diseased cartilage but could not be performed due to the poor clinical status of the patients or recurrence after anastomosis. Calibration with the Montgomery T tube was maintained for a mean of 5 years. The T tube was removed in 3 patients and was well tolerated in 4. Two patients died during the course of the study and two others required a definitive tracheotomy. Palliative treatment with Laser desobstruction and long-term calibration can be a useful alternative to conventional surgery.

Adult↗
PubMed1995

[Dysfunction of the facial nerve following total conservative parotidectomy for pleomorphic adenoma].

Two hundred and forty seven previously untreated pleomorphic adenoma of the parotid gland were operated with a total conservative parotidectomy between 1965 and 1992. The overall incidence for temporary facial nerve paresis and paralysis was 63.1% and 5.2%, respectively. None of the following variables sex, age, tumor size, tumor location, tumor contact with the facial nerve, degeneration of the pleomorphic adenoma, inadvertent tumor spillage, use of Surgical, and postoperative hematoma were statistically related to facial nerve dysfunction. Kaplan-Meier actuarial analysis demonstrated that facial nerve dysfunction recovery was noted until the 18th postoperative month. The use of the linear regression model with Pearson correlation underscores that the recovery time of facial nerve function significantly statistically increased with the patient's age (p = .0017). The overall incidence for permanent facial paresis and paralysis was 3.6% and 0%, respectively. Implications of these findings are discussed together with a review of the medical literature.

Adenoma, Pleomorphic↗
PubMed1994

A clinical trial of continuous cisplatin-fluorouracil induction chemotherapy and supracricoid partial laryngectomy for glottic carcinoma classified as T2.

BACKGROUND: Vertical partial laryngectomy (VPL) and radiation therapy (RT) are the recommended conventional conservative options for glottic carcinoma classified as T2. In series presenting more than 100 patients with a minimum 3-year follow-up, however, local recurrence rates were reported as 22-43.5%. The authors' experience with a new strategy based on continuous cisplatin-fluorouracil induction chemotherapy (IC) and supracricoid partial laryngectomy with cricohyoepiglottopexy (CHEP) is presented. METHODS: A retrospective analysis of 67 patients who presented with untreated moderately to well differentiated invasive glottic carcinoma classified as T2, managed from 1983 to 1991 with IC and CHEP, was conducted. Statistical analysis of survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors and survival, local recurrence, and nodal recurrence. Clinical response, histologic response, IC toxicity and postoperative course were reported. RESULTS: The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate were 92.3%, 5.6%, 1.5%, 1.8%, and 5.6%, respectively. Overall laryngeal preservation was achieved in 65 patients (97%). Ultimate local control was achieved in all patients but one. Nodal recurrence was statistically more likely in patients presenting with a local recurrence. Analysis of the specimens demonstrated complete histologic response to IC in 25 (37.3%) patients. A strong statistical relation (P < 0.0001) was noted between complete clinical response after IC and complete histologic response. CONCLUSIONS: The change from the prevailing treatment modalities of RT and VPL to a new multimodal strategy (IC+CHEP) did not decrease survival and allowed for an increase in laryngeal preservation rate. The high rate (37.3%) of complete histologic response suggests that IC deserves further consideration in the management of patients with glottic carcinoma classified as T2. The favorable results achieved in this series, when compared with historic controls, should stimulate prospective clinical trials comparing the two surgical procedures (CHEP vs. VPL with or without IC) for resection of Stage II glottic carcinoma.

Adult↗
PubMed1994

Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients.

A 25-year experience with total conservative parotidectomy for primary benign pleomorphic adenoma (PBPA) of the parotid gland in a consecutive series of 229 patients has been reviewed. This study focuses on survival, morbidity, PBPA recurrence, postoperative facial nerve dysfunction, and Frey's syndrome. Surgical death was never encountered in this study. The overall incidence for postoperative hemorrhage, hematoma, seroma, skin necrosis, great auricular nerve schwannoma, and keloid scar was 1.7%, 6.1%, 4.8%, 0.9%, 15.7%, and 8.3%, respectively. Five-, 10-, 15-, and 20-year PBPA control actuarial rate was 99.6%. The overall incidence for temporary facial paresis and paralysis was 64.6% and 5.6%, respectively. Kaplan-Meier actuarial analysis demonstrated that paresis recovery was noted until the eighteenth postoperative month. The overall incidence for permanent facial paresis and paralysis was 3.9% and 0%, respectively. None of the following variables--sex, age, PBPA size, PBPA location, PBPA contact with the facial nerve, inadvertent PBPA spillage, or surgeon's experience--was statistically related to PBPA recurrence and facial nerve dysfunction. The overall incidence for Frey's syndrome was 65.9%. Kaplan-Meier actuarial analysis demonstrated the need for a minimal 5-year follow-up to assess Frey's syndrome incidence. The mean age was statistically lower in patients presenting with Frey's syndrome.

Adenoma, Pleomorphic↗
PubMed1994

Extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy.

Extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy (TCHEP) was studied as an alternative to total laryngectomy in 16 patients with glottic carcinoma presenting a 10-15 mm of anterior subglottic extent. The technique of the procedure is described. Results were analyzed for tumor free margins, tracheostomy decannulation, oral alimentation, phonation and disease free interval. The 3-year survival and local control rate were 68% and 86.7%, respectively. Our preliminary data suggest that the TCHEP procedure is a viable alternative to total laryngectomy for patients presenting with varying degrees of carcinoma extension below the free edge of the true vocal cords.

Adult↗
PubMed1994

[Inverted nasosinusal papilloma and lateronasal rhinotomy].

The authors report about 18 cases of inverting papillomas treated between 1972 and 1992. (17 men and 1 woman). The minimum follow-up was of 30 months. The mean age was 55 years with ages ranging from 26 to 85 years. The most frequent symptom encountered was unilateral nasal obstruction. A synchronous carcinoma occurred in 2 patients. Treatment was always surgical: lateral rhinotomy and total ethmoidectomy. A local recurrence occurred in 1 on 16 benign inverting papillomas (6.2%). No local recurrence occurred in malignant inverting papillomas treated by surgery and followed by postoperative radiation. A metachronous malignant papilloma never occurred. Because of the high risk of recurrence and malignant transformation and after analyzing the literature, the authors recommend a lateral rhinotomy and total ethmoidectomy with as limited after effects as possible.

Adult↗
PubMed1994

[Cisplatin-fluorouracil chemotherapy in epidermoid cancers of glottic origin staged as T2].

A retrospective analysis of 94 patients presenting well-differentiated untreated invasive glottic squamous cell carcinomas, staged as T2 according to the 1987 Union Internationale contre le Cancer staging classification system, managed at our institution from March 1982 to April 1991 with cisplatin-fluorouracil neo-adjuvant chemotherapy, was conducted. Following neo-adjuvant chemotherapy, partial laryngeal surgery, and radiation therapy were performed in 85.1% (80/94) and 4.2% (3/94) of cases, respectively. Perioperative chemotherapy (fluorouracil) and postoperative chemotherapy (cisplatin-fluorouracil) was performed in 68.7% (55/80) and 63.7% (51/80) of patients who underwent surgery, respectively. Following neoadjuvant chemotherapy, one patient (1.1%) refused any form of treatment, and "exclusive" chemotherapy was performed in 9.6% (9/94) of cases. A 3-year follow-up was always achieved and 66 patients (70.2%) presented with a 5-year follow-up. A complete clinical response was achieved in 32.9% of cases following neo-adjuvant chemotherapy. A complete histological response was noted in 31.2% (25/80) of patients treated with partial laryngeal surgery following neo-adjuvant chemotherapy. A strong statistical relation was noted between complete clinical response and complete histological response (p < .0001). Chemotherapy related death never occurred in our series however chemotherapy related toxicity lead to reduction in the drug dosages and chemotherapy arrest in 14.3% and 3.6% of cases, respectively. The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary estimate was 84.9%, 8.4%, 1.1%, 2.2%, and 10%, respectively. The overall local recurrence rate varied from 25% following neo-adjuvant chemotherapy and radiotherapy, to 33.3% following "exclusive" chemotherapy, and 3.7% following neo-adjuvant chemotherapy and partial laryngeal surgery. Overall local control and laryngeal preservation was achieved in 98.9% and 97.8% of patients respectively. Our data suggests that the use of neo-adjuvant cisplatin-fluorouracil induction chemotherapy deserves further consideration in the management of glottic carcinomas staged as T2.

Adult↗
PubMed1994

[Malignant transformation of inverted papilloma of the nasal sinuses.. Apropos of a series of 7 cases].

Seven cases of malignant inverting papillomas are presented (6 men and 1 woman) with ages ranging from 31 to 72 years (mean age: 58 years); the minimum follow up was 37 months. The diagnosis was based on the histopathologic analysis of biopsy in five patients. In two patients the diagnosis was confirmed by the pathological analysis of the specimen. Treatment was always surgical: lateral rhinotomy and total ethmoidectomy. Neoadjuvant chemotherapy was given to four patients. Post operative radiation therapy was delivered in five patients. Five patients on seven died: local recurrence and systemic metastases: 3; systemic metastases: 1; second primary: 1. Reports from the literature are discussed. The authors emphasize the treatment modalities based on complete tumor removal through lateral rhinotomy.

Adult↗
PubMed1993

Cricohyoidopexy in selected infrahyoid epiglottic carcinomas presenting with pathological preepiglottic space invasion.

Nineteen patients who presented with infrahyoid epiglottic squamous cell carcinoma with gross pathological preepiglottic space invasion, not amenable to a partial horizontal supraglottic laryngectomy, were offered a supracricoid partial laryngectomy with a cricohyoidopexy technique; this was an attempt to preserve physiological phonation, respiration, and deglutition while achieving the same local control rate as with a total laryngectomy. Preoperative chemotherapy and bilateral jugulocarotid lymph node dissection were performed in all cases. Patients were monitored for at least 5 years or until death. No patients were unavailable for follow-up. The 5-year actuarial survival (Kaplan-Meier method) was 84.2%. Local recurrence, nodal recurrence, and distant metastasis occurred once in our series, while six patients presented with a second primary tumor. We present, analyze, and compare functional results with those of the previously reported series. Our experience with the supracricoid partial laryngectomy with a cricohyoidopexy, in the face of selected infrahyoid epiglottic squamous cell carcinoma invading the preepiglottic space, not amenable to a partial horizontal supraglottic laryngectomy, suggested that a total laryngectomy might be avoided without decreasing the cure rate.

Adult↗
PubMed1993

Supracricoid hemilaryngopharyngectomy in selected pyriform sinus carcinoma staged as T2.

From 1964 to 1985 supracricoid hemilaryngopharyngectomy (SCHLP) was performed at the authors' institution for 34 selected pyriform sinus carcinomas staged as T2. Tumors involved the anterior part of the pyriform sinus, the lateral wall, the medial wall, and the whole aryepiglottic fold in all cases. Tumors with invasion of the apex of the pyriform sinus, of the retrocricoid region, of the posterior pharyngeal wall, or with fixation of the true vocal cord were excluded from the study. Such a technique was aimed at preserving physiologic phonation, respiration, and swallowing while achieving the same local control rate as pharyngolaryngectomy. Patients were monitored for at least 6 years or until death. No patients were lost to follow-up. The 5-year cause-specific survival rate was 55.8%. The main cause of death was second primary tumor. The 5-year actuarial local recurrence rate was 3.4%. The authors' experience with the SCHLP technique challenges the traditional teaching of pharyngolaryngectomy and establishes this technique as a safe method of voice preservation in selected cases of pyriform sinus carcinomas.

Adult↗
PubMed1993

[Partial surgery of epitheliomas at the level of the glottis. An update].

Seven hundred and thirty three patients with glottic squamous cell carcinoma were treated with partial laryngeal surgery at our institution over a sixteen years period of time. Three hundred and ninety four patients were operated from 1972 through 1980 and three hundred and thirty three from 1980 through 1988. This retrospective study analyse local failure according to the surgical technique performed. Surgical technique was either a thyrotomy, a vertical partial laryngectomy or a supracricoid laryngectomy with cricohyoidoepiglottopexy. Among the 394 patients treated from 1972 through 1980, local failure was reported according to the T stage, the precise tumor location within each stage, the true vocal cord mobility and the surgical procedures. There was a diverse group of lesions within each T stage that responded differently to the surgical approaches. The differences in the local recurrence rates are discussed in terms of careful preoperative assessment and choice of surgical technique. This study support the premise that the choice of the surgical technique requires accurate preoperative assessment of tumor extend and laryngeal mobilities.

Carcinoma↗
PubMed1993

[Laryngostroboscopy].

Videostroboscopy has become an essential examination for the assessment of vocal function. The authors describe and review the development of this technique with an analysis and discussion of its indications and results.

Fiber Optic Technology↗
PubMed1993

[Conservative surgery of the larynx as an alternative to total laryngectomy after neoadjuvant chemotherapy. Initial results].

A retrospective study of 149 squamous cell carcinomas of the larynx and epilarynx in whom a total laryngectomy was initially planned is reported. All the patients were treated by neoadjuvant chemotherapy. After completion of chemotherapy, the initially planned therapeutic protocol was modified in 56 patients (37.6%) in order to preserve the laryngeal physiologic functions. A total laryngectomy was performed in 23 patients (41%), radiation therapy was administered to 14 (25%) patients chemotherapy was prolonged in 15 patients (26.8%) and four deaths were related to chemotherapy toxicity (7.2%). Actuarial survival of patients treated by partial laryngectomy was statistically higher than survivals of patients treated either by radiation therapy or prolonged chemotherapy. After completion of neoadjuvant therapy patients who refused a total laryngectomy had the worst survival of the series. These results suggest that surgery of the residual tumor (partial laryngectomy) after neoadjuvant chemotherapy could be indicated for selected laryngeal carcinoma in whom a total laryngectomy was initially planned.

Actuarial Analysis↗
PubMed1992

T1 squamous cell carcinoma of the arytenoid.

Twenty-two cases of early squamous cell carcinoma of the arytenoid cartilage staged as T1 according to the 1983 American Joint Committee for Cancer Staging Classification system were reviewed. Eighteen percent of the patients showed no symptoms. In the remaining 82%, the main presenting symptom was pain in the form of sore throat, odynophagia, or otalgia. Radiotherapy and partial laryngeal surgery were the options retained for the treatment of the larynx. A "watch and wait" policy or preventive treatment of the ipsilateral jugulocarotid lymph nodes were the treatment options retained for the neck. Significant differences were noted in terms of local and nodal recurrence between the two programs. Results indicate that partial laryngeal surgery with total arytenoidectomy and preventive treatment of the neck appear to be advisable for this particular type of primary lesion.

Adult↗
PubMed1992

[Partial posterior cordectomy with laser CO2 in bilateral recurrent paralysis].

Thirteen patients with bilateral vocal cord abductor paralysis were treated by Carbon Dioxide Laser Posterior Cordectomy. 6 out of 7 patients were decannulated. 92% of patients recovered a physiologic respiration. Advantages of this surgical technique are discussed in comparison with Endoscopic Laser Arytenoidectomy.

Adult↗
PubMed1992

[Stage T1 malignant tumors of the arythenoid. Analysis of a series of 26 cases].

26 malignant tumours of the arytenoid classified as T1 according to the UICC 1987, were treated in the ENT and Cervico-Facial Surgery wards to Hospital Laennec between 1961 and 1990. The natural history of these lesions, locoregional efficiency of the different treatments used, the part played by chemotherapy, survival, causes of death and therapeutic modalities used as a last measure, have been analysed. The frequency of tumours with neuroendocrine has been emphasized. Such a diagnosis should be questioned when the initial biopsy does not diagnose a well differentiated epidermoid carcinoma. The use of argyrophil colouring in order to find neurosecretive granules helps in carrying out the diagnosis. The treatment of tumours, classed T1 N0 M0, of the arytenoid, is based on partial, laryngeal surgery associated with a preventive, jugulo-carotidian-ipsilateral ganglionary intervention.

Actuarial Analysis↗