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PubMed1979

Carcinoma of the lip.

(1) Carcinoma of the lip occurs predominantly in men in their seventh and eighth decades of life. (2) Epidermoid carcinoma is the most common malignant lip tumor. (3) Metastases to cervical lymph nodes are uncommon. (4) Elective neck dissection is not indicated. (5) Therapeutic radical neck dissection can benefit the patient in the presence of proved suprahyoid lymph node metastases. (6) The five year survival rate for epidermoid carcinoma of the lip is higher than the rate for epidermoid carcinoma of other sites in the oral cavity or pharynx. (7) Local recurrence does not correlate with the size of the primary tumor. (8) Initial treatment failures can frequently be salvaged surgically.

Aged↗
PubMed1981

Squamous carcinoma of the base of the tongue: a clinicopathologic study of 81 cases.

Ninety-one patients were treated for squamous cell carcinoma of the base of the tongue between 1960 and 1974. Eighty-one of those patients were treated in a consistent manner, either by radiotherapy alone or preoperative radiotherapy plus total en bloc excision with a radical neck dissection. Eighteen patients were treated by radiotherapy alone (1800-7900 rads) to the primary site and bilaterally to the neck. Fifteen of these patients died within five years. Sixty-three patients were treated with preoperative irradiation (1800-7900 rads) followed by total primary excision with ipsilateral neck dissection. This latter group had a 50% five-year survival. Death due to uncontrolled tumor occurred within five years, whereas death after five years postinitial therapy was due to unrelated reasons. Unfavorable prognostic features were poor differentiation of the tumor, lack of histologic evidence of radiation-induced regression of the tumor, and more than three neck lymph node metastases in the initial neck dissection. Cox regression analysis showed that absence of histologic response to therapy was associated with a failure rate 4.05 times higher than that seen in patients whose tumors did respond. Primary tumor size did not affect prognosis as long as the tumor was technically resectable. Primary recurrences occurred in at least 20% of cases regardless of the presence or absence of surgical margin involvement.

Adult↗
PubMed2002

Supracricoid partial laryngectomy as salvage surgery after radiation failure.

BACKGROUND: Radiotherapy is often chosen as the definitive treatment for early stage laryngeal carcinoma. Total laryngectomy is the main procedure for failures. Endoscopic treatment of recurrences by CO(2) laser has found limited application. Partial laryngectomy through an external approach has been proposed as salvage surgery, and the vertical partial laryngectomy (VPL) is the most mentioned surgical technique in the literature, although there are, to date, very few reports regarding the use of the supracricoid partial laryngectomy (SCPL) as salvage surgery after radiation failure. OBJECTIVES: The aim of the study is to check the feasibility of SCPL with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) in patients with laryngeal recurrence after radiation failure and to evaluate the oncologic results, morbidity, and functional outcome. METHODS: Fifteen consecutive patients were treated with salvage intent by SCPL from January 1992 to December 1998. CHEP and CHP were performed in 11 and 4 patients, respectively. Five patients underwent homolateral surgical neck dissection, and one underwent bilateral neck dissection. All patients had a temporary tracheostomy, and two patients required percutaneous endoscopic gastrostomy (PEG) to ensure feeding. Functional rehabilitation started 2 weeks after the operation. RESULTS: The results have been evaluated in terms of oncologic outcome and functional preservation. Twelve patients are alive with a minimum follow-up of 36 months and 3 patients died after 36 days, 6 and 14 months after surgery, the first and second patient from heart failure and the third from lung metastasis. Respiratory function was recovered in all cases. Oral intake began 12 days after surgery, and in 14 cases satisfactory swallowing was recovered 30 days after surgery. An acceptable quality of the voice was achieved by most patients, and a high rate of local immediate complications was solved in all cases. CONCLUSIONS: SCPL represents an effective technique as salvage treatment of laryngeal cancer after exclusive radiotherapy; there is a good functional recovery with acceptable morbidity and good oncologic long-term control.

Aged↗
PubMed1999

[Neck reoperations in patients with laryngeal, lingual and tonsillar neoplasms].

One of the most common reasons of failure in head and neck cancer treatment are metastases in regional lymph nodes. Preoperative assessment of the neck lymphatic system is an important task, but even more crucial goal is to monitor the patients after initial operation or combined treatment. The frequency of nodal recurrences ranged from 9% to 23%. It constitute nearly 50% of all treatment failures in larynx, tongue and tonsil malignancies. There are different methods of therapy in nodal recurrence treatment, but the most recommended, easily accessible and widely used is surgery. The group of 2134 patients (1580--larynx cancer, 286--tongue and floor of mouth cancer, 268--tonsil cancer) treated between 1987-1997 were operated in ENT Dept. of K. Marcinkowski University of Medical Sciences in Poznań. In 269 patients were detected the nodal recurrence. In 149 cases the recurrence was homolateral, in 48 heterolateral, in 71 patients the neck was not previously treated. 152 patients were irradiated on the neck fields just after primary surgery. The rate of recurrences was 12.6%. Authors analysed and compared the percentage of recurrences for different primary lesions: larynx, tongue and tonsil neoplasms. The period of time from the last control examination to the moment of recurrence detection, its frequency on particular nodal levels, number of recurrences and trends between years 1992-1997 were assessed. 208 patients who developed nodal recurrence had surgical salvage, 59 patients were not qualified to surgery because of the lesion extension. Neck re-operations were divided into 3 main types: selective, modified radical and radical neck dissection. The frequency of particular neck dissection types, curative rates and difficulties of performing the salvage surgery were discussed.

Catchment Area, Health↗
PubMed2000

[Childhood thyroid carcinoma: an analysis of 14 cases].

OBJECTIVE: To reveal the clinical characteristics, causes of misdiagnosis, treatment and prognosis of thyroid carcinoma in children. METHODS: Fourteen patients under 14 years of age with thyroid carcinoma were retrospectively reviewed. RESULTS: According to UICC's clinical and histopathologic classification (1989), there were 12 cases of papillary carcinomas (83.3%), 2 cases of follicular carcinomas (16.7%). All but one case were in stage I. Cervical lymph node metastasis was found in 12 cases (85.7%). Diagnosis was incorrect in 7 cases. All patients were operated, including unilateral neck dissection in 11 and bilateral neck dissection in 2. One patient received palliative subthyroidectomy and postoperative 131I treatment. In the follow-up period of 2 to 13 years (mean 6 years), no patient died. CONCLUSION: Thyroid cancer in children are mostly papillary carcinomas with good prognosis, regardless of high frequency of cervical lymph node metastases. Early cases can be picked up if misdiagnosis be avoided.

Adenoma↗
PubMed1991

Early pharyngolaryngeal carcinomas with palpable nodes. French Head and Neck Study Group (GETTEC).

Three hundred thirteen patients with T1 or T2 tumors of the piriform fossa (n = 181) or epilarynx (n = 132), all with involved nodes (57 N1, 101 N2a, 52 N2b, 25 N2c, 76 N3), were included in a multicenter study. Twenty-one percent were treated with radical neck dissection and radiotherapy to the neck and tumor, 17% by partial laryngeal surgery and radical neck dissection plus postoperative radiotherapy (RT), and 62% by RT only, with surgery in reserve. After treatment, residual tumor was present in 26 patients and residual nodes in 24. Recurrences were local in 27 patients and nodal in 46. Distant metastasis occurred in 28% of the patients. Among 173 patients who died, local failure occurred in 45 (isolated in 20), nodal failure in 70 (isolated in 39), and distant metastasis in 95 (isolated in 68). The median survival was 18 months. The survival rate of the 313 patients was 32% at 3 years and 18% at 5 years, with no difference according to location, protocol, nodal level, or regional nodal status, except for the 76 patients with N3 disease (3-year survival: 17%).

Combined Modality Therapy↗
PubMed2005

[Surgical treatment of postcricoid carcinoma].

OBJECTIVE: To explore the surgical techniques in surgical treatment of postcricoid carcinoma. METHODS: Twenty-one cases with postcricoid carcinoma were treated surgically. The TNM stage were as follows: T3NOM0 5 cases, T3N1M0 1 case, T3N2M0 2 cases, T4NOM0 7 cases, T4N1M0 4 cases, T4N2M0 1 case, T4N3M0 1 case. The laryngeal and pharyngeal functions were rebuilt by the remaining tissue when the lesions entirely removed. Ten cases were surgically treated with laryngeal functions preserved and 11 cases with total laryngectomy. Eight cases were received unilateral neck dissection, and 3 cases were received bilateral neck dissection. All the cases received postoperative radiotherapy. RESULTS: The follow-up interval varied from 60 to 276 months with average interval 96 months. Four cases died of cervical metastasis,3 died of local recurrence, 1 died of cardiopulmonary failure, 2 died of unknown reasons. The overall 3 and 5 year survival rates were 61.9% (13/21) and 52.4% (11/21), respectively. Among 10 cases having laryngeal functions partially restored (voice and deglutition), the postoperative complications included 5 cases of pharyngeal fistula, 3 hypopharyngeal stenosis and 1 severe aspiration. CONCLUSIONS: The preservative surgery is feasible for the selected cases with postcricoid carcinoma. The laryngeal function can be partially restored with lesions entirely removed. The patients can gain satisfied survival rate and quality of life.

Adult↗
PubMed2006

Lymphadenectomy for papillary thyroid cancer: changes in practice over four decades.

AIMS: Lymphadenectomy in the management of papillary thyroid cancer (PTC) has evolved. The aim of this study was to examine the changing role of neck dissection as reflected in the practice of a large thyroid unit over four decades. METHODS: A retrospective cohort study of patients that underwent primary thyroid surgery for papillary cancer in a single unit in the period 1958-2002. Nine 5-year periods were considered and the data relevant to the treatment of the regional lymph nodes reviewed. RESULTS: Nine hundred patients with PTC underwent surgery between 1958 and 2002 of whom 32.7% underwent lymph node dissection (LND). The use of lymphadenectomy increased from 21.4% in 1958-1962 to 48.1% in 1998-2002 of which 84% underwent a selective lymph node dissection (SLND)-a dissection where the LND is determined by the extent of the disease encountered. The mean number of nodes removed during SLND was 12.6 (range 1-56) of which a mean of 3.1 (24.8%) (0-19) were involved by the disease. Cervical levels 6 and level 4 were those most frequently dissected. There was no statistically significant difference in the complication rates in patients undergoing neck dissection and those not. CONCLUSION: The four decade experience reflects a move away from modified radical neck dissection and cherry picking towards SLND. Growing evidence suggests that lymphadenopathy in adult PTC is an adverse prognostic factor. SLND, a lymphadenectomy tailored to the extent of the disease process, is the coherent treatment for PTC since it serves the dual purpose of staging as well as control of local disease. This can be achieved with little morbidity when performed in a specialist centre.

Carcinoma, Papillary↗
PubMed2001

Sentinel node localization in oral cavity and oropharynx squamous cell cancer.

OBJECTIVE: To evaluate the feasibility and predictive ability of the sentinel node localization technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. DESIGN: Prospective, efficacy study comparing the histopathologic status of the sentinel node with that of the remaining neck dissection specimen. SETTING: Tertiary referral center. PATIENTS: Patients with T1 or T2 disease and clinically negative necks were eligible for the study. Nine previously untreated patients with oral cavity or oropharyngeal squamous cell carcinoma were enrolled in the study. INTERVENTIONS: Unfiltered technetium Tc 99m sulfur colloid injections of the primary tumor and lymphoscintigraphy were performed on the day before surgery. Intraoperatively, the sentinel node(s) was localized with a gamma probe and removed after tumor resection and before neck dissection. MAIN OUTCOME MEASURES: The primary outcome was the negative predictive value of the histopathologic status of the sentinel node for predicting cervical metastases. RESULTS: Sentinel nodes were identified in 9 previously untreated patients. In 5 patients, there were no positive nodes. In 4 patients, the sentinel nodes were the only histopathologically positive nodes. In previously untreated patients, the sentinel node technique had a negative predictive value of 100% for cervical metastasis. CONCLUSIONS: Our preliminary investigation shows that sentinel node localization is technically feasible in head and neck surgery and is predictive of cervical metastasis. The sentinel node technique has the potential to decrease the number of neck dissections performed in clinically negative necks, thus reducing the associated morbidity for patients in this group.

Adult↗
PubMed2006

Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer.

OBJECTIVES: Planned neck dissection after chemoradiation (CR) is often advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease who demonstrate a clinical complete response to CR because identification of residual occult nodal disease is difficult. We sought to investigate the utility of positron emission tomography-computed tomography (PET-CT) in identifying patients with occult nodal disease after CR. STUDY DESIGN: Nonrandomized retrospective cohort analysis. MATERIALS AND METHODS: The medical records of all patients treated with primary CR for advanced HNSCC with N2 or N3 disease from December 2003 to June 2005 were reviewed. Patients with a clinical complete response were eligible for inclusion if PET-CT performed at 8 to 10 weeks after CR showed no evidence of distant disease and they were treated with a planned neck dissection. RESULTS: Seventeen patients met study criteria. PET-CT was positive for residual nodal disease in 11 (64.7%) patients, with a standardized uptake value (SUV) range of 1.7 to 3.8. Pathologic examination revealed residual viable carcinoma in five (29.4%) patients, with tumor size ranging from 2.0 to 9.5 mm. Carcinoma was present in 2 of 11 (18.2%) patients with positive PET-CT scans and 3 of 6 (50%) patients with negative PET-CT scans. The sensitivity and specificity of PET-CT in predicting occult nodal disease was 40% and 25%, respectively. There was no correlation between PET-CT findings and histologic findings (P = .26) or between SUV and size of viable tumor (P = .67). CONCLUSIONS: A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET-CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.

Adult↗
PubMed2002

Fine-needle aspiration cytology of the sentinel lymph node in head and neck cancer.

UNLABELLED: In squamous cell carcinoma of the head and neck, staging of the neck cannot rule out occult metastatic disease. An improved staging is necessary to avoid elective neck dissection in patients staged as N0. The study was performed to determine the feasibility of the detection of occult metastatic disease by ultrasound-guided fine-needle aspiration cytology (USgFNAC) of sentinel lymph nodes (SLN). METHODS: Sixteen consecutive patients diagnosed with oral, oropharyngeal, or dermal squamous cell carcinoma who had been staged as N0 underwent lymphoscintigraphy in double tracer technique to localize SLNs. A USgFNAC was performed on SLNs before elective neck dissection. The results of USgFNAC were compared with pathohistologic findings, which were regarded as the gold standard. RESULTS: Seven of 16 patients were upstaged to N+ after histopathologic examination of the neck dissection specimen. In only 1 of these patients was metastatic disease detected by USgFNAC of the SLN. CONCLUSION: The combination of lymphoscintigraphy and USgFNAC of the SLN improves preselection of N+ patients and, thus, the staging procedures. However, based on present results this method does not seem reliable in deciding whether an elective neck dissection can be avoided. A biopsy of the SLN with close histopathologic work-up seems to be mandatory for the detection of occult metastatic disease, because the merely incidental aspiration of micrometastatic material within normal-sized lymph nodes results in a high number of false-negative results by USgFNAC.

Biopsy, Needle↗
PubMed2005

[Clinical research on 2228 cases of thyroid gland tumors].

OBJECTIVE: To discuss outcome of thyroid tumor patients treated with surgery. METHODS: Total number of patients was 2228. These patients of thyroid tumors from 1992-2004 (2072 cases of benign thyroid diseases and 156 cases of thyroid carcinoma) were recruited. The clinical and follow-up datum were retrospective analyzed. RESULTS: (1) Benign thyroid tumors with near-total thyroidectomy including 1761 thyroid adenoma, 207 nodular goiter and 104 Hashimoto thyroiditis, the incidence of recurrent laryngeal nerve paralysis was 0.2%, 55 cases (2.6%) received secondary surgery. All the patients have no hypocalcemia or hemorrhage after operation. (2) Eighty-one cases of papillary carcinoma of the thyroid ( > 1 cm) and 60 cases of microcarcinoma. Unilateral thyroidectomy, contralateral near-total thyroidectomy and ipsilateral modified neck dissection were performed in unilateral papillary carcinoma of thyroid. Among the 9 cases of follicular carcinoma of thyroid, 7 were performed of near-total thyroidectomy without neck dissection, others were the same as papillary carcinoma. Bilateral total thyroidectomy and bilateral modified neck dissection were performed in 2 cases of the medullary thyroid cancer and 1 case of the undifferentiated thyroid cancer. By direct method the 5-year survival was 95.5% (64/67), and by Kaplan-Meier method, it was 98.0%. The treatment of microcarcinoma are multiple. There is no relapse or metastases in 60 cases of papillary thyroid microcarcinoma. The 5-year survival was 100.0%, 1 cases occurred recurrent laryngeal nerve paralysis in thyroid cancer. No hypocalcemia or hemorrhage. Eight case relapsed in 156 cases of thyroid carcinoma,3 cases died. CONCLUSION: The correct surgical management for the patients with thyroid tumor should benefit for the prognosis and reduce the complications and the recurrence of the operation.

Adolescent↗
PubMed2003

Carcinoma of the parotid gland.

BACKGROUND: The low incidence and heterogeneity of histiotypes of primary parotid carcinomas makes these tumors histologically and epidemiologically difficult to evaluate. The present study reviews a single institution's experience in the treatment of primary parotid carcinomas during the last 10 years. METHODS: The charts of 98 consecutive patients who had a primary parotid carcinoma and who received primary curative treatment were analyzed retrospectively. The tumors were grouped into high-grade and low-grade malignancies. The effect of treatment modalities on locoregional control, the incidence of locoregional recurrences and distant metastases, and survival rates are evaluated and compared between high- and low-grade malignancies. RESULTS: High- and low-grade malignant tumors were observed in 50 and 48 cases, respectively. Lymph node metastases were detected in 25 of 98 (25%) patients, of whom 8 of 22 (22%) clinically NO staged patients underwent elective neck dissection. In 24 of 26 resected facial nerves, a histologic tumor infiltration was confirmed, in 14 high-grade and 10 low-grade tumors. Local recurrence developed in 13 patients and was associated in 7 with high-grade and in 6 with low-grade tumors. All but 1 of the low-grade malignancies with local recurrence did not receive postoperative irradiation. Regional recurrence developed in 11 patients and distant metastases developed in 10, 3 in combination with a neck recurrence and 1 with a local recurrence. The survival rate at 5 years for low- and high-grade carcinomas was 87% and 56% and the disease-free survival rate 72% and 48%, respectively. CONCLUSIONS: The incidence of occult metastases in clinically N0-elective neck dissection was 22%. A routine elective neck dissection in all N0 parotid carcinomas is suggested. There is no statistically significant difference between low- and high-grade tumors as for the rate of local recurrence and, as all except one of the low-grade malignancies with local recurrence did not receive postoperative irradiation, postoperative irradiation is not only suggested for high-grade carcinomas but also for T2 to T4 low-grade carcinomas.

Adolescent↗
PubMed1984

Combined surgery and postoperative irradiation in the treatment of cervical lymph nodes.

One hundred seventy-three patients with squamous carcinomas of the laryngopharynx, oral cavity, and oropharynx received planned, combined resection of the primary neoplasm and radical neck dissection (when N1, N2, or N3 lymphadenopathy was present) followed by megavoltage irradiation to the primary sites and bilateral cervical regions between 1975 and 1982. Radical neck dissections were performed in all patients with N2 and N3 cervical lymphadenopathy, in 90% of those with N1 necks, but in only 4% whose necks were staged NO. Neck failures occurred in 10%, 22%, 19%, and 38% of patients with stages N0, N1, N2, and N3 necks, respectively. The most ominous pathologic feature was soft-tissue extension in the radical neck dissection specimen. Initially clinically benign contralateral lymph nodes became involved in only 9% of these patients.

Carcinoma, Squamous Cell↗
PubMed1995

Accuracy of intraoperative staging of the NO neck in squamous cell carcinoma.

Management of the neck in squamous cell carcinoma of the upper aerodigestive tract continues to be a topic of great debate. One major problem is that incorrect clinical staging is expected in approximately 20% of necks. This is true of both clinical stage NO and N+ necks, even when imaging studies are used. This prospective study of 108 necks in 79 patients examined the role of intraoperative palpation and inspection in improving the surgeon's ability to predict nodal stage. Of 62 patients with NO necks clinically on both sides, 26 were staged N+ by intraoperative node examination. Nineteen of the 26 were histologically negative (73% false-positive). Of the 36 patients staged intraoperatively as NO, 10 were histologically positive (28% false-negative). Of 108 necks judged clinically to be NO, 25 (23%) had occult metastases and 11 (10%) had extracapsular spread. Forty-one of 108 clinical NO necks were believed to have positive nodes at the time of neck dissection. Of these 41 necks, 30 (73%) were found to be histologically NO (false-positive). Of the 67 clinical NO necks that were also believed to be NO intraoperatively, occult metastases were found in 14 (21% false-negative). Therefore, intraoperative staging did not significantly improve the false-negative rate. Frozen-section biopsy obtained in the operating room was reliable in 24 (92.3%) of 26 patients. Although frozen-section biopsy was not performed in all patients, these data suggest that upstaging the neck without frozen-section biopsy is much less reliable. This study supports the use of frozen-section biopsy before converting the selective dissection to a radical or modified neck dissection in most instances.

Biopsy↗
PubMed1997

Near-total laryngectomy for treatment of advanced laryngeal cancer.

BACKGROUND: In order to assess whether near-total laryngectomy (NTL) could successfully reach the cure and preserve the voice in advanced laryngeal cancer, we studied 28 patients with T3/T4 squamous cell carcinoma of the larynx treated with NTL in our institution. METHODS: A retrospective analysis has been carried out from 1990 through 1994. We classified 24 patients as Stage III and 4 patients as Stage IV. All patients had lateral neck dissection. Survival was analyzed under the Kaplan-Meier method. RESULTS: Twenty-six patients achieved voice preservation. Two patients in the bilateral neck dissection group had a metastatic lymph node on the opposite side. No patient had local recurrence. Three patients died of the disease, and 1 patient was salvaged with neck dissection. Three-year disease-free survival was 85%. CONCLUSION: This technique is useful in the treatment of selected cases of advanced laryngeal cancer and achieves local control of the lesion in all cases. The survival is comparable with that of patients submitted to total laryngectomy, regarding the extent of lesion. Voice preservation can be achieved in most cases.

Actuarial Analysis↗
PubMed1995

[Lymphatic system--topographic and functional considerations contributing to complications in neck surgery].

During neck surgery some complications can involve the lymphatic system as well. The injury of the thoracic duct is the most important. A case of chylorrhoea after left radical neck dissection, which had been done by reason of metastases of larynx carcinoma, is reported. Chylorrhoea had yielded after underpin and ligation of the thoracic duct. Four weeks after radical neck dissection extensive tumor in postoperative scar had been found, and two weeks later numerous tumors in scar, on the neck, chin, face and chest had appeared. Patient had died ten weeks after neck dissection among the symptoms of cancerous cachexia.

Chylothorax↗
PubMed2006

Does clinical and radiological response predict complete tumor control in N2-N3 squamous cell head and neck cancer after non-operative management of the neck?

CONCLUSION: A complete clinical and radiological response observed following chemotherapy and radiotherapy is not predictive of the absence of residual disease. Moreover, salvage neck surgery does not always seem to be an effective strategy. Consequently, early neck dissection should be advised for patients with complete clinical and radiological response (CCRR) after chemoradiotherapy for tumors with N2-N3 disease. BACKGROUND: We retrospectively reviewed the outcome of 28 patients with N2-N3 disease treated initially with chemotherapy and radiotherapy. PATIENTS AND METHODS: A neck dissection was performed for all patients with residual disease in the neck. RESULTS: A CCRR in the neck was achieved in 25 of 28 patients. The remaining three patients with residual neck mass underwent a salvage neck dissection: the pathological examination confirmed the persistence of tumoral disease. No regional failure was observed in these three patients. In 25 patients considered to have CCRR in the neck, 5 patients (20%) developed regional recurrence. Successful salvage approach was not possible for any of these patients.

Adult↗