Recipient vessels for free flaps in advanced facial oncologic defects

Abstract Objectives To prospectively compare the results of microvascular flap reconstruction of midface and scalp advanced oncologic defects using superficial temporal versus cervical as recipient vessels. Methods This is a parallel group clinical trial with 1:1 allocation ratio of patients who underwent midface and scalp oncologic reconstruction with free tissue flap from April 2018 to April 2022 in a tertiary oncologic center. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels (Group A) and those in whom cervical vessels were used as the recipient vessels (Group B). Patient gender and age, cause and localization of the defect, flap choice for reconstruction, recipient vessels, intraoperative outcome, postoperative course, and complications were recorded and analyzed. A Fisher's exact test was used to compare outcomes between the 2 groups. Results On the basis of the different recipient vessels, 32 patients were randomized into 2 groups, and of these 27 patients completed the study: Group A with superficial temporal recipient vessels (n = 12) and Group B with cervical recipient vessels (n = 15). There were 18 male and 09 female patients with an average age of 53.92 ± 17.49 years. The overall flap survival rate was 88.89%. The overall complication rate for vascular anastomosis was 14.81%. The total flap loss rate in patients with superficial temporal recipient vessels was higher than the complication rate in those with cervical recipient vessels but with no statistical significance (16.67% vs. 6.66%, p= 0.569). Minor complications occurred in 05 patients without statistical significance between the groups (p= 0.342). Conclusion In the group with superficial temporal recipient vessels, the postoperative rate of free flap complications was similar than the cervical recipient vessel group. Therefore the use of superficial temporal recipient vessels for midface and scalp oncologic reconstruction could be a reliable option.

The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma / Impacto da biópsia do linfonodo sentinela na qualidade de vida em pacientes com carcinoma espinocelular da cavidade oral

Abstract Introduction Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown. Objective The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection. Methods Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire. Results The evaluation of the questionnaires showed a late worsening of the domains appearance (p = 0.035) and chewing (p = 0.041), as well as a decrease of about 10% of general quality of life (p = 0.025) in patients undergoing selective neck dissection ​​in comparison to those undergoing sentinel lymph node biopsy. Conclusion Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.

Resumo Introdução A biópsia de linfonodo sentinela é um método comprovado para estadiamento cervical em pacientes com carcinoma espinocelular inicial da cavidade oral, porque apresenta menor taxa de morbidade do que o método tradicional de esvaziamento cervical seletivo, com os mesmos resultados oncológicos. Porém, o verdadeiro efeito desse método na qualidade de vida desses pacientes permanece desconhecido. Objetivo Avaliar a qualidade de vida de pacientes com carcinoma espinocelular de cavidade oral T1/T2N0 submetidos a biópsia do linfonodo sentinela em comparação aos pacientes nos quais o esvaziamento cervical seletivo foi feito. Método Estudo transversal que incluiu 24 pacientes, após 36 meses de seguimento, dos quais 15 foram submetidos a biópsia do linfonodo sentinela e nove a esvaziamento cervical seletivo. Todos os pacientes responderam ao questionário de qualidade de vida da University of Washington. Resultados A avaliação dos questionários evidenciou pioria tardia dos domínios aparência (p = 0,035) e mastigação (p = 0,041), bem como diminuição de cerca de 10% da qualidade de vida geral (p = 0,025) nos pacientes submetidos a esvaziamento cervical seletivo em comparação com aqueles submetidos a biópsia do linfonodo sentinela. Conclusão Pacientes com carcinoma espinocelular de cavidade oral em estágio inicial submetidos a biópsia do linfonodo sentinela apresentaram melhores resultados tardios de qualidade de vida geral, principalmente quanto à aparência e à mastigação, quando comparados aos pacientes submetidos a esvaziamento cervical seletivo.

Short-term survival in extensive craniofacial resections

OBJECTIVES: Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (±18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

Thyroid cancer surgical indication during pregnancy: systematic literature review and series of illustrative cases

Introduction: Thyroid papillary carcinoma is the second most frequent type of cancer during pregnancy. Its diagnosis is related to patient fear and anxiety. There is little consensus on when to perform surgery in those cases. Objective: To evaluate and discuss timing possibilities for surgical treatment in thyroid cancer in pregnant women. Methods: Systematic literature review based on online search at the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and National Center for Biotechnology Information (NCBI) databases. Retrospective analysis of thyroidectomies performed in the second trimester of pregnancy by the authors between 1999 and 2019. Results: The systematic review included nine articles. Their conclusions diverge with respect to the optimal timing of thyroid surgery. The medical literature considers thyroidectomy after safe delivery. The most recent studies are more flexible regarding carrying out this surgery during the second trimester of pregnancy. In the authors' experience (n=5), surgical treatment during the second trimester of pregnancy is a good option for more aggressive tumors. Conclusion: More aggressive cases of thyroid papillary carcinoma can be treated with surgery during the second trimester of pregnancy. Performing the surgery after delivery is safer in the case of less aggressive cancer cases. The decision should consider hospital costs, surgery risks, and patient anxiety in relation to cancer.

Supratracheal laryngectomy: a multi-institutional study / Laringectomia supratraqueal: um estudo multi-institucional

Abstract Introduction: Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective: To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods: This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results: Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. Conclusion: Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.

Resumo Introdução: A laringectomia supratraqueal tem sido descrita como um procedimento cirúrgico com objetivo de preservar a função da laringe (respiração, fonação e deglutição), sem prejuízo no controle oncológico locorregional, para câncer glótico ou supraglótico com extensão à subglote e/ou envolvimento da articulação cricoaritenóidea. A opção pela laringectomia supracricoide nesses casos poderia resultar em grande risco para margens de ressecção comprometidas. Objetivo: Determinar a segurança, viabilidade, adequação das margens cirúrgicas e os resultados da laringectomia supratraqueal para o câncer de laringe intermediário e avançado através da revisão dos resultados de três instituições distintas no Brasil. Método: Estudo retrospectivo, com análise dos prontuários de 29 pacientes submetidos à laringectomia supratraqueal, de outubro de 1997 a junho de 2017. O tipo de laringectomia realizada foi classificado de acordo com a classificação da Sociedade Laringológica Europeia para laringectomias horizontais. Foram avaliados os resultados precoces e tardios. As taxas de sobrevida (global, específica, livre de doença e livre de laringectomia total) foram calculadas. O tempo médio de seguimento foi 44 meses. Resultados: Dos 29 pacientes submetidos à laringectomia supratraqueal, 25 não tinham tratamento prévio. Um paciente (3,4%) teve margens comprometidas. Quatro pacientes (13,8%) recidivaram. Desses, três tiveram recidiva local e um apresentou recidiva regional. Cinco pacientes (17,2%) necessitaram de totalização da laringectomia, duas por ruptura da pexia e três por recidiva local. Quatro desses pacientes (80%) obtiveram sucesso na totalização. Quatro pacientes (13,8%) foram a óbito, dois por complicações pós-cirúrgicas e dois por recidiva. As sobrevidas global, específica, livre de doença e livre de laringectomia total em 5 anos foram, respectivamente, 82,1%; 88,2%; 83,0% e 80,2%. Conclusão: Pacientes selecionados com câncer intermediário e avançado de laringe podem ser beneficiados com laringectomia supratraqueal, que ofereceu sobrevida livre de laringectomia total e sobrevida específica de 80,2% e 88,2%, respectivamente.

Invasión ósea del carcinoma de células escamosas de la cavidad oral, análisis clínico - patológico de 62 casos / Bone invasion of squamous cell carcinoma of the oral cavity, clinical-pathological analysis of 62 cases

RESUMEN Introducción: El pronóstico de pacientes con carcinoma de células escamosas (CEC) de la cavidad oral con presencia de invasión ósea continua sombrío. El patrón de invasión ósea puede ser usado como indicador de agresividad y correlacionado con el comportamiento clínico del tumor. Objetivo: Evaluar los patrones histopatológicos de invasión ósea en pacientes con CEC de la cavidad oral y correlacionarlos con la tasa de sobrevida. Materiales y métodos: La muestra fue constituida por 62 pacientes con presencia de CEC en la cavidad oral e invasión ósea. Las características epidemiológicas e histopatológicas fueron tabuladas y analizadas. Los Test Chi- cuadrado y exacto de Fischer fueron empleados para verificar las asociaciones estadísticas entre los datos. Resultados: Fueron afectados más hombres en la quinta década de vida y observada una fuerte asociación con tabaquismo y etilismo crónico. Fueron relatadas muertes en 58% de los pacientes, en un periodo de 5 años. El patrón histológico más prevalente fue el infiltrativo, asociado a menores tasas de sobrevida. Conclusión: El análisis del patrón histopatológico de los CEC de la cavidad oral, puede ser usado como factor pronóstico auxiliando en la decisión del abordaje del tratamiento oncológico.

SUMMARY Introduction: Prognosis for patients with squamous cell carcinoma (SCC) in oral cavity with bone invasion presence is concerning. Bone invasion patterns can be used to indicate aggressiveness and can be correlated with tumor clinical behavior. Objective: To evaluate bone invasion histopathological patterns in patients with oral cavity SCC and correlate them with the survival rate. Materials and methods: 62 patients with presence of SCC in the oral cavity as well as bone invasion were recruited for this study. Epidemiological and histopathological characteristics were tabulated and analyzed. Fischer's Square and Exact Tests were used to verify any statistical associations between the data. Results: More men were affected, especially in the fifth decade of life, and a strong association with smoking and chronic alcoholism was observed. Deaths were reported in 58% of patients, over a period of 5 years. The most prevalent histological pattern was the infiltrative, associated with lower survival rates. Conclusion: An analysis of the histopathological patterns of oral cavity SCC can be used as a prognostic factor thereby assisting with the decision of which oncological treatment approach to use.

Evaluation of lung function in patients submitted to total laryngectomy / Avaliação da função pulmonar em pacientes submetidos à laringectomia total

Abstract Introduction: The post-laryngectomy state is characterized by several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment. Objective: Characterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device. Methods: This transversal study included 50 patients submitted to total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer. Results: 56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals. Conclusion: Most patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.

Resumo Introdução: A condição pós-laringectomia é caracterizada por várias alterações na função pulmonar. Uma estimativa confiável da função pulmonar pode ser muito útil em pacientes laringectomizados para prevenir complicações após as intervenções cirúrgicas e avaliar os resultados do tratamento. Objetivo: Caracterizar a presença de distúrbios funcionais respiratórios e o padrão funcional de pacientes laringectomizados através do uso de um dispositivo extratraqueal. Método: Estudo transversal que incluiu 50 pacientes submetidos à laringectomia total pelo menos seis meses antes desta investigação, como tratamento de escolha para o câncer de laringe. Resultados: Dos participantes, 56% apresentavam padrão respiratório alterado, assim distribuídos: 14 com padrão obstrutivo sem aprisionamento aéreo, 11 com padrão obstrutivo e aprisionamento aéreo e apenas três com padrão restritivo. Em média, verificou-se que a difusão encontrava-se diminuída (74,3%) e a resistência das vias aéreas aumentada (121,7%) em relação aos resultados esperados em brasileiros. Conclusão: A maioria dos pacientes submetidos à laringectomia total apresenta função pulmonar alterada, do tipo obstrutiva, quase sempre associada a história de tabagismo.

Superficial cervical plexus blockade improves pain control after thyroidectomy: A randomized controlled trial

OJECTIVES: The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS: In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS: The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS: The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.

Assessment of quality of life in patients with advanced oral cancer who underwent mandibulectomy with or without bone reconstruction

INTRODUCTION Malignant neoplasms of the head and neck, due to its anatomical location, can cause significant alterations in vital functions related to feeding, communication and social interaction of the affected patients. Objective To analyze the quality of life of patients with advanced malignant neoplasms of the oral cavity and submitted to radical operations with curative intent. Material and methods 47 patients with oral cavity squamous cell carcinoma (SCC), in stages III and IV, underwent surgical treatment with segmental mandibulectomy and complementary radiotherapy. The patients were submitted to the quality of life questionnaires after a minimum time of six months after the surgical treatment. Results Of the 183 patients, only 47 (25.7%) were able to answer the questionnaire and were included as the sample of the study. The majority of patients selected were male (39; 82.9%). The mean age was 64.4 years. The majority of the patients presented clinical stage IV (83%) and were submitted to adjuvant radiotherapy (95.4%). The mean score obtained after the questionnaires were applied was 64.6. The worst scores were found in swallowing and chewing. Conclusion There were no statistically significant differences in the domains of quality of life between the two groups studied (with bone reconstruction versus no bone reconstruction). Patients interviewed 2 years or more after treatment presented higher scores (p = 0.02).

RESUMO INTRODUÇÃO As neoplasias malignas de cabeça e pescoço, pela própria localização anatômica, podem acarretar alterações significativas em funções vitais relacionadas à alimentação, comunicação e interação social dos indivíduos afetados. OBJETIVO Analisar a qualidade de vida dos pacientes com neoplasias malignas avançadas de cavidade oral, submetidos a operações radicais com intenção curativa. MATERIAL E MÉTODOS 47 pacientes portadores de carcinoma espinocelular de cavidade oral, em estádios III e IV, foram submetidos ao tratamento cirúrgico com mandibulectomia segmentar e radioterapia complementar. Os pacientes foram submetidos ao teste de qualidade de vida após o tempo mínimo de seis meses do tratamento cirúrgico. RESULTADOS Dos 183 pacientes, com apenas 47 (25,7%) foi possível a realização da entrevista, compondo estes a amostra para o estudo. A maioria dos pacientes do grupo selecionado era do sexo masculino, total de 39 homens (82,9%). A idade média foi de 64,4 anos. A maioria dos pacientes apresentava estadiamento clínico IV (83%), sendo submetidos à radioterapia adjuvante (95,4%). A média do escore obtido após a avaliação dos questionários foi de 64,6. Os piores escores foram encontrados nos quesitos deglutição e mastigação. CONCLUSÃO Não houve diferenças estatisticamente significativas nos domínios de qualidade de vida entre os dois grupos estudados (com reconstrução óssea versus sem reconstrução óssea). Pacientes entrevistados dois anos ou mais após o tratamento apresentaram escores superiores (p=0,02).

Supracricoid Laryngectomy: The Function of the Remaining Arytenoid in Voice and Swallowing

Abstract Introduction Supracricoid laryngectomy still has selected indications; there are few studies in the literature, and the case series are limited, a fact that stimulates the development of new studies to further elucidate the structural and functional aspects of the procedure. Objective To assess voice and deglutition parameters according to the number of preserved arytenoids. Methods Eleven patients who underwent subtotal laryngectomy with cricohyoidoepiglottopexy were evaluated by laryngeal nasofibroscopy, videofluoroscopy, and auditory-perceptual, acoustic, and voice pleasantness analyses, after resuming oral feeding. Results Functional abnormalities were detected in two out of the three patients who underwent arytenoidectomy, and in six patients from the remainder of the sample. Almost half of the sample presented silent laryngeal penetration and/or vallecular/ hypopharyngeal stasis on the videofluoroscopy. The mean voice analysis scores indicated moderate vocal deviation, roughness and breathiness; severe strain and loudness deviation; shorter maximum phonation time; the presence of noise; and high third and fourth formant values. The voices were rated as unpleasant. There was no difference in the number and functionality of the remaining arytenoids as prognostic factors for deglutition; however, in the qualitative analysis, favorable voice and deglutition outcomes were more common among patients who did not undergo arytenoidectomy and had normal functional conditions. Conclusion The number and functionality of the preserved arytenoidswere not found to be prognostic factors for favorable deglutition efficiency outcomes. However, the qualitative analysis showed that the preservation of both arytenoids and the absence of functional abnormalities were associated with more satisfactory voice and deglutition patterns.

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

SUMMARY OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the harmonic scalpel compared to the conventional technique in patients submitted to total thyroidectomy. METHOD: This is a systematic review with inclusion of randomized controlled trials (RCTs) that compared both techniques. An electronic search was carried out in the Medline and Lilacs databases until June 2017. The outcomes analysed were operation time, intraoperative bleeding, surgical morbidity, and costs. RESULTS: Data from 31 primary studies were included. The use of the harmonic scalpel correlates to a shorter operation time (p <0.001) and a lower volume of intraoperative bleeding (p <0.001). There were no differences in the risk of transient (p = 0.53) and permanent (p = 0.70) hypocalcaemia, transient (p = 0.61) and permanent (p = 0.50) dysfunctions of the inferior laryngeal nerve and hematoma (p = 0.14). CONCLUSION: Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique.

Accuracy of sentinel lymph node mapping in detecting occult neck metastasis in papillary thyroid carcinoma

ABSTRACT Objectives: The objectives of this study were to evaluate the following: 1) the accuracy of sentinel lymph node mapping (SLNM) in detecting metastasis in papillary thyroid carcinoma (PTC), and 2) if SLNM could modify the American Joint Committee on Cancer (AJCC) staging of previous cN0 PTC patients. Subjects and methods: Forty SLNM were performed prospectively in 38 consecutive cN0 PTC patients, with total thyroidectomy and elective compartment neck dissection (CND). The results of SLNM were compared with CND pathological findings to verify the accuracy of sentinel SLNM. Results: The mean patients' follow-up was 36 months. A total of 133 SLN were found at levels VI, II, III and IV. The SLN was identified in 95% of the patients with one false negative, 95% sensitivity, a 94% negative predictive value and 97% accuracy. The SLNM upstaging from cN0 to pN+ was 49%, and to stages III and IVa, it was 21%. Conclusions: For this series of cN0 PTC patients: 1) SLNM accuracy was 97%, and 2) SLNM upstaging from cN0 to pN+ was 49%, whereas to stages III and IVa, it was 21%.

Malignancy rates for Bethesda III subcategories in thyroid fine needle aspiration biopsy (FNAB)

OBJECTIVES: Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS: Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS: FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.

Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer / Resultado oncológico de tratamento cirúrgico versus protocolo de preservação de órgão em câncer de laringe e hipofaringe

Summary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

Resumo Introdução: A partir de estudos do início dos anos 1990, popularizou-se o tratamento não cirúrgico com radioquimioterapia, com a perspectiva de manutenção do resultado oncológico e preservação do órgão em pacientes com carcinoma espinocelular avançado de laringe e hipofaringe. Entretanto, estudos posteriores demonstraram aumento da recorrência e da mortalidade com a difusão do tratamento não cirúrgico. Objetivo: Comparar o resultado oncológico dos tratamentos cirúrgico e não cirúrgico de pacientes com câncer de laringe e hipofaringe e avaliar as variáveis associadas à recidiva de doença. Método: Estudo de coorte retrospectiva de pacientes submetidos ao tratamento cirúrgico (laringectomia total ou parcial) e não cirúrgico (radioterapia isolada, radioterapia concomitante a quimioterapia ou quimioterapia de indução seguida de radioterapia e quimioterapia) de 134 pacientes, sendo 62 no grupo cirúrgico e 72 no não cirúrgico. Resultados: As taxas de sobrevivência livre de doença foram maiores no grupo cirúrgico (81,7% vs. 62,2%; p=0,028), principalmente em estádios III/IV (p=0,018), tumores localmente avançados T3 e T4a (p=0,021) e casos N0/N1 (p=0,005). A presença de linfonodos cervicais, principalmente N2/N3, foi considerada fator de risco para recidiva de doença nos dois grupos (HR=11,82; IC95% 3,42-40,88; p<0,0001). Pacientes não submetidos ao tratamento cirúrgico apresentaram 3,8 vezes mais chance de desenvolvimento de recidiva (HR=3,76; IC95% 1,27-11,14; p=0,017). Conclusão: Pacientes com câncer de laringe ou hipofaringe tratados de forma não cirúrgica tiveram menor sobrevivência livre de doença, especialmente nos tumores localmente avançados (T3 e T4a) e com pescoço pouco comprometido (N0/N1).