Feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform for pharyngolaryngeal tumors. Methods: A retrospective analysis was performed on 55 consecutive cases with resection of pharyngolaryngeal tumors by transoral robotic surgery with da Vinci Xi platform from July 27, 2020 to October 31, 2021 in the Department of Head and Neck Surgery, Fudan University Eye, Ear, Nose and Throat Hospital, including 44 males and 11 females, aged 25-79 years. There were 41 cases of oropharyngeal tumors, 9 cases of parapharyngeal space tumors, 2 cases of laryngeal tumors, 2 cases of hypopharyngeal tumors and 1 case of retropharyngeal space tumor. Operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheotomy, nasal feeding, hemorrhage and other complications were analyzed. Results: Of the 55 patients, 54 received resection of pharyngolaryngeal tumors by da Vinci robot through oral approach, and only 1 case of pyriform sinus carcinoma underwent a conversion to open surgery due to poor exposure of lower margin. The average surgical time for the patients with transoral robotic surgeries was 64.4 min, the average blood loss was 24.8 ml, the average postoperative hospital stay was 6.9 d, and the average oral feeding time was 11.1 d. Seventeen patients (30.9%) underwent preventive tracheotomy during surgery. Among 38 cases of laryngeal cancer, 28 underwent simultaneously neck dissection. No serious complications occurred in all patients during and after operation. The follow-up time was 1-15 months. Aside from 1 patient had a relapse 10 months after surgery, other patients had no recurrence or metastasis. Conclusion: Transoral robotic surgery with da Vinci Xi is safe, effective and minimally invasive for resection of pharyngolaryngeal tumors under reasonable indications.

Expression and clinical significance of hypoxia-inducible factor-1alpha and cyclooxygenase-2 in laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of hypoxia-inducible factor-1alpha (HIF-1alpha) and cyclooxygenase-2 (COX-2) in laryngeal squamous cell carcinoma (LSCC), while determine their relationship with clinicopathologic characteristics and prognosis.</p><p><b>METHODS</b>Tumor tissues were obtained from 60 patients who underwent resection of laryngeal carcinoma in Affiliated First People's Hospital of Shanghai Jiaotong University. Immunohistochemistry (Envision DAKO) was used to detect the expressions of HIF-1alpha and COX-2 in the tumor tissues. As control group, 15 cases of atypical hyperplasia, 10 cases of leukoplakia of vocal cord and 10 cases of polyp of vocal cord were studied. All patients were regularly followed up and the clinical data were collected systematically.</p><p><b>RESULTS</b>Positive staining rates of HIF-1alpha and COX-2 were 95.0% (57/60) and 98.3% (59/60), respectively in all 60 specimen of LSCC. The positive expressions in LSCC were significantly higher than those in atypical hyperplasia, leukoplakia and polyp of vocal cord ( Fisher's exact test, P < 0.01). The expression of HIF-1alpha was correlated with COX-2 in LSCC (r = 0.526, P < 0.01). High level expressions of HIF-1alpha and COX-2 were 35.0% (21/60) and 38.3% (23/60) respectively. High level expression of HIF-1alpha was significantly correlated with clinical stages (chi2 = 4.331, P < 0.05) and lymph nodes metastases (Fisher's exact test, P < 0.05). High level expression of COX-2 was significantly correlated with clinical stage (chi2 = 8.539, P < 0.01) and T stages (chi2 = 6.792, P < 0.01). With univariate analysis, high level expressions of HIF-1alpha and COX-2 were significantly associated with a worse overall survival (chi2 = 6.003, P < 0.05 and chi2 = 9.489, P < 0.01, respectively) and disease-free survival (chi2 = 5.010, P < 0.05 and chi2 = 6.102, P < 0.05, respectively). With multivariate analysis, recurrence and high level expression of COX-2 were two unfavorable prognostic factors (RR = 7.104, P = 0.003; RR = 5.714, P = 0.008).</p><p><b>CONCLUSIONS</b>The expressions of HIF-1alpha and COX-2 played an important role in the process of tumorigenesis and development of LSCC, The expression of HIF-1alpha was correlated with COX-2 in LSCC. COX-2 and recurrence were probably significant risk factors for prognosis of LSCC.</p>