Parapharyngeal space tumors: Diagnosis and surgical management

Forty three patients presenting with parapharyngeal space [PPS] tumors were studied. Diagnosis was based on history, physical examination and imaging procedures [C. T scan, MRI, MRA, metastatic workup and fine needle aspiration cytology [FNAC] under C. T or U.S guidance]. Surgical approaches used for treatment included transcervical, transparotid, transcervical-transparotid, transcervical-transmandibular and transmaxillary. Most patients [90.7%] presented with cervical mass. Pain was present in 8 patients, tongue paresis in 6 patients, and dysarthria in 5 patients.C. T scan was done for all patients, MRI was done for 16 patients and MRA was done for 7 patients. Angiography was done for 3 patients and balloon occlusion test was done for 2 patients. FNAC was done in 19 patients. Surgical resection was done for all patients in the form of wide local excision of the tumor. Transcervical approach was used in 14 patients, transparotid cervical in 11 patients, mandibular swing in 7 patients. Temporary tracheostomy was done in 16 patients, ipsilateral neck dissection in 3 patients. Two patients required pectoralis major myocutaneous flap and 3 needed free flaps for wound closure. Recurrence occurred in 3/32 benign cases with reoperation and no recurrence later. 6/11 malignant cases presented with recurrence 2 needed reoperation while the rest treated by chemo or radiotherapy. Management of PPS tumors is a challenge because of the complexity of the space and different histological types of the lesions. Proper diagnosis as well as different surgical approaches according to the location of the lesion can provide complete resection with satisfactory outcome

Laparoscopic staging of intra-abdominal malignancies: Feasibility and technique

A prospective study was carried our between July, 2000 and July, 2003 on 88 patients with intra-abdominal malignancies at the National Cancer Institute, Cairo University. Laparoscopic evaluation of their abdominal lesions as regards primary site, staging and biopsy if needed was assessed. Out of 88 patients, the hepatobiliary region was the most common site 59 cases] followed by gastrointestinal tract [26 cases] and retroperitoneal area [3 cases]. Biopsies were obtained in 17 cases [19.4%]. Laparoscopy did affect the management decision in 18 cases [20.5%] by proving the presence of local spread of the lesion beyond the primary site or presence of peritoneal involvement which was not detected by imaging modalities. Laparoscopy failed in staging of lesions in 5 patients [5.6%] and laparotomy was done for staging. On the other hand in 55 [62.5%] patients laparotomy was done after laparoscopy for definite resection. There was no mortality, while there were 5 [5.6%] morbidities, bleeding in three cases and bowel injury in two cases. Laparoscopy is a valuable modality in diagnosis of intra-abdominal malignancies as it can accurately define stage of the disease by visualization of the primary site and its relation to the surrounding structures, detecting small lesions and peritoneal involvement away from original site that can easily missed by routine imaging modalities. It can also obtain fluids and tissues for cytological and histopathological examination under direct vision. Its benefit concerning the prevention of formal laparotomy to assess resectability of the lesions, thereby decreasing postoperative pain and ensuring early return to normal activities and shorter hospital stay is obvious. It may diminish the time between determining optimum therapy and starting of chemotherapy or radiotherapy. It may ultimately be a more economical method of staging many intra-abdominal malignancies by avoidance of both unnecessary laparotomy and redundant preoperative staging modalities