Recurrence and surgical salvage of sinonasal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the significant clinicopathologic factors related to tumor recurrence in patients with sinonasal squamous cell carcinomas (SCC) and to evaluate the effectiveness and plausibility of surgical salvage in the recurrent cases.</p><p><b>METHODS</b>The clinicopatholgic data of 107 patients with primary sinonasal SCC treated from 1996 to 2007 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to define the risk factors related to tumor recurrence. Salvage surgery with was selectively carried out in the recurrent sinonasal SCC using different surgical approaches, including lateral rhinotomy midfacial degloving or combined craniofacial approach. Immediate reconstruction of major surgical defects were performed with latissimus dorsi flap, pectoralis major myocutanneous flap, temperalis fasciomuscular flap, free rectus abdominis flap and free radial forearm flap. All patients were routinely follwed up and 5-year survival were calculated using directly calculating method and Kaplan-Meier's method.</p><p><b>RESULTS</b>The 5-year survival rate of 107 cases was 52.3% (56/107). Local recurrence was the most common pattern of tumor relapse. Forty-four of the 107 cases had recurrence. Logistic regression analysis showed the T stag was the most important impacting factor for tumor recurrence (OR = 0.258, P = 0.001). Of 44 cases with recurrence, 33 cases underwent salvage surgery and the 5-year survival rate after salvage surgery was 29.1%.</p><p><b>CONCLUSIONS</b>T stag is the most important impacting factor for tumor recurrence. Salvage surgery with immediate reconstruction of major surgical defects should be carried out in the selective cases of recurrent sinonasal SCC.</p>

Outcomes of salvage laryngectomy after initial radiation failure in laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone.</p><p><b>METHODS</b>A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model.</p><p><b>RESULTS</b>Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15(20.8%) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7%, 22.2% and 6.9%, respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45.8% and 36.1%, respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy, surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphotic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion.</p><p><b>CONCLUSIONS</b>Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.</p>

Clinicopathologic aspects of locoregional recurrence of hypopharyngeal cancer and their implication on the survival of patients / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic aspects of locoregional recurrence and their implication on the survival in patients with hypopharyngeal cancer.</p><p><b>METHODS</b>A retrospective review of 101 patients with hypopharyngeal cancer that were treated with surgical management and postoperative radiotherapy from 1998 to 2004 was performed. The clinicopathologic risk factors for locoregional recurrence were evaluated by using univariate chi(2) tests and multiple stepwise Logistic regression models. Survival analysis was performed by using Kaplan-Meier method, Log-Rank test and Cox proportional hazard model.</p><p><b>RESULTS</b>The overall incidence of locoregional recurrence in this series of hypopharyngeal cancer was 43.6% (44/101). The rates of recurrence were local 13.9% (14/101), regional 31.7% (32/101). In a multivariate Logistic regression analysis, it was confirmed that number of levels with pathologic lymph node (OR = 0.334, P = 0.0242) was the most significant risk factors for locoregional recurrence. The same for regional recurrence was capsule rupture of pathologic lymph node (OR = 0.353, P = 0.0389) and multilevel positive nodal involvement in neck (OR = 0.259, P = 0.0069). The overall survival of hypopharyngeal cancer was 23.2%, and reduced to 11.4% for locoregional recurrence. The recurrences were managed by salvage surgery in 12 cases, which included local recurrences after partial pharyngolaryngectomy, ipsilateral regional recurrences after selective neck dissection, and contralateral regional recurrences at initially uninvolved neck. The overall survival of those patients sustained 33.3%. A multivariate Cox regression analysis revealed that the factors impacting the prognosis were recurrent time (RR = 0.317, P < 0.0001) and treatment modality after locoregional recurrence (RR = 6.119, P = 0.0001).</p><p><b>CONCLUSIONS</b>Locoregional recurrences are frequent and have a very negative impact on patient survival in hypopharyngeal cancer, which most commonly have a regional recurrence. Salvage surgery in suitable cases seems to improve survival rates. Much attention should be paid to cervical pathological factors for locoregional recurrences in hypopharyngeal cancer, especially multilevel and capsule rupture of pathologic lymph node.</p>

Investigations on salvage surgery-related problems for stomal recurrence after total laryngectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the related issues concerning salvage surgery for stomal recurrence (SR) after total laryngectomy.</p><p><b>METHODS</b>A retrospective study was conducted to analyse the clinical data from 36 patients suffering from SR after total laryngectomy, who were treated by salvage surgery from January 1990 to January 2006. Some related issues concerning salvage surgery for SR were studied and analysed, which include preoperative evaluations, surgical approaches and techniques, management of perioperative complications and outcomes of treatment.</p><p><b>RESULTS</b>After careful preoperative evaluations and predictions, a complete resection of tumor was achieved in 33 out of 36 SR patients. Two patients sacrificed because of ruptures of major vessels including the common carotid eaters and the innominate artery 3 weeks and 2 months after the operation. The overall 1-year, 2-year and 3-year survival of this group of patients were 68.8%, 42.8% and 12.5%, respectively. Besides, postoperative complications comprise 23 cases of hypothyroidisms, 6 cases of wound infection and saliva leakage, 8 cases of donor site complications (including dehiscence of wound in 3 cases, chest wall hematomas in 4 cases, and tumor seeding in 1 case), and hypopharyngeal stenosis in 4 cases, all of which were properly and promptly managed with uneventful outcomes.</p><p><b>CONCLUSIONS</b>SR after total laryngectomy is a dangerous and complicated status with poor prognosis. For the purpose of saving or elongating the patients's lives, the salvage surgery needs to be done on the condition that indicated candidates are properly selected, preoperative evaluations carefully conducted, and perioperative abnormal conditions unerroneously delt with.</p>

Multi-modalities for reconstruction of circumferential defects in the pharyngoesophageal region / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of multi-modalities in the reconstruction of circumferential defects after resection of cancers in pharyngoesophageal regions, and to compare the pros and cons between different surgical procedures.</p><p><b>METHODS</b>According to the nature and extend of defects, five different methods including pectoralis major myocutaneous flap, laryngeal tube replacement, free jejunum, free forearm flap and gastric pull-up were used to reconstruct the circumferential pharyngoesophageal defects in 72 patients. Function of deglutition and restoration of swallowing was regularly followed up and objectively evaluated.</p><p><b>RESULTS</b>A total of 35 cases of pectoralis major myocutaneous (PM) flaps, 8 cases of laryngeal tube replacement, 12 cases of free jejunum, 12 cases of free forearm flaps and 16 cases of gastric pull-up were performed. Different complications including wound infection, pharyngeal fistula, partial necrosis of PM flap, partial necrosis of gastric wall, stricture of anastomotic site were encountered in 15 cases. All patients survived the operation except one due to partial necrosis of the gastric wall. Two of 4 patients who developed anastomotic stricture can ingest half-liquid food, the remaining cases regained normal deglutition function. The mean postoperative follow-up time was 1. 6 years with 2-year survival rate of 45.3%.</p><p><b>CONCLUSIONS</b>Circumferential defects resulting from resection of carcinomas in pharyngoesophageal region can be reconstructed with different operative techniques depending on the nature and extend of the defects. Once the operative indications are properly selected, the good reconstructive results are to be achieved.</p>