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Article in English | WPRIM | ID: wpr-880867


Neck dissection for oral squamous-cell carcinoma (OSCC) is a clinically controversial issue and has therefore been the subject of abundant research. However, no one has performed a bibliometric study on this topic to date. The aim of this study was to assess the development of research on neck dissection for OSCC in terms of the historical evolution, current hotspots and future directions, particularly including research trends and frontiers from 2010 to 2019. Literature records related to research on neck dissection for OSCC were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was used as a tool to perform a bibliometric analysis of this topic. The survey included 2 096 papers. "Otorhinolaryngology" was the most popular research area. The most active institutions and countries were Memorial Sloan Kettering Cancer Center and the USA, respectively. Shah J.P. was the most cited author. Among the six identified "core journals", Head & Neck ranked first. The top three trending keywords were 'invasion', 'upper aerodigestive' and 'negative neck'. 'D'Cruz AK (2015)' was the most cited and the strongest burst reference in the last decade. The study evaluated the effect on survival of elective versus therapeutic neck dissection in patients with lateralized early-stage OSCC. The depth of invasion and the management of N0 OSCC were research frontiers in this field. The present study provides a comprehensive bibliometric analysis of research on neck dissection for OSCC, which will assist investigators in exploring potential research directions.

Bibliometrics , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms , Humans , Mouth Neoplasms/surgery , Neck Dissection
Article in Chinese | WPRIM | ID: wpr-880842


OBJECTIVE@#To investigate the effect of thoraco-laparoscopic esophagectomy on postoperative immune function of patients with esophageal carcinoma.@*METHODS@#Eighty-one patients undergoing radical esophagectomy in our hospital between January, 2017 and December, 2019 were enrolled in this study.According to the surgical approach, the patients were divided into endoscopic group (41 cases) and open surgery (3 incisions) group (40 cases).The immunological indicators (CD3@*RESULTS@#No death occurred in either of the group after the operation.On days 4 and 7 after the operation, CD3@*CONCLUSIONS@#Thoraco-laparoscopic resection of esophageal cancer can reduce postoperative secretion of proinflammatory factors, alleviate inflammatory responses, and promote the recovery of immune functions to accelerate postoperative recovery of the patients.

Carcinoma, Squamous Cell/surgery , Esophageal Neoplasms/surgery , Esophagectomy , Humans , Laparoscopy , Postoperative Complications , Postoperative Period
Arq. bras. oftalmol ; 83(6): 505-510, Nov.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1153075


ABSTRACT Purpose: To evaluate the safety and 12-month effect of treatment with pattern scanning laser photocoagulation for ocular surface squamous neoplasia in a low-resource setting with extremely limited access to an operating room. Methods: Adult patients with a clinical diagnosis of ocular surface squamous neoplasia underwent a complete ophthalmologic examination. After topical anesthesia and instillation of toluidine blue 1%, the lesion was treated using pattern scanning photocoagulation for a duration time that varied from 20 to 100 ms and power from 600 to 1,800 mW. Patients were examined on a weekly basis for the first month and underwent weekly retreatment of the remaining lesions, as necessary. Patients had a minimum follow-up of 12 months. Results: Thirty-eight patients (38 eyes) were included. All patients had clinical ocular surface squamous neoplasia that was confirmed by impression cytology. The age of patients ranged from 40 to 83 years (average: 65.5 years) and 28 of them were males (74%). The patients were divided into two groups: group I (immunocompetent) and group II (immuno­suppressed). In group I, 23 patients (74%) presented complete response with lesion control after laser treatment alone. In group II, two of seven patients (28%) showed treatment response during the follow-up. The average number of treatments was 2.5 (one to six laser treatments). Procedures were well tolerated. Conclusion: Short-term results of the laser photocoagulation approach for the treatment of ocular surface squamous neoplasia conjunctival lesions were favorable, with a 74% success rate observed in immunocompetent patients. This novel strategy is a less resource-intensive alternative that could demonstrate its usefulness in settings with shortages in operating rooms and in recurrent cases. Studies with longer follow-ups and larger sample sizes are warranted to confirm our findings and evaluate the effectiveness of laser treatment in association with topical chemotherapy.

RESUMO Objetivo: Avaliar a segurança e o efeito de 12 meses de tratamento com fotocoagulação pelo pattern scanning laser para neoplasia escamosa da superfície ocular em um ambiente com poucos recursos e acesso extremamente limitado a um tratamento cirúrgico. Métodos: Pacientes adultos com diagnóstico de neoplasia escamosa de superfície ocular foram submetidos a exame oftalmológico completo. Após anestesia tópica e instilação de azul de toluidina 1%, a lesão foi tratada com laser por um tempo de duração que variou de 20 a 100 ms e potência de 600 a 1800 mW. Os pacientes foram examinados semanalmente durante o primeiro mês e fo­ram retratados semanalmente das lesões restantes, conforme necessário. Os pacientes tiveram um seguimento mínimo de 12 meses. Resultados: Trinta e oito pacientes (38 olhos) foram incluídos no estudo. Todos os pacientes apresentaram neoplasia escamosa da superfície ocular clínica, confirmada por citologia de impressão. A idade dos pacientes variou entre 40 e 83 anos (média de 65.5 anos) e 28 deles eram do sexo masculino (74%). Os pacientes foram divididos em dois grupos: Grupo I (imunocompetente) e grupo II (imunossuprimido). No grupo I, 23 pacientes (74%) apresentaram resposta completa com o controle da lesão após o tratamento com laser. No grupo II, dois dos sete pacientes (28%) apresentaram resposta ao tratamento durante o acompanhamento. A média de aplicações de laser foi de 2,5 (1 a 6 aplicações). Os procedimentos foram bem tolerados. Conclusões: Os resultados a curto prazo da abordagem de fotocoagulação a laser para o tratamento das lesões conjuntivais de neoplasia escamosa de superfície ocular foram favoráveis, com uma taxa de sucesso de 74% observada em pacientes imunocompetentes. Essa nova estratégia é uma alternativa menos intensiva em recursos que pode demonstrar sua utilidade em ambientes com escassez de salas cirúrgicas e em casos recorrentes. Estudos com acompanhamentos mais longos e amostras maiores são necessários para confirmar nossos achados e avaliar a eficácia do tratamento a laser asso­ciado à quimioterapia tópica.

Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Squamous Cell , Conjunctival Neoplasms , Eye Neoplasms , Carcinoma, Squamous Cell/surgery , Conjunctival Neoplasms/surgery , Eye Neoplasms/surgery , Lasers , Light Coagulation
Braz. j. otorhinolaryngol. (Impr.) ; 86(6): 763-766, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142609


Abstract Introduction: Total rhinectomy is an uncommon procedure for the treatment of nasal malignancies, usually reserved for locally advanced tumors. There are few case series studying total rhinectomy in the literature, reporting conflicting results about recurrence and metastasis. Objective: Evaluate prognosis of total rhinectomy cases for malignant neoplasia in our institution. Methods: Retrospective review from January 2013 to September 2018, including all patients undergoing total rhinectomy in our Institution, under the care of the Head and Neck surgical team. Results: Ten patients were included, two men and eight women. The mean patient age was 71.6 years old. The majority had nasal skin (8 cases) carcinomas. Squamous cell carcinoma was present in seven cases. In total, six cases had regional metastasis, in a median period of 14.3 months. The overall mortality and disease specific mortality was 50% and 30%, respectively, in a median follow-up of 45.7 months. Conclusion: We observed high overall and disease-specific mortality among cases with advanced nasal malignancies undergoing total rhinectomy.

Resumo Introdução: A rinectomia total é um procedimento incomum para o tratamento de neoplasias nasais, geralmente reservado para tumores localmente avançados. Há poucas séries de casos que estudam a rinectomia total na literatura, as quais descrevem resultados conflitantes sobre recorrência e metástase. Objetivo: Avaliar o prognóstico de pacientes submetidos a rinectomia total por neoplasia maligna em nossa instituição. Método: Revisão retrospectiva de janeiro de 2013 a setembro de 2018, incluiu todos os pacientes submetidos a rinectomia total em nossa instituição, sob os cuidados da equipe de cirurgia de cabeça e pescoço. Resultados: Dez pacientes foram incluídos, dois homens e oito mulheres. A média de idade dos pacientes foi de 71,6 anos. A maioria apresentava carcinoma da pele nasal (oito casos). O carcinoma espinocelular estava presente em sete casos. Seis casos tiveram metástase regional em um período mediano de 14,3 meses. A mortalidade geral e a mortalidade específica da doença foram de 50% e 30%, respectivamente; o acompanhamento médio foi de 45,7 meses. Conclusão: Observamos alta mortalidade geral e específica da doença entre os casos com neoplasias nasais avançadas submetidas à rinectomia total.

Humans , Male , Female , Aged , Carcinoma, Squamous Cell/surgery , Nose Neoplasms/surgery , Nose , Retrospective Studies , Neoplasm Recurrence, Local/surgery
Rev. medica electron ; 42(5): 2398-2407, sept.-oct. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144743


RESUMEN Se presentó el caso de un paciente masculino de 60 años, blanco, que fue atendido en la Consulta de Oftalmología, del Hospital "Dr. Mario Muñoz", del municipio de Colón, provincia de Matanzas. Refirió que llevaba aproximadamente 20 días, con sensación de cuerpo extraño en el ojo izquierdo, enrojecimiento, secreción constante, fotofobia y una lesión que le había aumentado de tamaño durante este período; la que se tornaba dolorosa durante el parpadeo. Se decidió realizar este trabajo con el objetivo de mostrar los beneficios obtenidos al concluir el tratamiento aplicado a este tipo de tumor (AU).

ABSTRACT The authors present the case of a white male patient, aged 60 years, who assisted the Consultation of Ophthalmology of the Hospital "Dr. Mario Muñoz", of the municipality of Colon. He referred feeling a foreign body in the left eye for already 20 days, presence of redness, constant secretion, photophobia and a lesion that had grown during that period, painful when blinking. The authors decided to write this article with the objective of showing the benefits obtained with the applied treatment in this kind of tumor (AU).

Humans , Male , Adult , Signs and Symptoms , Carcinoma, Squamous Cell/epidemiology , Ophthalmology/methods , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Eye Foreign Bodies/complications , Eye Foreign Bodies/diagnosis , Risk Factors , Cornea/abnormalities , Photophobia/complications , Photophobia/diagnosis
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 184-192, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1115834


La recurrencia de carcinoma de células escamosas orofaríngeo (CCEOF) se asocia a mal pronóstico, particularmente en recurrencias en etapa avanzada. La cirugía en el contexto de rescate es más complicada por el tratamiento oncológico del tumor primario, por lo tanto, tiene un mayor riesgo de complicaciones y estadía hospitalaria. Sin embargo, la cirugía de rescate es la mejor oportunidad del paciente como tratamiento curativo y para supervivencia a largo plazo. La población de pacientes que reciben tratamiento para CCEOF ha cambiado en la última década, se ha reconocido que la incidencia de virus papiloma humano (VPH) asociado a CCEOF ha generado el gran aumento de CCEOF y el cambio asociado en las características de la población de pacientes, ahora los pacientes son más jóvenes y tienen menos comorbilidades. Con el aumento exponencial en la incidencia de CCEOF, la necesidad de cirugía de rescate en CCEOF podría verse en aumento. En vista del aumento de la incidencia de casos con carcinoma escamoso de orofaringe y su importante relación con el VPH, esta revisión se enfoca en la supervivencia tras cirugía de rescate con intención curativa y evaluar si con los avances en su tratamiento ha mejorado su pronóstico.

Recurrence of oropharyngeal squamous cell carcinoma (OPSCC) is associated with poor prognosis, particularly in advanced stage recurrences. Salvage surgery is complicated by previous oncological treatment of the primary tumor, therefore, it has a higher risk of complications and hospital stay. However, salvage surgery is the patient's best opportunity as a curative treatment and for long-term survival. The population of patients receiving treatment for OPSCC has changed in the last decade, it has been recognized that the incidence of human papilloma virus (HPV) associated OPSCC has generated an increase of OPSCC and changes in the epidemiology of the patient population, with younger patients and with less comorbidities. With the exponential increase in the incidence of OPSCC, the need for salvage surgery in OPSCC could increase in the future. In view of the increase in the incidence of cases with squamous oropharyngeal carcinoma and its relationship with HPV, this review focuses on survival after salvage surgery with curative intent and assessing whether the progress in its treatment has improved its prognosis.

Humans , Otorhinolaryngologic Surgical Procedures/methods , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Neoplasm Recurrence, Local , Papillomaviridae , Postoperative Complications , Prognosis , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/virology , Survival Rate , Salvage Therapy , Patient Selection , Medical Futility , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/virology
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 63-68, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1099203


Las cirugías de cabeza y cuello presentan un alto riesgo de sangrado que puede significar el uso de transfusiones sanguíneas. Existen casos en las que éstas son rechazadas, como sucede con los Testigos de Jehová. Se expone el caso de una paciente Testigo de Jehová con un tumor rinosinusal con alto riesgo de sangrado que consultó por epistaxis recurrente. Se evidencia un tumor ocluyendo la fosa nasal derecha de aspecto vascular a la rinoscopía y la tomografía computarizada. Múltiples aferencias de la arteria esfenopalatina y etmoidales se observaron en una angiografía cerebral. Previo a la resección, se embolizó la arteria maxilar. Durante la cirugía, se contó con un sistema de recuperación de sangre autóloga, hemodilución e infusión de ácido tranexámico. Se ligó la arteria etmoidal anterior derecha vía externa con apoyo endoscópico y luego se resecó el tumor vía endoscópica. La biopsia reveló un carcinoma sinonasal escamoso. Existen alternativas terapéuticas en pacientes que rechacen el uso de hemoderivados. Destacan medidas preoperatorias como la embolización endovascular, intraoperatorias como el uso de agentes hemostáticos, técnicas quirúrgicas y anestésicas. Es importante analizar todas las opciones disponibles de forma multidisciplinara y junto con el paciente, para determinar la conducta más adecuada a seguir.

Head and neck surgeries have a high risk of bleeding, and therefore could require the use of blood transfusions. There are cases for which blood transfusions are not an acceptable option, as is the case for Jehovah's Witnesses. We present the case of a Jehovah's Witness with a sinonasal tumor with a high risk of bleeding, who presented with recurrent epistaxis. Rhinoscopy and computed tomography revealed a vascular-like tumor occluding the right nasal cavity. Cerebral angiography showed afferents of the sphenopalatine and ethmoidal arteries leading to the tumor. Prior to the resection, the maxillary artery was embolized. During surgery, we relied on an autologous blood recovery system, hemodilution and tranexamic acid. Right anterior ethmoidal artery ligation was performed by an endoscopic assisted external approach. The tumor was resected endoscopically The biopsy revealed a squamous sinonasal carcinoma. There are therapeutic alternatives for patients who cannot receive blood products. There are preoperative measures such as endovascular embolization, intraoperative measures such as the use of hemostatic agents and specific surgical or anesthetic techniques. It's important to analyze all of the available options in a multidisciplinary team approach, and to take into consideration the patient's preferences, in order to determine the best surgical conduct.

Humans , Female , Middle Aged , Carcinoma, Squamous Cell/surgery , Nose Neoplasms/surgery , Jehovah's Witnesses , Religion and Medicine , Paranasal Sinus Neoplasms/surgery , Carcinoma, Squamous Cell/diagnostic imaging , Tomography, X-Ray Computed , Nose Neoplasms/diagnostic imaging , Blood Loss, Surgical/prevention & control , Treatment Refusal , Embolization, Therapeutic , Hemodilution
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 53-61, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090553


Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Laryngeal Diseases/surgery , Laryngeal Diseases/epidemiology , Larynx/surgery , Microsurgery , Papilloma/surgery , Occupational Risks , Aging/physiology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/epidemiology , Sex Factors , Laryngeal Edema/surgery , Laryngeal Edema/epidemiology , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/epidemiology , Medical Records , Cross-Sectional Studies , Retrospective Studies , Age Factors
Rev. argent. coloproctología ; 31(1): 21-27, mar. 2020. tab
Article in Spanish | LILACS | ID: biblio-1102171


Introducción: El tratamiento del carcinoma anal escamoso (CAE) en los pacientes HIV positivos resulta controvertido. Si bien las guías actuales recomiendan realizar en los pacientes con buen estado inmunológico la quimiorradioterapia (QRT) concurrente estándar, algunos autores consideran que estos pacientes presentan mayor toxicidad y peores resultados a largo plazo, por lo que requerirían un abordaje diferente. El objetivo de este trabajo es comparar los resultados del tratamiento del CAE en los pacientes VIH positivos y negativos. Diseño: Estudio retrospectivo comparativo. Pacientes y métodos: Se revisaron retrospectivamente las historias clínicas de los pacientes tratados en el Sector Coloproctología, Hospital Fernández, entre 01/2007 y 10/2018. Los del conducto anal se dividieron en: Grupo I: VIH negativos y Grupo II: VIH positivos. Se compararon variables demográficas, factores de riesgo específicos, estadificación, QRT (drogas, toxicidad y respuesta), tratamiento quirúrgico curativo/paliativo, persistencia/recurrencia y supervivencia específica y global. Resultados: Se incluyeron 28 pacientes (18 mujeres); margen: 2, conducto: 26 (Grupo I: 15. Grupo II: 11). Los VIH positivos eran en su mayoría hombres que tienen sexo con hombres vs. 100% de mujeres VIH negativas (p<0,01), más jóvenes (45,2±0,9 vs. 63,6±8; p<0,01) y tabaquistas (82% vs. 27%; p=0,005). No hubo diferencia significativa en la estadificación, aunque el Grupo II tuvo tumores con complicaciones más severas. Pudieron completar el tratamiento: Grupo I: 93%, Grupo II: 64% (p<0,05). Tuvieron respuesta completa a la QRT 13/14 (93%) pacientes del Grupo I y 3/7 (43%) del Grupo II (p<0,01). Hubo 3 recurrencias, 2 locorregionales y 1 a distancia (p=NS). Los VIH positivos requirieron más cirugías (82% vs. 27%; p<0,01). A 5 pacientes (4 del Grupo II) se les realizó una resección abdominoperineal (RAP). Tuvieron colostomía definitiva, con o sin RAP, el 46% de los pacientes, la mayoría VIH positivos (82% vs. 27%; p=0,002). En los VIH positivos el RR de mortalidad por cáncer fue 4 (IC95%: 1,01-16,5; p=0,02) y el RR de mortalidad global fue 5,45 (IC95%: 1,42-20,8; p=0,002). Tuvieron menor supervivencia, tanto global (p=0,001) como libre de enfermedad (p=0,01). Mediana de seguimiento: 27 meses (4-216).Conclusiones: Los pacientes VIH positivos con CAE se diferenciaron de los VIH negativos en una menor tasa de respuesta completa a la QRT y una mayor necesidad de tratamiento quirúrgico. Además, tuvieron una supervivencia global y libre de enfermedad significativamente menor que los VIH negativos. (AU)

INTRODUCTION: The treatment of anal squamous cell carcinoma (SCC) in HIV-positive patients is controversial. Although current guidelines recommend performing standard concurrent chemoradiotherapy (CRT) in patients with good immune status, some authors believe that these patients have greater toxicity and worse long-term results, so they would require a different approach. The purpose of this study was to compare the results of SCC treatment in HIV-positive and HIV-negative patients.DESIGN: Comparative retrospective study.PATIENTS AND METHODS: The records of patients treated in the Coloproctology Section, Hospital Fernández, between 01/2007 and 10/2018 were retrospectively reviewed. Those of the anal canal were divided into: Group I: HIV-negative and Group II: HIV-positive. Demographic variables, specific risk factors, staging, CRT (drugs, toxicity, and response), curative/palliative surgical treatment, persistence/recurrence, and cancer-specific and global survival were compared.RESULTS: 28 patients (18 women), margin: 2, conduit: 26 (Group I: 15. Group II: 11). The HIV-positive were mostly men who have sex with men (vs. 100% HIV-negative women; p<0.01), younger (45.2 ± 0.9 vs. 63.6 ± 8; p<0.01) and smokers (82% vs. 27%; p=0.005). There was no significant difference in staging, although Group II had tumors with more severe complications. Completed the treatment: Group I: 93%, Group II: 64% of patients (p<0,05). Thirteen out of 14 (93%) patients in Group I, and 3/7 (43%) patients in Group II had a complete response to CRT (p<0.01). There were 3 recurrences, 2 loco-regional and 1 distance (p=NS). HIV-positive required more surgery (82% vs. 27%; p<0.01). 5 patients (4 of Group II) underwent an abdominal-perineal resection (APR). Forty six percent of patients had permanent colostomy, with or without APR, most of them were HIV-positive (82% vs. 27%; p=0.002). In HIV-positive patients, the RR of cancer mortality was 4 (95% CI: 1.01-16.5; p=0.02) and the RR of overall mortality was 5.45 (95% CI: 1.42-20, 8; p=0.002). They also had lower overall (p=0.001) and disease-free survival (p=0.01). Median follow-up: 27 months (4 - 216).CONCLUSION: HIV-positive patients with anal SCC were different from HIV-negative patients in that they had a lower complete response rate to CRT, and a greater need for surgical treatment. They had a significantly lower overall and disease-free survival than HIV-negative patients. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Anus Neoplasms/therapy , Carcinoma, Squamous Cell/therapy , HIV Infections/complications , Chemoradiotherapy , Anus Neoplasms/surgery , Anus Neoplasms/complications , Anus Neoplasms/mortality , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/mortality , Survival Analysis , Retrospective Studies , Treatment Outcome , Proctectomy , Neoplasm Recurrence, Local , Neoplasm Staging
Braz. j. otorhinolaryngol. (Impr.) ; 86(1): 105-110, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1089368


Abstract Introduction Recently it has been reported that a high preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio may be related to increased recurrence risk, tumor aggressiveness, and worsened prognosis in various malignancies. Objective The objective of this research is to explore whether neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in parotid tumors may or may not be used as a cancer marker. Methods This retrospective research has been conducted on a total of 228 patients consisting of 83 healthy persons and 145 patients with a mass in the parotid gland, who applied to a tertiary referral center and underwent surgery. Patients have been divided into two groups by their histopathological findings as malignant or benign parotid tumor. A third group consisting of healthy people has been defined as the control group. Also the malignant parotid tumor group has been divided into two subgroups as early stage and advanced stage. The groups have been compared in terms of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and other laboratory data. Results The average neutrophil-lymphocyte ratio values of malignant parotid tumor, benign parotid tumor, healthy control groups were 2.51, 2.01, 1.79 respectively and the difference was statistically significant (p < 0.001). There was no significant difference between advanced stage and early stage parotid tumor groups in terms of average neutrophil-lymphocyte ratio value (p = 0.782). In dual comparisons, the platelet-lymphocyte ratio value of patients in the malignant group was found out to be statistically significantly higher than that of benign and control groups (p < 0.001 and p = 0.001 respectively). Conclusion To the best of our knowledge our research is the first in the medical literature comparing neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with parotid tumor. neutrophil-lymphocyte ratio and platelet-lymphocyte ratio can serve as cost-effective, repeatable, easily accessible, and helpful inflammatory markers in order to distinguish patients with malignant parotid tumor from healthy people.

Resumo Introdução Recentemente, tem sido relatado que as relações neutrófilo-linfócito e plaqueta-linfócito aumentadas no pré-operatório podem estar relacionadas ao aumento do risco de recorrência e agressividade do tumor e pior prognóstico em várias neoplasias malignas. Objetivo Investigar se as relações neutrófilo-linfócito e plaqueta-linfócito em tumores da parótida podem ou não serem utilizadas como marcadores de câncer. Método Esta pesquisa retrospectiva foi conduzida com 228 indivíduos, 83 saudáveis e 145 com tumor de parótida, os quais foram encaminhados a um centro de referência terciária e operados. Os pacientes foram divididos em dois grupos de acordo com os achados histopatológicos de malignidade e benignidade. O terceiro grupo foi composto por indivíduos saudáveis, foi definido como o grupo controle. Além disso, o grupo com tumores malignos da parótida foi dividido em dois subgrupos, um com pacientes em estágio inicial da doença e o outro com pacientes em estágio avançado. Os grupos foram comparados em termos das relações neutrófilo-linfócito e plaqueta-linfócito e outros dados laboratoriais. Resultados Os valores médios da relação neutrófilo-linfócito do tumor maligno de parótida, do tumor benigno de parótida e do grupo controle foram de 2,51, 2,01 e 1,79, respectivamente, com uma diferença estatisticamente significante (p < 0,001). Não houve diferença estatística entre os grupos em estágio avançado e em estágio inicial em termos de valor médio da relação neutrófilo-linfócito (p = 0,782). Em comparações duplas, o valor da relação plaqueta-linfócito dos pacientes do grupo do grupo com tumor maligno foi estatisticamente maior do que nos grupos com tumor benigno e controle (p < 0,001 e p = 0,001, respectivamente). Conclusão Que seja de nosso conhecimento, nosso estudo é o primeiro na literatura médica a comparar a relação neutrófilo-linfócito e a relação plaqueta-linfócito em pacientes com tumor de parótida. As relações neutrófilo-linfócito e plaqueta-linfócito podem servir como marcadores inflamatórios de baixo custo, reproduzíveis, de fácil acesso e úteis, a fim de distinguir os pacientes com tumor maligno de parótida de pessoas saudáveis.

Humans , Male , Female , Adult , Middle Aged , Parotid Neoplasms/pathology , Lymphocytes/cytology , Carcinoma, Squamous Cell/pathology , Adenoma, Pleomorphic/pathology , Neutrophils/cytology , Platelet Count , Prognosis , Preoperative Care , Parotid Neoplasms/surgery , Parotid Neoplasms/blood , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/blood , Retrospective Studies , Adenoma, Pleomorphic/surgery , Adenoma, Pleomorphic/blood , Lymphocyte Count , Environmental Biomarkers , Neoplasm Staging
ABCD arq. bras. cir. dig ; 33(4): e1567, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152638


ABSTRACT Background: Southern Brazil has one of the highest incidences of esophageal squamous cell carcinoma in the world. Transthoracic esophagectomy allows more complete abdominal and thoracic lymphadenectomy than transhiatal. However, this one is associated with less morbidity. Aim: To analyze the outcomes and prognostic factors of squamous esophageal cancer treated with transhiatal procedure. Methods: All patients selected for transhiatal approach were included as a potentially curative treatment and overall survival, operative time, lymph node analysis and use of neoadjuvant therapy were analyzed. Results: A total of 96 patients were evaluated. The overall 5-year survival was 41.2%. Multivariate analysis showed that operative time and presence of positive lymph nodes were both associated with a worse outcome, while neoadjuvant therapy was associated with better outcome. The negative lymph-node group had a 5-year survival rate of 50.2%. Conclusion: Transhiatal esophagectomy can be safely used in patients with malnutrition degree that allows the procedure, in those with associated respiratory disorders and in the elderly. It provides considerable long-term survival, especially in the absence of metastases to local lymph nodes. The wider use of neoadjuvant therapy has the potential to further increase long-term survival.

RESUMO Racional: O sul do Brasil tem uma das maiores incidências de carcinoma epidermoide do esôfago no mundo. A esofagectomia transtorácica permite linfadenectomia abdominal e torácica mais completa do que a transhiatal. No entanto, esta está associado à menor morbidade. Objetivo: Analisar os desfechos e fatores prognósticos do câncer epidermoide do esôfago que foram tratados com procedimento transhiatal. Métodos: Foram incluídos todos os pacientes selecionados para abordagem transhiatal como tratamento potencialmente curativo correlacionando sobrevida geral, tempo operatório, análise de linfonodos e uso de terapia neoadjuvante. Resultados: Foram avaliados 96 pacientes. A sobrevida geral em cinco anos foi de 41,2%. A análise multivariada mostrou que o tempo operatório e a presença de linfonodos positivos foram associados a pior resultado, enquanto a terapia neoadjuvante contribuiu para melhor resultado. O grupo de linfonodos negativos teve taxa de sobrevivência em cinco anos de 50,2%. Conclusão: A esofagectomia transhiatal pode ser empregada com segurança em pacientes que apresentem desnutrição com grau que permita o procedimento, nos com distúrbios respiratórios associados e nos idosos. Proporciona sobrevida em longo prazo considerável, especialmente na ausência de metástases para linfonodos locais. O uso mais amplo da terapia neoadjuvante tem o potencial de aumentar ainda mais a sobrevida em longo prazo.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Esophageal Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Esophagectomy , Diabetes Mellitus, Type 2 , Esophageal Squamous Cell Carcinoma/surgery , Brazil , Retrospective Studies , Treatment Outcome , Lymph Node Excision
J. appl. oral sci ; 28: e20190198, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1056596


Abstract Pathological parameters have been indicated as tumor prognostic factors in oral carcinoma. Objective: The objective of this study was to investigate the impact of pathological parameters on prognosis of patients affected only by tongue and/or floor of the mouth squamous cell carcinoma (SCC). Methodology: In total, 380 patients treated in the Brazilian National Cancer Institute (INCA) from 1999 to 2006 were included. These patients underwent radical resection followed by neck dissection. The clinical and pathological characteristics were recorded. The Kaplan-Meier method and Cox proportional hazards model were used in survival analysis. Overall survival (OS), cancer-specific survival (CSS) and disease-free interval (DFI) were estimated. Cox residuals were evaluated using the R software version 3.5.2. Worst OS, CSS and DFI were observed in patients with tumors in advanced pathological stages (p<0.001), with the presence of perineural invasion (p<0.001) and vascular invasion (p=0.005). Results: Advanced pathological stage and the presence of a poorly differentiated tumor were independent prognostic factors for OS and CSS. However, advanced pathological stage and perineural invasion were independent predictors of a shorter OS, DFI and CSS. Conclusion: Pathological stage and perineural invasion were the most significant pathological variables in survival analysis in tongue and/or floor of the mouth SCC.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Mouth Neoplasms/pathology , Tongue Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Mouth Floor/pathology , Neck Dissection/methods , Time Factors , Mouth Neoplasms/surgery , Mouth Neoplasms/mortality , Tongue Neoplasms/surgery , Tongue Neoplasms/mortality , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/mortality , Regression Analysis , Disease-Free Survival , Kaplan-Meier Estimate , Neoplasm Grading/methods , Neoplasm Staging
Gac. méd. espirit ; 21(3): 112-121, sept.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1090449


RESUMEN Fundamento: La técnica del tonel de Schuchardt, está indicada cuando el defecto en el labio compromete del 30-75 % del labio, de localización central y paramedial que afecta bermellón y piel; en este caso se usó el colgajo para reconstruir una lesión tumoral más lateral. La técnica aparece descrita para extraer el tonel de espesor parcial, sin embargo, teniendo en cuenta el margen oncológico recomendado en este caso la excéresis abarcó todo el espesor del labio. Objetivo: Presentar un caso de un paciente con un carcinoma epidermoide del 40 % en el labio inferior intervenido en el Hospital General Camilo Cienfuegos. Presentación del caso: Paciente masculino de 43 años de edad tratado durante un año por queilitis actínica, portador de una lesión exofítica, infiltrante que ocupaba el 40 % del labio inferior. Se estableció como impresión diagnóstica un carcinoma epidermoide y se decidió el tratamiento quirúrgico. Atendiendo a las características individuales del paciente y a las de la lesión, se eligió la técnica del tonel descrita por Schuchardt. Conclusiones: Las lesiones malignas de los labios pueden incidir enmascaradas por el cuadro clínico de lesiones premalignas como la queilitis actínica por lo que es importante mantener un seguimiento estrecho de estos casos. Al aplicar el método clínico puede decidirse la intervención quirúrgica con diagnóstico presuntivo de carcinoma epidermoide, deben respetarse entonces los márgenes oncológicos recomendados. La técnica del tonel inicialmente descrita para pérdidas de tejidos mediales y paramediales del labio, de espesor parcial puede emplearse en defectos de localización más lateral y de espesor total con resultados satisfactorios.

ABSTRACT Background: The barrel of Schuchardt technique, is indicated when the defect in the lip compromises 30-75 % of it, from central to paramedial location which affects both, vermilion and skin; in this case, the flap was used for rebuilding a more lateral tumor lesion. The technique is described to extract the partial thickness barrel; however, taking into account the oncological margin recommended in this case, the hysteresis covered the entire thickness of the lip. Objective: To present a case of a patient with 40 % squamous cell carcinoma in the lower lip intervened at Camilo Cienfuegos General Hospital. Case report: A 43-year-old male patient treated for a year having actinic cheilitis, with an infiltrated exophytic lesion, occupying 40 % of the lower lip. A squamous cell carcinoma was diagnosed, so surgical treatment. Based on the individual characteristics of the patient and those of the lesion, the barrel technique described by Schuchardt was chosen. Conclusions: Malignant lesions of the lips can affect masked by the clinical picture of premalignant lesions such as actinic cheilitis, so it is important to keep a close follow-up of these cases. When applying the clinical method, the surgical intervention with presumptive diagnosis of squamous cell carcinoma can be decided, then the recommended oncological margins must be respected. The barrel technique initially described for losses of medial and paramedial tissues of the lip, of partial thickness can be used in defects of more lateral location and of total thickness with satisfactory results.

Lip Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Cheilitis/surgery
Braz. j. otorhinolaryngol. (Impr.) ; 85(5): 603-610, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1039288


Abstract Introduction: The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin. Objective: To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis. Methods: Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44 ± 28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors. Results: 45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR = 5.043; p = 0.015) and recurrence (HR = 11.586; p = 0.012). Resection margin did not result an independent predictor (HR = 0.757; p = 0.653). Conclusions: Our study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices.

Resumo Introdução: O tratamento do carcinoma de células escamosas de laringe necessita de uma estratificação precisa do risco, para a escolha da terapia mais adequada. O significado prognóstico da margem de ressecção ainda é motivo de debate, considerando-se os resultados contraditórios obtidos em vários estudos sobre a taxa de sobrevida de pacientes com margem de ressecção positiva. Objetivo: Avaliar o papel prognóstico da margem de ressecção em termos de sobrevida e risco de recorrência de tumor primário através da análise de sobrevida. Método: Entre 2007 e 2014, 139 pacientes com carcinoma de células escamosas de laringe foram submetidos à laringectomia parcial ou total e foram acompanhados por um tempo médio de 59,44 ± 28,65 meses. O status de margem de ressecção e outras variáveis, como sexo, idade, grau do tumor, pT, pN, técnica cirúrgica adotada e radio- e/ou quimioterapia pós-operatória, foram investigados como fatores prognósticos. Resultados: Dos pacientes, 45,32% foram submetidos à laringectomia total, enquanto os demais foram submetidos à laringectomia parcial. As margens de ressecção em 73,39% das amostras estavam livres, enquanto em 21 pacientes (15,1%) a avaliação anatomopatológica encontrou uma das margens próxima e 16 indivíduos (11,51%) apresentaram margem de ressecção comprometida. Apenas seis pacientes (4,31%) apresentaram recidiva, o que ocorreu em 83,33% desses pacientes no primeiro ano de seguimento. A sobrevida doença-específica foi de 99,24% em um ano, 92,4% em três anos e 85,91% em cinco anos. A análise multivariada de todas as covariáveis mostrou um aumento na taxa de mortalidade apenas em relação à pN (HR = 5,043; p = 0,015) e recidiva (HR = 11,586; p = 0,012). A margem de ressecção não demonstrou ser um preditor independente (HR = 0,757; p = 0,653). Conclusões: Nosso estudo não identificou a margem de ressecção como fator prognóstico independente; a maioria dos artigos publicados anteriormente não tem escolhas metodológicas unânimes e as coortes de pacientes analisados não são fáceis de comparar. Para chegar a uma concordância unânime em relação ao valor prognóstico da margem de ressecção, seria necessário fazer metanálises em estudos que compartilham a definição da margem de ressecção, metodologia e escolhas terapêuticas pós-operatórias.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Margins of Excision , Prognosis , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Survival Analysis , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Survival Rate , Retrospective Studies , Italy/epidemiology , Laryngectomy/methods , Neoplasm Recurrence, Local
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 98-100, sept. 2019. ilus.
Article in Spanish | LILACS | ID: biblio-1048365


El adenocarcinoma mucinoso primario de piel es una neoplasia anexial, maligna e infrecuente, que afecta principalmente a hombres en una relación 2:1 con respecto a las mujeres. Presenta mayor incidencia entre la sexta y séptima década de la vida, y se manifiesta como un tumor único, asintomático, de tamaño variable. La localización más frecuente es la región periorbitaria y el cuero cabelludo. Se comunica el caso de una paciente de 92 años, con diagnóstico de carcinoma mucinoso primario de piel, sin evidencia de enfermedad sistémica ni recurrencia local al año de la resección por cirugía micrográfica de Mohs. Describimos sus principales características clínicas, dermatoscópicas y hallazgos histopatológicos. (AU)

Primary mucinous adenocarcinoma of the skin is an adnexal, malignant, and infrequent neoplasm that mainly affects men with a 2: 1 ratio, with respect to women. It presents higher incidence between the sixth and seventh decade of life, and manifests as a single tumor, asymptomatic, of variable size. The most frequent location is the periorbital region and scalp. We report the case of a 92-year-old patient with a diagnosis of primary mucinous skin carcinoma, without evidence of systemic disease or local recurrence one year after resection by Mohs micrographic surgery. We describe its main clinical features, dermatoscopic and histopathological findings. (AU)

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Skin Neoplasms/diagnostic imaging , Adenocarcinoma, Mucinous/diagnostic imaging , Neoplasm Metastasis/diagnostic imaging , Scalp/pathology , Carcinoma, Squamous Cell/surgery , Adenocarcinoma, Mucinous/surgery , Adenocarcinoma, Mucinous/etiology , Adenocarcinoma, Mucinous/ultrastructure , Adenocarcinoma, Mucinous/epidemiology , Eccrine Glands/ultrastructure
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 338-342, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040026


Abstract Introduction The main modalities of surgical treatment for laryngeal cancer include transoral laser microsurgery (TLM), open preservation surgery, and total laryngectomy (TL). In the elderly, for the presence of comorbidities, the surgical approach more appropriate in many cases remains TL. The use of a stapler for the closure of the esophagus has been introduced to reduce surgical time and postoperative complications such as pharyngocutaneous fistula (PCF). Objective In the present study, we have evaluated the effectiveness of the use of the horizontal mechanical pharyngoesophageal closure in patients who underwent TL. Methods This nonrandomized study was performed on consecutive patients with histopathologically proven squamous cell endolaryngeal carcinoma. The TLwas performed using a linear stapler to mechanically suture the pharyngotomy using the semiclosed technique. Results A total of 33 patients underwent TL, and 13 of themunderwent neck dissection. A total of 15 patients (45.4%) were ≤70 years old, and 18 were > 70 years old. Analyzing the results in relation to age, patients > 70 years old showed tumors at an earlier stage than those aged ≤70 years old. Furthermore, in this group there was a greater number of patients who had comorbidities (p = 0.014). In total, we had 2 (6%) cases of PCF in 6.6% in the group ≤70 years old, and in 5.5% of the group > 70 years old (p = 1.00). Conclusions The use of the stapler for the horizontal closure of the pharyngoesophagectomy in the patients subjected to TL is proven to be useful and safe even when used in elderly patients.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Pharynx/surgery , Postoperative Complications/prevention & control , Surgical Staplers , Suture Techniques/instrumentation , Treatment Outcome , Cutaneous Fistula/prevention & control , Esophagus/surgery
Braz. j. otorhinolaryngol. (Impr.) ; 85(3): 357-364, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011629


Abstract Introduction: Although the red cell distribution width has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge few reports have focused on the prognostic value of red cell distribution width in laryngeal carcinoma. Objective: We aimed to explore whether the pretreatment red cell distribution width predicted recurrence in laryngeal cancer patients is a simple, reproducible, and inexpensive prognostic biomarker. Methods: All laryngeal cancer patients who underwent curative surgery (n = 132) over a 7 year study period were evaluated. Data on demographics, primary tumor site, T-stage, N-stage, histological features (differentiation; the presence of perineural/perivascular invasion), treatment group (total laryngectomy or partial laryngectomy) or adjuvant therapy (chemotherapy/radiotherapy); laboratory parameters (complete blood count, including the pre-operative red cell distribution width), and disease-free survival rates were retrospectively reviewed. All cases were divided into three groups by the red cell distribution width tertile [<13% (25th percentile) (n = 31), 13-14.4% (50th percentile) (n = 72), and >14.4% (75th percentile) (n = 29)]. Results: High-red cell distribution width group included more patients of advanced age, and more of those with recurrent and metastatic tumors (p = 0.005, 0.048, and 0.043, respectively). Individuals with red cell distribution width >14.4% (75th percentile) had lower disease free survival rates than did those with red cell distribution width <13% (25th percentile) (p = 0.014). Patients with red cell distribution width >14.4% at diagnosis were at a higher risk of locoregional recurrence (hazard ratio = 5.818, 95% confidence interval (95% CI) 1.25-26.97; p = 0.024) than patients with a normal red cell distribution width (<13%). Conclusion: We found that the pretreatment red cell distribution width was independently prognostic of disease free survival rate in patients with laryngeal cancer and may serve as a new, accurate, and reproducible means of identifying early-stage laryngeal cancer patients with poorer prognoses.

Resumo Introdução: Embora a amplitude de distribuição de eritrócitos tenha sido relatada como um preditor confiável de prognóstico em vários tipos de câncer, que seja de nosso conhecimento, poucos estudos se concentraram no valor prognóstico dessa medida no carcinoma laríngeo. Objetivo: Avaliar se a amplitude de distribuição de eritrócitos pré-tratamento prevê a recorrência em pacientes com câncer de laringe como um biomarcador prognóstico simples, reprodutível e não dispendioso. Método: Foram avaliados todos os pacientes com câncer de laringe submetidos à cirurgia curativa (n = 132) durante sete anos. Dados demográficos, local do tumor primário, estágio T, estágio N, características histológicas (diferenciação; presença de invasão perineural/perivascular), grupo de tratamento (laringectomia total ou laringectomia parcial) ou terapia adjuvante (quimioterapia/radioterapia); parâmetros laboratoriais (hemograma, inclusive a amplitude de distribuição de eritrócitos pré-operatório) e a sobrevida livre de doença foram revisados retrospectivamente. Todos os casos foram divididos em três grupos pelo tercil da amplitude de distribuição de eritrócitos [< 13% (percentil 25) (n = 31), 13%-14,4% (percentil 50) (n = 72) e > 14,4% (percentil 75) (n = 29)]. Resultados: O grupo com amplitude de distribuição de eritrócitos elevado incluiu um número maior de pacientes com idade avançada e mais pacientes com tumores recorrentes e metastáticos (p = 0,005, 0,048 e 0,043, respectivamente). Os indivíduos com a amplitude de distribuição de eritrócitos > 14,4% (percentil 75) apresentaram taxas de sobrevida livre de doença menores do que aqueles com a amplitude de distribuição de eritrócitos < 13% (percentil 25) (p = 0,014). Pacientes com a amplitude de distribuição de eritrócitos > 14,4% no diagnóstico apresentaram maior risco de recorrência locorregional [Hazard Ratio = 5,818, intervalo de confiança de 95% (IC 95%) 1,25-26,97; p = 0,024] do que pacientes com a amplitude de distribuição de eritrócitos normal (< 13%). Conclusão: Verificamos que a amplitude de distribuição de eritrócitos pré-tratamento foi um fator prognóstico independente de sobrevida livre de doença em pacientes com câncer de laringe e pode servir como um novo parâmetro, preciso e reprodutível, para identificar pacientes com câncer de laringe em estágio inicial com piores prognósticos.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/blood , Laryngeal Neoplasms/blood , Erythrocyte Indices , Prognosis , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/mortality , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/mortality , Predictive Value of Tests , Retrospective Studies , Disease-Free Survival , Laryngectomy , Neoplasm Recurrence, Local , Neoplasm Staging
Braz. j. otorhinolaryngol. (Impr.) ; 85(3): 344-350, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011626


Abstract Introduction: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. Objective: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. Methods: In total, 29 male patients (average years 58.20 ± 9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. Results: The mean maximum phonation time was 8.68 ± 4.21 s in Group A and 15.24 ± 6.16 s in Group B (p > 0.05). The S/Z (s/s) ratio was 1.23 ± 0.35 in Group A and 1.08 ± 0.26 in Group B (p > 0.05); the voice handicap index averages were 9.86 ± 4.77 in Group A and 12.42 ± 12.54 in Group B (p > 0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73 ± 3.08 in Group A and 13.64 ± 1.49 in Group B (p > 0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21 ± 4.11, 32.21 ± 6.85, and 20.14 ± 2.17 in the Group B, and 29.20 ± 2.54, 32.4 ± 4.79, and 19 ± 1.92 in Group A, respectively. Conclusion: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

Resumo Introdução: O câncer laríngeo é o câncer mais comum do trato respiratório superior. Os principais métodos de tratamento incluem cirurgia (laringectomia parcial e laringectomia total) e radioterapia. A disfunção laríngea é observada em ambas as modalidades de tratamento. Objetivos: Comparar os resultados funcionais pós-operatórios da técnica de laringectomia padrão supracricoide e a técnica de laringectomia supracricoide modificada com o uso do músculo esterno-hióideo. Método: Foram incluídos 29 pacientes do sexo masculino (média de 58,20 ± 9,00 anos, intervalo de 41 a 79) com carcinoma espinocelular de laringe submetidos à laringectomia supracricoide parcial. Os pacientes foram divididos em dois grupos em termos de técnicas cirúrgicas. Todos os pacientes do Grupo A foram submetidos à laringectomia padrão supracricoide entre janeiro de 2007 e novembro de 2011. No Grupo B, todos os pacientes foram submetidos à laringectomia supracricoide modificada entre agosto de 2010 e novembro de 2011. A avaliação endoscópica da deglutição por fibra ótica, os escores da versão curta do Voice Handicap Index e do MD Anderson Dysphagia Inventory, o tempo de alimentação oral e a decanulação dos pacientes foram comparados após a cirurgia em cada grupo. Resultados: A média do tempo máximo de fonação foi de 8,68 ± 4,21 segundos no Grupo A e 15,24 ± 6,16 segundos no Grupo B (p > 0,05). A razão S/Z (seg/seg) foi de 1,23 ± 0,35 no Grupo A e 1,08 ± 0,26 no Grupo B (p > 0,05); as médias do Voice Handicap Index foram 9,86 ± 4,77 no Grupo A e 12,42 ± 12,54 no Grupo B (p > 0,05); as médias da avaliação endoscópica da deglutição por fibra ótica foram calculadas como 12,73 ± 3,08 no Grupo A e 13,64 ± 1,49 no Grupo B (p > 0,05). Na avaliação da deglutição pelo MD Anderson Dysphagia Inventory, os escores emocional, físico e funcional foram 29,21 ± 4,11, 32,21 ± 6,85 e 20,14 ± 2,17 no Grupo B e 29,20 ± 2,54, 32,4 ± 4,79 e 19 ± 1,92 no Grupo A, respectivamente. Conclusão: Embora não haja diferença estatística nas comparações de resultados funcionais, se as regras forem respeitadas na seleção pré-operatória do paciente, a laringectomia supracricoide parcial modificada pode ser aplicada com segurança e ganhos significativos podem ser alcançados em termos de resultados funcionais.

Humans , Male , Adult , Middle Aged , Aged , Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Recovery of Function/physiology , Cricoid Cartilage/surgery , Laryngectomy/methods , Carcinoma, Squamous Cell/physiopathology , Laryngeal Neoplasms/physiopathology , Retrospective Studies , Treatment Outcome , Larynx/physiopathology
Int. braz. j. urol ; 45(3): 560-571, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012321


ABSTRACT Purpose: To introduce our experience with intracorporeal ileal conduit and evaluate the safety and feasibility of this endoscopic urinary diversion. Materials and Methods: Between March 2014 and July 2017, thirty-six consecutive patients underwent laparoscopic radical cystectomy with intracorporeal ileal conduit. Patients' demographic data, perioperative data, 90-days postoperative outcomes and complications were collected. This cohort were divided into two groups of 18 patients each by chronological order of the operations to facilitate comparison of clinical data. Data were evaluated using the students' T test, Mann-Whitney test and Fisher's Exact test. Results: All surgeries were completed successfully with no conversion. Median total operating time and median intracorporeal urinary diversion time were 304 and 105 minutes, respectively. Median estimated blood loss was 200 mL, and median lymph node yield was 21. Twenty-six Clavien grade < 3 complications occurred within 30-days and 9 occurred within 30-90 days. Five Clavien grade 3-5 complications occurred within 30 days. No statistically significant differences were found between the two groups except for intracorporeal urinary diversion time. At median follow-up of 17.5 (range 3-42) months, 6 patients experienced tumor recurrence/metastasis and 4 of these patients died. Conclusions: Intracorporeal ileal conduit following laparoscopic radical cystectomy is safe, feasible and reproducible. With the accumulation of experience, the operation time can be controlled at a satisfactory level.

Humans , Male , Female , Adult , Aged , Urinary Diversion/methods , Urinary Bladder Neoplasms/surgery , Adenocarcinoma/surgery , Cystectomy/methods , Laparoscopy/methods , Postoperative Complications , Time Factors , Urinary Bladder Neoplasms/pathology , Anastomosis, Surgical , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Adenocarcinoma/pathology , Prospective Studies , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Surgical Stomas , Neoplasm Grading , Operative Time , Medical Illustration , Middle Aged , Neoplasm Staging