Management of parapharyngeal space tumors at the national cancer institute, Egypt

The purpose of this study is to evaluate parapharyngeal space [PPS] tumors as regards clinicopathological features, preoperative assessment, different surgical approaches, perioperative complications, patterns of recurrence and the role of non-surgical treatment. This study included twenty five patients with [PPS] tumors presented to the NCI, Cairo University, from October 2001 to March 2003. The data of each patient included age, sex, presenting symptoms and signs, provisional diagnosis, preoperative investigations, operative data, histopathological examination, non-surgical treatment and state at follow up. All were collected and analyzed. This study included 12 males and 13 females. The mean age was 37.1 years. The main presenting symptom and sign was neck swelling. All patients were subjected to CT scan, while 9 patients had MRI. Nineteen patients underwent fine needle aspiration cytology [FNAC] which was conclusive in only 16 patients. Benign lesions were found in 12 patients [48%] and malignant lesions in 13 patients [52%]. Parotid gland tumors [40%] and neurogenic tumors [16%] were the commonest. Surgical excision was done in 22 cases. There was no postoperative mortality and overall postoperative morbidity was 9% [2/22]. Eight patients received postoperative radiotherapy. Three patients with lymphoma were treated with chemotherapy and two of them received involved field radiotherapy to the Waldyer's ring region. On follow up to 12-30 months, there were only one local and two distant recurrences in the malignant group. Surgery is the mainstay treatment for tumors of the [PPS]. The addition of postoperative radiotherapy in certain indications in malignant tumors of the [PPS] will improve the local control

Ileocecal interpositional graft for gastric replacement after total gastrectomy

The aim of this study is to evaluate the technique of ileocecal segment interpositional graft after total gastrectomy for gastric cancer with assessment of its advantages and disadvantages. This is a prospective study carried out at the National Cancer Institute, Cairo University. Twenty four patients with gastric carcinoma were identified from December 1998 to February 2003. All of them were submitted to surgery after preoperative clinical, radiological and endoscopic diagnosis. Total gastrectomy with ileocecal interpositional graft were done [19 subdiaphragmatic reconstruction and 5 intrathoracic reconstruction]. Patients were followed up for at least 12 months for postoperative morbidity, body weight, reflux and dumping symptoms. Gastrografin swallow, barium swallow, upper GIT endoscopy were routinely done in all patients and pouch emptying time by Tc-99m sulpher colloid was done in 11 patients only. Perioperative mortality was 8.3% [2/24]. No patient reported reflux symptoms-or showed endoscopic findings of reflux esophagitis in the subdiaphraematic reconstruction group and mild reflux was noted in only one patient in the intrathoracic reconstruction group. No patient reported dumping symptoms. Emptying time showed good capacity as a reservoir of food. Postoperative decrease in body weight averaged less than 10% of preoperative weight. ileocecal interposition graft after total gastrectomy has the advantages of preventing reflux esophagitis and providing functional replacement of the stomach as a reservoir for ingested food. It can be done with acceptable morbidity and mortality. It is simpler than some of the pouch reconstructions and deserves more attention

Appraisal of completion thyroidectomy for well differentiated thyroid carcinoma [WDTC]

Fifty patients with total lobectomy for WDTC were subjected to completion thyroidectomy [between 15 days to 4 years] following their initial procedure. Patients were categorized into two groups: Group I comprised 36 patients with no clinical evidence of any residual disease at the time of their completion procedure and Group II comprised 14 patients who at the time of their completion surgery had recurrent diseases either locoregional or metastatic. Completion thyroidectomy was shown to be a fairly safe procedure with a low incidence of complications [4% incidence of recurrent laryngeal nerve injury and 10% transient hypocalcemia]. When completion thyroidectomy is performed electively after complete lobectomy, residual subclinical disease will be discovered in 33% of the cases and the prognosis would be better