Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery / 中华肿瘤杂志

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

Laryngeal reconstruction by complex hyoid bone flap after frontal partial laryngectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The aim of this study was to describe a new technique of combined hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction after tumor resection, and to evaluate outcome.</p><p><b>METHODS</b>Six patients requiring an frontal partial laryngectomy for cancer were enrolled between September 2008 and August 2012.</p><p><b>RESULTS</b>Nasogastric feeding was initiated within 24 hours. The mean times to swallow batter, ability to drink water and removal of the nasogastric tube were 2.6, 5.5 and 6.3 days. All patients had good respiratory function. There were no deaths, and no reports of postoperative dyspnea or dysphagia. The vocal quality was satisfactory, slightly deeper and raspy, and the volume was weak when calling. The final follow-up assessment was in August 2012, and the overall mean follow-up period was 29.5months, range 14 to 47 months. Case two subsequently underwent total laryngectomy for recurrence in the paraglottic space, but there was no evidence of further tumor recurrence at the final assessment.</p><p><b>CONCLUSIONS</b>The combined muscle-pedicle hyoid bone and thyrohyoid membrane flap is a reliable graft for one-stage repair of laryngotracheal defects, providing effective repair of the mucosa and cartilage support. Vocal quality, swallowing function and ventilation after the procedure were favorable.</p>

Treatment results and prognostic factors of patients undergoing postoperative radiotherapy for laryngeal squamous cell carcinoma / 癌症

Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this study were to evaluate the treatment outcomes of PRT for patients with laryngeal carcinoma and to identify the value of several prognostic factors. We reviewed the records of 256 patients treated for laryngeal squamous cell carcinoma between January 1993 and December 2005. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank test was employed to identify significant prognostic factors for DFS and OS. The Cox proportional hazards model was applied to identify covariates significantly associated with the aforementioned endpoints. Our results showed the 3-, 5-, and 10-year DFS for all patients were 69.9%, 59.5%, and 34.9%, respectively. The 3-, 5-, and 10-year OS rates were 80.8%, 68.6%, and 38.8%, respectively. Significant prognostic factors for both DFS and OS on univariate analysis were grade, primary site, T stage, N stage, overall stage, lymph node metastasis, overall treatment times of radiation, the interval between surgery and radiotherapy, and radiotherapy equipment. Favorable prognostic factors for both DFS and OS on multivariate analysis were lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment. In conclusion, our data suggest that lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment are favorable prognostic factors for DFS and OS and that reducing the overall treatment times of radiation to 6 weeks or less and the interval between surgery and radiotherapy to less than 3 weeks are simple measures to remarkably improve treatment outcome.

Roles of single photo emission computed tomography-CT in detecting residual tumor from patients with thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>As newly, functional, diagnostic measure-18F-deoxyglucose single photo emission computed tomography (18F-FDG SPECT-CT) has well sensitivity and specialty , it was proved availability in differentiating benign and malignant tumor. In this study, it was compared the efficiency of detecting residual tumor of thyroid cancer between 18F-FDG SPECT-CT and CT-TWIN.</p><p><b>METHODS</b>During May 2004 to August 2004, 56 patients with thyroid disease were divided into two groups, one group was 32 cases suffered thyroid tumor, another was 24 cases suffered improper operation. All cases must take 18F-FDG SPECT-CT and CT-TWIN.</p><p><b>RESULTS</b>Forty eight cases had been performed operation, and 8 cases waited and watched because they didn't be found residual tumor by 18F-FDG SPECT-CT and CT-TWIN. The results in detecting thyroid tumor showed that the same rate of diagnostic correction of SPECT-CT was 87.5% (28/32), and the Youden index of SPECT-CT was 0.667, higher than that of CT which was 87.5% (28/32) and 0.633 respectively. When the results two methods were accordant, the rate of diagnostic correction was 100% (24/24), and Youden index was 1, and the result had statistic signification. The rate of diagnostic correction of SPECT-CT in detecting residual tumor was 84.6%, and its Youden index was 0.675. The rate of diagnostic correction of CT in detecting residual tumor was 75.0%, and its Youden index was 0.492; and the result had statistics signification by being compared two different measures.</p><p><b>CONCLUSIONS</b>SPECT-CT and CT all had higher diagnostic efficacy, and they could promote the diagnostic efficacy when they have the same diagnosis in detecting thyroid tumor. The rate of detecting residual tumor of SPECT-CT was 81.3%, compared with that of CT the diagnostic efficacy has greater raise.</p>

Pathological character and treatment of epithelial-myoepithelial carcinoma of salivary gland / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review and evaluate pathologic features and treatment of epithelial-myoepithelial.</p><p><b>METHODS</b>Retrospectively reviewed 14 cases' pathological and clinical materials of epithelial-myoepithelial carcinoma of salivary gland. Eight cases origine from parotid gland, 2 cases from hard palate, 3 cases from submandibular gland and 1 case from nasal cavity. Three cases were performed induction chemotherapy preoperation. One case had palliative radiotherapy. Thirteen cases were performed radical surgery and 6 cases had radiotherapy postoperation.</p><p><b>RESULTS</b>Tumor arisen mostly from parotid gland and neck lymph node metastasis rate was 14.28% (2/14). The survival rate was calculated with Kaplan-Meier method. The overall 3-, 5- and 10-year survival rate were 67.20%, 45.49% and 17.06%. Its histological characteristics were inner layer composed by adenoid cells and outer layer composed by myoepithelial cells. Immunohistochemical exam show cytokeratin, S-100 and actin reaction positive.</p><p><b>CONCLUSIONS</b>Epithelial-myoepithelial carcinoma easily develops recurrence. It is sensitivity to radiotherapy and chemotherapy to some extent. It is suitable to adopt surgical treatment as primary modality combined with other therapies.</p>

Management option for cervical metastases in tongue squamous cell carcinoma with clinically N0 neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice.</p><p><b>METHODS</b>Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed.</p><p><b>RESULTS</b>Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control.</p><p><b>CONCLUSIONS</b>Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.</p>

Treatment of second primary malignant tumor induced by radiotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of a second primary malignant tumor induced by previous radiotherapy.</p><p><b>METHODS</b>From March 1970 to March 1997, 108 nasopharyngeal cancer (NPC) patients who developed a second primary malignant tumor induced by radiotherapy were treated. There were squamous carcinoma 43 (39.8%), sarcoma 26 (24.1%), malignant fibrous histiocytoma 14 (13.0%), adenoid cystic carcinoma 12 (11.1%), thyroid papillary adenocarcinoma 8 (7.4%) and malignant melanoma 5 (4.6%). Fifty patients underwent operation, 32 received radiotherapy, 18 received chemotherapy and 8 received operation combined with chemotherapy.</p><p><b>RESULTS</b>The 3- and 5-year tumor-free survival rates were 64.0% and 36.0% in the operation group. They were 34.4% and 18.8% in the radiotherapy group.</p><p><b>CONCLUSION</b>Surgery, if not contra-indicated, is the first choice for the second primary malignant tumor induced by radiotherapy. Aggressive treatment for these patients is, hence, indicated clinically.</p>