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1.
Eur Arch Otorhinolaryngol ; 279(3): 1431-1434, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1626886

ABSTRACT

PURPOSE: This study aimed to evaluate whether there was a significant change in the laryngeal cancer stage before and after the COVID-19 pandemic. METHODS: This retrospective cohort study was conducted to evaluate the data of patients who operated due to laryngeal cancer in a tertiary referral hospital's ear, nose, and throat (ENT) department between June 2018 and 2021. The patients were included at the same period of the years to rule out any seasonal changes. The basic characteristic, tumor localization, and TNM stage of the patients were compared. RESULTS: 97 patients were operated due to laryngeal cancer during the time period reviewed. 57 (58.8%) patients were operated before and 40 (41.2%) after the COVID-19 pandemic. When comparing the patients before and after the COVID-19 pandemic period, the mean age significantly differed between the study groups that older age was observed in patients who admitted before the COVID-19 pandemic (62.8 ± 6.5 vs. 57.3 ± 6.8, p < 0.001). Regarding the TNM classification, the patients in the after COVID-19 pandemic group had higher rates of T4 stage laryngeal cancer compared to before COVID-19 pandemic group (12 (30%) vs. 4 (7%), p: 0.003). CONCLUSION: Younger patients have operated after the COVID-19 pandemic, and the patients were presented with larger tumor sizes. The pandemic may increase the time between diagnosis and surgery in laryngeal cancer patients.


Subject(s)
COVID-19 , Laryngeal Neoplasms , COVID-19/epidemiology , Humans , Laryngeal Neoplasms/epidemiology , Laryngeal Neoplasms/surgery , Pandemics , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
2.
Am J Otolaryngol ; 43(2): 103319, 2022.
Article in English | MEDLINE | ID: covidwho-1588363

ABSTRACT

PURPOSE: Changes in the entire health care system during COVID-19 epidemic have affected the management of patients with head and neck cancer and posed several clinical challenges for ENT surgeons. Therefore, the present study aimed to investigate the effect of COVID-19 on the stage and the type of surgical treatments used in laryngeal cancer (including total laryngectomy, supracricoid partial laryngectomy (SCPL) and transoral laser microsurgery (TLM)) and also to compare the results of April 2020 to April 2021 with the previous year. MATERIALS AND METHODS: This cross-sectional study was performed on all patients with a diagnosis of laryngeal cancer who underwent surgery in the tertiary care center from April 2020 to April 2021 and the year before the pandemic in the same time. Demographic, cancer stage, and treatment data of all patients were recorded and analysis in two groups. RESULTS: Patients referred at the time of the virus outbreak; 111 were male and 5 were female, and in the group of patients referred before COVID-19, 90 were male and 12 were female. The type of surgical treatment of laryngeal cancer, mean time elapsed from sampling to surgery, stage of disease and mean tumor volume was statistically significant differences in patients before and during the outbreak. CONCLUSION: Patients who referred for diagnosis and treatment at the time of COVID-19 outbreak had more advanced stages of the disease and also the tumor volume was higher in them than patients who had referred before the outbreak. It is necessary to provide new solutions, education and treatment management for patients with laryngeal cancer in such pandemics.


Subject(s)
COVID-19 , Laryngeal Neoplasms , Laser Therapy , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Laryngeal Neoplasms/epidemiology , Laryngeal Neoplasms/etiology , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Laser Therapy/methods , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
3.
Am J Otolaryngol ; 42(6): 103162, 2021.
Article in English | MEDLINE | ID: covidwho-1321975

ABSTRACT

OBJECTIVE: Restriction in healthcare services during the COVID-19 pandemic caused delays in the diagnosis and treatment of several diseases. To overcome the risk of missed diagnosis of head and neck cancers, before deleting the scheduled appointments, we have introduced a selection of the patients by examining the clinical presenting issue and previous medical history. The aim of this study is to show the effects of the abovementioned strategy on the diagnosis and management of laryngeal cancer. METHODS: Data were extracted from the Hospital software regarding the new diagnosis of laryngeal SCC in the periods from March 2020 to December 2020 during the pandemic (study group) and from March 2019 to December 2019 (control group) were collected. Data were compared regarding: TNM stage, time from first medical examination to histological diagnosis (Time-1), and time form histological diagnosis to beginning of treatments (Time-2). RESULTS: The final study group was composed by 19 laryngeal cancers, the control group by 25 cases. No significant differences were found in the tumour stage between the groups. In the study group, Time-1 was shorter (24 days versus 43 days, p = 0.012), while Time-2 in surgically-treated patients was longer (20 days versus 9 days, p = 0.012). CONCLUSION: During the pandemic, there was a dramatic lack of medical and nurse staff needed for surgical procedures. As consequence, the time between the diagnosis of malignancy and surgical treatment increased. In our unit, an efficient patient selection strategy to reschedule medical appointments avoided a dangerous shift toward higher laryngeal cancer stages.


Subject(s)
COVID-19 , Delayed Diagnosis/prevention & control , Delivery of Health Care/statistics & numerical data , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/prevention & control , Aged , Appointments and Schedules , Female , Humans , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Time Factors
4.
Otolaryngol Head Neck Surg ; 164(2): 277-284, 2021 02.
Article in English | MEDLINE | ID: covidwho-1140418

ABSTRACT

OBJECTIVE: To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. STUDY DESIGN: Prospective cohort study. SETTING: Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation. SUBJECTS AND METHODS: All patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician's call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice. RESULTS: Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, P = .03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre- vs post-video call: 13.97 vs. 10.23, P < .0001) and reported high levels of satisfaction about the service. CONCLUSION: Remote approach may be a viable support in the management of patients with voice prosthesis rehabilitation.


Subject(s)
COVID-19/epidemiology , Laryngeal Neoplasms/surgery , Laryngectomy/rehabilitation , Larynx, Artificial/adverse effects , Telemedicine , Triage , Adult , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/etiology , Anxiety/prevention & control , Depression/diagnosis , Depression/etiology , Depression/prevention & control , Female , Humans , Laryngeal Neoplasms/psychology , Laryngectomy/adverse effects , Laryngectomy/psychology , Larynx, Artificial/psychology , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Treatment Outcome , Voice Training
7.
Ann Surg Oncol ; 28(2): 877-885, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-926421

ABSTRACT

BACKGROUND: The COVID-19 pandemic has required triage and delays in surgical care throughout the world. The impact of these surgical delays on survival for patients with head and neck squamous cell carcinoma (HNSCC) remains unknown. METHODS: A retrospective cohort study of 37 730 patients in the National Cancer Database with HNSCC who underwent primary surgical management from 2004 to 2016 was performed. Uni- and multivariate analyses were used to identify predictors of overall survival. Bootstrapping methods were used to identify optimal time-to-surgery (TTS) thresholds at which overall survival differences were greatest. Cox proportional hazard models with or without restricted cubic splines were used to determine the association between TTS and survival. RESULTS: The study identified TTS as an independent predictor of overall survival (OS). Bootstrapping the data to dichotomize the cohort identified the largest rise in hazard ratio (HR) at day 67, which was used as the optimal TTS cut-point in survival analysis. The patients who underwent surgical treatment longer than 67 days after diagnosis had a significantly increased risk of death (HR, 1.189; 95% confidence interval [CI], 1.122-1.261; P < 0.0001). For every 30-day delay in TTS, the hazard of death increased by 4.6%. Subsite analysis showed that the oropharynx subsite was most affected by surgical delays, followed by the oral cavity. CONCLUSIONS: Increasing TTS is an independent predictor of survival for patients with HNSCC and should be performed within 67 days after diagnosis to achieve optimal survival outcomes.


Subject(s)
Hypopharyngeal Neoplasms/surgery , Laryngeal Neoplasms/surgery , Mouth Neoplasms/surgery , Oropharyngeal Neoplasms/surgery , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Squamous Cell Carcinoma of Head and Neck/surgery , Time-to-Treatment/statistics & numerical data , Aged , COVID-19 , Cohort Studies , Delivery of Health Care , Female , Humans , Hypopharyngeal Neoplasms/mortality , Laryngeal Neoplasms/mortality , Male , Middle Aged , Mouth Neoplasms/mortality , Oropharyngeal Neoplasms/mortality , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2 , Squamous Cell Carcinoma of Head and Neck/mortality , Surgical Oncology
8.
J Otolaryngol Head Neck Surg ; 49(1): 59, 2020 Aug 10.
Article in English | MEDLINE | ID: covidwho-705369

ABSTRACT

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/organization & administration , Laryngeal Neoplasms/surgery , Laryngectomy/statistics & numerical data , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Female , Humans , Laryngeal Neoplasms/diagnosis , Laryngectomy/methods , Larynx, Artificial , Male , Ontario , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Prosthesis Implantation/methods , Prosthesis Implantation/statistics & numerical data , Risk Assessment
9.
Ann Otol Rhinol Laryngol ; 130(1): 104-107, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-614415

ABSTRACT

OBJECTIVE: To date, no cases have been reported on the effects of COVID-19 in laryngectomees. CASE PRESENTATION: We herein presented two clinical cases of laryngectomized patients affected by COVID-19, detailing their clinical course and complications. DISCUSSION: In our experience, permanent tracheostomy did not significantly affect the choice of treatment. However, dedicated devices and repeated tracheal toilettes may be needed to deal with oxygen-therapy-related tracheal crusting. CONCLUSION: In conclusion, laryngectomees should be considered a vulnerable population that may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways. The role of the ENT specialist is to guide airway management and inform the support-staff regarding specific needs of these patients.


Subject(s)
COVID-19/therapy , Laryngectomy , Oxygen Inhalation Therapy/methods , Pharyngectomy , Tracheostomy , Aged , Airway Management/methods , COVID-19/drug therapy , Humans , Humidifiers , Hypopharyngeal Neoplasms/surgery , Laryngeal Neoplasms/surgery , Male , Oropharyngeal Neoplasms/surgery , Pyriform Sinus , Squamous Cell Carcinoma of Head and Neck/surgery
10.
Eur Urol Focus ; 6(5): 1058-1069, 2020 09 15.
Article in English | MEDLINE | ID: covidwho-548746

ABSTRACT

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic raised concerns about the safety of laparoscopy due to the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion in surgical smoke. Although no case of SARS-CoV-2 contagion related to surgical smoke has been reported, several international surgical societies recommended caution or even discouraged the use of a laparoscopic approach. OBJECTIVE: To evaluate the risk of virus spread due to surgical smoke during surgical procedures. EVIDENCE ACQUISITION: We searched PubMed and Scopus for eligible studies, including clinical and preclinical studies assessing the presence of any virus in the surgical smoke from any surgical procedure or experimental model. EVIDENCE SYNTHESIS: We identified 24 studies. No study was found investigating SARS-CoV-2 or any other coronavirus. About other viruses, hepatitis B virus was identified in the surgical smoke collected during different laparoscopic surgeries (colorectal resections, gastrectomies, and hepatic wedge resections). Other clinical studies suggested a consistent risk of transmission for human papillomavirus (HPV) in the surgical treatments of HPV-related disease (mainly genital warts, laryngeal papillomas, or cutaneous lesions). Preclinical studies showed conflicting results, but HPV was shown to have a high risk of transmission. CONCLUSIONS: Although all the available data come from different viruses, considering that the SARS-CoV-2 virus has been shown in blood and stools, the theoretical risk of virus diffusion through surgical smoke cannot be excluded. Specific clinical studies are needed to understand the effective presence of the virus in the surgical smoke of different surgical procedures and its concentration. Meanwhile, adoption of all the required protective strategies, including preoperative patient nasopharyngeal swab for COVID-19, seems mandatory. PATIENT SUMMARY: In this systematic review, we looked at the risk of virus spread from surgical smoke exposure during surgery. Although no study was found investigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or any other coronavirus, we found that the theoretical risk of virus diffusion through surgical smoke cannot be excluded.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Hepatitis B virus , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy , Papillomaviridae , Pneumonia, Viral/transmission , Smoke , COVID-19 , Colectomy , Condylomata Acuminata/surgery , Condylomata Acuminata/virology , Gastrectomy , Hepatectomy , Humans , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/virology , Minimally Invasive Surgical Procedures , Pandemics , Papilloma/surgery , Papilloma/virology , Papillomavirus Infections , Risk , SARS-CoV-2 , Warts/surgery , Warts/virology
13.
Head Neck ; 42(6): 1131-1136, 2020 06.
Article in English | MEDLINE | ID: covidwho-66373

ABSTRACT

BACKGROUND AND METHODS: There is an added level of complexity in the management of head and neck cancer patients with underlying immunosuppressive disorders during the COVID-19 pandemic. Head and neck oncologists are tasked with balancing the dual risks of cancer progression in the setting of impaired tumor immunity and increased susceptibility to life-threatening complications from exposure to viral infection for patients and providers. Through two cases of immunocompromised patients with newly diagnosed head and neck malignancies, we aim to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under these difficult circumstances. RESULTS: After careful consideration of the options, we took different approaches in the care of these two patients. CONCLUSIONS: Ultimately, there is no uniform set of rules to apply to this heterogeneous group of immunocompromised patients. We provide some general principles to help guide patient management during the current pandemic.


Subject(s)
Conservative Treatment/methods , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/therapy , Immunocompromised Host , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Time-to-Treatment/organization & administration , Adult , COVID-19 , Clinical Decision-Making , Communicable Disease Control/methods , Disease Management , Female , Follow-Up Studies , Head and Neck Neoplasms/pathology , Humans , Interdisciplinary Communication , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/surgery , Patient Safety , Risk Assessment , Sampling Studies , Time Factors , United States , Vocal Cords/pathology , Vocal Cords/surgery
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