Fistula and stenosis after 135 (pharyngo)laryngectomies.

BACKGROUND: Despite progress made with reconstruction, morbidity is still elevated after (pharyngo)laryngectomy. The present study was designed to determine the incidence and predisposing factors of the complications following (pharyngo)laryngectomy. METHODS: Primary surgical treatment was delivered in 60 patients. Seventy-five patients underwent surgical salvage following radiotherapy. Different factors were evaluated as potentially predisposing to fistula formation. RESULTS: Stenosis is rare: 5.1% in the present series. A pharyngocutaneous fistula developed in 48.8% of patients. After a multivariate analysis, the site of the tumour was defined as a significant risk factor for pharyngocutaneous fistula formation. CONCLUSIONS: Despite progress made with reconstruction, morbidity is still elevated after major resection of the phary golarynx. Stenosis, a frequent complication when partial pharyngectomy is needed, is rare: 5.1% in the present series. Fistulas are relatively frequent but the majority resolved either with local irrigation or with subsequent flaps. The site of the tumour was a significant risk factor for pharyngocutaneous fistula formation, as defined by a multivariate analysis.

[Pharyngolaryngectomy for advanced and recurrent cancer: prognostic factors and complications]. / Pharyngolaryngectomies des cancers avancés et récidivants : etude des facteurs de pronostic et complications.

INTRODUCTION: The aim of this study was to evaluate the results of the initial surgical treatment and salvage treatment for advanced laryngopharyngeal cancer. METHODS: From 1984 to 1997, primary surgical treatment was undertaken in 60 patients. 75 patients underwent surgical salvage following radiotherapy. RESULTS: 55/135 patients (40.7%) experienced local regional relapse. The overall survival at 5 years was 43.9% in the first group of patients treated initially with surgery. In the group of patients treated with salvage surgery, the overall survival at 5 years was 40.2%. A multivariate analysis showed that involved lymph nodes (p = 0.0004), a nutritional score inferior to 5 (p = 0.03), positive resection margins (hazard ratio 2.05; 95% c.i. 1.03 to 4.04 ; p = 0.03), a local-regional relapse (p = 0.04) and appearance of metastasis (p = 0.03) were independent risk factors for overall survival. Survival is dependent from each factor, and each factor is independent from each other Stenosis was rare: 5.1% in the present series. A pharyngocutaneous fistula developed in 49.6% of patients. After a multivariate analysis, the site of the tumor (odds 2.26; 95% c.i. 1.05 to 4.85; p = 0.03) had an influence for apparition of a fistula. CONCLUSION: Initial surgical surgery and salvage surgery of respectively 43.9% and 40.2% overall survival compares favorably with the literature. Despite progress made with reconstruction, morbidity is still elevated in a selected group defined after analysis of pronostic factors.

Construction of an optimal destructive sampling design for noncompartmental AUC estimation.

Based on toxicokinetic studies of a destructive sampling design, this work was aimed at selecting the number of time points, their locations, and the number of replicates per time point in order to obtain the most accurate and precise noncompartmental estimate of the area under the concentration-time curve (AUC). From a prior population pharmacokinetic model, the design is selected to minimize the scaled mean squared error of AUC. Designs are found for various sample sizes, number of time points, and a distribution of animals across time points from being very unbalanced to balanced. Their efficiencies are compared both theoretically and based on simulations. An algorithm has been implemented for this purpose using the symbolic resolution and numerical minimization capabilities of Mathematica and an example of its use is provided. This method provides efficient tools for constructing, validating, and comparing optimal sampling designs for destructive sampled toxicokinetic studies.