Prevention of periprosthetic leakage with double flange voice prosthesis: a systematic review and management protocol proposal.

OBJECTIVE: To conduct a systematic review of the use and results of the Provox®VegaTMXtraSealTM in the prevention of periprosthetic leakage and to propose a management protocol for this voice prosthesis. METHODS: Systematic search based on the PRISMA Statement during February 2020. Keywords were double flange, periprosthetic leakage, voice prosthesis, and laryngectomy. RESULTS: Four articles with 315 voice prosthesis (94 XtraSeal and 221 controls) in 55 patients were found. The XtraSeal mean duration was 114.28 ± 73.2 (CI 95%, 98.29-130.26) days compared to 102.98 ± 17.74 (CI 95%, 100.62-105.35) days of the control group. Out of 266 replacements, endoprosthetic leakage was the most frequent cause in both groups (62.41%). Periprosthetic leaks were less frequent in the XtraSeal (9.62%) than in the control group (22.43%). CONCLUSIONS: The XtraSeal could be effective in preventing periprosthetic leakage and lengthening the time between replacements. Studies with a robust methodology are necessary to confirm these results. Managing voice prosthesis is complex and requires a multidisciplinary and systematic approach by experienced professionals to reduce replacements and complications. Incorrect placement of the XtraSeal could cause a foreign body reaction and consequently inflammation, extrusion, or pressure lesions. The Tower of Hercules protocol: (1) Measurement of the tracheoesophageal fistula using the Provox® Measure, (2) Minimization of XtraSeal slack by avoiding the complete visualization of the prosthesis' blue ring, (3) Nasofibroscopic examination of the oesophageal wall confirming both flanges are in correct position; could prevent or minimize complications derived from the use of the XtraSeal.

Relationship between allergic rhinitis and diamine oxidase activity: A preliminary report.

AIM: To analyze the diamine oxidase (DAO), the main catabolic enzyme of histamine, degradation activity and its relation with symptoms of persistent allergic rhinitis. METHODS: In this descriptive and analytical observational study, we collected DAO activity levels and the nasal peak inspiratory flow. RESULTS: Enzymatic activity deficit in 108 patients was 46.3% (95% CI, 0.44 - 0.63), 33.33% in mild and 47.92% in moderate/severe rhinitis (p = 0.376). The nasal peak inspiratory flow in patients with a deficit in DAO activity was 76.30 ± 28.40 L/min compared to 93.62 ± 37.50 L/min in patients with normal enzymatic activity (p = 0.010). CONCLUSIONS: It seems that the lower the catabolic activity of DAO, the lower the nasal peak inspiratory flow observed. Although DAO activity levels could be a severity biomarker in allergic rhinitis, a cause-effect association cannot be concluded. The enzyme could be another actor in the pathophysiology of allergic rhinitis.

ENT emergencies during the first wave of COVID-19 pandemic in Spain: Our experience.

OBJECTIVES: To analyze the characteristics of the visits attended to in an ENT Emergency Department (ENT-ED) during the first wave of COVID-19, comparing them with the emergencies attended to during the same period of time in 2019. METHODS: Descriptive and analytical observational retrospective study of all emergency consultations between March 1, 2020, and May 21, 2020, carried out by the Otorhinolaryngology-Head and Neck Surgery Department of a tertiary university hospital. The adequacy of consultations was assessed with the Hospital Emergency Suitability Protocol (HESP). The correlation between the emergencies and the SARS-CoV-2 confirmed cases was assessed with a generalized linear model. RESULTS: Although there was a decrease of almost 50% in ENT-ED visits during the first wave of COVID-19, the pattern of most cases remained similar to the pre-COVID-19 era: non-urgent consultations, not previously assessed by Primary Care (PC), being considered inadequate by the HESP. The three main reasons for consultation were otalgia, odynophagia, and epistaxis. The number of ENT-ED visits and the total number of confirmed cases of SARS-CoV-2 in the health area were correlated. CONCLUSIONS: SARS-CoV-2 pandemic was a challenge for the Spanish health system. The critical epidemiological situation experienced during March, April, and May explains the reduction in the number of visits to the ENT-ED. However, this condition did not affect the predominant pattern of visits with respect to the pre-COVID-19 era, which were mostly inadequate. A strengthening of PC and an improvement in the population's health education is essential.

Carcinoma de paratiroides, una causa inusual de hiperparatiroidismo primario / Parathyroid carcinoma, an unusual cause of primary hyperparathyroidism

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Use of double flange voice prosthesis for periprosthetic leakage in laryngectomised patients: A prospective case-crossover study.

INTRODUCTION: Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. One of the main problems of voice prosthesis is the periprosthesis leakage. Provox Vega XtraSeal incorporates a double flange on the pharyngeal side of the prosthesis in order to avoid these failures. The aim of the study is to compare the device lifetime between the Provox Vega and Provox Vega XtraSeal and to examine possible related factors that influence their duration. METHODS: Prospective case-crossover study in 20 laryngectomised patients with Provox Vega and periprothesis leakage to whom a Provox Vega XtraSeal was placed. Survival and possible factors that affect voice prosthesis were studied using Kaplan-Meier curves and Cox Proportional Hazards Regression with Schoenfeld residuals to test the possible assumptions. RESULTS: A total of 230 prostheses were evaluated. The most frequent reason for replacement was due to an endoprosthesis leakage (n = 146, 67%) in both models. Mean lifetime of Provox Vega was 104.474 ± 7.29 days (CI 95% 90.19-118.76) and of Provox XtraSeal was 176.76 ± 26.46 days (CI 95% 124.9-228.61) (P = .012). Complementary treatment with radiotherapy demonstrated a higher device survival (P = .007). DISCUSSION: Provox XtraSeal seems to be effective reducing the number of changes due to periprosthetic leakage, thus increasing the survival of voice prosthesis.

Provox 2® and Provox Vega® device life-time: a case-crossover study with multivariate analysis of possible influential factors and duration.

INTRODUCTION: Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. Current literature is limited and contradictory about the possible causes of device failure. The aim of the study is to compare the device life-time between the Provox 2 and Provox Vega and to examine possible related factors that influence their duration. METHODS: Retrospective case-crossover study in 34 laryngectomized patients who had undergone tracheoesophageal voice rehabilitation using indwelling Provox 2 and Provox Vega voice prostheses between 2010 and 2016 in a tertiary care centre. RESULTS: A total of 440 prostheses were evaluated. The most frequent reason for replacement was due to an endoprosthesis leakage (n = 221, 64.2%) in both models. Radiotherapy increases the risk of prosthesis replacement (IRR = 1.88, p = 0.007) as well as bilateral neck dissection (IRR = 1.56, p = 0.017) in Provox 2. Age and unilateral neck dissection do not seem to influence the duration of the prosthesis. Mean life-time of Provox 2 was 106.64 days and 124.19 days for Provox Vega (p = 0.261). Complementary treatment with radiotherapy demonstrated a lower device survival (p < 0.001). DISCUSSION: Results confirmed the non-significant differences on device life between Provox Vega and Provox 2, as well as the relevant role of radiotherapy treatment in the increase of replacements and diminution of the device duration.

Segundos tumores primarios en cáncer de cabeza y cuello / Second primary tumours in head and neck cancer

Introducción y objetivos: Los segundos tumores primarios afectan más a pacientes con cáncer de cabeza y cuello que a la población general. Con preferencia por cabeza y cuello, pulmón y esófago, afectan la supervivencia a largo plazo. El objetivo es estudiar la incidencia, localización en relación con el tumor índice y su estadio, cronología de aparición, relación con la edad del paciente y supervivencia posdiagnóstico. Material y método: Estudio retrospectivo de 579 pacientes diagnosticados de carcinoma epidermoide de cabeza y cuello, tratados con intención curativa y seguimiento mínimo de 24 meses. El 42,4% (246/579) eran estadios I y II, y el 57,6% (334/579) restante eran estadios III y IV. Resultados: El 15% (87/579) de los pacientes desarrollaron un segundo tumor, y el 9,2% (8/97) desarrollaron un tercer tumor. Las localizaciones más frecuentes fueron cabeza y cuello, 37,9% (33/87), pulmón, 36,8% (32/87), esófago, 5,7% (5/87) y colorrectal, 5,7% (5/87). La supervivencia a 5 y 10 años de pacientes sin segundo tumor fue del 65,1 y 52,7% respectivamente, frente a una 58,7 y 40,2% de los que sí lo desarrollaron. Conclusiones: La incidencia de segundos tumores se ha incrementado en los últimos años y suponen una disminución en la supervivencia de los pacientes. La revisión periódica y la reducción del consumo de alcohol y tabaco son, ante la ausencia de diagnóstico precoz efectivo, la mejor manera de reducir su incidencia (AU)

Introduction and objectives: Head and neck cancer patients have a higher risk of second primary tumours than the general population. The most frequent locations are head and neck, lung and oesophagus, decreasing long-term survival. The aim of this work was to analyse the incidence, location according to index tumour and stage, chronology, patient age, and survival after diagnosis. Method: Retrospective study on 579 patients with head and neck squamous cell carcinoma, treated with curative intent, with a minimum 24-month follow-up. Early stages (I/II) were 42.4%, and 57.6% were stages III and IV. Results: Second primary tumour incidence was 15% (87/579), with 9.2% (8/97) developing a third tumour. The most frequent locations of the second tumours were head and neck, 37.9% (33/87); lung, 36.8% (32/87); oesophagus, 5.7% (5/87); and colon, 5.7% (5/87). Five- and 10-year survival in patients without a second tumour was 65.1% and 52.7% respectively, versus 58.7% and 40.2% in those who developed one. Conclusions: The incidence of second primary tumours increased in the last decade, having a negative effect on survival. Since no specific early diagnosis tool is available, alcohol and tobacco avoidance along with scheduled follow-up are suggested procedures to reduce its incidence (AU)

Second primary tumours in head and neck cancer. / Segundos tumores primarios en cáncer de cabeza y cuello.

INTRODUCTION AND OBJECTIVES: Head and neck cancer patients have a higher risk of second primary tumours than the general population. The most frequent locations are head and neck, lung and oesophagus, decreasing long-term survival. The aim of this work was to analyse the incidence, location according to index tumour and stage, chronology, patient age, and survival after diagnosis. METHOD: Retrospective study on 579 patients with head and neck squamous cell carcinoma, treated with curative intent, with a minimum 24-month follow-up. Early stages (I/II) were 42.4%, and 57.6% were stages III and IV. RESULTS: Second primary tumour incidence was 15% (87/579), with 9.2% (8/97) developing a third tumour. The most frequent locations of the second tumours were head and neck, 37.9% (33/87); lung, 36.8% (32/87); oesophagus, 5.7% (5/87); and colon, 5.7% (5/87). Five- and 10-year survival in patients without a second tumour was 65.1% and 52.7% respectively, versus 58.7% and 40.2% in those who developed one. CONCLUSIONS: The incidence of second primary tumours increased in the last decade, having a negative effect on survival. Since no specific early diagnosis tool is available, alcohol and tobacco avoidance along with scheduled follow-up are suggested procedures to reduce its incidence.

Hipocalcemia postiroidectomía total: incidencia, control y tratamiento / Hypocalcaemia after total thyroidectomy: incidence, control and treatment

Introducción: La hipocalcemia es la complicación más frecuente de la tiroidectomía total, si bien pasajera en la mayoría de los casos. Objetivo: Identificar factores patológicos y quirúrgicos, que pudieran estar asociados a un mayor riesgo de hipocalcemia. Material y método: Se analizaron 254 pacientes sometidos a tiroidectomía total, analizando la incidencia de hipocalcemia postoperatoria y definitiva en función de los factores relacionados con la etiología de la afección tiroidea y los factores quirúrgicos. Resultados: El 29,1% presentó hipocalcemia postoperatoria y el 4,7% hipocalcemia definitiva. La incidencia de hipocalcemia postoperatoria fue significativamente menor (p<0,05) en pacientes a los que se les completaba la tiroidectomía total en un segundo tiempo, 12 vs. 31% cuando se realizaba la tiroidectomía total en un solo tiempo. Los pacientes con Graves-Basedow presentaron hipocalcemia postoperatoria en el 50% de los casos. El tiempo medio de recuperación de la función paratiroidea fue de 5,2 meses y en el 72,2% se produjo antes de los 6 meses. Conclusiones: La presencia de hipocalcemia postoperatoria es una complicación frecuente de la tiroidectomía total, que se recupera en la mayoría de las ocasiones. Los pacientes con Graves-Basedow tienen un mayor riesgo de padecer esta complicación, por lo que deben ser controlados de forma estrecha. El control postoperatorio a las 24 y 48h no es útil en la identificación de los pacientes con riesgo de hipocalcemia (AU)

Introduction: Hypocalcaemia, although usually transitory, is the most frequent complication after total thyroidectomy. Objective: To identify factors associated with a higher risk of hypoparathyroidism and related to aetiology and surgical procedure. Material and method: A total of 254 total thyroidectomies were analysed for the incidence of transitory or permanent hypocalcaemia based on the relationship with etiological and surgical factors. Results: Transient hypocalcaemia was present in 29.1% of the cases and permanent hypocalcemia was present in 4.7%. Postoperative hypocalcaemia was lower in patients with completion thyroidectomy than in patients that underwent total thyroidectomy in a single operation, 12% vs. 31%. Patients with Graves-Basedow disease developed postoperative hypocalcaemia in 50% of the cases. Mean recovery time of parathyroid function was 5.2 months, with 72.2% of the patients recovering before 6 months. Conclusions: Postoperative hypocalcaemia is a frequent complication of total thyroidectomy, but it is seldom permanent. Patients with Graves-Basedow disease have a higher incidence of postoperative hypocalcaemia and need closer follow-up. Postoperative calcium level analysis at 24 and 48hours after surgery is not useful for rapid identification of patients at high risk of hypocalcaemia (AU)

Hypocalcaemia after total thyroidectomy: incidence, control and treatment.

INTRODUCTION: Hypocalcaemia, although usually transitory, is the most frequent complication after total thyroidectomy. OBJECTIVE: To identify factors associated with a higher risk of hypoparathyroidism and related to aetiology and surgical procedure. MATERIALS AND METHODS: A total of 254 total thyroidectomies were analysed for the incidence of transitory or permanent hypocalcaemia based on the relationship with etiological and surgical factors. RESULTS: Transient hypocalcaemia was present in 29.1% of the cases and permanent hypocalcemia was present in 4.7%. Postoperative hypocalcaemia was lower in patients with completion thyroidectomy than in patients that underwent total thyroidectomy in a single operation, 12% vs. 31%. Patients with Graves-Basedow disease developed postoperative hypocalcaemia in 50% of the cases. Mean recovery time of parathyroid function was 5.2 months, with 72.2% of the patients recovering before 6 months. CONCLUSIONS: Postoperative hypocalcaemia is a frequent complication of total thyroidectomy, but it is seldom permanent. Patients with Graves-Basedow disease have a higher incidence of postoperative hypocalcaemia and need closer follow-up. Postoperative calcium level analysis at 24 and 48 h after surgery is not useful for rapid identification of patients at high risk of hypocalcaemia.

Gel nasal y hendidura olfatoria / Nasal gel and olfactory cleft

Objetivo: Identificar si un gel administrado mediante un inhalador de cabeza radial puede alcanzar la hendidura olfatoria y si su distribución intranasal se modifica según el método de aplicación. Material y método: Se estudiaron 16 voluntarios a los que se administró un gel teñido de modo diferente en cada fosa, realizándose una endoscopia tras 1 y 7 min. Resultados: No se identificó gel a nivel de la hendidura olfatoria, cornete medio o meato medio independientemente del método de administración utilizado. En el vestíbulo se identificó colorante en todos los casos. En el lado derecho la segunda localización más frecuente fue el cornete inferior con una incidencia del 87% al minuto y del 75% a los 7 min. Le siguieron el tabique, 75 y 62%, y el meato inferior, 6,2 y 12,5%. En el lado izquierdo la segunda localización más frecuente fue el tabique, 18,7 y 13,5%, seguida del meato inferior, 6,5 y 65%. Las diferencias en la presencia de colorante a nivel del septo (p < 0,01) y el cornete inferior fueron significativas. Conclusiones: No se ha identificado la presencia de gel a nivel de la hendidura olfatoria, cornete medio o meato medio. La distribución se localiza a nivel de la parte anterior e inferior de la fosa nasal, con diferencias significativas si se emplean métodos de administración diferentes (AU)

Objective: To evaluate whether a nasal gel, administrated using a radial-hole inhaler, reaches the olfactory cleft and if a different administration method influences distribution. Material and method: Sixteen healthy volunteers underwent a nasal endoscopy at 1 and 7 minutes after the administration of a intranasal gel, with a different method in each fossa. Results: No dye deposition was identified at the olfactory cleft, middle turbinate or middle meatus. In all cases the gel was identified at the nasal vestibule. On the right side, the second most frequent dye identification area was the inferior turbinate, with a rate of 87% at the first minute and 75% at 7 minutes. It was followed by the septum (75 and 62%) and the inferior meatus (6.2 and 12.5%). On the left side, the second most frequent stained area was the septum (18.7 and 13.5%), followed by the inferior meatus (6.5 and 65%). No inferior turbinate staining was found in the left side. There was a significant difference in the deposition rate at the septum (P<0.01) and inferior turbinate (P<0.001), when both administration methods were compared. Conclusions: No nasal gel, administrated using a radial-hole inhaler, was found at the olfactory cleft, middle turbinate or middle meatus. Gel distribution was located at the anterior and inferior portion of the nose, independent of the administration method used. Significantly different gel distribution rates were found at the septum and inferior turbinate when the 2 administration methods were compared (AU)

Nasal gel and olfactory cleft.

OBJECTIVE: To evaluate whether a nasal gel, administrated using a radial-hole inhaler, reaches the olfactory cleft and if a different administration method influences distribution. MATERIAL AND METHOD: Sixteen healthy volunteers underwent a nasal endoscopy at 1 and 7minutes after the administration of a intranasal gel, with a different method in each fossa. RESULTS: No dye deposition was identified at the olfactory cleft, middle turbinate or middle meatus. In all cases the gel was identified at the nasal vestibule. On the right side, the second most frequent dye identification area was the inferior turbinate, with a rate of 87% at the first minute and 75% at 7 minutes. It was followed by the septum (75 and 62%) and the inferior meatus (6.2 and 12.5%). On the left side, the second most frequent stained area was the septum (18.7 and 13.5%), followed by the inferior meatus (6.5 and 65%). No inferior turbinate staining was found in the left side. There was a significant difference in the deposition rate at the septum (P<.01) and inferior turbinate (P<.001), when both administration methods were compared. CONCLUSIONS: No nasal gel, administrated using a radial-hole inhaler, was found at the olfactory cleft, middle turbinate or middle meatus. Gel distribution was located at the anterior and inferior portion of the nose, independent of the administration method used. Significantly different gel distribution rates were found at the septum and inferior turbinate when the 2 administration methods were compared.

Replica a la carta «Reconstrucción de orofaringe e hipofaringe. ¿Qué hemos aprendido?» / Reply to the letter «Oropharynx and hypopharynx reconstruction. What have we learnt?»

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Evolución de la calidad de vida en pacientes intervenidos de carcinomas de orofaringe, laringe o hipofaringe / Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma

Introducción y objetivos: La calidad de vida (CV) es un parámetro que se utiliza de forma habitual a la hora de elegir el tratamiento de un paciente con cáncer. En pacientes con cáncer de cabeza y cuello, la eliminación de estructuras anatómicas directamente relacionadas con funciones básicas (comer, hablar, respirar) hace que las secuelas del tratamiento quirúrgico se consideren como determinantes en la calidad de vida de los pacientes. El objetivo del presente estudio es evaluar si la calidad de vida de pacientes tratados quirúrgicamente por un carcinoma de laringe, hipofaringe u orofaringe cambia a lo largo del tiempo, comparando su calidad de vida previa al tratamiento, a los 3 y 6 meses post tratamiento. Material y método: Estudio prospectivo realizado entre los meses de noviembre de 2008 y junio de 2009, con 53 pacientes diagnosticados y tratados de carcinoma de cabeza y cuello sometidos a: cirugía parcial (n=32) y radical (n=21). Análisis de calidad de vida mediante el cuestionario general de la European Organization of Research and Treatment of Cancer (EORTC) EORTC QLQ-C30 y el específico de cabeza y cuello EORTC QLQ-H&N35 antes del tratamiento, a los tres y seis meses después. Resultados: No existen diferencias significativas en el estado de salud general de ambos grupos. Los mayores cambios se producen en la escala funcional. No se encontraron diferencias en los problemas de deglución o sentimiento de enfermedad, reflejándose problemas evidentes de fonación en ambos grupos. Conclusiones: La aplicación rutinaria de cuestionarios de calidad de vida en pacientes oncológicos ofrece la posibilidad de conocer en que esferas y medida los pacientes se ven afectados por el tratamiento y las secuelas, permitiendo adecuar la información y los tratamientos de apoyo y rehabilitación a las verdaderas necesidades de los pacientes (AU)

Introduction: The assessment of quality of life in patients with head and neck cancer is dependent on many variables. Objective: The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy. Material and method: Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards. Results: No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups. Discussion and conclusions: The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients (AU)

Grupos de riesgo en carcinomas diferenciados de tiroides / Risk groups in differentiated thyroid carcinomas

Introducción: El 80% de los carcinomas de tiroides corresponden a tumores diferenciados y la supervivencia causa específica a más de 20 años es superior al 90%. A pesar de su incremento en los últimos años, la supervivencia se mantiene estable. La evaluación de los factores pronósticos y de riesgo ha demostrado su utilidad en la selección de los tratamientos más adecuados a cada paciente. Material: Hemos analizado la incidencia de carcinomas de tiroides, agrupándolos según diferentes tipos de criterios (TNM, GAMES, MACIS) comparándolos con los índices referidos en la literatura. Analizamos así mismo el índice de complicaciones. Resultados: La incidencia de tumores malignos en la población operada de tiroides es del 28,8%, siendo el 88% carcinomas bien diferenciados. El 80% corresponde a grupos de bajo riesgo, equivalentes en los tres sistemas de estratificación. El 16% eran multifocales, y en el 50% la lesión mayor medía menos de 2cm. El índice de parálisis recurrencial definitiva fue del 1,2%, y de 2,7% el de hipoparatiroidismo definitivo. Conclusiones: La incidencia de grupos de riesgo de nuestra serie es similar a la de la literatura. El 80% de los pacientes tienen un expectativa de vida superior al 95% a 20 años. La evaluación de los criterios de riesgo debería determinar la amplitud de la resección, reduciendo el riesgo de complicaciones en aquellos pacientes que no se beneficien de una cirugía más agresiva (AU)

Introduction: Well-differentiated thyroid carcinoma represents 80% of all thyroid malignant tumours, with a survival rate of over 95% at 20 years in 80% of the cases. Although its incidence is increasing, survival remains unchanged. Prognostic factor evaluation allows identifying patients at high or low risk of recurrence, selecting those who will benefit from more aggressive therapy. Material: We have reviewed the incidence of malignant thyroid neoplasm, selecting them according to three different system definitions (TNM, GAMES, MACIS), as well as by post-surgical complication rate. Results: Malignant neoplasm represents 28.8% of the thyroid-operated patients, 88% corresponding to well-differentiated carcinomas. 80% are in the low risk group, with similar numbers in all three staging system definitions. Multicentricity was found in 16%, with 50% of the lesions smaller than 2cm. Permanent recurrent nerve palsy was 1.2% and 2.7% presented permanent postoperative hypocalcaemia. Conclusions: Risk group percentage is similar to that reported in the literature, with 80% having expected survival over 95% at 20 years. Risk factor evaluation should help to individualise treatment options, avoiding overtreatment and complications in patients that will not benefit from more aggressive therapy (AU)

[Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma]. / Evolución de la calidad de vida en pacientes intervenidos de carcinomas de orofaringe, laringe o hipofaringe.

INTRODUCTION: The assessment of quality of life in patients with head and neck cancer is dependent on many variables. OBJECTIVE: The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy. MATERIAL AND METHOD: Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards. RESULTS: No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups. DISCUSSION AND CONCLUSIONS: The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients.

[Risk groups in differentiated thyroid carcinomas]. / Grupos de riesgo en carcinomas diferenciados de tiroides.

INTRODUCTION: Well-differentiated thyroid carcinoma represents 80% of all thyroid malignant tumours, with a survival rate of over 95% at 20 years in 80% of the cases. Although its incidence is increasing, survival remains unchanged. Prognostic factor evaluation allows identifying patients at high or low risk of recurrence, selecting those who will benefit from more aggressive therapy. MATERIAL: We have reviewed the incidence of malignant thyroid neoplasm, selecting them according to three different system definitions (TNM, GAMES, MACIS), as well as by post-surgical complication rate. RESULTS: Malignant neoplasm represents 28.8% of the thyroid-operated patients, 88% corresponding to well-differentiated carcinomas. 80% are in the low risk group, with similar numbers in all three staging system definitions. Multicentricity was found in 16%, with 50% of the lesions smaller than 2 cm. Permanent recurrent nerve palsy was 1.2% and 2.7% presented permanent postoperative hypocalcaemia. CONCLUSIONS: Risk group percentage is similar to that reported in the literature, with 80% having expected survival over 95% at 20 years. Risk factor evaluation should help to individualise treatment options, avoiding overtreatment and complications in patients that will not benefit from more aggressive therapy.

Reconstrucción de orofaringe e hipofaringe. ¿Qué hemos aprendido? / Oropharynx and hypopharynx reconstruction. What have we learnt?

Introducción y objetivos: La reconstrucción de orofaringe e hipofaringe demanda importante recursos técnicos y humanos. El objetivo es analizar nuestro programa de reconstrucción durante los últimos 13 años. Métodos: Se realizó un estudio retrospectivo de 43 procedimientos reconstructivos de orofaringe e hipofaringe realizados entre 1993–2008. Resultado: El 67,4 % (29/43) fueron microvasculares (fasciocutáneo radial 17, recto anterior del abdomen 10, escapular 1, yeyuno 1) y el 42,6% (14/43) miocutaneos (pectoral mayor 13, dorsal ancho 1). El 83% (37/43) eran tumores de orofaringe y el 17% (6/43) de hipofaringe, siendo estadio IV el 70% (30/43), 26% (11/43) estadio III y 4% (2/43) estadio II. La estancia media fue de 54 días. El 74,4% (32/43) presentó algún tipo de complicación postoperatoria, siendo la más frecuente la fístula salivar, 62,5% (20/32). El fracaso por necrosis de los colgajos microvasculares fue del 20% (6/29). Se realizó un microvascular cada 5,5 meses, y un miocutáneos cada 11,1 meses. La radioterapia previa y la cirugía de rescate no influyeron de forma significativa en la incidencia de complicaciones. Conclusiones: La reconstrucción es un reto apasionante y agradecido cuando todo va bien, pero cuando fracasa, es frustrante para el médico, pero mucho más lo es para el paciente. Por ello, la colaboración entre equipos implicados en la reconstrucción de cabeza y cuello es importante sobre todo en centros en los que el volumen de pacientes no permite adquirir, de forma rápida, la destreza y experiencia que este tipo de cirugía requiere (AU)

Introduction and objectives: Oropharyngeal and hypopharyngeal reconstructions require significant human and technical resources. This study analysed our reconstruction program over the last 13 years. Material and Methods: Retrospective study in a tertiary reference centre. Results: Forty-three reconstruction procedures, of which 67.4 % (29/43) were microvascular (radial forearm 17, rectus abdominis 10, scapular 1, jejunum 1) and 42.6% (14/43) myocutaneous (pectoralis major 13, latissimus dorsi 1). Of these reconstructions, 83% (37/43) were for oropharyngeal defects and 17% (6/43) for hypopharyngeal defects, with 70% Stage IV (30/43), 26% Stage III (11/43) and 4% (2/43) Stage II. Mean Hospital stay was 54 days. Complications were present in 74.4% (32/43), salivary fistula being the most frequent (62.5%; 20/32). Ischemic necrosis was present in 20% (6/29) of the microvascular flaps. One microvascular flap was performed every 5.5 months, and one myocutaneous every 11.1 months. Previous radiotherapy and salvage surgery did not significantly increase the rate of complications. Conclusions: Reconstruction of pharyngeal defects is a challenging and demanding task, one that is great when everything runs perfectly and disastrous when failure takes place, mainly for the patient. Disciplines related with head and neck reconstruction should create multidisciplinary teams to increase experience, particularly in centres where the number of patients available makes it difficult to get the expertise and confidence this surgery demands for accomplishing the objectives of patient satisfaction and functional restoration (AU)

Tratamiento quirúrgico de las estenosis subglóticas / Surgical treatment of subglottic stenosis

Introducción: Las estenosis de localización subglótica son poco frecuentes, siendo su principal mecanismo etiopatogénico la intubación orotraqueal. El objetivo es analizar la experiencia en el tratamiento, revisando el tipo de terapéutica, porcentaje de decanulación, evolución sintomática postratamiento y número de procedimientos por paciente. Material y método: Dieciséis pacientes diagnosticados y tratados de estenosis subglótica entre 1995–2007. Se recogieron datos clinicopatológicos que incluyen: edad, sexo, etiología, clínica, grado de severidad (clasificación de Cotton), métodos diagnósticos, tipo de tratamiento, evolución sintomática, decanulación y número de procedimientos. Analizamos nuestros resultados comparándolos con otros estudios para conocer la evolución, morbilidad y porcentaje de éxitos con las terapéuticas propuestas. Resultados: El 75% eran mujeres con edad media de 60 años. El 75% presentaban antecedente de intubación prolongada. El síntoma de presentación fue disnea (94%) y el 69% precisó traqueotomía de urgencia. Se trataron quirúrgicamente 10 pacientes: 7/10 láser CO2, 2/10 dilataciones y 1/10 cirugía abierta. La decanulación tras la cirugía fue posible en el 60% del total. El número de procedimientos por paciente fue 1,37. Discusión: El tratamiento de las estenosis subglóticas debe individualizarse según las características del paciente, el tipo de estenosis y la severidad de la misma. El uso de técnicas láser proporciona buenos resultados en grados leves-moderados, asociando baja morbilidad. La cirugía abierta estaría reservada para los grados más severos de estenosis y tras el fracaso del láser CO2 (AU)

Introduction: Subglottic stenosis is rare, its primary pathogenic mechanism being tracheal intubation. Its incidence has declined in recent decades due to improved material and reduced intubation time. The objective of this study was to analyse the experience in treating this disease, emphasising the type of treatment used, the rate of decannulation obtained, symptomatic changes after treatment, and the total number of procedures performed per patient. Materials and methods: The study included 16 patients diagnosed and treated for subglottic stenosis in our department from 1995 to 2007. Clinicopathologic data were collected including: age, sex, etiology and severity (the Cotton classification), diagnostic methods used, type of treatment, progression of symptoms, decannulation and number of procedures performed per patient. To identify changes, morbidity and success rate with the proposed treatment, we analysed our results, comparing them with those collected in other studies. Results: Of the cases analysed, 75% were women, with a mean age of 60 years; 75% of the total cases had a history of prolonged intubation. The presenting symptom was dyspnea (94%), and 69% required an emergency tracheotomy. Ten patients were treated surgically: 7/10 CO2 laser, 2/10 dilation and 1/10 open surgery. Decannulation after surgery was possible in 60% of the total. The number of procedures per patient was 1.37. Conclusions: Subglottic stenosis treatment must be individualised based on patient characteristics, type of stenosis and severity. The use of endoscopic laser provides the best results in mild to moderate degrees with low morbidity. Open surgery was reserved for severe degrees, and after the failure of the CO2 laser (AU)