Pretreatment thrombocytosis: a prognostic marker for oral squamous cell carcinoma?

PURPOSE: Thrombocytosis associated with poorer prognoses seems to be a frequent preoperative finding in different kind of cancers. The aim of the present study was to evaluate whether thrombocytosis can be used as a prognostic marker for oral squamous cell carcinoma (SCC). METHODS: Altogether, 288 patients with oral SCC were considered, as well as all platelet counts between 1 and 5 days prior to surgical treatment, recurrence rate, and lymph node metastasis. The minimum follow-up time was 12 months. RESULTS: The mean preoperative thrombocyte score of the patients who received surgery was 259.55 ± 83.8 Tsd/µl; 273 out of 288 patients were in the normal thrombocyte range, and 12 had a thrombocytosis. From 51 patients with recurrence, three were in the thrombocytosis group, and 45 patients with recurrence were in the normal thrombocyte range. CONCLUSION: The present results do not confirm that thrombocytosis can be seen as marker for poor tumor prognosis.

Evaluation of white blood cell count as a possible prognostic marker for oral cancer.

INTRODUCTION: There seems to be increasing evidence that inflammation leads to cancer. For several cancers, an association with white blood cell (WBC) count has been reported. So far, no studies have been performed for cancer of the oral cavity and WBC. Therefore, the aim of the present study was to look at whether WBC count can be used as a prognostic marker for recurrence or metastases for oral cancer. MATERIAL AND METHODS: For 278 patients with oral cancer, the preoperative WBC count was compared with the clinicopathological information: age, gender, T-status, N-status, recurrence, metastases, follow-up time, and time till recurrence or metastases appeared. RESULTS: Out of 278 patients, 48 developed recurrence, 24 second tumors, 46 cervical metastases, and 14 distant metastases. The mean follow-up time was 35.97 months (range: 12-107 months). Significant Pearson correlation at the 0.05 level could be found for the T-status (0.046), but not for the N status (0.121). No significant correlation could be found between WBC count and the development of recurrence or metastases. CONCLUSION: In conclusion, our findings demonstrate that elevated WBC count does not seem to be a predictor for recurrence or for further metastases. Further research is recommended to investigate the WBC count in precancerous lesions and in HPV positive patients with oral SCC.

Evaluation of the pectoralis major flap for reconstructive head and neck surgery.

PURPOSE: The pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery. PATIENTS AND METHODS: The records of all patients treated with a PMMF between 1998 and 2009 were systematically reviewed. Data of recipient localization, main indication, and postoperative complications were analyzed. RESULTS: The male to female ratio was 17:3, with a mean age of 60 years (45-85). Indications in 7 patients were recurrence of a squamous cell carcinoma, in one case an osteoradionecrosis and in 12 cases an untreated squamous cell carcinoma. In 6 male patients (30%), a complication appeared leading to another surgery. CONCLUSION: The PMMF is a flap for huge defects in head and neck reconstructive surgery, in particular when a bulky flap is needed in order to cover the carotid artery or reconstructive surgery, but the complication rate should not be underestimated in particular after radiotherapy.

Screening recurrence and lymph node metastases in head and neck cancer: the role of computer tomography in follow-up.

INTRODUCTION: Follow-up of patients with oral cancer is being questioned with regard to financial costs and effectiveness. Therefore, the aim of the present study was to evaluate whether local recurrence and cervical lymph node metastases were first discovered clinically or by routine computer tomography. MATERIALS AND METHODS: The records of all 317 patients that were treated for an oral cancer between 1998 and 2008 were systematically reviewed. Criteria for inclusion were tumor histology with a squamous cell carcinoma of the head and neck, and regular follow-up examinations with a minimum follow-up time of 12 months, including clinical and radiological (CT) controls. All patients had the first CT after 6 months, followed by yearly CT controls. RESULTS: Out of 315 patients with an oral squamous cell carcinoma, 294 were evaluated. Those experiencing neither recurrence of the tumor nor lymph node metastases constituted 62%. Local recurrence was seen in 36 (12%), lymph node metastases in 32 (11%), and both in 16 (6%). Of the 32 patients with lymph node metastases, 25 were recognized first clinically, and 7 were detected by routine CT scans; concerning local recurrence, 32 appeared clinically, and 4 were detected by routine CT scans. CONCLUSION: Routine CT for follow-up is still indicated for detecting lymph node metastases as well as local recurrence.

A new method for closure of large donor side defects after raising the pectoralis major flap.

BACKGROUND: Although free flaps are reliable for head and neck reconstructions, the pectoralis major flap (PMF) is still often used. In cases of a large PMF, the closure of the donor side can be a challenge. CASE REPORT: A technique, originally developed for the treatment and prevention of abdominal ruptures after laparotomy, is presented as an alternative for closure of large donor side defects. CONCLUSION: The use of Ventrofil® is an additional option for large donor side defects and especially to bridge the period of postoperative swelling. If utilized special attention must be paid to possible pressure necrosis of the underlying skin.

Head and neck cancer in the elderly: a retrospective study over 10 years (1999 - 2008).

INTRODUCTION: Treatment of elderly patients is in many ways different from that for younger ones. The aim of the present study was to identify the particular characteristics and needs of elderly patients suffering from head and neck cancer. From these patterns, considerations for this special group can be deduced. PATIENTS AND MATERIAL: The subjects for this study consisted of 376 patients suffering from head and neck cancer that were treated between 1999 and 2008, 99 (26.3.%) of whom were older than 70 years and were evaluated retrospectively concerning smoking/alcohol abuse, ASA status, kind of malignant neoplasm, localization and treatment. RESULTS: The male-female ratio was 53:46, and mean age, 79 years (71 - 98). Out of 95 patients with a squamous cell carcinoma, 4 patients had a verrucous form. Out of 99 patients, 26 had a maxillary carcinoma and 12 patients had experienced previous non-head-and-neck cancer. An ASA score of 2 or 3 was found in 86 of the patients. CONCLUSION: The group of patients with head and neck cancer who were older than 70 years was characterized by a higher portion of female patients, a higher number of maxillary carcinomas, and a higher prevalence of previous second cancer. Making decisions in cancer therapy for elderly patients is challenging. Patients suffering from operable head and neck cancer should be treated with curative intent and with regard to quality of life if a careful assessment of comorbidities is performed preoperatively.

C-reactive protein levels: a prognostic marker for patients with head and neck cancer?

BACKGROUND: Recent advances in understanding complex tumor interactions have led to the discovery of an association between inflammation and cancer, in particular for colon and lung cancer, but only a very few have dealt with oral cancer. Therefore, the aim of the current study was to investigate the significance of preoperative C-reactive protein (CRP) levels as a parameter for development of lymph node metastases or recurrence. MATERIALS AND METHODS: In 278 patients with oral cancer, preoperative CRP levels were compared with development of recurrence and metastasis. RESULTS: In 27 patients from the normal CRP group, and in 21 patients from the elevated CRP group, local recurrence was observed. Concerning lymph node metastases, 37 patients were in the normal group and 9 patients in the elevated CRP group. No significant correlation could be found between elevated CRP levels and metastasis (p = 0.468) or recurrence (p = 0.137). CONCLUSION: Our findings do not appear to support a correlation between preoperative CRP levels and development of recurrence or metastases. In further studies, CRP levels in precancerous lesions and in Human Papilloma Virus (HPV) positive patients with oral squamous cell carcinoma (SCC) should be studied.

Tibial stress fracture after fibular graft harvesting: an unusual complication.

INTRODUCTION: Fibular grafts are commonly used in reconstructive head and neck surgery, and several complications have been reported. Tibial stress fracture, however, is rare. PATIENT: A 65-year-old woman presented with a tibial stress fracture 10 weeks after a vascularized fibular flap had been harvested for a mandibular defect due to osteoradionecrosis. The main symptom was activity-related pain after a period of no complaints. CONCLUSIONS: One should be aware of the complications, particularly after weeks or months, in cases of activity-related pain in the lower extremities. Prevention can be implemented by an awareness of the need to build up the muscles for supporting the tibia in the initial healing phase.

Free flap monitoring protocol.

In microsurgery, the successful salvage of free tissue transfer is dependent on the rapid decision to return to the operating room. Therefore, a free flap monitoring protocol is presented, including checking color, temperature, capillary return, and signal from a handheld Doppler ultrasonograph in an intraoperatively marked skin area directly over the pedicle.

Aggressive fibromatosis of the head and neck: a new classification based on a literature review over 40 years (1968-2008).

BACKGROUND: Fibromatosis is an aggressive fibrous tumor of unknown etiology that is, in some cases, lethal. Until now, there has been no particular classification for the head and neck. Therefore, the aim of the present study was to review the current literature in order to propose a new classification for future studies. METHODS: An evidence-based literature review was conducted from the last 40 years regarding aggressive fibromatosis in the head and neck. Studies that summarized patients' data without including individual data were excluded. RESULTS: Between 1968 and 2008, 179 cases with aggressive fibromatosis of the head and neck were published. The male to female ratio was 91 to 82 with a mean age of 16.87 years, and 57.32% of the described cases that involved the head and neck were found in patients under 11 years. The most common localization was the mandible, followed by the neck. All together, 143 patients were followed up, and in 43 (30.07%), a recurrence was seen. CONCLUSION: No clear prognostic factors for recurrence (age, sex, or localization) were observed. A new classification with regard to hormone receptors and bone involvement could improve the understanding of risk factors and thereby assist in future studies.

Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review.

Microvascular free tissue transfer is a reliable technique for head and neck reconstruction with success rates of 90-99%. Currently, there is no consensus concerning antithrombotic agents, antibiotics, or monitoring techniques. Therefore, the aim of this study was to review current literature dealing with microvascular free-tissue transfer and factors influencing the outcome. In addition to excellent microsurgical techniques, coupling devices are a promising new technique, but are not useful in all arteries. Antibiotics should be given in three doses, as a more lengthy dosage time seems to have no advantage. The risk for elderly patients can be best assessed by the American Society of Anesthesiologists (ASA) score, but early mobilization, including intense chest physiotherapy, is important. Anticoagulation can be considered in cases of small vessels, significant size mismatch, vein graft, or vessels of poor quality. Monitoring should be done hourly during the first 24 hours and then every 4 hours for the next 2 postoperative days.