Supracricoid partial laryngectomy versus other traditional partial laryngectomy for selected laryngeal cancers / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the oncological and functional outcomes in patients undergoing supracricoid partial laryngectomy with other traditional partial laryngectomy.@*METHOD@#One hundred and fourteen patients treated from 1992 to 2007 were selected from all laryngeal cancer patients undergo partial laryngectomy through random match method by tumour subsite, TNM stage and age. Among them, 58 were supraglottic cancers, 56 were glottic cancers. Patients were divided into supracricoid laryngectomy group and other partial laryngectomy group. Each group includes 57 cases. We compare the 3-year and 5-year actuarial survival, local control rate and decannulation rate between two groups.@*RESULT@#The 3-year and 5-year actuarial survival estimate was 90% and 87% for supracricoid partial laryngectomy, 97% and 92% for other partial laryngectomy (P > 0.05); Local control rate estimate was 94.2% for supracricoid laryngectomy and 91% for other partial laryngectomy(P > 0.05); Decannulation rate was 98% for supracricoid laryngectomy and 89.5% for other partial laryngectomy(P>0. 05); The decannulation was ever lower in horizontal-vertical partial laryngectomy than supracricoid partial laryngectomy (75% versus 98%, P < 0.01).@*CONCLUSION@#Comparing with other partial laryngectomy, supracricoid partial laryngectomy seems to have higher decannulation rate and is a considerable choice for selected laryngeal cancer.

Malignant fibrous histiocytoma: outcome of tumours in the head and neck compared with those in the trunk and extremities.

Malignant fibrous histiocytoma is one of the commonest soft tissue sarcomas in adults, affecting, in order of frequency, the extremities, trunk and head and neck. We treated 131 patients with malignant fibrous histiocytoma by radical, wide, or marginal resection. Their mean age was 43 years, and there were 54 in the head and neck and 77 in the trunk and extremities. The extent of clearance of the tumour, local recurrence, and 5-year survival were studied in these two groups. In the head and neck group, local recurrences developed in 86% after marginal resection, 66% after wide resection and 27% after radical resection. The comparative figures in the trunk and extremities group were 75, 71 and 18%, respectively. The overall 5-year survival was 48% in the head and neck group and 77% in the trunk and extremities group (p=0.03). Repeat operations for recurrences of tumour offered a 'cure rate' of 23% in the head and neck group and 61% in the trunk and extremities group. Inadequate resection of the sarcoma in the head and neck was associated with a high incidence of local recurrence and a poor prognosis. Therefore, we suggest that the initial operation for sarcoma in the head and neck should be as radical as possible to reduce the chance of local recurrence and to improve the outcome.

Management of tonsillar squamous cell carcinoma / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To discuss treatment options for tonsillar squamous cell carcinoma.</p><p><b>METHODS</b>A total of 108 patients with biopsy-proven tonsillar squamous cell carcinoma, treated between 1984 and 2000, were reviewed, including 82 men and 26 women, with ages ranging from 19 to 70 years. Treatments consisted of either radiotherapy and surgery reserved as salvage treatment (Salvage Surgery, 83 patients), or planned surgery with preoperative radiation (Planned Surgery, 25 patients). Radiotherapy was delivered primarily in a dosage of 60 - 70 Gy for Salvage Surgery patients and 40 - 50 Gy for Planned Surgery patients. Both salvage and planned surgeries were radical, with resection of the lateral oropharyngeal wall, segmental resection of the mandible and neck dissection. The pectoralis major myocutaneous flaps were used to repair surgical defects.</p><p><b>RESULTS</b>The percentages of radical surgery used in the Salvage Surgery and Planned Surgery groups were 24.1% (20/83) and 88.0% (22/25), respectively (P = 0.000). The local recurrence rates were 28.9% (24/83) and 20.0% (5/25) in the Salvage Surgery and Planned Surgery groups, respectively (P = 0.378). The neck recurrence rates were 9.6% (8/83) and 8.0% (2/25) in the Salvage Surgery and Planned Surgery groups respectively (P = 0.804). The 5-year survival rates were 59.3% and 55.3% in the Salvage Surgery and Planned Surgery groups, respectively (P = 0.7056).</p><p><b>CONCLUSIONS</b>Although the two treatments had a similar survival rate, Salvage Surgery avoided 60% commando operations compared with the Planned Surgery group, which benefits to recovery of oral functions. Primary radiotherapy is recommended as the treatment of choice for tonsillar squamous cell carcinoma. After radical radiotherapy, salvage surgery should be undertaken in the case of tumor remnants or recurrences.</p>

Multidisciplinary cooperation in surgical treatment of complex head and neck tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To study the multidisciplinary cooperation in surgical treatment of complex head and neck tumors.</p><p><b>METHODS</b>The data from 22 patients with head and neck tumors who had been given neurosurgery, orthopaedic surgery, plastic and otological surgery were reviewed from April 1995 to June 2000.</p><p><b>RESULTS</b>Eight of 14 cases of benign tumors had been resected radical; 5 of 8 malignant cases had been moval of macroscopic tumor and 3 received operation for symptom improvement. No surgical death and serious complications were observed. The recurrence rate benign tumors was 21.4% (3/14), all of which were operated on at other hospitals. Follow-up for a year showed that in 8 cases of malignant tumors, 3 were tumor free, 2 survived with tumor, and 3 died.</p><p><b>CONCLUSIONS</b>To obtain good outcome in treatment for patients with complex tumors of head and neck, cooperative efforts between multidisciplinary surgery are necessary.</p>

Transmaxillary approach for surgical removal of the invasive skull base tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the capable use of transmaxillary approach for surgical removal of invasive skull base tumors, the indications and the key points of this approach.</p><p><b>METHODS</b>From November 1998 to July 2001, 27 consecutive patients with skull base tumor were operated through transmaxillary approach, including 6 patients with nasopharyngeal carcinoma, 5 with nasopharyngeal angiofibroma, 5 with nasopharyngeal cystadenocarcinoma, 2 with olfactory neuroblastoma, 2 with poorly differentiated carcinoma, 2 with sarcoma, 1 with maxillary carcinoma, 2 with schwannoma, and 2 with chordoma. Most of them (18/27) were recurrent tumor and 17/27 tumors involved important intracranial structures. All patients were followed up 2 - 33 months (average 16 months) and the clinical data was reviewed.</p><p><b>RESULTS</b>The tumors could be totally removed in all patients. There were no operative mortality and morbidity. After operation, 2 patients died of cancer recurrence in 5 and 8 months separately. One patient had metastasis to the lungs 11 months after operation. Two patients had local recurrence in 7 and 12 months postoperation seperately and live with the tumor now. The rest patients are back to their routine life.</p><p><b>CONCLUSIONS</b>Transmaxillary approach facilitates the surgical removal of invasive skull base tumors. The exposure is wide. The lesion as well as the important anatomy structures can be viewed directly and clearly. The tumor removal could be done more thoroughly and safely. This approach is suitable for the patients in whom tumor involves the skull base extensively and may be difficult to deal with by other approaches.</p>

Evaluation for submental island flap / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effect of submental island flap.</p><p><b>METHODS</b>The influence of head and neck radiotherapy and neck lymph node metastasis on the flap was analysed. The clinical effect in the near future and longterm of submental island flap for defects repair was evaluated.</p><p><b>RESULTS</b>Thirty-eight submental island flap were applied for reconstruction of head and neck defects following cancer ablation between July of 1997 to December of 1999. 16 of these had preoperative radiotherapy at both donor site and receive site, and neck dissections with resection of primary lesions were simultaneously performed in 18 patients. The success rate was 89.5% (34 of 38). All repaired cases had well matched skin with facial surface and excellent texture for intraoral function.</p><p><b>CONCLUSIONS</b>Routine preoperative radiation does do not influence the success and healing of the flap. For tumor complete resection, appropriate cases should be chosen. We believe this flap is worthwhile in addition to the existing armamentarium of reconstruction options both facially and intraorally.</p>

Analysis of the factors influencing cervical lymphatic metastasis of the floor of mouth carcinoma / 中国癌症杂志

Purpose:To investigate the local factors that influenced cervical lymphatic metastasis and prognosis of the floor of mouth carcinoma.Methods:A retrospective study was undertaken of 65 patients with squamous cell carcinoma of floor of mouth, who were treated between 1983 and 1998. Local factors including the tumor location, the tumor size, local invasion and pathological differentiation were investigated for the correlation with cervical lymphatic metastasis and prognosis of the disease.Results:Cervical lymphatic metastasis was 46.2% (30/65) for these 65 patients, and 96.6% of the involved lymph nodes were located in level Ⅰ(submandibular region) of the neck. Of these 65 patients, cervical lymphatic metastasis was 62.2% and 40.0% for 45 anterior and 20 posterior floor of mouth carcinoma, respectively ( P = 0 .096).Cervical metastasis was 59.5% and 21.7% for tumor size greater than or less than 3 cm, respectively ( P = 0.003).Cervical metastasis was 46.8% and 44.4% for tumors invading the tongue or not, respectively.Cervical metastasis was 60 0% and 42 0% for tumors invading the gum or not, respectively.Cervical metastasis was 76.5% for the poorly differentiated and was 42.1% for the moderately and well differentiated squamous cell carcinoma ( P = 0.018). The overall 5 years survival was 46.4% for the 65 patients. The 5 years survival was 61.4% for these without cervical metastasis and 28.9% for these with cervical metastasis ( P = 0.0013).Conclusions:The local factors such as the tumor size greater than 3 cm, tumor invasion to the tongue and the gum, and the poorly differentiated squamous cell carcinoma of floor of mouth increased the incidence of cervical metastasis, and therefore adversely influenced the prognosis.