Complicaciones de la laringectomía total: experiencia de 7 años en un hospital universitario de Paraguay / Complications of total laryngectomy: a 7-year experience in a university hospital in Paraguay

Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas superiores. La laringectomía total es el tratamiento de elección en casos avanzados, pero se asocia a una alta tasa de complicaciones. Objetivos: Conocer la prevalencia de las complicaciones posquirúrgicas de la laringectomía total y los factores asociados en pacientes con cáncer de laringe. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal, revisando el comportamiento de la laringectomía total y sus principales complicaciones en la Cátedra y Servicio de Otorrinolaringología del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, Paraguay, de 2015 a 2022. Se incluyeron pacientes mayores de 18 años, de ambos sexos, postoperados de laringectomía total, con diagnóstico anatomopatológico de neoplasia de laringe. Se excluyeron pacientes no operados, con fichas incompletas o que abandonaron el tratamiento. Se analizaron variables demográficas, clínicas, quirúrgicas y anatomopatológicas. Resultados: Se incluyeron 10 pacientes, todos varones, con edad media de 56,3 ± 10,2 años. El 90% presentaba hábitos tóxicos. La complicación más frecuente fue la fístula faringocutánea (70%), seguida por infección del sitio quirúrgico (10%) y sangrado posoperatorio (10%). El 71,4% de las fístulas se resolvieron con medidas conservadoras. El 30% tenía afectación supraglótica y el 57,1% de los que presentaron complicaciones recibieron radioterapia previa. Conclusión: Las complicaciones de la laringectomía total son frecuentes, principalmente la fístula faringocutánea. La afectación supraglótica y la radioterapia previa se asociaron a mayor tasa de complicaciones. Se requieren estudios prospectivos con muestras más grandes para confirmar estos hallazgos.

Introduction: Laryngeal cancer is the most common malignant neoplasm of the upper aerodigestive tract. Total laryngectomy is the treatment of choice in advanced cases, but it is associated with a high rate of complications. Objectives: To determine the prevalence of postoperative complications of total laryngectomy and associated factors in patients with laryngeal cancer. Materials and methods: Observational, descriptive, retrospective, cross-sectional study, reviewing the behavior of total laryngectomy and its main complications in the Department of Otorhinolaryngology of the Hospital de Clínicas, Faculty of Medical Sciences, National University of Asunción, Paraguay, from 2015 to 2022. Patients over 18 years of age, of both sexes, who underwent total laryngectomy, with anatomopathological diagnosis of laryngeal neoplasm were included. Non-operated patients, those with incomplete records or who abandoned treatment were excluded. Demographic, clinical, surgical and anatomopathological variables were analyzed. Results: Ten patients were included, all male, with a mean age of 56.3 ± 10.2 years. Ninety percent had toxic habits. The most frequent complication was pharyngocutaneous fistula (70%), followed by surgical site infection (10%) and postoperative bleeding (10%). Conservative measures resolved 71.4% of the fistulas. Thirty percent had supraglottic involvement and 57.1% of those who presented complications received previous radiotherapy. Conclusion: Complications of total laryngectomy are frequent, mainly pharyngocutaneous fistula. Supraglottic involvement and previous radiotherapy were associated with a higher rate of complications. Prospective studies with larger samples are required to confirm these findings.

Asociación entre la infección por virus del papiloma humano y el carcinoma de laringe en adultos de 35-75 años de edad en el instituto nacional del cáncer rosa emilia sánchez pérez de tavarez (incart), en el período agosto 2012 - enero 2019, santo domingo, república dominicana / Association between human papillomavirus infection and laryngeal carcinoma in adults between 35 and 75 years of age at the Rosa Emilia Sánchez Pérez de Tavarez National Cancer Institute (INCART), in the period August 2012 - January 2019, Santo Domingo, Dominican Republic

Introducción: el carcinoma de cabeza y cuello comprende un grupo de neoplasias que comparten un origen anatómico similar. Ocupan el sexto lugar mundial entre las neoplasias de todas las localizaciones, y el sitio afectado con mayor frecuencia es la cavidad oral. Ahora se reconoce el rol del virus del papiloma humano como factor independiente en el desarrollo de estas neoplasias. En los últimos 15 años se ha observado un incremento en la incidencia de carcinoma de células escamosas inducido por virus del papiloma humano (VPH). Materiales y métodos: este es un estudio observacional de tipo descriptivo transversal. Se realizó un análisis documental de los expedientes clínicos de los pacientes que cumplan con los criterios de inclusión. Resultados: en este estudio fue encontrada una prevalencia del 14 % del VPH en cánceres laríngeos. El tipo 16 del VPH fue el único identificado y descrito entre los expedientes clínicos de este estudio y, este último, con una prevalencia de un 20 %. Discusión: el VPH puede estar involucrado en el desarrollo de algunos cánceres de laringe y su rol puede ser más predominante en hombres mayores de 50 años.

Introduction: Head and neck carcinoma comprises a group of neoplasms with similar anatomical origins. They occupy the sixth place in the world among the neoplasias of all the locations, and the most affected site is the oral cavity. The role of the Human Papillomavirus as an independent factor in the development of these neoplasms is now recognized. In the last 15 years, an increase in the incidence of squamous cell carcinoma induced by Human Papillomavirus (HPV) has been observed. Methods: This is an observational study of transversal descriptive type. A documental analysis of the clinical files of the patients that meet the inclusion criteria was performed. Results: in this study, a 14 % prevalence of HPV in laryngeal cancers was found. Type 16 HPV was the only one identified and described in the clinical files of this study and the latter with a prevalence of 20 % Discussion: HPV may be involved in the development of some laryngeal cancers and its role may be more predominant in men older than 50 years.

Relato de caso: actinomicose mimetizando neoplasia laríngea / Case report: actinomycosis mimicking laryngeal neoplasia / Caso clínico: actinomicosis que simula una neoplasia laríngea

A actinomicose é uma infecção rara causada por bactérias do gênero Actinomyces sp. que são importantes constituintes das flora comensal de animais e humanos, colonizando a orofaringe, o trato respiratório superior, o trato gastrointestinal e o trato genital feminino. Diante de uma lesão na mucosa associada a um desequilíbrio nas defesas do organismos, as bactérias se infiltram nas estruturas, gerando uma infecção. As áreas mais comumente afetadas por esta patologia correspondem às regiões cervicofacial (50%), abdominal (20%) e torácica (15 a 20%), sendo o envolvimento laríngeo bastante raro (< 5% dos casos), com poucos casos descritos na literatura. Este estudo visa relatar o caso de um paciente de 76 anos com actinomicose mimetizando neoplasia de laringe, através da revisão do prontuário, descrevendo o quadro clínico e evidenciando os exames de imagem realizados na investigação com o objetivo de alertar os profissionais de saúde e compartilhar informações sobre esta patologia para que possa fazer parte do diagnóstico diferencial de doenças granulomatosas e infecciosas da laringe, principalmente em pacientes com mais de 50 anos, visando o diagnóstico precoce e o tratamento adequado.

Actinomycosis is a rare infection caused by bacteria of the genus Actinomyces sp. which are important constituents of the commensal flora of animals and humans, colonizing the oropharynx, the upper respiratory tract, the gastrointestinal tract and the female genital tract. Faced with a lesion in the mucosa associated with an imbalance in the organism's defenses, the bacteria infiltrate the structures, generating an infection. The areas most commonly affected by this pathology correspond to the cervicofacial (50%), abdominal (20%) and thoracic (15 to 20%) regions, and laryngeal involvement is quite rare (< 5% of cases), with few cases described in the literature. This study aims to report the case of a 76-year-old patient with actinomycosis mimicking laryngeal neoplasm, through the medical record review, describing the clinical picture and evidencing the imaging tests performed in the investigation with the purpose of alerting health professionals and sharing information about this pathology so that it can be part of the differential diagnosis of granulomatous and infectious diseases of the larynx, especially in patients older than 50 years, aiming at early diagnosis and appropriate treatment.

La actinomicosis es una infección rara causada por bacterias del género Actinomyces sp. que son componentes importantes de la flora comensal de animales y humanos, colonizando la orofaringe, el tracto respiratorio superior, el tracto gastrointestinal y el tracto genital femenino. Ante una lesión de la mucosa asociada a un desequilibrio de las defensas del organismo, las bacterias se infiltran en las estructuras, generando una infección. Las áreas más comúnmente afectadas por esta patología corresponden a las regiones cervicofacial (50%), abdominal (20%) y torácica (15 a 20%), siendo la afectación laríngea bastante rara (< 5% de los casos), con pocos casos descritos en la literatura. El presente estudio tiene como objetivo relatar el caso de una paciente de 76 años con actinomicosis simulando neoplasia laríngea, a través de la revisión de la historia clínica, describiendo el cuadro clínico y mostrando los estudios de imagen realizados en la investigación, con el propósito de alertar a los profesionales de la salud y compartir información sobre esta patología para que forme parte del diagnóstico diferencial de las enfermedades granulomatosas e infecciosas de la laringe, particularmente en pacientes con edad superior a 50 años, con vistas al diagnóstico precoz y tratamiento adecuado.

Lysyl Oxidase Like-4 (LOXL4) as a tumor marker and prognosticator in advanced stage laryngeal cancer / Proteína tipo-lisil oxidase-4 (LOXL4) como marcador tumoral e prognóstico no câncer de laringe em estágio avançado

Abstract Introduction: Lysyl oxidase-like 4 is an amine oxidase from the lysyl oxidase family that was previously shown to be overexpressed in head and neck cancer and upregulated in response to hypoxia. The possible role of lysyl oxidase-like 4 as a tumor marker in advanced stage larynx cancer was investigated. Objective: To investigate the expression of lysyl Oxidase-Like 4 protein in advanced stage laryngeal cancer and elucidate its possible role as a tumor marker, predictor of treatment response and prognosticator. Methods: Diagnostic specimens of 72 patients treated for stage III-IV laryngeal squamous cell carcinoma were evaluated for lysyl oxidase-like 4 expression by immunohistochemistry. Results: Lysyl oxidase-like 4 expression was correlated with advanced tumor stage (p = 0.041) and better differentiation (p = 0.025) but was independent of tumor diameter (p = 0.456). Response to induction chemotherapy or the need for salvage laryngectomy were not affected by lysyl oxidase-like 4 expression (p = 0.999, p = 0.070 respectively). Increased lysyl oxidase-like 4 expression was associated with better 2 year overall survival in both univariate (p = 0.036) and multivariate analyses (p = 0.014). Conclusion: Lysyl oxidase-like 4 expression emerges with advancing stages, is lost with worsening differentiation, and may have tumor suppressive properties in larynx cancer.

Resumo Introdução: A proteína tipo-lisil oxidase-4 é uma amina oxidase da família lisil oxidase cuja superexpressão em câncer de cabeça e pescoço e up-regulação em resposta à hipóxia foram previamente demonstradas. O possível papel da proteína tipo-lisil oxidase-4 como um marcador tumoral no câncer de laringe em estágio avançado foi investigado. Objetivos: Investigar a expressão da proteína tipo-lisil oxidase-4 no câncer de laringe em estágio avançado e elucidar seu possível papel como marcador tumoral, preditor da resposta ao tratamento e do prognóstico. Método: Amostras diagnósticas de 72 pacientes tratados para carcinoma espinocelular da laringe em estágio III-IV foram avaliadas quanto à expressão da proteína tipo-lisil oxidase-4 por imuno-histoquímica. Resultados: A expressão de proteína tipo-lisil oxidase-4 foi correlacionada com o estágio avançado do tumor (p = 0,041) e melhor diferenciação (p = 0,025), mas foi independente do diâmetro do tumor (p = 0,456). A resposta à quimioterapia de indução ou a necessidade de laringectomia de resgate não foram afetadas pela expressão da proteína tipo-lisil oxidase-4 (p = 0,999, p = 0,070 respectivamente). O aumento da expressão da proteína tipo-lisil oxidase-4 foi associado a melhor sobrevida global de 2 anos nas análises univariada (p = 0,036) e multivariada (p = 0,014). Conclusão: A expressão da proteína tipo-lisil oxidase-4 surge com o avanço dos estágios e desaparece com pioria da diferenciação e pode ter propriedades supressoras de tumor no câncer de laringe.

Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and local disease control on a cohort of 153 patients / Impacto do status da margem de ressecção e microcirurgia transoral a laser de revisão no câncer glótico inicial: análise da preservação do órgão e controle local da doença em uma coorte de 153 pacientes

Abstract Introduction Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision. Objective The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery. Methods We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resection margins were classified as follows: "free" if macroscopic margin-tumor distance was at least 2 mm, as "close" if it was less than 2 mm and "positive" if the margin was involved by carcinoma. Patients were divided into two groups: patients with free resection margins (Group A) and patients with positive, close or not-evaluable resection margins (Group B). Group A (36) underwent periodic followup. Group B (117) underwent a second look laser CO2 2 months after surgery. Fifteen patients of Group A with suspected persistence of carcinoma during followup underwent a second laser resection after a time interval of 4-8 months after first surgery. Overall survival, disease-free survival, disease-specific survival, ultimate local control with laser alone and organ preservation rates were estimated. Results Five-year overall survival rate and 5-year disease-specific survival were 100% in both groups. The five-year laryngeal preservation rate was 100% in Group A and 95.2% in Group B. Five-year disease-free survival was 92.15% and 5-year ultimate local control with laser alone in 92.15% of patients. Conclusion This study has demonstrated that revision Transoral Laser Microsurgery is able to confirm the oncological radicality in most cases, even in the case of positive, close or non-evaluable margins. Considering our results, according to our experience, the second look with CO2 laser is a therapeutic strategy to consider, even in the case of close or non-evaluable as well as positive margins.

Resumo Introdução A microcirurgia transoral a laser representa o tratamento de escolha para o câncer glótico inicial. Seu uso e sua eficácia estão relacionados principalmente à exposição laríngea e à profundidade da extensão do tumor. A avaliação histopatológica da margem cirúrgica representa uma das principais questões sobre a microcirurgia a laser transoral e excisão oncológica completa. Objetivo Analisar o impacto da cirurgia de revisão na preservação de órgãos e controle local da doença em pacientes com câncer glótico inicial tratados por microcirurgia a laser transoral. Método Fizemos um estudo retrospectivo em uma coorte de 153 pacientes com câncer glótico inicial (Tis, T1, T2) tratados por microcirurgia transoral a laser. As margens de ressecção foram classificadas da seguinte forma: livre, se a distância margem macroscópica-tumor fosse de pelo menos 2 mm; próxima, se fosse menor do que 2 mm; e positiva se a margem fosse afetada pelo carcinoma. Assim, os pacientes foram divididos em dois grupos: com margens de ressecção livres (grupo A) e com margens de ressecção positivas, próximas ou não avaliáveis (grupo B). O grupo A (36) foi submetido a seguimento periódico. O grupo B (117) foi submetido a uma cirurgia de revisão com laser de CO2 2 meses após a cirurgia. Quinze pacientes do grupo A com suspeita de persistência do carcinoma durante o seguimento foram submetidos a uma segunda ressecção a laser após um intervalo de 4 a 8 meses após a primeira cirurgia. A sobrevida global, a sobrevida livre de doença, a sobrevida doença-específica, o controle local final com laser isolado e as taxas de preservação de órgãos foram estimados. Resultados A taxa de sobrevida global em cinco anos e a sobrevida doença-específica em 5 anos foi de 100% em ambos os grupos. A taxa de preservação laríngea em cinco anos foi de 100% no grupo A e 95,2% no grupo B. A sobrevida livre de doença em cinco anos foi de 92,15% e o controle local final em 5 anos com laser isolado em 92,15% dos pacientes. Conclusões A revisão da microcirurgia transoral a laser é capaz de confirmar a radicalidade oncológica na maioria dos casos, mesmo em caso de margens positivas, próximas ou não avaliáveis. Considerando nossos resultados, de acordo com a nossa experiência, a cirurgia de revisão (second look) com laser de CO2 é uma estratégia terapêutica a ser pensada mesmo no caso de margens próximas ou não avaliáveis, bem como em margens positivas.

Role and mechanism of miR-548-3p/ DAG1 in the occurrence and malignant transformation of laryngeal carcinoma / Papel y mecanismo de miR-548-3p/DAG1 en la aparición y transformación maligna del carcinoma de laringe

Abstract The AMC-HN-8 cell line and the primary human laryngeal epithelial cell lines were utilized in this work to explore the molecular mechanism of miR-548-3p regulating the gene DAG1 to induce the occurrence and malignant transformation of laryngeal carcinoma. Non-coding RNA miR-548- 3p overexpression plasmid, interference plasmid and blank plasmid were constructed, and the plasmids were transfected into AMC-HN-8 cells, respectively. Meanwhile, a non-transfected plasmid group and a human laryngeal epithelial primary cell group were set up. Five groups of cells were named as NC (Normal control), Model, Ov-miR-548-3p, Sh-miR-548-3p and Blank-plasmid group. The luciferase reporter experiment was used to analyze the regulation characteristics of hsa-miR-548-3p on dystrophin-associated glycoprotein 1 (DAG1). Immunofluorescence was used to analyze the relative expression characteristics of the protein DAG1. The cell cloning experiment was used to analyze the proliferation characteristics of AMC-HN-8. The scratch healing test was used to analyze the migration ability of AMC-HN-8. The transwell test was used to analyze the invasion ability of AMC-HN-8. The RT-PCR was used to analyze the expression level of miR-548-3p. Western blot experiments were used to analyze the expression of protein DAG1, laminin α2 (LAMA2) and utrophin (UTRN). The luciferase report experiment and immunofluorescence test found that the expression of DAG1 and miR-548-3p are positively correlated. Cell cloning, scratching and migration experiments identified that the activity of laryngeal cancer cells was positively correlated with the expression of DAG1. The results of Western blot analysis further strengthened the above conclusions. Through carrying out research on the cellular levels, our work has demonstrated that miR-548-3p regulated the content of protein DAG1, and then further induced malignant transformation of laryngeal carcinoma.

Resumen En este trabajo se utilizaron la línea celular AMC-HN-8 y la línea celular epitelial laríngea humana primaria, para explorar el mecanismo molecular regulador del miR-548-3p sobre el gen DAG1 para inducir la aparición y la transformación maligna del carcinoma laríngeo. Se construyeron el plásmido de sobreexpresión de miR-548-3p de ARN no codificante, el plásmido de interferencia y el plásmido en blanco, y los plásmidos se transfectaron en células AMCHN-8 respectivamente. Mientras tanto, se establecieron un grupo de plásmidos no transfectados y un grupo de células primarias epiteliales laríngeas humanas. Se nombraron cinco grupos de células como NC (control normal), modelo, OvmiR-548-3p, Sh-miR-548-3p y grupo de plásmido en blanco. El experimento indicador de luciferasa se utilizó para analizar las características de regulación de hsa-miR-548-3p en la glicoproteína 1 asociada a distrofina (DAG1). Se utilizó inmunofluorescencia para analizar las características de expresión relativa de la proteína DAG1. El experimento de clonación celular se utilizó para analizar las características de proliferación de AMC-HN-8. Se utilizó la prueba de cicatrización por rascado para analizar la capacidad de migración de AMC-HN-8. La prueba de transwell se utilizó para analizar la capacidad de invasión de AMCHN-8. Se utilizó RT-PCR para analizar el nivel de expresión de miR-548-3p. Se usó un experimento de transferencia Western (Western blot) para analizar las expresiones de la proteína DAG1, laminina α2 (LAMA2) y utrofina (UTRN). El experimento de reporte de luciferasa y la prueba de inmunofluorescencia encontraron que la expresión de DAG1 y miR-548-3p están positivamente correlacionadas. Los experimentos de clonación celular, rascado y migración, identificaron que la actividad de las células cancerosas de laringe se correlacionó positivamente con la expresión de DAG1. Los resultados del análisis de transferencia Western fortalecieron aún más las conclusiones anteriores. A través de la investigación a nivel celular, nuestro proyecto ha demostrado que miR-548-3p regula el contenido de la proteína DAG1 y luego induce la transformación maligna del carcinoma de laringe.

Survival results of 3786 patients with stage I or II laryngeal squamous cell carcinoma: a study based on a propensity score / Resultados de sobrevivência de 3.786 pacientes com carcinoma epidermoide de laringe em estádio I ou II: um estudo baseado em escore de propensão

Abstract Introduction Laryngeal squamous cell carcinoma is the second most prevalent malignancy among head and neck tumors, and the treatment of patients with stage I or II disease can be performed with surgery or radiation therapy. National population studies describing therapeutic results comparing these modalities are unusual, but they can be very important to direct treatment guidelines. Objective To evaluate the survival results of patients with laryngeal squamous cell carcinoma at clinical stages I or II, according to the main therapeutic modalities used. Methods Cross-sectional, population-based study using the database of Fundação Oncocentro de São Paulo from January 2000 to March 2019. Inclusion criteria were patients with laryngeal squamous cell carcinoma in clinical stages cT1-2N0. To compensate for the non-random allocation of patients and the imbalance between confounding variables between groups, we used the propensity score methodology. Results A total of 3786 patients met the inclusion criteria. Regarding the cT stage, there were 2171 patients (57.3%) with cT1 tumors. Patients in the public health system had a longer time between diagnosis and treatment (p< 0.001). The analysis by propensity score showed that patients treated with surgery had a tendency towards better disease-specific survival (p = 0.012). Comparing radiotherapy alone versus its combination with radiochemotherapy, radiotherapy alone showed a tendency towards a better survival rate (p< 0.001). Conclusion Analysis by propensity score identified better results for disease-specific survival in patients with laryngeal squamous cell carcinoma at clinical stages I and II treated by surgery when compared to radiotherapy.

Resumo Introdução O carcinoma epidermoide de laringe é o segundo mais prevalente entre os tumores de cabeça e pescoço e o tratamento dos pacientes com doença em estádio I ou II pode ser feito com cirurgia ou radioterapia. Estudos populacionais nacionais que descrevem os resultados terapêuticos e compararam essas modalidades são poucos frequentes, mas podem ser muito importantes para orientar diretrizes de tratamento. Objetivo Avaliar os resultados de sobrevida dos pacientes com carcinoma epidermoide de laringe em estádios clínicos I ou II de acordo com as principais modalidades terapêuticas usadas. Método Estudo transversal de base populacional com a base de dados da Fundação Oncocentro de São Paulo de janeiro de 2000 a março de 2019. Os critérios de inclusão foram pacientes com carcinoma epidermoide de laringe em estádios clínicos cT1-2N0. Para compensar pela alocação não randômica dos pacientes e pelo desequilíbrio entre variáveis confundidoras entre os grupos, usamos a metodologia do escore de propensão. Resultados Preencheram os critérios de inclusão 3.786 pacientes. Em relação ao estádio cT, houve 2.171 pacientes (57,3%) com tumores cT1. Os pacientes do sistema único de saúde (SUS) apresentaram um maior tempo entre o diagnóstico e o tratamento (p < 0,001). A análise por escore de propensão mostrou que os pacientes submetidos a cirurgia apresentaram uma tendência de melhor sobrevida doença específica (p = 0,012). Comparando-se radioterapia isolada versus combinação com radioquimioterapia, o tratamento isolado demonstrou tendência a melhor taxa de sobrevida (p< 0,001). Conclusão A análise por escore de propensão identificou melhores resultados de sobrevida doença específica em pacientes com carcinoma epidermoide de laringe estádios clínicos I e II tratados por cirurgia quando comparados a radioterapia.

Fiber burden and asbestos-related diseases: an umbrella review / Niveles de exposición y enfermedades relacionadas con el asbesto

Objective: What are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects. Method: An umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument. Results: We retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those > 10 μm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 μm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels <0.1 f/ml. No reviews provided information on exposure concentrations for pulmonary fibrosis. Currently, there is limited evidence in humans to establish the causal relationship between gastrointestinal cancer and asbestos exposure. Conclusions: Banning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml. (AU)

Objetivo: Revisar la evidencia científica disponible sobre los niveles de exposición al asbesto y su relación con los efectos sobre la salud. Método: Se realizó una revisión de revisiones sistemáticas y metaanálisis en inglés, desde 1980 hasta marzo de 2021. Se incluyeron revisiones que involucran exposiciones cuantificadas al asbesto y resultados de salud. La revisión se adaptó a las indicaciones de la Declaración PRISMA. La calidad metodológica de los estudios seleccionados fue evaluada mediante el instrumento AMSTAR. Resultados: Se recuperaron 196 referencias y tras aplicar la estrategia de búsqueda y analizar la calidad se seleccionaron 10 revisiones para un análisis en profundidad. Para el cáncer de pulmón, se observó mayor riesgo con la exposición a anfíboles. Las fibras más largas y delgadas presentaron mayor capacidad de causar cáncer de pulmón, especialmente aquellas de longitud >10μm. Para el mesotelioma, las fibras más largas y delgadas también fueron más patógenas; los anfíboles ≥ 5μm se asociaron con un mayor riesgo de mesotelioma. Ningún estudio observó mayor riesgo de cáncer de pulmón o de mesotelioma con niveles de exposición al asbesto <0,1 f/ml. Ningún estudio proporcionó información sobre concentraciones de exposición para la fibrosis pulmonar. Actualmente existe evidencia limitada en humanos para establecer la relación causal entre la exposición al asbesto y el cáncer gastrointestinal. Conclusiones: Prohibir toda exposición al asbesto es la mejor medida para prevenir sus efectos negativos para la salud. Las revisiones y metaanálisis de más alta calidad respaldan que hay escaso riesgo de cáncer de pulmón y de mesotelioma con niveles de exposición diaria por debajo de 0,1 f/ml. (AU)

Fiber burden and asbestos-related diseases: an umbrella review.

OBJECTIVE: What are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects. METHOD: An umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument. RESULTS: We retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those > 10 µm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 µm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels <0.1 f/ml. No reviews provided information on exposure concentrations for pulmonary fibrosis. Currently, there is limited evidence in humans to establish the causal relationship between gastrointestinal cancer and asbestos exposure. CONCLUSIONS: Banning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml.

Comparación de sutura mecánica con sutura manual de la faringe en laringectomía total / Comparison of mechanical suture with manual suture of the pharynx in total laryngectomy

Introducción: La sutura mecánica es una opción para el cierre de la faringorrafia en laringectomía total por cáncer de laringe. Objetivo: Comparar el uso de sutura mecánica lineal con sutura manual de la faringe durante la laringectomía total por cáncer de laringe. Material y Método: Se realizó un estudio de tipo experimental prospectivo. Se compararon dos grupos pacientes: Los pacientes con sutura mecánica desde 2018 a marzo de 2020 y los pacientes con sutura manual previa a enero de 2018 en el Servicio de Otorrinolaringología del Hospital Barros Luco. Se analizaron fístula faringo-cutánea posoperatoria (FFC), tiempo operatorio, estadía hospitalaria y costo. Resultados: El estudio incluyó a 14 pacientes, cada grupo con n = 7. El grupo con sutura mecánica presento 0% de FFC y el grupo sutura manual 28%. El grupo con sutura mecánica reinicio alimentación a los 7 días y el grupo con sutura manual en promedio a los 11,5 (7-23) días. (p = 0,0023). El tiempo promedio de cirugía para el grupo experimental es de 288 ± 37,4 minutos y con sutura manual 311 ± 32,4 minutos. (p = 0,0176). El promedio de hospitalización para el grupo experimental fue de 11 ± 2,6 días (9 a 16), y para el grupo control fue de 21 ± 14 días (10 a 49) (p < 0,0001). Conclusión: La sutura mecánica es un procedimiento fácil de usar y seguro. Existiría un beneficio en el uso de sutura mecánica para el cierre faríngeo al compararlo con la sutura manual al disminuir el número de FFC, el tiempo operatorio y los días de hospitalización.

Introduction: Mechanical suture is an option for the closure of the pharyngorrhaphy in total laryngectomy due to laryngeal cancer. Aim: To compare the use of linear mechanical suture with manual pharyngeal suture during total laryngectomy for laryngeal cancer. Material and Method: A prospective experimental study was carried out. Two patient groups were compared: patients with mechanical suture from 2018 to March 2020 and patients with manual suture prior to January 2018 at the otorhinolaryngology service of the Barros Luco Hospital. Postoperative pharyngocutaneous fistula (FFC), operative time, hospital stay and cost were analyzed. Results: The study included 14 patients, each group with n = 7. The group with mechanical suture presented 0% of FFC and the group with manual suture 28%. The group with mechanical suture restarted feeding at 7 days and the group with manual suture on average at 11.5 (7-23) days (p = 0.0023). The average surgery time for the experimental group was 288 ± 37.4 minutes, while for the group with manual suture was 311 ± 32.4 minutes (p = 0.0176). The mean hospitalization for the experimental group was 11 ± 2.6 days (9 to 16), and for the control group it was 21 ± 14 days (10 to 49) (p < 0.0001). Conclusion: The mechanical suture is an easy to use and safe procedure. There would be a benefit in the use of mechanical suture for pharyngeal closure when buying it with manual suture by reducing the number of FFCs, operative time and days of hospitalization.

Comparison of Patients With Total and Salvage Laryngectomy.

INTRODUCTION AND OBJECTIVES: Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival. METHODS: The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death. RESULTS: The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P = .000) and between fistula and infection (P = .000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P = .038), T4 (P = .026), lymphovascular invasion (P = .019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P = .005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P = .026). CONCLUSIONS: Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.

Comparación de pacientes con laringectomía total primaria y de rescate / Comparison of patients with total and salvage laryngectomy

Introducción y objetivos: La laringectomía total (LT) es uno de los tratamientos disponibles en los carcinomas de laringe localmente avanzados o como rescate ante el fracaso de la preservación de órgano, logrando altas tasas de supervivencia y escasas complicaciones. El objetivo de nuestro trabajo es analizar los resultados oncológicos obtenidos, comparándolos con la literatura actual y analizando sus complicaciones y supervivencia.MétodosSe incluyeron 62 pacientes con carcinoma primario de laringe tratados mediante LT primaria o de rescate entre los años 2003 y 2019. Analizamos las características demográficas, clínicas y anatomopatológicas, el estadio tumoral, los tratamientos complementarios, las complicaciones postoperatorias, las recidivas locorregionales, las metástasis y las causas de muerte.ResultadosLos pacientes tenían una edad media de 64 años, el 90,3% eran hombres, el 96,8% eran fumadores y el 43,5% tenían pluripatología. El 82,3% tenían un estadio localmente avanzado. Al 71% se les realizó LT primarias y al 29% de rescate. Al 59,6% se les practicó vaciamiento cervical asociado. El 30,6% tenían invasión linfovascular, el 30,6% invasión perineural y el 14,5% afectación de márgenes. Durante el seguimiento, el 17,7% presentaron una recidiva locorregional y el 11,3% metástasis a distancia. En cuanto a tratamientos complementarios, el 56,4% de los pacientes recibieron tratamiento adyuvante. La incidencia de hemorragia fue del 11,3%, la de infección del 14,5% y la de fístula faringocutánea del 21%. Hubo significación estadística entre la fístula y la hemorragia (p=0,000) y entre la fístula y la infección (p=0,000). No se encontraron diferencias estadísticamente significativas entre los factores estudiados de la LT primaria y de rescate.(AU)

Introduction and objectives: Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival.MethodsThe study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death.ResultsThe mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P=.000) and between fistula and infection (P=.000). No statistically significant differences were found between the studied factors of primary and salvage TL. (AU)

18F-FDG-PET/CT in laryngeal cancer: comparison with conventional imaging and prognostic role.

OBJECTIVE: The aim of this study was to investigate the diagnostic accuracy of staging 18 F-FDG-PET/CT in laryngeal cancer, compare these results with conventional imaging (CI) and assess the value of 18 F-FDG-PET/CT features to predict survival. METHODS: Fifty-four patients with laryngeal squamous cell cancer and baseline 18 F-FDG-PET/CT were retrospectively enrolled. The PET images were analyzed visually and semi-quantitatively by measuring several metabolic parameters. A combination of clinical follow-up/imaging follow-up and/or histopathology was taken as reference standard. Progression free survival (PFS) and disease specific survival (DSS) were computed using Kaplan-Meier curves. RESULTS: All primary tumors were clearly identified by CI, and 52/54 by 18 F-FDG-PET/CT with a sensitivity of 96.3%. Cervical nodal metastases were detected in 40/54 patients at 18 F-FDG-PET/CT and in 34/49 patients at CI. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy on a patient-based analysis for nodal disease were 100%, 85.7%, 94.6%, 100% and 95.9% at 18 F-FDG-PET/CT, and 91.4%, 85.7%, 94.1%, 80%, 89.8% at CI. Diagnostic performances of PET/CT and CI were not significantly different on a patient-based, side-by-side and level-by-level analysis. 18 F-FDG-PET/CT recognized distant metastases in 7 patients allowing to an upstaging. At a median follow-up of 27 months, relapse/progression of disease occurred in 31 patients and death occurred in 32. Metabolic tumor volume (MTV T), MTV total and total lesion glycolysis (TLG) showed to be independent prognostic factors for PFS. CONCLUSIONS: Both CI and PET/CT had good diagnostic performances for the staging of laryngeal cancer; baseline metabolic features (MTV and TLG) showed an important prognostic value in assessing the rate of PFS.

Comparison of patients with total and salvage laryngectomy. / Comparación de pacientes con laringectomía total primaria y de rescate.

INTRODUCTION AND OBJECTIVES: Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival. METHODS: The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death. RESULTS: The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P=.000) and between fistula and infection (P=.000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P=.038), T4 (P=.026), lymphovascular invasion (P=.019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P=.005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P=.026). CONCLUSIONS: Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.

Laringectomía total en el adulto mayor, Guantánamo 2015-2019 / Laringectomia total em idosos, Guantánamo 2015-2019 / Total laryngectomy in older adult, Guantanamo 2015-2019

Introducción: El cáncer laríngeo en el adulto mayor tiene una incidencia elevada por múltiples factores que se incrementan con la edad, pero con un tratamiento específico adecuado como la laringectomía total permiten mejorar y elevar la calidad de vida de estos pacientes. Objetivo: Caracterizar el resultado de las intervenciones por laringectomía total realizadas en pacientes adultos mayores en el servicio de Otorrinolaringología del Hospital General Docente "Dr. Agostinho Neto", provincia Guantánamo, en el período de enero de 2015 a diciembre de 2019. Método: Se realizó un estudio descriptivo, retrospectivo de corte transversal en el total de pacientes (n=32) de 60 años y más a los que se les realizó laringectomía total durante el periodo estudiado. Las variables estudiadas fueron: edad, sexo, hábitos tóxicos, condicionantes prequirúrgicas, técnica quirúrgica y complicaciones más frecuentes. Los datos se obtuvieron de las historias clínicas. Resultados: La mayoría de los pacientes correspondió al sexo masculino (90,6 porciento) entre 70-74 años; el 71,8 porciento de los pacientes fumaba. La laringectomía total combinada con tiroidectomía unilateral o bilateral y vaciamiento cervical selectivo fue la técnica quirúrgica más empleada y el faringostoma la complicación predominante. Conclusiones: La caracterización de los resultados de la laringectomía total en el adulto mayor portador de carcinoma epidermoide laríngeo aporta datos que permiten una mejor atención integral a este grupo poblacional(AU).

Introduction: Laryngeal cancer has a high incidence in older adult due to various factors which has been increasing in frequency with age. However, assuming an adecuated and specific treatment like total laryngectomy, allows improving and enhancing the patient's quality of life. Objective: To characterize the outcomes of total laryngectomy in older adult patients treated in the otorhinolaryngology service at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo, from January 2015 to December 2019. Method: A descriptive, retrospective, and cross-sectional study was conducted on the total of patients (n=32) 60 and older, who underwent total laryngectomy during the mentioned period. Variables used were as follow: age, sex, toxic habits, preoperative conditions, surgical technique and, most frequent complications. Data was gathered from medical records. Results: Male patients 70 to 74 years were predominant (90.6 percent) and most of them smoked (71.8 percent). Total laryngectomy combined with unilateral or bilateral thyroidectomy and selective neck dissection was the most common surgical technique used and pharyngostoma was the predominant complication. Conclusions: The characterization of total laryngectomy outcomes in older adult with laryngeal squamous cell carcinoma provides important data for better comprehensive care in this population group(AU).

Introdução: O câncer de laringe em idosos apresenta alta incidência devido a múltiplos fatores que aumentam com a idade, mas com um tratamento específico adequado como a laringectomia total, melhoram e melhoram a qualidade de vida desses pacientes. Objetivo: Caracterizar o resultado da laringectomia total realizada em pacientes idosos no serviço de Otorrinolaringologia do Hospital General Docente "Dr. Agostinho Neto", província de Guantánamo, no período de janeiro de 2015 a dezembro de 2019. Método: Estudo descritivo, retrospectivo e transversal em todos os pacientes (n=32) com 60 anos ou mais que realizaram laringectomia total. durante o período estudado. As variáveis estudadas foram: idade, sexo, hábitos tóxicos, condições pré-cirúrgicas, técnica cirúrgica e complicações mais frequentes. Os dados foram obtidos dos prontuários médicos. Resultados: A maioria dos pacientes era do sexo masculino (90,6 porcento) entre 70-74 anos; 71,8 porcento dos pacientes fumavam. A laringectomia total combinada com tireoidectomia unilateral ou bilateral e dissecção cervical seletiva foi a técnica cirúrgica mais utilizada e a faringostomia a complicação predominante. Conclusões: A caracterização dos resultados da laringectomia total em idosos com carcinoma espinocelular de laringe fornece dados que permitem uma melhor assistência integral a este grupo populacional(AU).

Recovering records on cancer of the larynx from anonymous health information databases / Recuperação de registros de câncer de laringe de bancos de dados anônimos de saúde

ABSTRACT: Objective: To develop a linkage algorithm to match anonymous death records of cancer of the larynx (ICD-10 C32X), retrieved from the Mortality Information System (SIM) and the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in Brazil. Methodology: Death records containing ICD-10 C32X codes were retrieved from SIM and SIH-SUS, limited to individuals aged 30 years and over, between 2002 and 2012, in the state of São Paulo. The databases were linked using a unique key identifier developed with sociodemographic data shared by both systems. Linkage performance was ascertained by applying the same procedure to similar non-anonymous databases. True pairs were those having the same identification variables. Results: A total of 14,311 eligible death records were found. Most records, 10,674 (74.6%), were exclusive to SIM. Only 1,853 (12.9%) deaths were registered in both systems, representing true pairs. A total of 1,784 (12.5%) cases of laryngeal cancer in the SIH-SUS database were tracked in SIM with different causes of death. The linkage failed to match 167 (9.4%) records due to inconsistencies in the key identifier. Conclusion: The authors found that linking anonymous data from mortality and hospital records is a feasible measure to track missing records and may improve cancer statistics.

RESUMO: Objetivo: Desenvolver um algoritmo de vinculação de registros para parear registros de óbito por câncer de laringe (CID-10 C32X), recuperados do Sistema de Informação de Mortalidade (SIM) e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) do Brasil. Métodos: Foram filtrados registros de óbitos contendo códigos CID-10 C32X do SIM e do SIH-SUS, de indivíduos de mais de 30 anos, entre 2002 e 2012, no Estado de São Paulo. As bases de dados foram vinculadas por meio de um identificador único e de variáveis sociodemográficas comuns a ambos os sistemas. O desempenho da vinculação de dados foi aferido aplicando-se o mesmo procedimento em bancos de dados nominais. Os pares verdadeiros apresentavam os mesmos valores nas variáveis de identificação. Resultados: Ao todo, 14.311 registros elegíveis de óbito foram encontrados. A maioria dos registros, 10.674 (74.6%), era exclusiva do SIM. Apenas 1.853 (12.9%) óbitos foram registrados em ambos os sistemas, representando pares verdadeiros. Um total de 1.784 (12.5%) casos de câncer de laringe presentes no SIH-SUS constavam com diferentes causas de óbito no SIM. Houve falha na vinculação em 167 (9.4%) registros, devido a inconsistências na chave de identificação. Conclusão: Constatou-se que a vinculação de dados anônimos de registros hospitalares e registros de óbito é viável e pode auxiliar na melhoria de estatísticas de câncer.

Which risk factors are associated with stomal recurrence after total laryngectomy for laryngeal cancer? A meta-analysis of the last 30 years / Quais fatores de risco estão associados à recorrência estomal após laringectomia total para câncer de laringe? Uma meta-análise dos últimos 30 anos

Abstract Introduction Stomal recurrence is a troublesome complication after total laryngectomy. Despite a large number of studies having been performed, there is still controversy about which risk factors are most significant for the development of stomal recurrence. Objective The objective of the present meta-analysis was to analyze the potential factors leading to stomal recurrence after total laryngectomy. Methods PubMed, Web of Science, Cochrane Library, and Ovid databases were systematically searched using multiple search terms. Eighteen studies with 6462 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. Results The results showed that, tumor subsite (supraglottic vs. subglottic, RR = 0.292, 95% CI 0.142-0.600, p = 0.001; glottic vs. subglottic, RR = 0.344, 95% CI 0.175-0.676, p = 0.002), T stage (RR = 0.461, 95% CI 0.286-0.742, p = 0.001), preoperative tracheotomy (RR = 1.959, 95% CI 1.500-2.558, p < 0.001) were the high-risk factors associated with the development of stomal recurrence. Conclusion From the results of our study, tumor subsite, T stage and preoperative tracheotomy were the significant risk factors for stomal recurrence. Methodologically high-quality comparative investigations are needed for further evaluation.

Resumo Introdução A recorrência estomal pós-laringectomia total e é uma complicação de difícil manejo. Apesar de um grande número de estudos ter sido feito, ainda há controvérsias sobre quais fatores de risco são mais significativos para o seu desenvolvimento. Objetivo O objetivo da presente meta-análise foi analisar os fatores potenciais para recorrência estomal após a laringectomia total. Método As bases de dados PubMed, Web of Science, Cochrane Library e Ovid foram sistematicamente pesquisadas com vários termos de busca. Dezoito estudos com 6.462 pacientes foram identificados. A qualidade da evidência foi avaliada pelo National Institute for Health and Clinical Excellence. Resultados Os resultados mostraram que o subsítio tumoral (supraglótico vs. subglótico, RR = 0,292, IC 95% 0,142 ± 0,600, p = 0,001; glótico vs. subglótico, RR = 0,344, IC 95% 0,175 ± 0,676, p = 0,002), estágio T (RR = 0,461, IC 95% 0,286 ± 0,742, p = 0,001), traqueotomia pré-operatória (RR = 1,959, IC 95% 1.500 ± 2.558, p < 0,001) foram os fatores de alto risco associados ao desenvolvimento de recorrência estomal. Conclusão Com base nos resultados de nosso estudo, o subsítio do tumor, o estágio T e a traqueotomia pré-operatória foram fatores de risco significativos para recorrência estomal. São necessárias investigações comparativas metodologicamente de alta qualidade para maior avaliação.

Transoral laser microsurgery for early glottic cancer at a tertiary hospital in Mexico City.

OBJECTIVE: The objective of the study was to analyze the results of endoscopic laser microsurgery for early glottic carcinoma treatment (Stages I and II) at a Tertiary Center in Mexico City. MATERIALS AND METHODS: Descriptive, retrospective review of 40 patients with early glottic carcinoma who were treated with endoscopic laser microsurgery with curative intent at our institution from November 2003 to December 2013. RESULTS: The study yielded 4 pTis, 19 pT1a, 8 pT1b, and 9 pT2 patients. Mean patient follow-up time was 7.4 years (range 3-12.9 years). Post-operative bleeding requiring surgical intervention occurred in 1 (2.5%) patient. Kaplan-Meier results at 3 and 5-year estimates were as follows: overall survival was 92.5 and 87%, respectively; laser only local control was 94.9 and 91.6%, respectively; and disease specific survival and ultimate local control rate were 97.5% for both time periods. We found a 97.5% (39/40) organ preservation rate. CONCLUSIONS: Laser microsurgery for glottic carcinoma treatment is an emerging technique in Mexico. Our results are promising as reported by other authors in Europe and United States of America, which support the replicability of the surgical technique refined by Dr. Wolfgang Steiner.

OBJETIVO: Analizar los resultados del tratamiento del carcinoma glótico temprano (estadios I y II) con microcirugía láser en un hospital de tercer nivel en Ciudad de México. MÉTODO: Estudio descriptivo y retrospectivo en 40 pacientes con cáncer glótico temprano tratados con microcirugía láser de noviembre de 2003 a diciembre de 2013. RESULTADOS: Se estudiaron 4 pTi, 19 pT1a, 8 pT1b y 9 pT2. El tiempo promedio de seguimiento fue de 7.4 años (rango: 3 - 12.9). Se presentó un sangrado posoperatorio con revisión quirúrgica (2.5%). Las curvas de Kaplan-Meier de estimación a 3 y 5 años mostraron una sobrevida total del 92.5 y 87%, respectivamente; control local solo con láser del 94.9 y 91.6%, respectivamente; sobrevida específica de la enfermedad y control local global del 97.5%, para ambos periodos de tiempo. El porcentaje de conservación del órgano fue del 97.5% (39/40). CONCLUSIONES: La microcirugía láser para el tratamiento del cáncer glótico temprano es una técnica que se aplica paulatinamente en México. Nuestros resultados son prometedores y equiparables a los reportados por otros autores en Europa y en los Estados Unidos de América, lo que sustenta la reproducibilidad de la técnica quirúrgica implementada por el Dr. Wolgang Steiner.

Fascitis necrotizante en región anterior del cuello / Necrotizing fasciitis in the anterior region of neck

RESUMEN Introducción: la fascitis necrotizante corresponde a una infección bacteriana de los tejidos blandos, caracterizada por necrosis difusa y rápidamente progresiva del tejido celular subcutáneo y sistema músculo aponeurótico, acompañado de un acentuado compromiso séptico sistémico. Presentación del caso: se presenta el caso de un paciente de 66 años de edad, masculino, negro, con antecedentes de una neoplasia de laringe sin diagnóstico histológico, que fue recibido en el cuerpo de guardia del servicio de Otorrinolaringología del Hospital Abel Santamaría Cuadrado, por presentar un cuadro de gran toma del estado general, fiebre, disnea inspiratoria, estridor; al examen físico se encontró lesión ulcero necrótica de gran extensión en la región anterior del cuello. Se estableció el diagnóstico de una fascitis necrotizante del cuello y una neoplasia de laringe causante de un síndrome disneico laríngeo. Se procedió a realizar necrectomía y traqueostomía e ingreso del paciente. Conclusiones: la fascitis necrotizante de la región anterior del cuello a punto de partida de una neoplasia laríngea es una infección poco común, rápidamente progresiva y de difícil diagnóstico en estadío temprano.

ABSTRACT Introduction: necrotizing fasciitis corresponds to a bacterial infection of the soft tissues, characterized by diffuse necrosis and rapidly progressive infection of the cellular subcutaneous tissue and muscular aponeurotic system, accompanied by an accentuated septic systemic compromise. Case report: a 66 year old, male, black patient with a history of a laryngeal neoplasia without histological diagnosis, who came to the emergency room of the otolaryngology service at Abel Santamaria Cuadrado General Teaching Hospital. He presented an inadequate chart of general condition, fever, inspiratory dyspnea and stridor; at physical examination, an ulcer necrotic lesion of great extension was found in the anterior region of neck and a laryngeal neplasia triggering a laryngeal dyspnoeic syndrome; performing necrectomy and tracheostomy as well as the admission of patient. Conclusions: necrotizing fasciitis of the anterior region of neck from the starting point of a laryngeal neoplasia is a rare infection, having a rapidly and progressive expansion of difficult diagnosis in early stages.

Which risk factors are associated with stomal recurrence after total laryngectomy for laryngeal cancer? A meta-analysis of the last 30 years.

INTRODUCTION: Stomal recurrence is a troublesome complication after total laryngectomy. Despite a large number of studies having been performed, there is still controversy about which risk factors are most significant for the development of stomal recurrence. OBJECTIVE: The objective of the present meta-analysis was to analyze the potential factors leading to stomal recurrence after total laryngectomy. METHODS: PubMed, Web of Science, Cochrane Library, and Ovid databases were systematically searched using multiple search terms. Eighteen studies with 6462 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. RESULTS: The results showed that, tumor subsite (supraglottic vs. subglottic, RR=0.292, 95% CI 0.142-0.600, p=0.001; glottic vs. subglottic, RR=0.344, 95% CI 0.175-0.676, p=0.002), T stage (RR=0.461, 95% CI 0.286-0.742, p=0.001), preoperative tracheotomy (RR=1.959, 95% CI 1.500-2.558, p<0.001) were the high-risk factors associated with the development of stomal recurrence. CONCLUSION: From the results of our study, tumor subsite, T stage and preoperative tracheotomy were the significant risk factors for stomal recurrence. Methodologically high-quality comparative investigations are needed for further evaluation.