Oncological and surgical outcome of total laryngectomy in combination with neck dissection in the elderly.

There are controversial data on oncological and surgical outcome after major head and neck cancer surgery in the elderly. The aim of this study was to evaluate the outcome of elderly cancer patients after total laryngectomy in combination with neck dissection. A total of 58 patients separated into two age groups (28 < 65 vs. 30 ≥ 65 years) with hypopharyngeal and laryngeal cancer who underwent total laryngectomy and neck dissection were enrolled. Comorbidities of both age groups using the Charlson comorbidity index, hospitalization days as well as surgical complications evaluated by the Clavien-Dindo classification were examined. Overall and disease-free survivals of all patients were analyzed. The average follow-up was 2.9 years. Surgical complication rate was significantly increased in elderly (p = 0.04). However, complications could be treated without surgical intervention in most cases without significant extension of hospitalization. Locoregional and distant control did not significantly differ in both age groups. Disease-free and overall survival showed no significant differences for the two age groups by the Kaplan-Meier analysis (p = 0.66 and 0.08, respectively). Total laryngectomy in combination with neck dissection can be considered in elderly patients with satisfactory oncological and surgical outcome.

Extent of Salvage Neck Dissection in Advanced Oro- and Hypopharyngeal Cancer.

BACKGROUND/AIM: Primary radiochemotherapy (RCT) is becoming increasingly important in patients with oro- and hypopharyngeal cancer. However, debate exists on the extent of salvage neck dissection (ND) in those patients. The purpose of the present study was to evaluate the regional control after salvage ND. PATIENTS AND METHODS: Clinical, histological and radiological data, results of 51 patients with oro- or hypopharyngeal cancer and N2 neck who underwent selective ND in case of radiological evidence of residual neck disease, were retrospectively analyzed. RESULTS: Altogether 52 metastases were detected in 20 (39.2%) patients by histological examination. They were localized in level II (n=23), III (n=13), IV (n=11) and V (n=5). Regional recurrence occurred in 4 patients (7.8%) in previous dissected neck levels in the follow-up. CONCLUSION: Selective ND of suspicious neck levels for residual disease after RCT of oro- and hypopharyngeal cancer seems to be a sufficient treatment.

Human papilloma virus (HPV) is not implicated in the etiology of Warthin's tumor of the parotid gland.

CONCLUSION: The lack of human papilloma virus (HPV) sequences as well as potential HPV-activated cells such as cells that would be p16- and Ki-67 positive does not support a role of HPV in the pathogenesis of this lesion. OBJECTIVE: The exact etiopathogenesis of Warthin's tumor of the parotid gland is still unclear. The aim of the present study was to evaluate if HPV could play a role in the development of this parotid lesion. METHODS: Tissue samples from 40 Warthin's tumors of the parotid gland were investigated by PCR followed by in situ hybridization. The immunohistochemical expression of p16 and the dual immunostaining of p16 and Ki-67 were evaluated in all samples. RESULTS: Strong and diffuse p16 immunoreactivity was found in 7 of the 40 cases (17.5%). In situ hybridization showed a diffuse episomal signal in those samples. However, PCR could not reliably detect the presence of HPV genes. Furthermore, p16-expressing epithelial cells were mostly negative for the proliferation marker Ki-67.