[About laryngeal mask: is the lowest price material the better cost-efficacy choice?]. / Comparaison de quatre masques laryngés à usage unique pour la chirurgie carcinologique du sein: une approche médico-économique.

OBJECTIVE: The main goal of this study was to achieve a medico-economic comparison between four disposable laryngeal masks (LM) (LMA-Unique™, Ambu AuraOnce™, I-Gel™ and LMA-Suprême™). STUDY DESIGN: A prospective, randomized, monocentre study. MATERIAL AND METHODS: In a center, using routinely LMA-Unique masks, scheduled breast surgery patients were allocated into four groups according to the LM model. After the induction, the modalities of use were collected, as well as the intraoperative events that required additional anesthetic equipment. The real cost of each model was calculated (cost of the mask+extra cost related to complications). Using the LMA-Unique as a reference, we performed a cost-efficacy analysis. We realized a cost-efficiency analysis putting in parallel the impact on the cost and the incidence of the events. RESULTS: A total of 178 patients were included. According to the cost-efficacy analysis, the dominant model was the Ambu AuraOnce™ (Δreal cost: -34.2%, Δevents: -30.6%). The LMA-Unique™ was dominated because of a high morbidity rate. The I-Gel™ and LMA-Suprême™ models were more efficient but more expensive (Δreal cost: +16% and +22.5% respectively). To compensate for additional costs, it would be necessary to apply a price reduction of at least 50%. CONCLUSIONS: Despite their better efficiency and safety, the latest generation laryngeal masks are still expensive in spite of a low rate of complication. These results do not take into account very rare and severe complications not met in this study in the limited size; then the economic and medical impact can influence the choice beyond the simple analysis cost-efficiency.

Management and outcome of head and neck squamous cell carcinomas in obese patients.

Head and neck squamous cell carcinomas are common lesions, related to chronic smoking and drinking behaviors. But in contrast to other cancers, effect of obesity on occurrence, diagnosis, treatment and prognosis of these tumors remains to date unknown. This is a retrospective review of 111 obese patients (sex ratio=6.4, median age=54.5 year old), treated between 1999 and 2007. Risk factors, tumoral localization and staging (41% stage I-II) were the same as in general population. However, we found 26.1% difficult pan-endoscopies, 54% ACE-27 comorbidity scores ≥2 and 22.5% misstaged cervical lymphadenopathy. Treatment was based upon surgery (61%) or radiotherapy-chemotherapy (39%), and 37% of patients developed complications. Median follow up (38 months) and five-year overall survival (50%) are comparable to data in non obese patients. Although no direct relation between obesity and squamous cell carcinomas of the head and neck was found, obesity causes problems in tumor assessment and increases surgical complications rate. However, final good therapeutic tolerance and overall survival rate show that these patients should be managed like normal weighted ones. Receiving optimal treatments allow them to anticipate equivalent outcome as in general population.