RESUMO
Every science has limits to its operation, including medical science concerning malignancy. Beyond a certain stage of a disease, palliation is the only recourse. The word "palliation" amounts to an acceptance of defeat by a clinician while trying to salvage his cancer patients. It means that the patient should breathe and eat without much pain till death takes pity on him. Palliative surgery in laryngeal cancer amounts to doing tracheostomies and gastrostomies and administering painkillers. Most of my cases belong to this category. I extended the accepted parameters of surgical excisions for primary lesion and metastatic nodes. These excisions include laryngectomy with cervical esophagectomy, total laryngectomy, total cervical esophagetomy, total glossectomy, and total mandibulectomy. The extended radical neck dissections include carotid artery, vagus nerve, and sympathetic trunk on one side. Removal of these so-called vital structures was not only compatible with life but proved curative in 20 per cent of these cases.
Assuntos
Neoplasias Laríngeas/cirurgia , Anestesia por Inalação , Caquexia/etiologia , Doenças das Artérias Carótidas/cirurgia , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Metástase Linfática , Masculino , Neoplasias Mandibulares/cirurgia , Meperidina , Esvaziamento Cervical , Óxido Nitroso , Cuidados Paliativos/métodos , Medicação Pré-Anestésica , Lesões por Radiação/complicações , Sistema Nervoso Simpático/cirurgia , Neoplasias da Língua/cirurgia , Nervo Vago/cirurgiaRESUMO
India is a developling country with its necessary priorities. Therefore the limited resources which are available cannot be spared for basic cancer research. The population is close to 600 million -- 80 per cent living in villages and receiving hardly any medical aid. This has provided extensive clinical material which can be beneficially utilized for research. The following plan is suggested under the existing circumstances: 1. Motivation of specialists towards head and neck problems. 2. Creation of regional specialists in cancer hospitals. 3. Advanced cases as objects for research. 4. A universal law regarding compulsory postmortem. 5. In a developing country like India with limited resources highly academic investigations should have low priority. 6. Refresher courses for general practitioners to educate them regarding early clinical manifestations of laryngeal cancer. 7. Training of postgraduates. A postgraduate should be first trained in one's own country, particularly in a developing country like India. He can then go for further experience to other international centres. 8. Communication by way of publication. The clinicians from developing countries should have easy opportunity to get their works published in English journals.
