RESUMO
INTRODUCTION: Nowadays, 70% of patients in Europe and the USA are affected by a p16 + , potentially HPV driven oropharyngeal squamous cell carcinoma. However, despite the improved survival rate in this group, the quality-of-life remains low in cases which neck dissection took place. In this vein, in recent years, some surgeons have considered to avoid dissection of level IIB, proposing a supra-selective non-IIb neck dissection. MATERIALS AND METHODS: A retrospective, longitudinal, multicentric study was conducted, including patients with pathologically confirmed primary HPV + or HPV - OPSCC who went through surgical treatment for the primary lesion and neck dissection. RESULTS: 141 patients were included. Among them, 99 (70.2%) were male and 42 (29.8%) were female. The mean age was 62 ± 9 years (range 36-81). The most frequent anatomical location was the tonsil in 63 (44.7%) of patients. The most common approach was the classic transoral oropharyngectomy in 51 (36.2%) patients. Immunohistochemistry for p16 was positive in 62 (44%) patients. One-hundred and five (74.5%) patients received a unilateral ND, and a 36 (25.5%) a bilateral ND. Of those, a 12.8% (18/141) of patients were level IIb LN + . According to our results, level IIb ND should be considered in patients underwent therapeutic ND with positive LN metastasis in level IIa (OR = 9.83; 95% CI 3.463-27.917) or III (OR = 6.25; 95% CI 2.158-18.143), advanced (T3/T4) oropharyngeal primary tumors (OR = 3.38; 95% CI 1.366-8.405), and patients with ENE (OR = 6.56; 95% CI 2.182-19.770), regardless of p16 status. CONCLUSIONS: According to our results, level IIb ND should be considered in patients who underwent therapeutic ND with positive LN metastasis in level IIa or III, advanced oropharyngeal primary tumors, and patients with ENE, independently of p16 status. Prospective data are necessary to definitively ensure the safety of omitting ipsilateral or contralateral level IIb ND in cN - patients with early stage disease.
Assuntos
Neoplasias Orofaríngeas , Infecções por Papillomavirus , Carcinoma de Células Escamosas de Cabeça e Pescoço , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linfonodos/patologia , Metástase Linfática/patologia , Esvaziamento Cervical/métodos , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/cirurgia , Infecções por Papillomavirus/patologia , Estudos Prospectivos , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologiaRESUMO
La disforia de género o transexualismo es una condición que comprende a las personas que padecen profundo malestar o rechazo hacia el sexo biológico por cuanto se identifican con el sexo opuesto. Por lo tanto, se asocia a disfunción biopsicosocial y compromiso severo de la calidad de vida. En Colombia se han producido notables avances de índole constitucional y legislativa en las dos últimas décadas, los cuales son discutidos en la presente revisión. En el tratamiento multidisciplinario de los pacientes transexuales, el último paso corresponde a la cirugía de reasignación genital. El propósito de esta revisión es investigar el estado actual de la cirugía de reasignación genital enfocada en el contexto nacional.
Gender dysphoria or transsexualism is a condition that includes people who suffer from deep discomfort or rejection of biological sex because they identify with the opposite sex. Therefore, it is associated with biopsychosocial dysfunction and severe compromise of their quality of life. In Colombia there have been notable advances of a constitutional and legislative nature in the last two decades, which are discussed in the present review. In the multidisciplinary treatment of transgender patients, the last step corresponds to genital reassignment surgery. The purpose of this review is to investigate the current status of genital reassignment surgery within the national context.
