[Malignant minor salivary gland tumors of the larynx].

OBJECTIVE: To study the clinical features, treatment and prognosis of malignant minor salivary gland tumors of the larynx. METHODS: Treatment and outcome were retrospectively analyzed in a consecutive series of 15 patients with malignant minor salivary gland tumors of the larynx treated in this hospital from 1959 to 2005. Ten patients (66.7%) had adenoid cystic carcinoma and 2 (13.3%) had adenocarcinoma. The other three patients had mucoepidermoid carcinomas, polymorphic adenocarcinoma and base cell carcinoma respectively. Eleven (73.3%) were located in the supraglottis and 4 (26.7%) in the subglottis. Fourteen had surgery (7 with adjuvant radiotherapy) and one was treated with radiotherapy plus chemotherapy. Five patients were found to have recurrent disease, 4 of whom underwent salvage surgery, 1 of whom had palliation radiotherapy. RESULTS: With a median follow-up of 8 years (ranging from 2 to 16 years), 7 patients are alive. Five patients have no evidence of disease, 1 of whom had surgery alone, 4 of whom were treated with surgery plus radiotherapy. Four patients died of distant metastases in a range of 2 to 10 years. The other 4 patients were lost to follow-up after treatment (ranging from 2 years to 16 years). Seven patients developed recurrent disease, 1 of whom had local recurrence alone, 1 had regional recurrence alone, 2 had distant metastases alone, and 3 had local and distant metastases. CONCLUSIONS: Minor salivary gland carcinomas of the larynx are rare and they are prone to the local recurrence and the distant metastasis in advanced stage. Distant metastases remain the principal cause of treatment failure. Surgery is the primary treatment modality used in most cases and the radiotherapy combining surgery has better local and regional control rate.

[Reconstruction with free jejunal interposition for defect after tumor resection of hypopharyngeal and cervical esophageal cancer].

OBJECTIVE: To discuss the use of free jejunal flap in reconstruction for circumferential defect after tumor resection of hypopharyngeal and cervical esophageal cancer. METHODS: Retrospective review of 51 patients who underwent circumferential pharyngoesophageal reconstruction with free jejunal flap after tumor ablation. RESULTS: In 51 patients, 5 had flap failure and the flap success rate was 90% (46/51). Forty-five patients had oral intake after operation excluding one who had anastomosis stenosis and 5 who had flap failure. The 1-year and 3-year survival rate was 62% and 48% respectively. Positive surgical marginal status and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area were indicators for bad prognosis. Except 5 patients who had flap failure, one of which died from mediastinal infection, no other severe complications occurred. CONCLUSIONS: Patients reconstructed with free jejunal flap after resection of hypopharyngeal and cervical esophageal cancer had low mortality and few complications. Those without positive surgical margin and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area had higher survival rate. Most of them had good quality of life. The choice of free jejunal flap for reconstruction of hypopharyngoesophageal defect was appropriate in selected patients who had guarantee of negative surgical margin and no external invasion.

[The surgical treatment and reconstructive methods in management of hypopharyngeal cancer].

OBJECTIVE: To study the surgical treatment and the long-term effect of different reconstructive methods in surgical treatment of hypopharyngeal cancer. METHODS: A retrospective review of 303 (265 males, 38 females, ages ranging from 32 to 77 years) cases with hypopharyngeal cancer that were treated with surgical treatment from 1965 to 1998 were accomplished. Of the 303 cases, 130 cases were treated with different reconstructive methods and 173 cases without reconstruction. Of the 130 (stage II, 5; III, 16; IV, 109) cases, 94 were originated from pyriform sinus, 18 from posterior pharyngeal wall and 18 from postcricoid. Fifteen patients were reconstructed with free jejunum. Eighty-one patients were performed total pharyngo-larygo-oesophagectomy and gastric pull-up. Ten patients were treated with vascularized colon. Twenty patients were reconstructed with pectorals major myocutaneous flap. Four patients were reconstructed with other methods. Of the 173 (stage I, 7; II, 12; III, 51; IV, 103) cases, 160 were originated from pyriform sinus, 8 from posterior pharyngeal wall and 5 from postcricoid. RESULTS: The overall 3 and 5 years survival rate of 130 patients with reconstruction were 43.2%, 36.4% respectively. The overall 5 years survival rate of 173 patients with no reconstruction was 47.7%. The overall rate of regular swallowing was over 80%. The mortality rate in period of surgery of gastric pull-up and pectorals major myocutaneous flap were 8.6% and 15% respectively. No patients with free jejunum and vascularized colon died. The overall complication rate in nineties was lower than before 1990 (chi2 = 13.457, P = 0.004). The highest complication rate occurred in patients with pectorals major myocutaneous flap. In contrast to other reconstruction methods, the rate of success of swallowing was higher in patients with free jejunum. CONCLUSIONS: In selected patients these reconstruction techniques enable functional rehabilitation of swallowing. Even high survival rate was obtained after extended partial pharyngolaryngectomy.

[Retrospective analysis of effectiveness of tonsillar squamous cell carcinoma: report of 108 cases].

BACKGROUND & OBJECTIVE: There is a controversy in selecting either radiotherapy plus surgery reserved as salvage (Salvage S) or the planned surgery plus preoperative radiotherapy (Planned R+S) as the treatment modality for the tonsillar squamous cell carcinoma. Among stage III- IV patients, the tumor size and the lymph node metastasis were insufficient as the prognostic predictors. The authors retrospectively reviewed the patients with this disease who were treated in Cancer Hospital of Chinese Academy of Medical Sciences to analyze the indications and prognosis of the two treatments. METHODS: A total of 108 patients with biopsy-proven tonsillar squamous cell carcinoma were reviewed from 1984 to 2000. The patients were divided into Salvage S group (group A, 83 cases) and Planned R+S group (group B, 25 cases). Treatment outcome and the surgery related oral dysfunctions were compared in the two groups. The relationship between the response to radiotherapy and the survival rate was analyzed. RESULTS: The composite resection that led to oral dysfunction was undertaken for 20 (24.1%) of group A patients and for 22 (88.0%) of group B patients. The 5-year survival rates were 59.3% and 55.4% in group A and group B patients, respectively (P=0.706). The 5-year survival rates were 73.0% and 76.9% in the patients whose lymph nodes and surgical specimen showed obvious response to radiotherapy,respectively. CONCLUSION: The two treatment modalities reached similar survivals. However, compared with the planned surgery, 60% of composite resection would be withdrawn if surgery reserved as salvage, being benefit to the oral function. The responses to radiotherapy in the lymph nodes and the surgical specimen were good predictors of prognosis.