Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract.

CONTEXT AND OBJECTIVE: Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. DESIGN AND SETTING: Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de S?o Paulo (FCMSCSP). METHODS: We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). RESULTS: Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. CONCLUSIONS: SND may be a good option for treating node-positive necks in selected cases.     

Pharyngocutaneous fistulae following total laryngectomy comparison between manual and mechanical sutures

The extension of the surgery and closure type of the pharynx can be the determinants in the pharyngocutaneous fistula development. The objective of the study is to evaluate the incidence of pharingocutaneous salivary fistulae after total laryngectomies comparing manual and mechanical sutures. The study is designed as non-randomized, prospective clinical study. Sixty patients with squamous cell carcinoma were submitted to total laryngectomies. In 30 cases, the linear stapler (75 mm) closure (surgical technique described in details) and in other 30 cases manual suture was used. The cases of mechanical suture were prospective and consecutive and the cases of manual suture were a review series of patients who underwent a manual suture of pharynx, in the same period of time. The statistical analysis between the two groups concluded that both were comparable. Fistulae incidence was 6.7% (2/30) in the group with the mechanical suture and 36.7% (11/30) in the group with manual suture closure, presenting a significant difference (p = 0.0047). The total laryngectomy with mechanical closure is an easy and fast learning technique, allowing watertight closure of the pharynx with a low risk of contamination of the surgical field. It is an assured method, even in previously irradiated patients, since we respect the limits of its indication regarding the extension of primary tumor that must be confirmed by previous suspension laryngectomy performed in the operating room.     

Predictive factors for late cervical metastasis in stage I and II squamous cell carcinoma of the lip

European Archives of Oto-Rhino-Laryngology - Many authors have described clinicopathologic parameters as factors related to cervical lymph node metastasis development in CN0 stage lip cancer....     

A nine-year institutional experience with near-total laryngectomy

BACKGROUND: Pearson's near-total laryngectomy (NTL) is an alternative procedure to total laryngectomy in selected patients with advanced laryngeal cancer. Based on our experience with NTL for >9 years, we present here the functional results, complications, and survival rates. METHODS: A retrospective study was carried out from January 1993 to May 2002. We studied 15 patients with advanced laryngeal, oropharyngeal, and hypopharyngeal cancer who underwent NTL. Survival rates were calculated using the Kaplan-Meier method. RESULTS: The most common complication was fistula (8 of 15) followed by minor aspiration (4 of 15 patients). Eleven patients (73.5%) attained a good voice; 3 patients (19.9%) obtained a bad voice; and 1 did not achieved vocal ability. Three patients (19.9%) had local recurrence; no patients had neck recurrence; and 2 patients (13.3%) had distant metastasis. Six patients (40%) died from their disease, and 2 (13.3%) patients died from other causes. The 3-year actuarial survival rate was 81.6%. CONCLUSIONS: NTL is useful in the treatment of selected patients with advanced laryngeal, oropharyngeal, and hypopharyngeal cancer and results in good control and survival rates. Satisfactory functional results can be attained in the majority of patients. When the surgical margins are positive or close, TL must be carried out.