Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population

Altres ajuts: Acord transformatiu CRUE-CSICAltres ajuts: Open Access Funding provided by Universitat Autonoma de Barcelona. European Regional Development Fund (A Way to Build Europe).Purpose: Skeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3). Methods: Retrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3). Results: PCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027). Conclusion: Measuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL

Causes of long-term mortality in patients with head and neck squamous cell carcinomas

Altres ajuts: Acord transformatiu CRUE-CSICPurpose: After treatment of a head and neck squamous cell carcinoma (HNSCC), patients with an adequate control of the tumor have a decreased overall survival when compared to age- and gender-matched controls in the general population. The aim of our study was to analyze the causes of long-term mortality in patients with HNSCC. Methods: We carried out a retrospective study of 5122 patients with an index HNSCC treated at our center between 1985 and 2018. We analyzed the survival considering three causes of death: mortality associated with the HNSCC index tumor, mortality associated with a second or successive neoplasm, and mortality associated with a non-cancer cause. Results: After the diagnosis of an HNSCC the most frequent cause of death is the head and neck tumor itself during the first 3.5 years of follow-up. Thereafter, mortality is more frequently associated with competing causes of death, such as second malignancies and non-cancer causes. Mortality associated with second and successive neoplasms was 2.3% per year, a percentage that was maintained constant throughout the follow-up. Likewise, mortality attributable to non-cancer causes was 1.6% per year, which also remained constant. There were differences in the mortality patterns according to the characteristics of the patients. Conclusion: There are differences in the mortality patterns of patients with HNSCC depending on their characteristics. Knowledge of these patterns can help in the design of guidelines to improve the follow-up protocols of this group of patients to optimize the clinical cost-effectiveness

Factores de riesgo de la aparición de fístulas faringocutáneas tras una laringectomía total

En aquesta tesi doctoral vam estudiar els factors de risc que condicionaven l'aparició d'una fístula faringocutània (FFC) en el postoperatori d'una laringectomia total (LT). Per fer-ho, vam proposar una classificació de les fístules basada en la severitat clínica, segons la qual les fístules major eren aquelles que persistien 4 setmanes o més, requerien tractament quirúrgic, o s'associava a la mort perioperatòria del pacient. Vam revisar de forma retrospectiva tots els pacients operats de LT al nostre centre entre el 2000 i el 2019 (n=434). Per estudiar els factors de risc vam tenir en compte variables relacionades amb el pacient, el tumor i la cirurgia realitzada, aprofundint en l'anàlisi del tipus de sutura utilitzat i l'estudi de la sarcopènia. La sarcopènia es va avaluar a partir d'imatges de tomografia computeritzada, en les quals vam seleccionar l'àrea de secció muscular (ASM) en un tall axial a nivell de la vèrtebra C3, variable que vam definir com a sarcopènia directa. També vam calcular l'índex de massa muscular esquelètic (IMME) de l'estimació de l'àrea a L3, variable que vam definir com a sarcopènia estàndard. Mitjançant un anàlisi de partició recursiva vam obtenir els punts de tall en funció de l'aparició de FFC per les dues variables. Un 22,8% dels pacients va presentar una FFC. Els factors de risc independents que es van associar de forma significativa amb l'aparició d'una FFC van ser l'extensió de la cirurgia i el valor d'hemoglobina postoperatòria. En comparació als pacients amb una LT simple, els pacients tractats amb una LT amb faringectomia parcial que no van requerir una reconstrucció amb penjall van tenir un risc 4,0 vegades superior de presentar una FFC, i els pacients amb una laringofaringectomia que van requerir l'ús de penjalls, un risc 5,2 vegades superior. Els pacients amb nivells d'hemoglobina postoperatòria <99 g/L van mostrar un augment significatiu del risc d'aparició de FFC. Cal destacar que la radioteràpia prèvia i el tipus de sutura manual o mecànica no es van relacionar de forma significativa amb la freqüència d'aparició de FFC. D'acord amb la classificació segons la severitat clínica, un 74,7% dels pacients amb FFC complien els criteris de fístula major. De nou, els factors que es van relacionar amb el risc d'aparició d'una fístula major van ser l'extensió de la cirurgia i l'hemoglobina postoperatòria. Segons els punts de tall en funció de l'aparició de FFC, un 48,6% dels pacients va presentar sarcopènia directa i un 53,3% sarcopènia estàndard. Els pacients amb sarcopènia directa van mostrar un risc 4,0 vegades superior de presentar una FFC i els pacients amb sarcopènia estàndard, un risc 3,0 veces superior. A l'incloure la mesura de la sarcopènia en l'estudi multivariant dels factors de risc de FFC, aquesta variable va aparèixer com a únic factor de risc independent.En esta tesis doctoral estudiamos los factores de riesgo que condicionaban la aparición de una fístula faringocutánea (FFC) en el postoperatorio de una laringectomía total (LT). Para ello propusimos una clasificación de las fístulas basada en su severidad clínica, según la cual las fístulas major fueron aquellas que persistieron 4 semanas o más, requirieron tratamiento quirúrgico, o se asociaron a la muerte perioperatoria del paciente. Revisamos de forma retrospectiva todos los pacientes operados de LT en nuestro centro entre el 2000 y 2019 (n=434). Para estudiar los factores de riesgo tuvimos en cuenta variables relacionadas con el paciente, el tumor y la cirugía realizada, profundizando en el análisis del tipo de sutura utilizado y el estudio de la sarcopenia. La sarcopenia se evaluó a partir de imágenes de tomografía computarizada, en las que seleccionamos el área de sección muscular (ASM) en un corte axial a nivel de la vértebra C3, variable que definimos como sarcopenia directa. También calculamos el índice de masa muscular esquelético (IMME) de la estimación del área en L3, lo que definimos como sarcopenia estándar. Mediante un análisis de partición recursiva obtuvimos los puntos de corte en función de la aparición de FFC para las dos variables. Un 22,8% de los pacientes presentó una FFC. Los factores de riesgo independientes que se asociaron de forma significativa a la aparición de una FFC fueron la extensión de la cirugía y el valor de hemoglobina postoperatoria. En relación a los pacientes con una LT simple, los pacientes tratados con una LT con faringectomía parcial que no requirieron una reconstrucción con colgajo tuvieron un riesgo 4,0 veces superior de presentar una FFC, y los pacientes con una laringofaringectomía que requirieron el uso de colgajos, un riesgo 5,2 veces superior. Los pacientes con niveles de hemoglobina postoperatoria <99 g/L mostraron un aumento significativo del riesgo de aparición de FFC. Cabe destacar que la radioterapia previa y el tipo de sutura manual o mecánica no se relacionaron de forma significativa con la frecuencia de aparición de FFC. De acuerdo con la clasificación según la severidad clínica, un 74,7% de los pacientes con FFC cumplieron los criterios de fístula major. De nuevo, los factores que se relacionaron con el riesgo de fístula major fueron la extensión de la cirugía y la hemoglobina postoperatoria. Según los puntos de corte en función de la aparición de FFC, un 48,6% de los pacientes presentó sarcopenia directa y un 53,3% sarcopenia estándar. Los pacientes con sarcopenia directa mostraron un riesgo 4,0 veces mayor de presentar una FFC y los pacientes con sarcopenia estándar, un riesgo 3,0 veces mayor. Al incluir la medición de la sarcopenia en el estudio multivariante de los factores de riesgo de FFC, esta variable apareció como el único factor de riesgo independiente.In this doctoral thesis we studied the risk factors that condition the appearance of a pharyngocutaneous fistula (PCF) in the postoperative period after total laryngectomy (TL). For this purpose, we proposed a classification of fistulas based on their clinical severity, according to which major fistulas were those that persisted for 4 weeks or more, required surgical treatment, or were associated with perioperative mortality. We retrospectively reviewed all TLs performed in our centre between 2000 and 2019 (n=434). To study the risk factors we took into account variables related to the patient, the tumour and the surgery, delving into the analysis of the type of suture used and the study of sarcopenia. Sarcopenia was evaluated from computed tomography images, in which we selected the cross-sectional muscle area (CSMA) in an axial slice at the level of the C3 vertebra, a variable that we defined as direct sarcopenia. We also calculated the skeletal muscle mass index (SMMI) from the estimated area at L3, which we defined as standard sarcopenia. Using a recursive partitioning analysis we obtained the cut-off points according to the occurrence of PCF for the two variables. A total of 22.8% of patients developed a PCF. The independent risk factors that were significantly associated with the occurrence of a PCF were the extent of surgery and the postoperative haemoglobin levels. Relative to patients with simple TL, patients treated with TL with partial pharyngectomy who did not require flap reconstruction had a 4.0-fold increased risk of developing a PCF, and patients with laryngopharyngectomy who required the use of flaps had a 5.2-fold increased risk. Patients with postoperative haemoglobin levels <99 g/L had a significantly increased risk of developing PCF. It should be noted that previous radiotherapy and the type of suture (manual or mechanical) were not significantly related to the frequency of PCF occurrence. According to the classification based on the clinical severity, 74.7% of patients with PCF met the criteria for fistula major. Again, the factors that were related to the risk of fistula major occurrence were the extent of surgery and postoperative haemoglobin. According to the cut-off points based on the appearance of PCF, 48.6% of the patients showed direct sarcopenia and 53.3% had standard sarcopenia. Patients with direct sarcopenia showed a 4.0-fold increased risk of presenting a PCF and patients with standard sarcopenia, a 3.0-fold increased risk. When the measurement of sarcopenia was included in the multivariate analyses of PCF risk factors, this variable appeared as the only independent risk factor.Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològique

Notes sobre flora al·lòctona

The authors present some additions to synanthropic flora of the Catalonian countries. Several considerations about the distribution, origine, migration and phytocoenological adscription of certain species are also given

Lacrimal duct Surgery : Different Techniques and Long-Term Postoperative Results

Altres ajuts: acords transformatius de la UABPre-saccal obstructions of the lacrimal duct can be solved with a conjunctivodacryocystorhinostomy while saccal or post-saccal obstructions are restored with an external, endoscopic or laser dacryocystorhinostomy (DCR). The aim of the present study is to review the indications for each technique and to compare the results achieved. Retrospective review of 335 patients in whom 440 surgeries of the lacrimal duct were performed, with at least 4 months of follow-up. Outcomes in terms of symptoms and endoscopic findings during follow-up were considered. Successful results understood as resolution of symptoms were observed in 85% of cases treated with endoscopic DCR and in 62% of cases after laser DCR (p < 0.001). Among patients with recurrence of epiphora after surgery, 32% showed a visible ostium during endoscopy. Sixty-eight conjunctivodacryocystorhinostomies were performed, 68% of which required a tube replacement due to obstruction or extrusion. The mean duration of the tubes replaced was 10 months (range 3 days - 95 months). Endoscopic DCR shows better success rates than laser DCR. A considerable percentage of failures after DCR surgery present a visible ostium on endoscopic examination. This fact should lead to reconsider the initial diagnosis, ruling out functional problems or canalicular obstructions

Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population

Purpose: Skeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3). Methods: Retrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3). Results: PCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027). Conclusion: Measuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL

Causes of long-term mortality in patients with head and neck squamous cell carcinomas

Purpose: after treatment of a head and neck squamous cell carcinoma (HNSCC), patients with an adequate control of the tumor have a decreased overall survival when compared to age- and gender-matched controls in the general population. The aim of our study was to analyze the causes of long-term mortality in patients with HNSCC. Methods: we carried out a retrospective study of 5122 patients with an index HNSCC treated at our center between 1985 and 2018. We analyzed the survival considering three causes of death: mortality associated with the HNSCC index tumor, mortality associated with a second or successive neoplasm, and mortality associated with a non-cancer cause. Results: after the diagnosis of an HNSCC the most frequent cause of death is the head and neck tumor itself during the first 3.5 years of follow-up. Thereafter, mortality is more frequently associated with competing causes of death, such as second malignancies and non-cancer causes. Mortality associated with second and successive neoplasms was 2.3% per year, a percentage that was maintained constant throughout the follow-up. Likewise, mortality attributable to non-cancer causes was 1.6% per year, which also remained constant. There were differences in the mortality patterns according to the characteristics of the patients. Conclusion: there are differences in the mortality patterns of patients with HNSCC depending on their characteristics. Knowledge of these patterns can help in the design of guidelines to improve the follow-up protocols of this group of patients to optimize the clinical cost-effectiveness