Management of the irradiated N0-neck during salvage pharyngo-laryngeal surgery

Background: Salvage surgeries are challenging procedures, with an associated poor prognosis. Management of the N0 neck in those situations remains controversial. We aim to compare oncologic outcomes regarding neck management after surgery for N0 pharyngo-laryngeal carcinoma occurring after loco-regional radiotherapy. Methods: We conducted a multicentric retrospective study, including all patients undergoing surgery for persistent, recurrent or new primary N0 carcinoma of the oropharynx, hypopharynx or larynx between 2005 and 2015, following loco-regional radiotherapy. Results: A total of 239 patients were included, concerning respectively 44%, 34% and 22% oropharyngeal, laryngeal and hypopharyngeal tumors operated. A neck dissection was performed in 143 patients (60%), with an occult nodal metastasis rate of 9%. This rate was higher for hypopharyngeal carcinomas (18%, p = 0.16) and tumors with initial nodal involvement (16%, p = 0.05). With a median follow-up of 60 months, the median overall survival (OS) and progression-free survival rates (PFS) were 34 months and 25 months. We identified negative margin excision status, age at the time of surgery (under 60) and delay between RT and surgery over 2 years as the only variables associated with better OS (p < 0.0001 and p = 0.004) and PFS (p < 0.0001 and p = 0.010) in multivariable analysis, with no difference regarding neck management. Regional progression (alone or with distant metastasis) was noted in 10 cases: 4 in the neck observation group (4%) versus 6 in the neck dissection group (4%). Conclusion: Elective lymph node dissection of irradiated neck should not be routinely performed in patients undergoing surgery for persistent, recurrent or new primary pharyngo-laryngeal carcinoma

A Contemporary Review of Evidence for Transoral Robotic Surgery in Laryngeal Cancer

Numerous studies have shown that transoral robotic surgery (TORS) for oropharyngeal cancers is safe and that it yields satisfactory functional and oncological outcomes. For many teams worldwide, it is therefore a standard surgical approach with eligible patients. In the same time, TORS is increasingly being used and described in the context of laryngeal cancer surgery. It is proposed as an alternative to open approaches, which may yield inconsistent functional results and significant rates of postoperative complications. It may also be an alternative to definitive radiotherapy, which entails significant early and late toxicities. Moreover, it has been explored as an alternative to endoscopic laser surgery in patients with difficult exposure, even though there is still a lack of evidence about which procedure provides better vizualization of the vocal cords. This article provides a review of the indications for TORS in laryngeal cancer, the peri-operative morbidity, functional outcomes, and oncological results

A systematic review and meta-analysis of margins in transoral surgery for oropharyngeal carcinoma

International audienc

Dénutrition pré-opératoire et morbidité précoce post-opératoire en cancérologie ORL

La dénutrition pré-opératoire est un critère de morbidité chirurgicale reconnu, notamment les troubles de cicatrisation et les complications infectieuses. Les patients atteints d'un cancer ORL sont particulièrement dénutris en pré-opératoire, par les effets métaboliques propres du processus tumoral et par l'effet de masse local dysphagiant. L'objectif de cette étude était dans un premier temps d'évaluer, sur une cohorte rétrospective de 33 patients atteints d'un cancer du larynx, de l'hypopharynx ou de l'oropharynx, l'intérêt des différents critères de dépistage de dénutrition, et leurs corrélations avec les complications post-opératoires classés en majeures et mineures, et la durée d'hospitalisation. Dans un second temps, l'objectif était d'évaluer l'efficacité de la prise en charge nutritionnelle au CHRU de Rouen. 60.6% des patients étaient dénutris en pré-opératoire. L'index de Buzby s'est révélé le critère de dénutrition le plus sensible et le plus spécifique. L'index de masse corporelle n'a pas démontré d'intérêt dans cette cohorte. L'albuminémie était corrélée avec la durée d'hospitalisation. La perte de poids avant chirurgie était corrélée avec les complications majeures. Cette corrélation était significative dès 5% de perte de poids, et était très significative à partir de 10%. Les patients opérés d'un cancer de l'hypopharynx sont apparus comme la sous-population la plus à risque, avec une perte de poids avant chirurgie supérieure aux autres localisations et plus de complications majeures post-opératoires. Les complications majeures post-opératoires prédominantes dans l'ensemble de la cohorte étaient des troubles de la cicatrisation, notamment des stomies salivaires, et des complications infectieuses locales et générales. La prise en charge nutritionnelle au CHRU de Rouen a montré des dysfonctionnements prédominant dans la transmission des informations, et des pistes d'amélioration sont proposées pour réduire la morbi-mortalité chirurgicale des patients.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Transoral robotic surgery in head and neck carcinoma

International audienceTransoral robotic surgery in head and neck carcinom

Nasal angioma with osseous metaplasia

Nasal angiomas are rare. We report a case showing osseous metaplasia and discuss pathogenesis hypotheses. A 41-year-old woman presented with a right lateronasal firm, immobile mass, and interfering with glass wearing. The computed tomography scan imaging was suggestive of chondroma while the magnetic resonance imaging showed on T1-weighted images nodule isosignal, on T2-weighted images hypersignal, and intense enhancement after contrast substance injection. The lesion was surgically resected. Histological examination revealed a 0.8 cm angioma with multifocal osseous metaplasia. The diagnosis of nasal angiomas with extensive osseous metaplasia is difficult requiring microscopic examination. Conservative surgery is the treatment of choice even at an early stage due to the limited effectiveness of embolization or drugs on the osseous component

Exposition du plan glottique et cordectomies par voie endoscopique au Laser CO2

National audienc

Arytenoidectomie médiale endoscopique au laser CO2

Background and Objective: To evaluate the results of endoscopic laser medial arytenoidectomy (ELMA) for bilateral vocal fold paralysis. Study Design/Material and Methods: A prospective study was designed. 20 patients with bilateral vocal fold paralysis were included in this study. Five patients had a tracheotomy and all the other 15 patients had dyspnea on mild exertion. Acoustic and aerodynamic measurements, spirometric parameters and voice evaluation, were performed one week before surgery and 3 months after. Results: 18 bilateral ELMA were performed, and 2 unilateral. All patients improved subjectively in daily physical activities. The 5 patients with tracheotomy were decanulated post-operatively. No aspiration occurred after surgery. Jitter and Shimmer were altered (p=0.0078), whereas the voice quality subjective evaluations and spirometric objective evaluations did not show significant modifications after surgery. Conclusions: CO2 Endoscopic laser medial arytenoidectomy is a safe and efficient procedure, allowing subjective improvement of quality of life in patients with bilateral vocal fold paralysis, without degradation of voice quality