Lateral thoracic flap for donor site repair of pectoralis major myocutaneous flap

Objective: To study the use of the lateral thoracic flap to repair a pectoralis major flap donor site defect when primary closure is not possible. Study design: Prospective study. Subjects and methods: All patients requiring pectoralis major flap reconstruction after tumour extirpation in the head and neck region, whose chest wall donor defects could not be closed primarily, were recruited to the study; lateral thoracic flaps were performed to close the wounds. Results: Ten patients were recruited between July 2005 and November 2007. The patients were between 48 and 76 years of age. The lateral thoracic flap size ranged from 5 × 8 cm to 9 × 12 cm. All secondary donor sites in the lateral chest wall were closed primarily. There was no flap necrosis and the secondary donor sites healed without complications. Conclusion: The lateral thoracic flap is safe and reliable technique for reconstructing the chest wall donor defect from the pectoralis major flap when primary closure is not possible. © 2008.link_to_subscribed_fulltex

A comparative study of the clinicopathological significance of E-cadherin and catenins (α, β, γ) expression in the surgical management of oral tongue carcinoma

Purpose: E-cadherin and catenins are important epithelial adhesion molecules in normal epithelium. Loss of E-cadherin-catenin adhesion is an important step in the progression of many epithelial cancers. E-cadherin and catenins expression in carcinoma of the tongue were evaluated in relation to their clinicopathological features and prognostic values. Method: Immunohistochemical staining was carried out with E-cadherin and (α, β, γ)-catenin monoclonal antibodies for 85 surgical specimens of oral tongue carcinoma, nine matched metastatic lymph nodes, and seven locally recurrent tumours. Results: There was under-expression in 85% of E-cadherin, 94% of α-catenin, 89% of β-catenin, and 83% of γ-catenin in the primary tumours. There was no correlation of E-cadherin/catenin expression with sex, age, cancer stage, and differentiation. Nodal metastasis was found in 68% of patients with weak expression of γ-catenin compared with 9% with strong expression in primary tumours (chi-square, P = 0.02). E-cadherin was a significant prognostic factor for survival and recurrence; patients with weak E-cadherin expression had 53% 5-year survival compared with 85% with strong expression (Wilcoxon, P = 0.0159). Conclusions: Both E-cadherin and catenins were highly under-expressed in oral tongue carcinoma, metastatic lymph node, and recurrent tumour. γ-catenin had predictive value for nodal metastasis. E-cadherin was, however, a more important prognostic factor for recurrence and survival.link_to_subscribed_fulltex

Does unnecessary elective neck treatment affect the prognosis of N0 laryngeal cancer patients?

Among detractors of elective neck (N0) treatments, most suggest that lymphadenectomy removes a barrier to the spread of disease with deleterious immunologic consequences. To test this hypothesis we performed a retrospective comparison of the survival results of N0 laryngeal cancer patients who received unnecessary elective neck treatments (N0-) and those of N0 patients subjected to close and regular follow-up.A retrospective chart review of 749 N0 laryngeal cancer patients treated at the Institute of Otolaryngology-Head and Neck Surgery, University of Florence between January 1980 and January 1993 was performed. Of these, 245 (33\%) received elective neck dissection (ED), while the remaining 504 (67\%) N0 patients were subjected to close and regular follow-up (wait-and-see policy; WS).Of the 245 ED patients, 43 (17.5\%) showed an occult neck disease, while of the 504 WS subjects, 83 (17\%) developed neck metastases during follow-up. Moreover, 15 ED patients subsequently experienced a contralateral occult failure despite a unilateral negative neck specimen (N0-). Thus, ultimately 187 ED (164 of whom were treated unilaterally and 23 bilaterally) and 421 WS patients were used for survival analysis. No differences in terms of postoperative complications, local or distant failure or disease-free or overall actuarial survival were found between the two groups analyzed.These data indicate that unilateral or bilateral removal of cervical lymphatics in the absence of histologically proven lymph node metastases does not negatively affect the prognosis of N0 laryngeal cancer patients who were overtreated to the neck

P-cadherin expression and survival rate in oral squamous cell carcinoma:an immunohistochemical study

<p>Abstract</p> <p>Background</p> <p>P-cadherin (P-cad) is a transmembrane molecule involved in the cell-cell adhesion and similar to E-cadherin (E-cad), but less investigated in oncology, especially in <it>in vivo </it>studies. Aims of the present study were to assess the prevalence of P-cad expression in oral squamous cell carcinoma (OSCC) and to verify whether P-cad can be considered a marker of prognosis in patients with OSCC.</p> <p>Methods</p> <p>In a retrospective study, a cohort of 67 OSCC patients was investigated for P-cad expression and its cellular localization by immunohistochemistry; some respective healthy margins of resection were similarly investigated as standard controls. After grouping for P-cad expression, OSCCs were statistically analyzed for the variables age, gender, histological grading (G), TNM, Staging, and overall survival rate. Univariate and multivariate analyses were performed.</p> <p>Results</p> <p>37 cases (55.2%) of OSCC showed membranous/cytoplasmic positivity for P-cad, whereas 30 (44.8 %) were negative. Although with some differences in membranous vs cytoplasmic localization of P-cad in OSCC with different G, no statistical association was found between P-cad expression and any variables considered at baseline. In terms of prognostic significance, P-cad non expression was found to have an independent association with poorer overall survival rate than P-cad expressing group (P = 0.056); moreover, among P-cad +ve patients the best prognosis was for those OSCC with membranous (P < 0.0001) than those with cytoplasmic P-cad expression.</p> <p>Conclusion</p> <p>On the basis of these results, it is possible to suggest P-cad as an early marker of poor prognosis. The abnormal or lack of P-cad expression could constitute an hallmark of aggressive biological behavior in OSCC</p