Enhanced Morbidity of Pectoralis Major Myocutaneous Flap Used for Salvage after Previously Failed Oncological Treatment and Unsuccessful Reconstructive Head and Neck Surgery

Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications. Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. Results. Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx (P = 0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P = 0.002). The former condition is also associated with major reconstruction failure (P = 0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P = 0.044). Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF

Diabetes mellitus, metformin and head and neck cancer

Introduction: Diabetes mellitus (DM (Diabetes Mellitus)) is directly associated with some cancers. However, studies on the association between diabetes mellitus and head and neck cancer (HNC (Head and Neck Cancer)) have rendered controversial results. The objective of this study was to evaluate the association between DM and HNC, as well as the impact of metformin use on the risk of HNC. Material and methods: This case-control study was conducted within the framework of the Brazilian Head and Neck Genome Project in 2011-2014. The study included 1021 HNC cases with histologically confirmed squamous cell carcinoma of the head and neck admitted to five large hospitals in Sao Paulo state. A total of 1063 controls were selected in the same hospitals. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression. Results: Diabetic participants had a decreased risk of HNC (OR = 0.68; 95% CI: 0.49-0.95) than nondiabetic participants, and this risk was further decreased among diabetic metformin users (OR = 0.54; 95% CI: 0.29-0.99). Diabetic metformin users that were current smokers (OR = 0.13; 95% CI: 0.04-0.44) or had an alcohol consumption of >40 g/day (OR = 0.31; 95% CI: 0.11-0.88) had lower risk of HNC than equivalent non-diabetic participants. Conclusion: The risk of HNC was decreased among diabetic participants; metformin use may at least partially explain this inverse association. (C) 2016 Elsevier Ltd. All rights reserved.Peer reviewe

Mucosal melanoma of head and neck: survival analysis and clinicopathological prognostic factors

Objetivo: Estudar retrospectivamente 43 pacientes portadores de melanoma da mucosa de cabeca e pescoco, atendidos em tres servicos de cirurgia de cabeca e pescoco, no periodo de 1954 a 2002, quanto aos fatores clinicos e anatomopatologicos, a sobrevida e aos fatores prognosticos. Metodos: As instituicoes participantes foram: Departamento de Cirurgia de Cabeca e Pescoco e Otorrinolaringologia do Centro de Tratamento e Pesquisa Hospital do Cancer A C. Camargo, São Paulo, no periodo de 1954-2002; Servico de Cirurgia de Cabeca e Pescoco e Otorrinolaringologia do Complexo Hospitalar Heliopolis, São Paulo; no periodo de 1977-2002; e Disciplina de Cirurgia Cabeca e Pescoco do Departamento de Otorrinolaringologia e Cirurgia Cabeca e Pescoco da Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM) - Hospital São Paulo, São Paulo, no periodo de 1998-2002. Os dados colhidos das fichas medicas dos pacientes portadores de melanoma da mucosa de cabeca e pescoco foram: demograficos, caracteristicas clinicas da lesao, estadiamento clinico, tipo de tratamento e seguimento clinico. Foi realizada revisao anatomopatologica dos casos, segundo os criterios: presenca de areas com melanoma in situ, fase de crescimento radial ou vertical, profundidade de infiltracao tumoral, indice mitotico por contagem do numero de mitoses por 10 campos, presenca de invasao linfatica, invasao vascular, presenca de infiltracao perineural, infiltrado inflamatorio peritumoral e intratumoral, de nodulos satelites e quanto as margens cirurgicas. A sobrevida especifica por cancer a 5 anos foi calculada pelo metodo de Kaplan-Meier e a analise univariada e multivariada (Cox, Mantel). Resultados: Dos 43 casos, 25 estavam localizados na boca, 14, na regiao nasosinusal e 4, na faringe. Vinte e quatro pacientes foram submetidos a tratamento cirurgico, 13 a tratamento nao cirurgico e 6 casos, apenas a suporte clinico. A lesao pigmentada previa foi mais frequente nos casos de melanoma localizado na boca (p= 0,02). Os melanomas localizados na cavidade nasal apresentavam em 75 por cento dos casos profundidade do tumor maior do que 5mm (p=0,03) quando comparados aos da boca e faringe. A sobrevida especifica por cancer a 5 anos foi de 33,7 por cento nos melanomas da mucosa de cabeca e pescoco, sendo 33,8 por cento nos pacientes com melanoma de boca e 37,0 por cento para os tumores da cavidade nasal. Na analise univariada da sobrevida especifica por cancer a 5 anos, encontramos como fatores prognosticos: tempo de queixa (p= 0,01). estadio clinico (p= 0,03), invasao perineural (p=0,03) e marginalmente o tratamento cirurgico (p=0,06). Conclusoes: Na analise multivariada da sobrevida especifica por cancer a 5 anos, o risco de obito dos pacientes portadores de melanoma da mucosa de cabeca e pescoco foi 3,8 vezes maior no estadio clinico II quando comparado ao estadio I; 3,7 vezes maior nos pacientes com queixa menor do que tres meses quando comparada aos com mais que tres meses; e 2,5 vezes maior nos pacientes que nao foram submetidos ao tratamento cirurgicoBV UNIFESP: Teses e dissertaçõe

Quality of life impairment in patients with head and neck cancer and their caregivers: a comparative study

Abstract Introduction: Head and neck cancer represents 3% of all the types of malignant neoplasms and squamous cell carcinoma (SCC) is responsible for 90% of these cases. There have been some studies evaluating the quality of life of these patients, but little is known about the physical and emotional effects on their caregivers. Objective: To evaluate the quality of life of patients with head and neck cancer and their caregivers by applying validated questionnaires. Methods: Thirty patients with advanced tumors (SCC stage III or IV) and their 30 caregivers were included. Specific questionnaires (Coop/Wonca, EORTC QLQ-C30, EORTC H&N35, Coop/Wonca, and Caregiver Strain Index - CSI) were applied during routine medical consultations. Results: Of the 30 patients, 28 were males and 25 had stage IV tumors, with mean age of 56.6 years. 36.7% had the primary tumor in the oropharynx and 70% reported pain. The functional cognitive, physical, and emotional scales were the most affected. Pain, fatigue, and sleep disorders were the most prevalent symptoms. Of the 30 caregivers, 23 were females and 70% were the primary caregivers. 36.7% of the caregivers had high levels of stress, mainly related to the feeling of incapacity. The comparison between patients and caregivers demonstrated that the two groups had similar quality of life impairment: physical fitness (p = 0.487), mental health (p = 0.615), daily activities (p = 0.793), social activities (p = 0.301), changes in health (p = 0.649), and overall health (p = 0.168). Conclusion: Quality of life impairment is similar between patients and their caregivers. This result demonstrates that not only the patients show quality of life impairment, but their caregivers also have it and at similar proportions

Manutenção do tabagismo e etilismo em pacientes tratados por câncer de cabeça e pescoço: influência do tipo de tratamento oncológico empregado

OBJETIVO: Avaliar a taxa de manutenção do tabagismo e etilismo em pacientes tratados por carcinoma epidermoide da cabeça e pescoço e comparar o resultado observado com a modalidade do tratamento oncológico empregado. MÉTODOS: Foram incluídos 110 pacientes tratados por carcinoma epidermoide das vias aereodigestivas altas, divididos em grupo cirúrgico, tratado com cirurgia, e grupo clínico, tratado com quimioterapia e/ou radioterapia. Os pacientes foram entrevistados a fim de determinar se houve manutenção dos hábitos após o tratamento. Comparou-se a taxa de manutenção dos hábitos com a modalidade de tratamento empregada. Testou-se também a relação entre o status oncológico dos pacientes com as taxas de tabagismo e etilismo encontradas. RESULTADOS: Entre os tabagistas, 35% mantiveram este hábito após o tratamento. No grupo clínico, houve um percentual significativamente maior de pacientes que mantiveram o tabagismo com relação ao grupo cirúrgico (58,3% x 25%; p = 0,004). Entre os etilistas, 16,6% continuaram a ingerir bebidas alcoólicas, percentagem que também se mostrou maior no grupo clínico (23,8% x 13,3%), porém sem diferença estatisticamente significativa. O status oncológico dos pacientes não apresentou relação com a manutenção dos hábitos estudados. CONCLUSÃO: São altas as taxas de manutenção de tabagismo e etilismo após o tratamento do carcinoma epidermoide de cabeça e pescoço, especialmente se considerarmos o tabagismo nos pacientes tratados com quimioterapia e/ou radioterapia. Uma abordagem multidisciplinar mais efetiva é necessária com vista a obter melhores taxas de abandono do tabaco e do álcool, especialmente no grupo de pacientes submetidos a tratamentos não cirúrgicos

Tobacco and alcohol use after head and neck cancer treatment: influence of the type of oncological treatment employed

SummaryObjectiveTo assess the cigarette smoking and alcohol intake maintenance rate in patients treated for head and neck squamous cell carcinoma and to compare the observed outcome with the type of oncological treatment employed.MethodsOne hundred and ten patients treated for high aero-digestive tract squamous cell carcinoma were included and divided into a surgical group, treated with a surgery, and a medical group, treated with chemotherapy and/or radiation. The patients were interviewed to determine whether or not they had persisted with the smoking and drinking behavior after treatment. The habit maintenance rate was compared with the treatment modality employed. The relationship between the oncological status of the patients and the cigarette smoking and alcohol intake rates found was also tested.ResultsAmong smokers, 35% maintained the habit after treatment. The medical group had a significantly higher percentage of patients maintaining smoking compared with the surgical group (58.3% vs 25.0%; p=0.004). Among alcohol users, 16.6% kept drinking alcoholic beverages, with a percentage also shown higher for the medical group (23.8% vs 13,3%), but with no statistically significant difference. The oncological status of patients was not related to the maintenance of the habits studied.ConclusionSmoking and alcoholism maintenance rates are high after head and neck squamous cell carcinoma is treated, especially if we consider smoking in patients treated with chemotherapy and/or radiation. A more effective multidisciplinary approach is required in order to obtain better rates of tobacco and alcohol quitting, especially in patients undergoing non-surgical treatments

Pectoralis major myocutaneous flaps for head and neck reconstruction: factors influencing occurrences of complications and the final outcome

CONTEXT AND OBJECTIVE: Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. The aim of this study was to identify factors that may cause complications and influence the final result from reconstructions using pectoralis major myocutaneous flaps (PMMFs) for head and neck defect repair following cancer resection. DESIGN AND SETTING: Cross-sectional study at the Hospital de Ensino Padre Anchieta of Faculdade de Medicina do ABC (FMABC). METHODS: Data on 58 patients who underwent head and neck defect reconstruction using PMMFs were reviewed. The final result from the reconstruction (success or failure) and the complications observed were evaluated in relation to the patients' ages, area reconstructed, disease stage, previous oncological treatment and need for blood transfusion. RESULTS: There were no total flap losses. The reconstruction success rate was 93.1%. Flap-related complications occurred in 43.1% of the cases, and half of them were considered major. Most of the complications were successfully treated. Defects originating in the hypopharynx were correlated with the development of major complications (p = 0.02) and with reconstruction failure (p < 0.001). Previous oncological treatment negatively influenced the reconstruction success (p = 0.04). CONCLUSIONS: Since the risk factors for developing major complications and reconstruction failure are known, it is important to heed the technical details and provide careful clinical support for patients in a more critical condition, so that better results from using PMMFs can be obtained