- Obstructive sleep apnoea as a late complication after tracheostomy. [Journal Article]
- JLJ Laryngol Otol 2019 Jun 14; :1-4
- CONCLUSIONS: Drug-induced sleep endoscopy should always be used for visualisation of anatomical structures below the vocal folds in patients with a history of cervical trachea surgery. These two cases demonstrate the importance of drug-induced sleep endoscopy in planning conservative and surgical treatments, contributing significantly to operative success.
- Post-laryngectomy adjuvant radiotherapy in patients with pharyngocutaneous fistulae: Treatment regimens, outcomes and complications in 67 patients. [Letter]
- COClin Otolaryngol 2019 May 02
- Surgical Treatment of Advanced Staged Hypopharyngeal Cancer. [Review]
- AOAdv Otorhinolaryngol 2019; 83:66-75
- It is not uncommon for patients with hypopharyngeal cancer to present at an advanced stage of disease. Surgical treatment provides a cure for the tumour with immediate relief from obstruction to the …
It is not uncommon for patients with hypopharyngeal cancer to present at an advanced stage of disease. Surgical treatment provides a cure for the tumour with immediate relief from obstruction to the airway and the swallowing passage. Careful planning of surgery is important to ensure good outcome of treatment and prevent complications, some of which may be fatal. The shape of the hypopharynx resembles that of a funnel, with a wide circumference above in continuity with the oropharynx, and a small circumference below where it joins with the cervical oesophagus. As a result, while small tumours require the partial removal of the hypopharynx, large tumours, especially those involving the post-cricoid region, warrant a complete, circumferential pharyngectomy. For tumours that invade the cervical esophagus, transcervical approach is still feasible, and this is facilitated by the removal of the manubrium, allowing access to the tumour and resection with clear margins. In the presence of synchronous tumours lower down in the esophagus, pharyngo-laryngo-esophagectomy is indicated. Successful reconstruction of defects after tumour extirpation allows proper wound healing and early delivery of adjuvant radiotherapy. It is also important to ensure quick recovery of the long-term swallowing function. It ranges from the use of the soft tissue flap with skin island that is sutured as a patch to the remnants of the pharyngeal mucosa, to the use of a visceral flap, such as the free jejunal flap, to repair the circumferential pharyngectomy defects. The treatment protocol is personalized according to the extent of the tumour and the characteristics of the patients.
- Future Perspectives in Hypopharyngeal Cancer Care. [Review]
- AOAdv Otorhinolaryngol 2019; 83:167-175
- Recent advances in minimal access surgery have shown promise in the treatment of limited hypopharyngeal lesions. In spite of their functionally excellent results in individual patients, it currently …
Recent advances in minimal access surgery have shown promise in the treatment of limited hypopharyngeal lesions. In spite of their functionally excellent results in individual patients, it currently remains unlikely that these approaches will gain a more major universal impact on hypopharyngeal cancer care. In advanced stage hypopharyngeal cancer, the use of the traditional radical surgery, such as laryngo-pharyngectomy, is no longer accepted by many patients. In recent years, most would rather opt for less mutilating treatment, preferring a non-surgical option. Patients, families and medical practitioners frequently ignore or misunderstand the associated mortality and morbidity consequence of such an approach. Although synergy between chemotherapy and radiotherapy enhances the efficacy of the treatment, chemo-radiation as currently used achieves a tumour response in < 80%, with relapses of the tumour during the follow-up period, indicating that surgery is the only effective treatment option as salvage. Advances in molecular research have improved our understanding of oncogenesis, tumour spread and the mechanisms of metastases. Innovative strategies have become available that manipulating tumours or the host to favour conditions receptive for disease eradication. These advances have gone through pre-clinical testing and are currently being used in early clinical trials using approaches such as replacement of defective genes, suicide gene therapy, and immunologic gene therapy. Precision oncology may eventually be able to predict which patients are more likely to respond to specific cancer therapies based on increasingly accurate, high-resolution biomarkers based on molecular diagnostics of individual tumours. Currently concentrating cancer treatment at specialised head and neck cancer institutions is likely to contribute faster and more sustained results at improving patient outcomes for hypopharyngeal cancer care than any individual innovation in surgery, radiation oncology or systemic treatment. Preventative work should continue by governments with the elimination of the preventable risk factors (abusive use of alcohol, tobacco and betel nut chewing) may reduce the incidence of the disease.
- A new lateral cervical approach for salvage total laryngo-pharyngectomy. [Case Reports]
- AOActa Otorhinolaryngol Ital 2019; 39(1):61-64
- Hypopharyngeal cancer treatment: Does initial surgery confer survival benefit? [Journal Article]
- HNHead Neck 2019; 41(7):2167-2173
- CONCLUSIONS: Due to its survival advantage, primary surgery followed by adjuvant treatment should be considered as a viable treatment of HSCC.
- The impact of surgical margin status on the outcomes of locally advanced hypopharyngeal squamous cell carcinoma treated by primary surgery. [Journal Article]
- AOActa Otolaryngol 2018; 138(12):1136-1145
- CONCLUSIONS: The tailored extent of surgical resection margin was recommended for locally advanced hypopharyngeal carcinomas according to primary tumor stage.
- Postoperative Complication Assessments of Different Reconstruction Procedures after Total Pharyngolaryngoesophagectomy: Tubular Gastric Pull-Up versus Whole Gastric Pull-Up. [Journal Article]
- ASAm Surg 2018 Dec 01; 84(12):1927-1931
- Hypopharynx carcinoma tends to be diagnosed at advanced stage and usually has a poor prognosis because of the high incidence of submucosal spreading and lymphatic metastasis. Total pharyngolaryngoeso…
Hypopharynx carcinoma tends to be diagnosed at advanced stage and usually has a poor prognosis because of the high incidence of submucosal spreading and lymphatic metastasis. Total pharyngolaryngoesophagectomy (PLE) is mostly used as a curative intervention for this deadly disease, and a commonly used reconstruction method after PLE is gastric pull-up, which could be further divided into tubular gastric pull-up and whole gastric pull-up procedures. Aiming to achieve a precise guidance on optimal reconstruction method after PLE, the present study evaluated the postoperative complications involving in different gastric pull-up procedures in patients with hypopharynx cancer. A total of 52 consecutive patients with hypopharyngeal cancer who underwent total PLE with gastric pull-up reconstruction in Tianjin Medical University Cancer Institute and Hospital between 1996 and 2014 were analyzed in this study. Of these patients, 28 underwent tubular gastric pull-up reconstruction procedure (Group A), whereas 24 underwent whole gastric pull-up reconstruction procedure (Group B). We compared the postoperative complications between these two groups retrospectively. Postoperative anastomotic fistulas occurred in three patients in Group A (3/28) versus eight patients in Group B (8/24), leading to an incidence rate of 10.71 and 33.33 per cent, respectively. The incidence of intrathoracic stomach syndrome was 21.43 per cent in Group A (6/28) versus 58.33 per cent in Group B (14/24), and the incidence of reflux was 35.71 per cent in Group A (10/28) versus 66.67 per cent in Group B (16/24). All of the above postoperative complications exhibited statistical differences between two groups (P ≤ 0.05). This retrospective observation study suggests that compared with whole gastric pull-up, tubular gastric pull-up is a better reconstruction procedure of choice after PLE, evidenced by reduced incidences of postoperative anastomotic fistula, intrathoracic stomach syndrome, and reflux.
- Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer. [Journal Article]
- HNHead Neck 2019; 41(4):865-870
- CONCLUSIONS: For patients undergoing STL with MFTT, the majority of patients achieve a total oral diet regardless of their preoperative swallowing function. Advanced-stage recurrent tumors and increased extent of pharyngectomy contribute to poorer swallowing outcomes.
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- Outcomes following pharyngeal reconstruction in total laryngectomy - Institutional experience and review of literature. [Journal Article]
- IJIndian J Plast Surg 2018 May-Aug; 51(2):190-195
- CONCLUSIONS: Pharyngeal reconstruction in TL is feasible with good results. Majority of the patients swallow and regain acceptable swallowing function within 3 months.