Transoral robotic surgery (TORS) has gained acceptance for treating a variety of head and neck benign and malignant pathologies. Some TORS advantages are great 3D visualization, shorter operative times, increased range of movement in narrow spaces, getting a complete pathological specimen, and improved life quality (LQ), resulting in well-validated functionality and oncological outcomes. This is a retrospective case series of patients treated with TORS between 2013 and 2019. Preoperative, intraoperative, and postoperative variables were collected. Descriptive statistics were used to report medians and ranges for continuous variables. The number of cases and percentages were used to describe categorical variables. Fifteen patients have been treated for oncological pathologies with TORS in two Colombian health centers. Lateral oropharyngectomy was the most common surgery comprising 80% of surgeries. Three patients receiving this surgery also had one tongue base resection, one soft palate resection, and one retromolar trigone resection. Bilateral lingual and palatine tonsillectomy was performed in 13.3% of patients and supraglottic laryngectomy in 6.7%. Twelve patients (80%) had secondary wound healing, and three (20%) needed free flap reconstruction. After reviewing these initial experiences, we concluded that TORS is a versatile procedure for resection of tumor located in the oropharynx, supraglottis, and retromolar trigone. TORS is also useful for the reconstruction of subsequent defects with free flaps. We believed that some practical considerations must be published to help head and neck surgeons during the preoperative, intraoperative, and postoperative stages. Keywords Robotics . Head and neck neoplasms . Oropharyngeal neoplasms . Margins of excision This article is part of the Topical Collection on Surgery
Establecer una serie de recomendaciones para la realización de las traqueostomías, que se centren en la seguridad de los pacientes y de los equipos de atención médica durante la pandemia de COVID-19, minimizando el riesgo, la exposición viral y agotamiento del equipo de protección personal (EPP). Este documento está destinado a proporcionar los antecedentes, consideraciones y recomendaciones basadas en la literatura e información de primera línea de esta etapa de la pandemia. Estas recomendaciones pueden requerir individualización en función de la región del país, la institución, la capacidad instalada, los recursos y los factores específicos del paciente. Se encuentran en constante actualización según la evolución de la enfermedad y aparición de nuevos datos.
Epidermoplasia verruciforme como una entidad predisponente para carcinoma escamocelular en cabeza y cuello. Relato de un caso clínico familiar / Epidermodysplasia Verruciformis as a predisposal entity for squamous cell carcinoma. A familial case report.
Introduction: Adenoid Cystic Carcinoma of the sinonasal and skull base region is a challenging tumor to treat due to its late onset of presentation and frequent compromise of vital neurovascular structures. Surgical treatment followed by conventional irradiation are the optimal treatment options, often requiring extensive open approaches and mutilating interventions due to its localization. Endoscopic endonasal approaches are relatively new procedures that combined with new adjuvant radiation techniques could achieve similar oncological outcomes with significant less morbidity.Methods: We present the case of a patient with non-metastatic Adenoid Cystic Carcinoma (ACC) locally advanced of the sinonasal and skull base region diagnosed and treated at the Instituto Nacional de Cancerología of Bogotá D.C, Colombia between the years 2017 and 2020 who underwent endoscopic endonasal tumor resection and subsequent adjuvant management with Intensity modulated radiotherapy (IMRT).Results: Endoscopic and imaging control was performed according to the protocol of the surgical group with nasal endoscopies every 3-4 months during the first 2 years and serial images every 6 months. Follow up for 35 months with adequate local control and minimal aesthetic or functional sequelae.Conclusion: Multidisciplinary management with endoscopic endonasal resection and adjuvant radiotherapy appears to be an effective oncological alternative to open surgical procedures, with less morbid and minor functional sequelae, for patients with locally advanced ACC tumors of the sinonasal region.
Introduction Differentiated thyroid carcinoma (DTC) has increased incidence. Intermediate- and high-risk patients have lymph node relapse rate ranging from 10 to 50%, and receive multiple reinterventions, increasing the morbidity of the disease. Currently, there are no established guidelines for the use of second radioactive iodine (RAI) therapy after the reintervention for local recurrence. Materials and Methods This is a retrospective review of the medical records of 1,299 patients treated from January 2016 to July 2019 with DTC. We included 48 patients who received total thyroidectomy, RAI remnant ablation, surgery to remove the locally recurrent/persistent papillary thyroid carcinoma (PTC), and received a second RAI therapy. Results There were no significant differences between thyroglobulin (Tg) levels before reoperation (Tg0), Tg levels postoperatively (Tg1), and Tg levels after 6 months of second adjuvant RAI therapy (Tg2). However, we evidenced a 69.79% drop in first Tg levels (Tg0: 24.7 vs. Tg1: 7.56, p=0.851) and 44.4% decrease in second Tg levels (Tg1: 7.56 vs. Tg2: 4.20, p=0.544). Also, 77.1% of the patients did not have another documented recurrence. The median relapse-free time was 10.9 months (range: 1.3–58.2 months). Conclusion The results of the study cannot assess that a second RAI treatment after reoperation for locoregionally persistent or recurrent disease have a significant impact on treatment outcomes in intermediate- or high-risk patients with PTC. However, the 77.1% of patients have not presented a second documented recurrence and the median values of Tg and TgAb levels showed a substantial decrease after surgery and second RAI treatment.
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