Endoscopic and minimally invasive techniques represent a natural evolution for the discipline of head and neck surgery. Endoscopic head and neck surgery (eHNS) encompasses transoral laser microsurgery, transoral robotic surgery, as well as video-assisted and robotic surgery of the neck and thyroid. In the next 5 years, with robotic surgery and laser technology as a common platform, we foresee the development and widespread use of eHNS procedures, via transoral and transaxillary approaches.
Background: Eicosapentaenoic acid (EPA) containing nutritional supplement can reverse weight loss and increase lean body mass in a perioperative period of patients with head and neck cancer. To study effects of an EPA-enriched supplement compared with a conventional supplement in malnourished patients with head and neck cancer following surgery is primary objective. Methods: The patients were randomized into EPA-enriched and standard formula group. The supplements were prescribed 7 days preoperative through 14 days postoperative. Body weight and composition including serum parameters were measured from 7 days preoperative until 4 months postoperative. The hospitalized courses were recorded. Results: Thirty-one patients in each group consumed EPA-enriched and standard formula supplements. There was no significant body weight or composition changes perioperative. No significant differences in the hospitalized days and postoperative complications was observed. Conclusions: Body weight changes in malnourished patients with head and neck cancer following surgery were not influenced by EPA additives to perioperative nutritional supplements. K E Y W O R D S EPA-enriched, head and neck cancer, malnourished, supplement, surgery
The objective of this study is to compare the outcomes of transaxillary gasless endoscopic thyroidectomy (TGET) and conventional open thyroidectomy (COT). Thirty-three patients with thyroid nodule were enrolled. All patients were randomized into two different groups. Sixteen patients underwent TGET and 17 patients underwent COT. We analyzed the patients' characteristics, wound satisfaction, the intraoperative phase, hospitalization, pain, and costs. The operative time for the TGET group was significantly longer than in the COT group. The estimated blood loss, the hospitalized days, and pain between the two groups were not significantly different. The drainage content was significantly more in the TGET group. The patients' wound satisfaction and mean total cost per case were significantly greater in the TGET group. The TGET provided better cosmetic outcomes and was comparable regarding the estimated blood loss, pain, complication, and hospitalization. However, the TGET required a longer operative time which determines the higher costs.
Open access to the healthcare system had an influence on diagnostic delay. Public education and precise clinical acumen by HCPs in OSCC diagnosis are needed for early detection.
Objective
To evaluate the functional and oncologic outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with salvage cases after radiation-based treatment.
Methods
We conducted a retrospective case-control study at a single academic tertiary care institution. Functional outcomes were stratified by prior radiation, and assessed at baseline, <1 week postoperatively, and last follow-up.
Results
Five patients underwent TLM for previously untreated disease and five previously radiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy and none required radiotherapy. One salvage patient developed local recurrence. Length of feeding tube dependence (p=0.049) and rates of chronic aspiration (>1 month postoperatively, p=0.048) were significantly higher in salvage TLM cases compared with previously untreated cases. Median PSS-HN Understandability of Speech scores were 75 (“usually understandable”) in the salvage group compared with 100 (“always understandable”) in the previously untreated group.
Conclusions
Both local control and function were superior in previously untreated patients compared with salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.
Purpose of Study: An association of squamous cell carcinoma antigen (SCC-Ag) level with cancer prognosis has been reported in many studies. Our investigators conducted the first study determining a correlation between the SCC-Ag level and the tumor volume in head and neck cancer. Procedures: The SCC-Ag level of patients were measured from the serum, whilst the tumor volume was calculated by the ellipsoid formula and verified by logistic software on radiology. The correlation between SCC-Ag level and tumor volume was analyzed. Results: Fifty-two patients were studied, with the mean age of 62.4 years. Tumor types were: oral cavity cancer (11 cases, 21.6%), oropharyngeal cancer (21 cases, 40.38%), hypopharyngeal cancer (8 cases, 15.7%), and laryngeal cancer (12 cases, 23.5%). Mean tumor volume was 20.01 mL (range 0.02–91.46 mL). Mean SCC-Ag level was 2.69 ng/mL (range 0.5–14.6 ng/mL). The critical point of SCC-Ag was 5.8 ng/mL. The Pearson’s correlation coefficient between SCC-Ag level and tumor volume was 0.524 (p = 0.0002). Conclusions: SCC-Ag moderately correlates with tumor volume in head and neck cancer patients, with statistical significance. We suggest that using tumor volume, rather than a one-dimensional measurement such as tumor size, to analyze correlation with SCC-Ag offers a more accurate means of cancer prognosis.
Retropharyngeal metastasis of papillary thyroid carcinoma is a rare but well recognized phenomenon. Traditional open surgical approaches to nodal metastasis located in the retropharyngeal space are particularly morbid considering the relatively indolent nature of some thyroid cancers. Minimally invasive surgical approaches offer a useful alternative that is both low in morbidity and high in levels of patient acceptance. To assess feasibility and safety, we report a case series of robotic lymphadenectomy in two patients with thyroid cancer metastatic to the retropharyngeal space. Two patients, ages 66 and 73, with unilateral recurrent papillary carcinoma of the retropharyngeal lymph nodes had previously undergone thyroidectomy, neck dissection, and radioactive iodine ablation prior to retropharyngeal resection. Retropharyngeal lymphadenectomy via transoral robotic surgery was performed for both patients: for the first, the oropharyngeal wound was left to heal by secondary intention, while for the other patient, simple pharyngeal flap closure was performed. Retropharyngeal lymph node dissections were successfully carried out using a transoral robotic retropharyngotomy with the da Vinci surgical robotic system. Both patients tolerated the procedure well. One patient did developed temporary dysphagia which resolved with conservative measures, not requiring a feeding tube. We report the first two cases of transoral robot-assisted resection of thyroid cancer metastatic to the retropharyngeal lymph nodes. The technique is feasible, minimally invasive, and appears to be as safe as conventional surgical methods in achieving the goals of management of regionally metastatic disease.
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