Asunto(s)
Algoritmos , Intubación Intratraqueal/métodos , Cuidados Preoperatorios , Respiración Artificial/métodos , Obstrucción de las Vías Aéreas , Manejo de Caso , Urgencias Médicas , Femenino , Humanos , Intubación Intratraqueal/instrumentación , Máscaras Laríngeas , Masculino , Embarazo , Complicaciones del Embarazo , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/normas , Respiración Artificial/instrumentaciónRESUMEN
BACKGROUND AND OBJECTIVES: Treatment of multiple primary squamous cell carcinomas of the head and neck and oesophagus is controversial. The poor prognosis of these 2 types of carcinoma taken individually and their anatomic proximity complicate the therapeutic strategy and limit the treatment choices for each location. METHODS: From 1986 to 1998, 43 patients received curative treatment for multiple synchronous (n = 30) or metachronous (n = 13) primary neoplasms of the oesophagus and head and neck. For synchronous cancers, the therapeutic strategy consisted of first curing the head and neck cancer and then planning oesophagectomy according to the type of head and neck cancer therapy. RESULTS: Ten total oesopharyngolaryngectomies and 33 subtotal oesophagectomies were performed. The postoperative mortality rate was 9.3% (4/43). The rate of anastomotic leakage was 30% (13/43), and all such leaks were cervical. Pulmonary infection occurred in 19% of cases (8/43). A past history of cervical radiation therapy or cervicotomy did not appear to be a significant risk factor for anastomotic leakage or pulmonary complications. Oesophagectomy did not affect the functional results in the 31 patients whose larynx could be preserved. CONCLUSIONS: Oesophagectomy after head and neck cancer treatment is possible with a low mortality rate and acceptable morbidity.
Asunto(s)
Neoplasias Esofágicas/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Primarias Múltiples/cirugía , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Laringectomía , Masculino , Persona de Mediana Edad , Morbilidad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/mortalidad , Faringectomía , Análisis de SupervivenciaRESUMEN
BACKGROUND: Esophageal squamous cell carcinomas are frequently associated with head and neck cancers. The poor prognosis of each cancer, and their proximity, often limit the treatment options. This study was conducted to determine the characteristics and long-term outcome of such dual cancers. PATIENTS AND METHODS: We included 75 patients with esophageal carcinoma, of whom 25 had a synchronous head and neck malignancy. Curative treatment was possible in every case. The patients were divided into "solitary cancer" and "synchronous cancer" groups. RESULTS: The gender distribution, tumor location, and histological findings were similar in the two groups. Patients in the synchronous cancer group were younger than those in the solitary group (P < 0.0042). The operative mortality and pulmonary morbidity rates were not significantly different in the two groups. The rate of cervical anastomotic leaks was higher in the synchronous group (P < 0.05). The mean follow-up was 83 +/- 50 months. Five-year survival rates were not significantly different in the two groups (14.3% +/- 5.7% in the solitary group and 17.5% +/- 7.9% in the synchronous group). CONCLUSIONS: With aggressive treatment, the survival of patients with synchronous esophageal and head and neck cancers was similar to that of patients with isolated esophageal cancer.
Asunto(s)
Carcinoma de Células Escamosas/mortalidad , Neoplasias Esofágicas/mortalidad , Esofagectomía , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias Primarias Múltiples/mortalidad , Carcinoma de Células Escamosas/cirugía , Estudios de Casos y Controles , Neoplasias Esofágicas/cirugía , Esofagectomía/mortalidad , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Análisis de Supervivencia , Tasa de Supervivencia , Factores de TiempoRESUMEN
Many materials have been used to make immediate and intermediate obturator prostheses for the hemimaxillectomy patient. The weight of the obturator prosthesis is a major hindrance. A new thermoplastic material, Polysar, is described to create a hollow obturator extension for immediate and intermediate lightweight obturator prostheses.