RESUMEN
PURPOSE: Operative treatment is the main treatment option for parotid gland tumors. The purpose of this study was to present the authors' experience in the operative treatment of parotid gland malignant tumors, especially regarding feasibility and techniques in the most advanced cases. MATERIALS AND METHODS: This is a retrospective cohort study of parotid malignancies. The study included patients treated at the authors' university clinic from 2000 through 2010. The primary predictor variable was stage of disease. The primary outcome variables were 3- and 5-year overall and disease-free survival rates. The secondary predictor variables were nodal status, distant metastases, status of the facial nerve (FN), tumor diameter, extraparotid tumor extension, histology, and surgical procedure. The outcome variable was survival rate. Data were analyzed by χ(2) tests. RESULTS: Of 867 parotid tumors, 103 patients with malignancies (47 female, 56 male; 12 to 88 yr old) underwent 24 partial lateral, 34 lateral, 39 total, and 6 extended parotidectomies. The 3- and 5-year overall survival and 3- and 5-year disease-free survival rates for stages T1 and T2 were 100, 99, 91, and 85%, respectively, and those for stages T3 and T4 were 100, 70, 48, and 34%, respectively. Overall and disease-free survival rates were influenced by FN paralysis and histologic type. CONCLUSIONS: Final oncologic outcomes, recurrence, and survival rates in parotid malignancies are considerably affected by local tumor stage, malignancy, and FN paralysis before treatment. Infiltration of adjacent structures is not connected with a poorer prognosis as long as an extended parotidectomy is performed.
Asunto(s)
Neoplasias de la Parótida/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Adenoide Quístico/cirugía , Carcinoma de Células Escamosas/cirugía , Niño , Estudios de Cohortes , Supervivencia sin Enfermedad , Enfermedades del Nervio Facial/diagnóstico , Parálisis Facial/diagnóstico , Femenino , Humanos , Metástasis Linfática/diagnóstico , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Glándula Parótida/cirugía , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM OF THE STUDY: Aim of the study was to assess the results of surgical treatment of cervical recurrences in patients with thyroid cancer. MATERIAL AND METHODS: We assessed 66 reoperations of thyroid cancer recurrences in 51 patients. Reoperative surgeries covered I-VII neck levels. RESULTS AND CONCLUSIONS: The localization of cervical recurrence and the number of removed nodes did not depend on the type of thyroid cancer. Metastatic spread was predominantly observed in the central neck. Bilateral changes tended to be observed more often in younger patients (p = 0.07). Radical neck dissections were performed more often at younger age (p < 0.01). Postoperative vocal cord paresis was noted in 13 patients; in 5 permanent tracheotomy was necessary, and 2 underwent laser glottis procedures (posterior cordectomies). Two patients died in the postoperative period - 1 due to chylothorax and 1 due to severe bleeding from the common carotid artery.
RESUMEN
The aim of this study was to analyze two cases with advance tumors of the neck with infiltration of the common or internal carotid artery. Patients were surgically treated in Department of Otolaryngology Poznan University of Medical Sciences. Authors present the current state of knowledge concerning the proceedings in unresectable tumors of the neck and possibility to use the salvage surgery. Based on literature data and our own experience a risk of the carotid artery infiltrations is difficult to assay in diagnostic procedure. It decrease the possibility of radical surgery resection and indicate the most advance stage. Choosing the proper treatment requires interdisciplinary cooperation: ENT specialist, radiologist, vascular surgeon and oncologist. The high rate of complications and local recurrence rate makes the results of treatment are unsatisfactory.
Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/cirugía , Arteria Carótida Común/cirugía , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/cirugía , Recurrencia Local de Neoplasia/cirugía , Terapia Recuperativa/métodos , Humanos , Otolaringología/métodos , Polonia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The purpose of the study was to assess the feasibility of secondary neck dissections (ND) in different types of thyroid cancer (TC), to evaluate the influence of ND extent on morbidity and to describe biochemical and clinical outcomes. 51 patients previously operated for TC (33-well differentiated TC-WDTC, 15 medullary TC-MTC, 3 poorly differentiated TC-PDTC) presenting detectable nodal disease. Reoperations covered I-VII neck levels. Radical neck dissection was performed in 22 patients, selective neck dissection in 29 patients. 14 central compartment (CC), 10 mediastinal and 41 level IV excisions were performed. Postoperative complications occurred in 13 patients: 4 chyle leaks, 3 massive bleedings, 8 permanent vocal cord pareses, hypoparathyroidism in 22 patients (43.1%), 2 patients expired in perioperative period. In WDTC: in seven patients thyroglobulin level normalized directly after ND, in ten patients in the follow-up; six patients developed distant metastases. None of the patients with MTC achieved calcitonin level <10 pg/ml; nine patients developed distant metastases. None of the patients with PDTC achieved Tg <2 mg/ml; two patients died, the third developed distant metastases. Secondary ND in TC present a challenge by means of surgical approach and possibility of complications. In MTC and PDTC the long-term results were unsatisfactory. In WDTC, the secondary ND should be performed due to strong indications. Metastases localization in levels IV, VI, VII were connected with high complication rate, but these surgeries were crucial for satisfactory oncological outcomes.