RESUMO
SUMMARY: Locally advanced disease with larynx invasion is a challenge to the surgeon, but laryngectomy is almost never necessary in thyroid carcinoma. The aim of this study was to review the clinical outcomes of patients with locally advanced thyroid carcinoma invading the larynx who underwent laryngectomy. A case series of patients treated in a tertiary care hospital was reviewed. Data about the type of operation, method of reconstruction, complications and overall survival of 16 patients operated on between 2002 and 2015 with larynx invasion is presented. There were 10 females. The mean age was 63 ± 8.8 years. Besides total thyroidectomy and neck dissection, four patients underwent total pharyngolaryngectomy, 11 total laryngectomy and one hemi-laryngectomy. Reconstruction was made with regional flaps in 10 patients (7 pectoral/Bakamjian flaps and 3 gastric pull-through procedures) and a jejunum free flap in one patient. Two patients needed carotid artery reconstruction. Five tumours were classic (conventional) papillary carcinoma variants, while the others were aggressive histological varieties (insular, tall cell, sclerosing). The mean tumour size was 4.3 ± 1.6 cm. All tumours had lymphovascular invasion and 12 had positive lymph nodes. Concomitantly, oesophageal/hypopharyngeal invasion was present in 7 cases and invasion of carotid vessels in 2 cases. There were two postoperative deaths and two anastomotic leaks that were treated conservatively. The mean overall survival was 31 ± 33 months (median 27.6 months, range 0-120). Laryngectomy is an alternative surgical procedure to control selected cases of advanced thyroid carcinoma that offers good local control and long term survival.
Assuntos
Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Presentamos nuestra experiencia con la cirugia laparoscopica de la vesicula biliar en el periodo comprendido entre 1992 y 1998, realizada en instituciones tanto oficiales como privadas de nuestra ciudad. Los datos se recolectaron mediante los archivos de estadistica de dichos centros asistenciales, y a traves de una encuesta telefónica efectuada por los estudiantes de Medicina de VIII semestre de la Facultad de Ciencias para la Salud de la Univ. de Caldas. De un total de 1.325 historias clinicas, se pudo establecer contacto con 967 pacientes, los cuales entraron al estudio y se analizaron segun las diferentes variables.