scholarly journals A nyaki dissectiók onkológiai hozamának maximalizálása a sebészi morbiditás egyidejű minimalizálása mellett

2016 ◽  
Vol 157 (47) ◽  
pp. 1871-1879
Author(s):  
István Háromi ◽  
Imre Gerlinger ◽  
László Lujber ◽  
Balázs Bendegúz Lőrincz
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Surgical Techniques ◽  
Neck Surgery ◽  
Surgical Morbidity ◽  
Statistical Comparison ◽  
Regional Lymphadenectomy ◽  
Treatment Review ◽  
Nodal Yield

Cervical regional lymphadenectomy, also known as neck dissection, is a fundamental procedure in head and neck surgery. Its evolution over 110 years resulted in a great deal of confusion in the literature and in clinical practice, due to the heterogenicity in training, classification and surgical techniques, which makes outcomes comparability virtually impossible. The authors aim to clarify this situation in a structured manner, in order to facilitate communication among all specialists involved in multidisciplinary head and neck cancer care. The ultimate goal is to make sure that each and every head and neck cancer patient receives their optimal treatment. Review of the history and literature with statistical comparison of the two mainstraim methods regarding their nodal yield results. The applied surgical technique has a significant impact on nodal yield. An appropriate surgical concept achieves maximum oncologic benefit, minimum surgical morbidity with optimized adjuvant indications. Orv. Hetil., 2016, 157(47), 1871–1879.

The influence of nodal yield in neck dissections on lymph node ratio in head and neck cancer

Oral Oncology ◽  
2014 ◽  
Vol 50 (1) ◽  
pp. 59-64 ◽  
Author(s):  
C.C.M. Marres ◽  
M. de Ridder ◽  
I. Hegger ◽  
M.L.F. van Velthuysen ◽  
M. Hauptmann ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Node ◽  
Head And Neck ◽  
Neck Cancer ◽  
Lymph Node Ratio ◽  
Node Ratio ◽  
Nodal Yield

scholarly journals Bioelectrical impedance phase angle as a prognostic indicator of survival in head-and-neck cancer

2016 ◽  
Vol 23 (5) ◽  
pp. 481 ◽  
Author(s):  
M.S. Wladysiuk ◽  
R. Mlak ◽  
K. Morshed ◽  
W. Surtel ◽  
A. Brzozowska ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Phase Angle ◽  
Neck Cancer ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Neck Surgery ◽  
Department Head ◽  
Nutrition Status

Background Phase angle could be an alternative to subjective global assessment for the assessment of nutrition status in patients with head-and-neck cancer.Methods We prospectively evaluated a cohort of 75 stage iiib and iv head-and-neck patients treated at the Otolaryngology Department, Head and Neck Surgery, Medical University of Lublin, Poland. Bioelectrical impedance analysis was performed in all patients using an analyzer that operated at 50 kHz. The phase angle was calculated as reactance divided by resistance (Xc/R) and expressed in degrees. The Kaplan–Meier method was used to calculate survival.Results Median overall survival in the cohort was 32.0 months. At the time of analysis, 47 deaths had been recorded in the cohort (62.7%). The risk of shortened overall survival was significantly higher in patients whose phase angle was less than 4.733 degrees than in the remaining patients (19.6 months vs. 45 months, p = 0.0489; chi-square: 3.88; hazard ratio: 1.8856; 95% confidence interval: 1.0031 to 3.5446).Conclusions Phase angle might be prognostic of survival in patients with advanced head-and-neck cancer. Further investigation in a larger population is required to confirm our results.

Carotid Artery Resection for Head and Neck Cancer

1992 ◽  
Vol 101 (9) ◽  
pp. 778-781 ◽  
Author(s):  
Michael D. Maves ◽  
Matthew D. Bruns ◽  
Michael J. Keenan
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Head And Neck ◽  
Neck Cancer ◽  
Death Rate ◽  
Neck Surgery ◽  
Palliative Surgery ◽  
University Of Iowa ◽  
Artery Ligation ◽  
Artery Resection

Occasionally, the head and neck surgeon encounters a patient whose malignancy involves the carotid artery. In these patients, curative or palliative surgery may require excision of the common or the internal carotid artery. However, the high complication and death rates dissuade many surgeons from undertaking carotid artery resection. This study reviews the outcomes in 20 patients treated between 1979 and 1985 at the Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics, with resection of the carotid artery for head and neck cancer. The carotid artery was electively resected in 16 patients, while 4 patients underwent emergent carotid artery ligation. In the group of patients studied the stroke rate was 25%, the death rate 20%, and the combined stroke and death rate 30%. Of the patients who survived the procedure, all but 1 died of complications caused by tumor recurrence. These results are discussed, and compared with results from other studies.

scholarly journals Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S23-S27 ◽  
Author(s):  
P Charters ◽  
I Ahmad ◽  
A Patel ◽  
S Russell
Keyword(s):  
Intensive Care Unit ◽  
Head And Neck Cancer ◽  
Intensive Care ◽  
Head And Neck ◽  
Neck Cancer ◽  
Neck Surgery ◽  
World Health ◽  
Operative Care ◽  
Health Organization ◽  
The Uk

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer.Recommendations• All theatre staff should participate in the World Health Organization checklist process. (R)• Post-operative airway management should be guided by local protocols. (R)• Patients admitted to post-operative care units with tracheal tubes in place should be monitored with continuous capnography. Removal for tracheal tubes is the responsibility of the anaesthetist. (R)• Anaesthetists should formally hand over care to an appropriately trained practitioner in the post-operative or intensive care unit. (G)• Intensive care unit staff looking after post-operative tracheostomies must be clear about which patients are not suitable for bag-mask ventilation and/or oral intubation in the event of emergencies. (R)

scholarly journals Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S13-S22 ◽  
Author(s):  
A Robson ◽  
J Sturman ◽  
P Williamson ◽  
P Conboy ◽  
S Penney ◽  
...  
Keyword(s):  
Heart Failure ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Enzyme Inhibitors ◽  
Bleeding Risk ◽  
Neck Surgery ◽  
Converting Enzyme Inhibitors ◽  
Pre Treatment ◽  
Clean Contaminated

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer.Recommendations• Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R)• Patients with hypertension of over 180/110 or associated target organ damage, should have antihypertensive medication started pre-operatively as per British Hypertension Society guidelines. (R)• Rapidly correcting pre-operative hypertension with beta blockade appears to cause higher mortality due to stroke and hypotension and should not be used. (R)• Patients with poorly controlled or unstable ischaemic heart disease should be referred for cardiology assessment pre-operatively. (G)• Patients within one year of drug eluting stents should be discussed with the cardiologist who was responsible for their percutaneous coronary intervention pre-operatively with regard to cessation of antiplatelet medication due to risk of stent thrombosis. (G)• Patients with multiple recent stents should be managed in a centre with access to interventional cardiology. (G)• Surgery after myocardial infarction should be delayed if possible to reduce mortality risk. (R)• Patients with critical aortic stenosis (AS) should be considered for pre-operative intervention. (G)• Clopidogrel should be discontinued 7 days pre-operatively; warfarin should be discontinued 5 days pre-operatively. (R)• Patients with thromboembolic disease or artificial heart valves require heparin therapy to bridge peri-operative warfarin cessation, this should start 2 days after last warfarin dose. (R)• Cardiac drugs other than angotensin-converting enzyme inhibitors and angiotensin II antagonists should be continued including on the day of surgery. (R)• Angotensin-converting enzyme inhibitors and angiotensin II antagonists should be withheld on the day of surgery unless they are for the treatment of heart failure. (R)• Post-operative care in a critical care area should be considered for patients with heart failure or significant diastolic dysfunction. (R)• Patients with respiratory disease should have their peri-operative respiratory failure risk assessed and critical care booked accordingly. (G)• Patients with severe lung disease should be assessed for right heart disease pre-operatively. (G)• Patients with pulmonary hypertension and right heart failure will be at extraordinarily high risk and should have the need for surgery re-evaluated. (G)• Perioperative glucose readings should be kept within 4–12 mmol/l. (R)• Patients with a high HbA1C facing urgent surgery should have their diabetes management assessed by a diabetes specialist. (G)• Insulin-dependent diabetic patients must not omit insulin for more than one missed meal and will therefore require an insulin replacement regime. (R)• Patients taking more than 5 mg of prednisolone daily should have steroid replacement in the peri-operative period. (R)• Consider proton pump therapy for patients taking steroids in the peri-operative phase if they fit higher risk criteria. (R)• Surgery within three months of stroke carries high risk of further stroke and should be delayed if possible. (R)• Patients with rheumatoid arthritis should have flexion/extension views assessed by a senior radiologist pre-operatively. (R)• Patients at risk of post-operative cognitive dysfunction and delirium should be highlighted at pre-operative assessment. (G)• Patients with Parkinson's disease (PD) must have enteral access so drugs can be given intra-operatively. Liaison with a specialist in PD is essential. (R)• Intravenous iron should be considered for anaemia in the urgent head and neck cancer patient. (G)• Preoperative blood transfusion should be avoided where possible. (R)• Where pre-operative transfusion is essential it should be completed 24–48 hours pre-operatively. (R)• An accurate alcohol intake assessment should be completed for all patients. (G)• Patients considered to have a high level of alcohol dependency should be considered for active in-patient withdrawal at least 48 hours pre-operatively in liaison with relevant specialists. (R)• Parenteral B vitamins should be given routinely on admission to alcohol-dependent patients. (R)• Smoking cessation, commenced preferably six weeks before surgery, decreases the incidence of post-operative complications. (R)• Antibiotics are necessary for clean-contaminated head and neck surgery, but unnecessary for clean surgery. (R)• Antibiotics should be administered up to 60 minutes before skin incision, as close to the time of incision as possible. (R)• Antibiotic regimes longer than 24 hours have no additional benefit in clean-contaminated head and neck surgery. (R)• Repeat intra-operative antibiotic dosing should be considered for longer surgeries or where there is major blood loss. (R)• Local antibiotic policies should be developed and adhered to due to local resistance patterns. (G)• Individual assessment for venous thromboembolism (VTE) risk and bleeding risk should occur on admission and be reassessed throughout the patients' stay. (G)• Mechanical prophylaxis for VTE is recommended for all patients with one or more risk factors for VTE. (R)• Patients with additional risk factors of VTE and low bleeding risk should have low molecular weight heparin at prophylactic dose or unfractionated heparin if they have severe renal impairment. (R)

scholarly journals Electrochemotherapy in head and neck cancer: A review of an emerging cancer treatment (Review)

2018 ◽  
Author(s):  
Armando De Virgilio ◽  
Massimo Ralli ◽  
Lucia Longo ◽  
Patrizia Mancini ◽  
Giuseppe Attanasio ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Cancer Treatment ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Review

Reporting of Cosmesis in Head and Neck Reconstruction: A Systematic Review

2018 ◽  
Vol 160 (4) ◽  
pp. 573-579
Author(s):  
Peter M. Vila ◽  
Tam Ramsey ◽  
Lauren H. Yaeger ◽  
Shaun C. Desai ◽  
Gregory H. Branham
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Neck Surgery ◽  
Patient Questionnaire ◽  
Head And Neck Reconstruction ◽  
Exclusion Criteria ◽  
Neck Reconstruction ◽  
Cosmetic Outcomes ◽  
Validated Instrument

Objective To identify the method and rate at which cosmesis is reported after reconstruction from head and neck surgery among adults. Data Sources A medical librarian implemented search strategies in multiple databases for head and neck reconstruction, outcome assessment/patient satisfaction, and cosmesis/appearance. Review Methods Inclusion and exclusion criteria were designed to capture studies examining adults undergoing reconstruction after head and neck cancer surgery with assessment of postoperative cosmesis. The primary outcome was the method to assess cosmesis. Secondary outcomes were types of instruments used and the rate at which results were reported. Validated instruments used in these studies were compared and critically assessed. Results The search identified 4405 abstracts, and 239 studies met inclusion and exclusion criteria. Of these, 43% (n = 103) used a scale or questionnaire to quantify the cosmetic outcome: 28% (n = 66), a visual analog, Likert, or other scale; 13% (n = 30), a patient questionnaire; and 3% (n = 7), both. Of the 103 studies that used an instrument, 14% (n = 14, 6% overall) used a validated instrument. The most common validated instrument was the University of Washington Quality of Life (UWQOL) questionnaire (4%, n = 9). The most highly rated instruments were the UWQOL and the Derriford Appearance Scale. Conclusions Reporting of cosmetic outcomes after head and neck cancer reconstruction is heterogeneous. Most studies did not report patient feedback, and a minority used a validated instrument to quantify outcomes. To reduce bias, improve reliability, and decrease heterogeneity, we recommend the UWQOL to study cosmetic outcomes after head and neck reconstruction.

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