Oncological and functional results of laryngectomies for laryngeal cancer at Hôpital Principal de Dakar

INTRODUCTION: Delay in the diagnosis of cancers of the larynx affects the prognosis and often requires very mutilating surgery. AIM: To report the oncologic and functional outcomes of surgery for laryngeal cancers to Hôpital Principal de Dakar in Senegal. MATERIALS AND METHODS: This was a single-center retrospective study carried out from January 2009 to December 2014 in the ENT and head and neck surgery department including adult patients treated for curative surgery. RESULTS: Fifty patients were treated for laryngeal cancer. Thirty-seven of them underwent a laryngectomy. Lesions classified as cT2 represented 14%, and 16% were classified as cT1. Squamous cell carcinomas represented more than 97% of cases (36/37). Radiotherapy had completed the surgery in only 11 cases with an average delay of 2.75 months. Functionally, swallowing disorders were found in two patients with two cases of pharyngo-esophageal stenosis. On the carcinologic level, six patients presented a progression while four had tumor or lymph node recurrence. One patient showed lung metastasis. Overall survival at 7 years was 33%. CONCLUSION: The functional damage in laryngeal cancer surgery is significant and on the carcinologic level the results, although satisfactory, can be improved with a better availability of adjuvant treatments.

Differential kinetics of plasma procalcitonin levels in cerebral malaria in urban Senegalese patients according to disease outcome

<em>P. falciparum</em> malaria continues as the serial killer of over a million lives yearly, mainly for children in sub-Saharan Africa. For severe malaria, we are still on the quest for a prognostic marker of fatal outcome. We analysed the association between serum levels of Procalcitonin (PCT), a marker of septic inflammation, and clinical outcome in Senegalese patients admitted with confirmed cerebral malaria in the intensive care facility of Hopital Principal. A total of 98 patients living in the hypoendemic urban area of Dakar, Senegal, were enrolled during transmission seasons. Levels of PCT were compared between surviving vs the 26.5 % fatal cases in blood samples of the 3 days following hospitalisation. Mean PCT levels were elevated in patients with active infection, with a large range of values (0.1 to 280 nanog per mL), significantly higher on day 0 in fatal cases than in surviving (53.6 vs 27.3; P=0.01). No exact individual threshold level could indicate occurrence of fatality, however mortality could be most accurately predicted by PCT level above 69 nanog per ML and there was a very clear different profile of evolution of PCT levels on the 3 days of observation decreasing early from day 1 in surviving patients (P&lt;10–3), contrary to fatal cases. These results indicate that PCT kinetic rather than intrinsic level could be of use to predict a reduced risk of fatality in patient with cerebral malaria and could serve as potential predicting marker for severe malaria.