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Sentinel node biopsy in head and neck squamous cell carcinoma
P126
OtolaryngologyHead and Neck Surgery August 1999
Scientific SessionswMonday
patients who died of cancer, tumor recurred locally in 9 patients (64.2%), in the neck in 2 patients (14.2%), and 3 patients (22.6%) developed distant metastases. Univariate analysis revealed prognostic significance on cancer-specific survival for age (>65 years), presence of dyspnea, and lymph node status. Multivariate analysis confirmed these results. Conclusion: Total laryngectomy is a feasible modality of treatment for T3 glottic carcinoma, providing acceptable rates of cancer control and survival. Older patients with positive lymph nodes and dyspnea appear to have worse prognosis. However, conservation procedures should be improved in order to achieve more functional results with similar survival rates for patients with T3 glottic carcinoma. 10:02 AM
Sentinel Node Biopsy in Head and Neck Squamous Cell Carcinoma JOCHEN ALFREDWERNER MD (presenter); ANJA A DUENNE; BURKARD M LIPPERT; CHRISTOPH KUELKENSMD; Marburg Germany
Objectives: At the present time only a few announcements exist engaging with sentinel node (SN) biopsy in head and neck squamous cell carcinoma (HNSCC), although its sensitivity is still one of the most current questions in oncology. Methods: Intraoperative scintillation probe detection (ISPD) of the SN was performed in 12 patients (12 men) with HNSCC using a hand-held gamma probe (Navigator Gamma Guidance System; Auto Suture, Toenisvorst, Germany). Based on histopathological examination of neck dissection specimens, meaningfulness of ISPD was analyzed. Results: In 7 of 12 patients in whom histopathological examination showed a NO neck, SN was free of tumor as well. In 3 of 12 patients in whom histopathological examination showed a N+ neck, SN contained metastasis. In 2 of 12 patients a N+ neck was found histopathologically, while in both cases SN was free of tumor. Based on the localization, the possible first draining lymph node contained capsule rupture. Conclusion: The aim of SN biopsy in the NO neck is to detect early metastasis in order to indicate and define the extent of neck dissection. Concerning this, ISPD seems to be effective. Nevertheless there, are grounds for the belief that meaningfulness of SN biopsy may be reduced by special factors like capsule rupture. 10:t0 AM
Time Trade-Otis for Laryngeal Preservation in Cancer HIEU-HANHNGO MD MSC (presenter); SherbrookeCanada
Objectives: In advanced laryngeal cancers, laryngectomy offers a better survival than radiotherapy alone. However, the patient's attitude toward trade-offs between quality and quality of life should be considered in treatment choice. The objective of this study is to measure preferences or utilities for the
laryngectomy condition among affected and unaffected individuals and to explore potential influential factors. Methods: Fifty-five volunteers were interviewed using a standard technique including the time trade-off method (Torrance, 1972). Bivariate analyses were used to explore the effect of age, sex, and physical and socioeconomic factors. The most significant factors were identified by multivariate analysis. Results: The mean utility value for the laryngectomy condition is 0.60 (95% CI: 0.52-0.69). Excellent general health and being laryngectomized were associated with the highest utilities: 73.4 (95% CI: 64.6-82.2) and 83.2 (95% CI: 69.197.2). Age, education, associated illnesses, and having children were also significantly associated with preferences. Conclusion: Having lived with the condition may alter a person's goals and expectations. Judgments about the relative value of a health state may consequently change. Having poor health or associated illnesses make one avoid additional handicap. Certain socioeconomic factors may play a role. The head and neck surgeon should take these factors into consideration in treatment choice in laryngeal cancers.
9:30 to 10:18 AM MCC Room 275 9
Contributed Papers: Rhinology MICHAEL D POOLE MD PHD; PATRICK ANTONELLI MD (moderators)
9:30 AM
Management of Nasopharyngeal Stenosis YOSEFP KRESPIMD (presenter); New York NY
Objectives: Nasopharyngeal stenosis (NPS) is a rare complication following uvulopalatopharyngoplasty (UPPP) or laser-assisted uvulopalatoplasty (LAUP). NPS causes significant morbidity. Prevention of NPS can be achieved during palate surgery. Methods: Fourteen patients underwent repair of NPS utilizing the CO 2 laser. Severe cases were corrected with patients under general anesthesia. Mild cases were corrected with patients under local anesthesia in an office setting. A custommade stent (palate obturator) was left in place for approximately 4 months. Results: Thirteen of 14 patients had significant improvement of their NPS following CO 2 laser correction and stenting. Nine of 14 patients had more than 1 surgical procedure. Conclusion: Risk factors include (1) aggressive pillar resection, (2) extensive mucosal underlining, or (3) significant tissue destruction with electrocautery. Formation of NPS is directly attributed to improper surgical technique and is usually avoidable. In severe cases, surgical correction with a laser and use of prolonged stenting appears to be promising.
OtolaryngologyHead and Neck Surgery August 1999
Scientific SessionswMonday
patients who died of cancer, tumor recurred locally in 9 patients (64.2%), in the neck in 2 patients (14.2%), and 3 patients (22.6%) developed distant metastases. Univariate analysis revealed prognostic significance on cancer-specific survival for age (>65 years), presence of dyspnea, and lymph node status. Multivariate analysis confirmed these results. Conclusion: Total laryngectomy is a feasible modality of treatment for T3 glottic carcinoma, providing acceptable rates of cancer control and survival. Older patients with positive lymph nodes and dyspnea appear to have worse prognosis. However, conservation procedures should be improved in order to achieve more functional results with similar survival rates for patients with T3 glottic carcinoma. 10:02 AM
Sentinel Node Biopsy in Head and Neck Squamous Cell Carcinoma JOCHEN ALFREDWERNER MD (presenter); ANJA A DUENNE; BURKARD M LIPPERT; CHRISTOPH KUELKENSMD; Marburg Germany
Objectives: At the present time only a few announcements exist engaging with sentinel node (SN) biopsy in head and neck squamous cell carcinoma (HNSCC), although its sensitivity is still one of the most current questions in oncology. Methods: Intraoperative scintillation probe detection (ISPD) of the SN was performed in 12 patients (12 men) with HNSCC using a hand-held gamma probe (Navigator Gamma Guidance System; Auto Suture, Toenisvorst, Germany). Based on histopathological examination of neck dissection specimens, meaningfulness of ISPD was analyzed. Results: In 7 of 12 patients in whom histopathological examination showed a NO neck, SN was free of tumor as well. In 3 of 12 patients in whom histopathological examination showed a N+ neck, SN contained metastasis. In 2 of 12 patients a N+ neck was found histopathologically, while in both cases SN was free of tumor. Based on the localization, the possible first draining lymph node contained capsule rupture. Conclusion: The aim of SN biopsy in the NO neck is to detect early metastasis in order to indicate and define the extent of neck dissection. Concerning this, ISPD seems to be effective. Nevertheless there, are grounds for the belief that meaningfulness of SN biopsy may be reduced by special factors like capsule rupture. 10:t0 AM
Time Trade-Otis for Laryngeal Preservation in Cancer HIEU-HANHNGO MD MSC (presenter); SherbrookeCanada
Objectives: In advanced laryngeal cancers, laryngectomy offers a better survival than radiotherapy alone. However, the patient's attitude toward trade-offs between quality and quality of life should be considered in treatment choice. The objective of this study is to measure preferences or utilities for the
laryngectomy condition among affected and unaffected individuals and to explore potential influential factors. Methods: Fifty-five volunteers were interviewed using a standard technique including the time trade-off method (Torrance, 1972). Bivariate analyses were used to explore the effect of age, sex, and physical and socioeconomic factors. The most significant factors were identified by multivariate analysis. Results: The mean utility value for the laryngectomy condition is 0.60 (95% CI: 0.52-0.69). Excellent general health and being laryngectomized were associated with the highest utilities: 73.4 (95% CI: 64.6-82.2) and 83.2 (95% CI: 69.197.2). Age, education, associated illnesses, and having children were also significantly associated with preferences. Conclusion: Having lived with the condition may alter a person's goals and expectations. Judgments about the relative value of a health state may consequently change. Having poor health or associated illnesses make one avoid additional handicap. Certain socioeconomic factors may play a role. The head and neck surgeon should take these factors into consideration in treatment choice in laryngeal cancers.
9:30 to 10:18 AM MCC Room 275 9
Contributed Papers: Rhinology MICHAEL D POOLE MD PHD; PATRICK ANTONELLI MD (moderators)
9:30 AM
Management of Nasopharyngeal Stenosis YOSEFP KRESPIMD (presenter); New York NY
Objectives: Nasopharyngeal stenosis (NPS) is a rare complication following uvulopalatopharyngoplasty (UPPP) or laser-assisted uvulopalatoplasty (LAUP). NPS causes significant morbidity. Prevention of NPS can be achieved during palate surgery. Methods: Fourteen patients underwent repair of NPS utilizing the CO 2 laser. Severe cases were corrected with patients under general anesthesia. Mild cases were corrected with patients under local anesthesia in an office setting. A custommade stent (palate obturator) was left in place for approximately 4 months. Results: Thirteen of 14 patients had significant improvement of their NPS following CO 2 laser correction and stenting. Nine of 14 patients had more than 1 surgical procedure. Conclusion: Risk factors include (1) aggressive pillar resection, (2) extensive mucosal underlining, or (3) significant tissue destruction with electrocautery. Formation of NPS is directly attributed to improper surgical technique and is usually avoidable. In severe cases, surgical correction with a laser and use of prolonged stenting appears to be promising.