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Introduction: Oral squamous cell carcinoma (OSCC) presents a high tendency of lymph node metastasis (LNM). Objective: Determine which risk factors play a significant role in metastasis to cervical lymph nodes and to evaluate the influence of nodal involvement on overall survival of patients with OSCC. Method: Medical records of 350 patients with OSCC were retrospectively reviewed. The data were analyzed using the chi-square, Fisher’s exact and log-rank Mantel Cox tests and multinomial and Cox logistic regression. Results: Of the 350 medical records evaluated, 251 reported N0, 75 N1, 16 N2 and 8 N3. Male gender, referrals from private health care providers, T3/4 stage and non-surgical treatments were associated with LNM. In multivariate analysis, men and T3/4 tumors were shown to be independent risk factors for LNM. The independent risk factors for survival were male gender, nodal involvement (p = 0.017) and non-surgical treatment. Conclusion: Male gender and T-stage are risk factors for LNM in patients with OSCC. Moreover, the presence of LNM and age >65 years are associated with poor overall survival.urvivor.

Objective: To correlate the clinical lymph node classification with the pathological result of neck dissections performed in patients with head and neck cancer at the Otorhinolaryngology Department of the Hospital Universitario de Caracas from January 1, 2011 to December 31, 2016. Method: Descriptive, quantitative and retrospective study, which evaluated 27 patients, who underwent classical radical, modified radical and selective neck dissection. Results: average age 56 years, 77.8% male. The most frequent histological type was squamous carcinoma 81.5%. The most used type of dissection was selective 53.3%, followed by the classical radical 26.7% and the modified radical 20.0%, of these 36% presented local or cervical recurrence. Of the 16 patients with positive lymph nodes, 13 had patology confirmation, and all the negative nodes also had negative patology confirmation; regarding cervical recurrence, of the 7 cases where it was present, all positive nodes, and in the 11 patients negative nodes, all negative cervical recurrence. Conclusion: The relationship between the pathological and clinical classification, as well as the presence of positive lymph nodes in cervical recurrences are statistically significant and are related to the decrease in survival. Neck palpation continues to be a useful tool in therapeutic decision making, which has shown higher than average sensitivity and specificity.

ABSTRACT Introduction: papillary thyroid carcinoma is a tumor with good prognosis. However, some patients treated present neck recurrence. Objective: to evaluate the risk factors for neck recurrence. Methods: a retrospective study enrolled 89 patients (68 women and 21 men) diagnosed with papillary carcinoma who underwent total thyroidectomy. In 21 patients, neck dissection was performed and 62 patients underwent radioiodinetherapy. Twelve patients relapsed with metastasis in this period with an average of 3.6 years. Results: out of 89 patients, 76.4% were female. Relapse occurred in nine (13.23%) women and three (14.28%) men. The average age of the patients was 44 years in the control group and in patients with relapsed. Eighteen patients (23.37%) in the control group and eight (64.28%) who relapsed had positive lymph nodes at initial diagnosis. The tumor size was significantly larger in the group of patients with cervical recurrence (3.3cm vs. 1.6cm - p=0.008, Student t test), whereas the presence of metastatic lymph nodes at the moment of the first operation was also significant (p=0.004 -Fisher exact test). The tumor size was an independent risk factor for recurrence at the multivariate anaylsis (OR=2.4, IC95%:1.3-4.6 - p=0,007, logistic regression). Conclusion: there is an increase in the risk of lymph node recurrence during the follow up of 2.4 folds for each increase of 1cm in the longer nodule diameter.

La fístula quilosa, por daño del conducto torácico, aparece en el 1-2,5% de los pacientes sometidos a disección cervical. Las complicaciones asociadas incluyen desnutrición, compromiso inmune, formación de fístulas y necrosis cutánea con exposición carotídea, e incluso ruptura. De la literatura actual no se puede deducir ningún algoritmo de tratamiento definitivo, pero parece existir un consenso en realizar un manejo conservador de la mayoría de los casos. El manejo médico se basa en la teoría de que si se disminuye el flujo de quilo se permitirá el cierre espontáneo de la fístula, e incluye: drenaje conectado a vacío, reposo, vendaje compresivo (en discusión), intervención nutricional y uso de análogos de somatostatina. El manejo nutricional implica el uso de dietas bajas en grasa suplementadas con Triglicéridos de Cadena Media (MCT), Nutrición Enteral con TCM o Nutrición Parenteral total (NPT).Injury to the thoracic duct, leading to chyle leak, occurs in 1-2,5% of patients who undergo neck dissection. Associated complications include malnutrition, immune compromise, fistula formation and carotid blowout. No definitive treatment algorithm can be deduced from the current literature, but on last reviews, there is an agreement on the conservative management. Medical management is based on that decreasing chyle flow will allow for spontaneous closure of the chyle leak. Conservative treatment includes: closed vacuum drainage, bed-rest, nutrition modification and synthetic somatostatin analog. Nutrition modification involves a low-fat diet supplemented with medium-chain triglycerides (MCT), enteral nutrition with high percentage of MCT or parenteral nutrition.

La fístula linfática es una complicación con una incidencia considerable en los pacientes sometidos a una disección cervical. Su aparición puede conducir a serios problemas respiratorios y nutricionales. El tratamiento de esta patología ha sido y es en la actualidad debatido entre los diversos especialistas implicados. En las últimas revisiones parece existir consenso en tratar de forma conservadora la mayoría de ellas. Dentro del tratamiento médico conservador, la dieta baja en triglicéridos de cadena larga, es una parte fundamental.Chylous fistula after neck dissection is a welldescribed complication. This pHatology can lead to serious respiratory and nutritional complications. Therapeutical options for chylous fistula remains controversial. On last reviews, there are an agreement on the conservative management. Within of this management, low long-chain triglycerides fat diet is an essential part.

Introduction: Papillary thyroid microcarcinoma (PTMC) usually has an indolent course, but some have worse prognostic factors, such as the presence of central (6.9%-51.5%) and lateral (3%-49.6%) lymph node metastases. The aim of this study is to analyze the factors associated with PTMC with metastatic lymph nodes and its long-term prognosis., Methods: Retrospective study whose study population consists of patients with PTMC (size ≤1cm). Patients with previous thyroid surgery, other synchronous malignancies and ectopic location of the PTMC were excluded. Two groups were compared: PTMC without metastatic lymph nodes (group 1) and PTMC with metastatic lymph nodes (group 2). A multivariate analysis using a logistic regression model and a Kaplan-Meier survival analysis with log-rank test were performed., Results: Out of the 161 selected patients, 9.3% (n=15) had metastatic lymph nodes. Multifocality (OR 5.284, 95%CI 1.056-26.443; P=.043) and extrathyroidal extension (OR 7.687, 95%CI 1.405-42.050; P=.019) were associated with the presence of metastatic lymph nodes. In PTMC with metastatic lymph nodes, more aggressive treatments were performed: lymphadenectomy (4.8% vs. 100%; P<.001) and radioactive iodine (24.7% vs. 100%; P<.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 6.7%; P=.093). No patients died due to the disease., Conclusions: Multifocality and extrathyroidal extension of PTMC were associated with the presence of metastatic lymph nodes. Metastatic PTMC, with more aggressive treatments, presents an excellent long-term prognosis., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To present our experience treating 38 patients with pediatric thyroid carcinoma., Method: We received 44 pediatric patients with thyroid cancer between 2008 and 2016 in a specialized cancer center. A team of two surgeons treated all patients. We reviewed patient charts, treatment, pathology report, recurrence, and mortality. Qualitative variables were analyzed using Chi-square. Quantitative variables have a 95% confidence interval., Results: 82% (n = 31) of cases were female. Average age at diagnosis was 12 years. The most frequent symptom was a thyroid nodule (74%), and the most frequent method of diagnosis was fine needle aspiration. 11 patients (29%) had pulmonary metastasis. All patients underwent total thyroidectomy, and 33 cases (86%) also had lymph node dissection. There were 5 (13%) postoperative complications. 33 cases received radioactive iodine treatment after surgery., Conclusions: Pediatric thyroid cancer usually presents with multifocal disease. Female adolescents are affected more frequently than males. Differentiated thyroid cancer is the most frequent type, and it has excellent survival rates., (Copyright: © 2019 Permanyer.)

Introduction: It is unknown whether cervical lymphadenectomy as a treatment for cutaneous squamous cell carcinoma of the head and neck (cSCCh&n) increases survival in elderly patients. The aim of this study is to determine whether this procedure has an influence on the survival of these patients, and whether the Short-Form Charlson Comorbidity Index (CCI-SF) can be used as an alternative to age in the surgeon's estimation of elderly patient mortality., Methods: The study population included all patients diagnosed with cSCCh&n consecutively treated between 2006 and 2011. Non-invasive, non-cutaneous carcinomas were excluded. Patients were grouped according to their age (<70, 70-79, 80-89, >90), CCI-SF (<3, ≥3) and presence (N1) or absence (N0) of cervical metastases. The dependent variable was the performance or not of cervical lymphadenectomy. A univariate survival analysis was performed according to the presence of metastases, a bivariate analysis for each of the independent variables according to the received treatment and a multivariate analysis., Results: 416 cases were included. The mean survival time was greater in the N0 group. For each of the groups based on the presence of metastasis, the differences in the mean survival time according to age and CCI-SF were not significant, regardless of the treatment received. The multivariate analysis showed the influence of age (p=0.0001, OR=1.488, 95%CI=[1.318; 1.679]) and CCI-SF (p=0.001, OR=1.817, 95%CI=[1.257; 2.627]) in the N0 group. In the N1 group only regional treatment has a positive influence on survival (p=0.048, OR=0.15, 95%CI=[0.023; 0.981])., Conclusions: CCI-SF and age are good mortality indicators in cSCCh&n N0 patients, but not so in cSCCh&n N1 patients. In cSCCh&n N1 patients, regional treatment has a positive influence on survival. Differences cannot be affirmed in the mean survival time of patients with cSCCh&n, based on the development of metastases and the treatment given. New studies will be necessary., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

OBJETIVO: O esvaziamento cervical seletivo, removendo apenas os linfonodos com maior probabilidade de metástases, pode ser adequado para o tratamento do pescoço nos carcinomas epidermóides do andar inferior da boca. O objetivo deste estudo é avaliar os níveis linfonodais acometidos por metástases em uma série de pacientes tratados em uma única instituição. MÉTODO: Foram avaliados os registros de 416 pacientes com câncer de lábio, língua oral, soalho de boca, gengiva inferior, região jugal e trígono retromolar, submetidos à 519 esvaziamentos cervicais entre 1977 e 2001, quanto ao níveis linfonodais acometidos por metástases. RESULTADOS: O nível I estava acometido em 107/519 (20%) esvaziamentos, o nível II em 147/519 (28%), o nível III em 75/519 (14%), o nível IV em 32/419 (7%) e o nível V em 22/419 (5%). A taxa de falso-negativos e de falso-positivos foi de 36% e 30%, respectivamente. Os pacientes com metástases nos níveis I e/ou II, III, IV ou V tiveram uma média 2,2; 4,8; 6,5 e 7,5 linfonodos comprometidos, respectivamente (p < 0.0001). As metástases no nível IIb foram diagnosticadas em 21 (5%) pacientes, sendo que 11 (52%) deles tinham metástases no nível V (p < 0,0001). CONCLUSÃO: O esvaziamento cervical dos níveis I a IV remove quase todos os linfonodos com risco de metástases no carcinoma epidermóide do andar inferior da boca. O esvaziamento seletivo com esta extensão é adequado para o tratamento eletivo do pescoço (N0), onde ocorrem aproximadamente 30% de casos falso-negativos, e também pode ser suficiente no esvaziamento terapêutico (N+). Quando ocorrem metástases no nível IIb, aumenta significativamente o risco de metástases no nível V.

OBJETIVO: Estudo retrospectivo das características dos carcinomas epidermóides das vias aerodigestivas superiores relacionadas ao desenvolvimento de metástases cervicais bilaterais. MÉTODO: Foram revisados os prontuários de 150 pacientes com carcinoma epidermóide de boca, orofaringe, laringe e hipofaringe submetidos a esvaziamento cervical bilateral entre janeiro de 1979 e dezembro de 1996, dos quais foram selecionados 73 pacientes que apresentavam metástases bilaterais confirmadas no exame histológico. Foram considerados o estadiamento e a localização dos tumores, confrontando os achados com os estudos sobre drenagem linfática e distribuição das metástases cervicais neste tipo de tumor. RESULTADOS: Quatorze pacientes apresentaram tumor primário nos estádios T1 e T2, 57 nos estádios T3 e T4 e dois não foram estadiados (Tx). Nos cinco pacientes T1 ou T2 de laringe com metástases bilaterais, a lesão estava localizada na epiglote. CONCLUSÕES: Nos pacientes com lesões unilaterais que apresentaram disseminação bilateral, todos apresentavam lesões palpáveis unilaterais.

OBJETIVO: Analisar fatores que influenciam a ocorrência de metástase linfática cervical e a sobrevida nos tumores malignos epiteliais da glândula parótida. MÉTODO: Analisamos retrospectivamente os prontuários de 150 pacientes tratados em nossa instituição de 1974 a 1998. Vinte e quatro pacientes foram excluídos do estudo por não terem sido tratados primariamente por cirurgia. O 126 pacientes restantes foram submetidos a parotidectomia e incluídos neste estudo. Setenta e quatro pacientes tiveram sua cirurgia complementada por radioterapia pós-operatória. Trinta e quatro pacientes foram submetidos ao esvaziamento cervical associado a parotidectomia. A idade média foi de 49 anos. Todos os pacientes foram estadiados pela Classificação TNM da UICC de 1997, sendo 49 pacientes estágio I, 27 estágio II, 22 estágio III, and 28 estágio IV. A influência dos fatores analisados na ocorrência de metástase cervical foi estabelecida pelo teste do chi quadrado e por análise multivariada. A influência de fatores prognósticos na sobrevida específica de doença (SED) em 5 e 10 anos foi estabelecida pelo método de Kaplan-Meier e pelo teste log-rank. RESULTADOS: O tipo histopatológico de 40 pacientes foi o carcinoma mucoepidermóide, de 18 pacientes o adenocarcinoma (SOE), de 18 pacientes o carcinoma de células acinares, de 15 pacientes o carcinoma adenóide cístico, de 11 pacientes o carcinoma exadenoma pleomórfico, de 11 pacientes o carcinoma de ducto salivares, e de 13 pacientes outras histopatologias. Vinte e cinco pacientes apresentaram recidivas, 17 recidivas locais, quatro recidivas regionais, e quatro recidivas loco-regionais. A incidência geral de metástase linfática cervical foi de 17,5%. Metástases linfáticas cervicais ocultas ocorreram em cinco pacientes daqueles submetidos a esvaziamento cervical profilático. A presença de paralisia facial no diagnóstico, a idade, o estágio T, e o grau de malignidade foram relacionados a ocorrência de metástase linfática cervical na análise multivariada. Cinco fatores influenciaram negativamente o prognóstico, estágio T3-T4, alto grau de malignidade, presença de metástase cervical, paralisia facial no diagnóstico, e idade acima de 50 anos. A SED em 10 anos foi de 97% para o estágio I, 81% para o estágio II, 56% para o estágio III, e 20% para estágio IV. CONCLUSÕES: O grau de malignidade e o estágio foram os fatores prognósticos mais importantes. Apesar de ser um estudo retrospectivo e não randomizado, nossos dados sugerem que o esvaziamento cervical profilático deve ser considerado em casos de tumores de alto grau de malignidade, estágio T3-T4, e na presença de paralisia facial no diagnóstico.

OBJETIVO: Avaliar a localização das recidivas regionais em pacientes com carcinoma epidermóide de vias aerodigestivas superiores tratados com esvaziamento cervical, bem como os resultados do tratamento de resgate. MÉTODO: Foram avaliados os prontuários de 943 pacientes submetidos a esvaziamento cervical, dos quais foram selecionados 95 com diagnóstico de recidiva regional isolada como primeira manifestação de recorrência da doença. Foi avaliada a localização da recidiva (lado e nível linfático) e o controle da doença após o tratamento de resgate. RESULTADOS: As recidivas ipsilaterais ocorreram no nível II em 57% dos pacientes. O tratamento de resgate foi realizado em 51% das recidivas ipsilaterais e em 75% das recidivas contralaterais. O controle da doença 12 meses após o resgate foi de 31%, sendo 25% nas recidivas ipsilaterais e 37% nas contralaterais. CONCLUSÕES: As recidivas cervicais ocorrem predominantemente no nível II. As recidivas no nível I são freqüentes apenas nos tumores de boca e as recidivas no nível V são raras. A recidiva cervical tem prognóstico reservado mesmo entre os pacientes submetidos à retratamento com intenção curativa.

OBJETIVO: Foram estudados 25 pacientes portadores de neoplasias malignas da cabeça e pescoço (20 de vias aerodigestivas superiores e cinco da glândula tireóide), submetidos a esvaziamentos cervicais uni ou bilaterais (33 procedimentos), sendo 15 supra-omohióideos, 11 funcionais e sete em campos alargados. MÉTODO: Através da eletroneuromiografia (ENM), foram avaliados funcionalmente o músculo trapézio e o nervo espinhal após os diferentes procedimentos, aos 30 e 180 dias. RESULTADOS: Foram aferidos para as três formas de linfadenectomia 94% de desnervação do músculo trapézio, severa em 68% e moderada 32% (p = 0,001), portanto valores significativos. Quanto à avaliação do tipo de lesão do nervo espinhal, após 30 dias observou-se lesão de axônio (axonotmese) em 31 dos 33 procedimentos. Com relação à reinervação, esta foi detectada após 180 dias, sendo boa (21%), moderada (72%) e ruim (7%) para valores de p = 0,001 de significância estatística. CONCLUSÕES: A eletroneuromiografia foi um método efetivo na avaliação da unidade neuromuscular e o tipo de esvaziamento cervical conservador não foi determinante de alterações destas estruturas.

Objective: To identify the significant predictors of locoregional recurrence in early stage squamous cell carcinoma (SCC) of buccal mucosa with pathologically clear surgical margins and negative neck., Method: Seventy-three patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCC with clear surgical margins (>5mm margins each) and negative neck (N0) were included. None of the patients received postoperative radiotherapy or chemotherapy. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence., Results: Recurrence was observed in 22 of 73 (30%) cases. Twelve had local, seven had regional and three developed locoregional recurrences. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control., Conclusion: Lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) significantly increased the locoregional recurrence rate in early stage buccal SCC with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present., (Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Medullary carcinoma accounts for 1-2% of all thyroid malignancies. 13-20% of patients present with distant metastasis, with 45% of the cases affecting the liver., Clinical Case: A 50-year-old woman, diagnosed with medullary thyroid carcinoma, was treated with total thyroidectomy and a modified neck dissection in 1999. Two lymph node recurrences in the neck were treated with surgical resection; during surveillance, she developed elevated calcitonin levels, the recurrence site was identified with 18 F-DOPA PET/CT in the liver. Metabolic activity was not associated with a visible lesion in CT, MRI nor ultrasound. Radioguided surgery with 18 F-DOPA allowed an anatomic resection of segments IVb and V., Discussion: In patients with medullary carcinoma and elevated calcitonin during surveillance, 18 F-DOPA PET/CT is an option to evaluate the site of recurrence. Radioguided resection was feasible in this patient, whose hepatic recurrence was not visible with any other imaging method., Conclusion: Radioguided hepatic resection with 18 F-DOPA in metastatic medullary thyroid carcinoma is feasible when the recurrence site is not anatomically identified by any other imaging studies., (Copyright © 2017. Publicado por Elsevier España, S.L.U.)

Background: Cervical lymph node metastasis (LNM) has been proven to be a predictor for locoregional recurrence in differentiated thyroid carcinoma (DTC). Clinicopathological features could be effective predictive factors for central and lateral LNM of DTC, and provide references to surgeons for cervical neck dissection., Methods: Retrospective analysis of clinicopathological data was performed on 420 patients who underwent initial surgery from 2010 to 2015., Results: The incidence of central and lateral LNM was calculated. Of 420 patients, 247 (58.8%) exhibited central LNM, and 185 (44.1%) exhibited lateral LNM. There were 29 (6.9%) cases confirmed to have skip metastasis. Univariate and multivariate analysis revealed that tumour location, tumour size, multifocality, capsular invasion, affected lobes, and age were independent predictors of central LNM. Tumour location, capsular invasion, affected lobes, and tumour size were independent predictors of lateral LNM., Conclusions: Our findings suggest that tumour location, affected lobes, capsular invasion, age, tumour size and multifocality may be taken as predictive factors for cervical LNM of DTC. Meticulous perioperative evaluation of cervical LNM and prophylactic cervical lymph node dissection that aims to remove the occult lymph nodes may be an option for DTC with risk factors., (Copyright © 2017. Publicado por Elsevier España, S.L.U.)

Introduction: The presence of cervical lymph node metastases in patients with oral cavity squamous cell carcinoma reduces survival by up to 50%., Objective: The aims of this study are to assess the accuracy of clinical N staging versus pathological N staging and its impact on survival in order to identify predictive factors associated with the presence of occult neck metastases., Methods: Outcomes of 105 patients with oral cavity squamous cell carcinoma who underwent surgical treatment of the primary tumor and neck were retrospectively evaluated., Results: For pN0 and pN+ patients 5-year overall survival was respectively 53% and 27%; disease specific survival was 66% for pN0 and 33% for pN+. Patients with clinical negative lymph nodes were pathologically upstaged in 62% of cases. Disease specific survival according to staging discrepancy had statistically significant impact on survival (p=0.009)., Conclusion: Clinical staging usually underestimates the presence of nodal disease. Neck dissection should be performed in cN0 oral cavity squamous cell carcinoma., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Antecedentes: La disección radical de cuello es la única forma de estadificar a pacientes con neoplasias con riesgo de metástasis ganglionares. Se han efectuado diversos tipos de incisiones a lo largo de la historia, con el objetivo de obtener una exposición suficiente que permita la resección completa de los grupos ganglionares en riesgo. Es importante combinar la seguridad oncológica con unas adecuadas estética, funcionalidad y calidad de vida., Método: Evaluación retrospectiva del resultado obtenido con la incisión transversa en el cuello en pacientes sometidos a disección radical. El parámetro utilizado para saber si esta incisión es adecuada es el número de ganglios disecados., Resultados: Son 35 pacientes, 30 con metástasis de carcinoma epidermoide y 5 con metástasis de melanoma. La media de ganglios disecados fue de 25. Una sola incisión permitió la disección de los cinco niveles ganglionares; no se requirió convertir la incisión ni hacer ampliaciones verticales. El resultado cosmético fue satisfactorio en todos los pacientes, y no hubo complicaciones mayores., Conclusión: La incisión cervical única transversa permite el acceso a los cinco niveles cervicales y puede ser ampliada bilateralmente. En la presente serie, la media de ganglios disecados fue de 25, número suficiente para considerar al procedimiento completo. El resultado estético fue satisfactorio., Background: Radical neck dissection is the only way to stage patients with neoplasms at risk of lymph node metastases; various types of incisions have been made throughout history, the goal: to obtain sufficient exposure to allow complete resection of the nodal groups at risk. It is important to combine oncological safety with adequate aesthetics, functionality and quality of life., Methods: Retrospective evaluation of the result obtained with the transverse neck incision in patients submitted to radical neck dissection, the parameter used to know if this incision is adequate is the number of dissected lymph nodes., Results: There are 35 patients, 30 with metastasis of squamous cell carcinoma and 5 with melanoma metastasis. The average of dissected lymph nodes was 25. A single incision allowed the dissection of the five nodal levels, it was not necessary to convert the incision or make vertical enlargements; the cosmetic result was satisfactory in all patients, there were no major complications., Conclusion: The unique transverse cervical incision allows access to the five cervical levels, it can be enlarged bilaterally; in the present series, the mean number of dissected lymph nodes was 25 enough to consider the procedure as complete. The aesthetic result was satisfactory., (Copyright: © 2018 Permanyer.)

Introduction and Objectives: Total laryngectomy (TL), with eventual postoperative radiotherapy, has proven to be effective in treating cases of locally advanced hypopharyngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with hypopharyngeal cancer classified T3 and T4., Methods: We studied 59 patients (33 T3 and 26 T4a) with primary squamous cell carcinoma of the hypopharynx treated with TL from 1998 to 2012., Results: Mean age was 61 years with a male predominance (96.6%). All the patients were smokers and 96% consumed alcohol. Unilateral selective neck dissection (ND) was performed in 12 patients, unilateral radical ND in 11 patients, bilateral selective ND in 20 patients and radical ND plus selective ND in 14 patients. 66% of the patients received postoperative radiotherapy. Lymph node metastases occurred in 81% of the patients and extranodal invasion in 56% of them. 29% of the patients had loco-regional recurrence, 17% developed distant metastases, and 25% a second primary tumour. The 5-year disease-specific survival was 46%., Conclusions: TL extended to pharynx (with eventual postoperative radiotherapy) offers good oncological results in terms of loco-regional control and survival in locally advanced hypopharyngeal cancer, so organ preservation protocols should achieve similar oncological results to those shown by TL., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Objective: To evaluate the incidence and predictive factors for transient and permanent hypocalcemia and hypoparathyroidism following thyroidectomy., Method: We studied all the 162 patients that underwent thyroid surgery in the ENT department of the Centro Hospitalar Vila Nova Gaia/Espinho from January 2005 to December 2014. We reviewed pre-operative, 6h and 12h after surgery ionized calcium and PTH levels. All patients were reviewed and evaluated according to the following criteria: gender, age, thyroid function, histologic diagnosis of the specimen, surgery extension and presence or absence of hypoparathyroidism., Results: There were 31 (19.1%) cases of transient hypoparathyroidism and 8 (5%) of permanent hypoparathyroidism. No significant difference was found for transient hypoparathyroidism when patients were analyzed by gender. However, all cases of permanent hypoparathyroidism were observed in female individuals. Comparing hemithyroidectomy with all other surgical procedures, we found that extension of surgery was a great predictor of transient (p=0.0001) and permanent (p=0.001) hypoparathyroidism. Diagnosis of malignancy was a strong predictor of transient hypoparathyroidism (p=0.002). It was also associated with permanent hypoparathyroidism, although differences did not reach statistical significance (p=0.096)., Conclusion: Extension of surgery (total thyroidectomy) and diagnosis of malignancy are predictors of transient and permanent hypoparathyroidism., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Objectives: The aim of this study was to analyze the results of applying the predictive score (PS) of Cameron to perform elective tracheostomy (ET) in oral tumor surgery., Material and Methods: A retrospective and descriptive study was conducted on consecutive patients undergoing oral tumor surgery between January 2010 and December 2012. Items of the PS were collected: reconstruction and type of graft, mandibulectomy, bilateral neck dissection, and tumor location. Patients were grouped according to the management of the airway at the end of surgery into 4 groups: extubated, intubated, ET, and urgent tracheostomy. A cutoff of≥5 points PS was considered for conducting ET., Results: A total of 90 patients were included. Group distribution was: extubated=27.8%, intubated=17.8%, ET=53.3%, and one case (1.1%) of urgent tracheostomy. Using the cutoff value of PS≥5 points yielded a diagnostic sensitivity value of 0.7 for a 95% confidence interval (CI) (0.57 to 0.82), and a diagnostic specificity value of 0.9 (95% CI 0.79 to 0.99). The PPV was 0.9 (95% CI 0.81 to 0.99) and the NPV was 0.67 (95% CI 0.54 to 0.8). The AUC gave a value of 0.87 (standard error 0.36). The likelihood ratio was 6.48., Conclusion: The decision to perform an ET for oral tumor surgery can be enhanced using the PS of Cameron based on objective data., (Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

Background: Medullary thyroid cancer (MTC) represents approximately 5% of all thyroid cancers. Surgery is the only curative treatment, which includes total thyroidectomy and in most cases, neck dissection., Aim: To report our 10-year experience with surgical treatment of MTC., Material and Methods: Review of medical records and pathology reports of a university hospital. We retrieved data from 28 patients aged 47.2 ± 16 years (21 women) operated for a MTC treated between June 2002 and June 2012., Results: In 20 patients, MTC was diagnosed in the preoperative period. Total thyroidectomy was performed in all cases and included a neck dissection in 24 patients. Median follow-up was 48 (2-120) months. Twenty-five patients (89.2%) achieved complete remission of the disease and three had disease recurrence. There were no deaths during the follow up., Conclusions: The diagnosis of MTC is mainly based on cytology. Total thyroidectomy with neck dissection is the treatment of choice. An early-stage diagnosis is associated with low rates of recurrence and absence of mortality.

Background: The trichilemmal carcinoma is a rare malignant neoplasm, whose origin lies in the annexes of the skin, because of its low prevalence often confused with other dermal tumors, the differential diagnosis is not easy and is usually made by exclusion; in theory, its behavior is slow with little tendency to send both regional lymph node metastasis and systemic. Due to the limited number of cases there is no consensus on the prognosis, although it is generally considered good. The aim of this report is to show a case that, contrary to previous reports, the clinical presentation is aggressive with large soft tissue tumor infiltration around the site of origin in a patient without risk factors for skin cancer., Clinical Case: Male patient, 65 years old with cytologic diagnosis of carcinoma in a preprarotideal facial tumor, characteristics at diagnosis were infiltration of the facial skin, ear, and parotid gland. Complete block resection was performed, radical parotiroidectomy and radical neck dissection; the soft tissue defect was covered with a pediculated flap. The evolution was satisfactory it follow-up short though. We evaluated the experience in the literature regarding the prognosis and treatment of these patients., Conclusion: Trichilemmal carcinoma can be fully invasive behavior prognosis is difficult to know and probably depends on the clinical stage at diagnosis.

Introduction and Objectives: Squamous cell carcinomas of the oropharynx are aggressive tumours usually diagnosed at advanced stage. Their optimal treatment has not been established. The aim of this study was to compare the oncological and functional outcomes in patients with carcinomas of the oropharynx treated by radiotherapy (with chemotherapy in advanced stages) vs surgery (with radiotherapy in advanced stages)., Methods: A retrospective study on 50 patients with squamous cell cancer of the oropharynx treated by radiotherapy (with or without chemotherapy) at our institution between 1998 and 2008 was carried out. The oncological and functional results were compared with patients with same cancer location and stage treated by surgery (with or without radiotherapy). In both groups, the patients were classified as follows: 10% Stage I, 12% Stage II, 16% Stage III, 48% Stage IVa and 14% Stage IVb., Results: The 5-year disease-specific survival was 33% in the radiotherapy group and 52% in the surgical group (P=.17). Five-year disease-specific survival for Stage I and II patients was 82% in the radiotherapy group and 70% in the surgical group. In Stage III and IV disease, 5-year disease-specific survival was higher in the surgical group (47% vs 17%). The functional results were similar; anatomical and functional preservation of the larynx was higher in the radiotherapy group but the successful return to oral food intake was higher in the surgical group., Conclusions: The prognosis of squamous cell carcinoma of the oropharynx is poor. Oncological results in Stages I and II were similar for radiotherapy and surgical treatments. In advanced stages, the prognosis was better in patients treated by surgery with or without radiotherapy. Functional results were similar in both treatment modalities., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Objectives: To estimate the relevance of post-surgical neck nodal classification (pN) on the global survival of patients with advanced tumors of the larynx and hypopharynx, primarily treated with surgery including neck dissection (ND). To understand the prognostic significance of metastatic lymph nodes' extracapsular spread (ECS) and its impact on survival., Material and Methods: A retrospective review of patients primarily submitted for total laryngectomy (TL) with either elective or therapeutic bilateral ND. Overall and disease-free survival was analysed according to post-operative histopathological ND results, concerning the presence or absence of nodal involvement, number of affected nodes and the existence of ECS., Results: One hundred and twenty patients met the inclusion criteria of this study. Concerning nodal involvement, the histopathological evaluation demonstrated positive lymph nodes in 46.6% of the cN0 patients. The rate of patients alive after 2 years of follow-up, based on pN analysis, was 88.1% for the pN0 group, 65.4% for the group N+ without ECS, 46.2% for the N+ ECS+ (1 node) and 15.4% for the N+ ECS+ (more than 1 node) group (P<.001)., Conclusions: This study demonstrates a high prevalence of occult neck disease in tumours of the larynx and hypopharynx. The involvement of metastatic cervical lymph nodes has a negative impact on survival. Patients with multinodal ECS have a poorer survival, reflected by a higher rate of loco-regional and distant metastases, when compared to ECS in one single lymph node., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Multiple endocrine neoplasia syndrome, type 2B (MEN 2B), is a rare entity characterized by the presence of medullary thyroid cancer in 100% of the cases. The phenotype of this syndrome consists in the presence of marfanoid features and mucocutaneous neuromas. We describe the case of a male patient with MEN 2B syndrome who was diagnosed with medullary thyroid cancer after lung metastases was found. We analyze the role of DMSA-V and the new hybrid SPECT-CT scan systems in the extension study and monitoring of medullary thyroid cancer., (Copyright © 2010 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Objective: The aim of this study was to determine the predictive value of computed tomography (CT) i.e., its sensitivity and specificity in detecting metastatic lymph nodes of head and neck tumours. We also studied the capacity of CT in correct nodal staging., Patients and Methods: A CT was performed on 95 patients diagnosed with neoplastic disease of the pharynx and/or larynx. All patients subsequently underwent cervical lymph node dissections. In the imaging study, the following parameters were considered for suspected radiological nodal involvement: lymph node diameter greater than 10mm, lesion margins poorly defined, capsule enhancement after contrast administration and lymph nodes that, despite their size, had signs of central necrosis., Results: In the dissections, 70.53% resulted N+ in the histological study. The sensitivity of CT was 82.09% and the specificity, 85.71%. The CT detected positivity in 55 of the 67 histologically pathological dissections, while the CT detected negativity in 24 of the 28 dissections histologically negative. The weighted kappa index value was 0.6408, indicating limited capacity for appropriate staging of the lymph nodes., Conclusions: While the ability of CT to detect metastatic lymph nodes in head and neck tumours is quite acceptable, it is less so for correctly staging them. It is therefore necessary to look for other imaging tests that provide greater accuracy to avoid unnecessary elective neck dissections and to reduce morbidity and mortality from them. We must now pay attention to new imaging techniques such as PET and PET/CT., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Introduction: Drainage after radical neck dissection (RND) is routine and several factors impact the postoperative drainage number of days (PODND)., Objective: to determine the impact of trans-operative intravenous fluid management (TOFM) in in PODND., Methods: Retrospective analysis of patients subjected to some type of radical neck dissection. Variables analyzed: blood loss volume, radical neck dissection type, surgical time, anesthesia time, and trans-operative intravenous fluid management volume., Results: 120 patients included: average age 58.3 years; 60 males and 60 females. Radical neck dissection most frequent indications: thyroid cancer (36.6%), laryngeal cancer (15.8%) and tongue cancer (7.5%). Radical neck dissection most frequent types: 47 modified radical (39.2%), 22 lateral (18.3%) and 16 supra-omohyoid (13.3%). Median surgical time 3.55 hours, median anesthesia time 4.3 hours, median blood loss 278 ml, related to transoperative intravenous fluid management. Classical radical neck dissection was performed in 13 patients in whom postoperative drainage number of days was greater than in the other types (p = 0.08). No difference in postoperative drainage number of days among the different types of radical neck dissection. An apparent association was found between trans-operative intravenous fluid management volume and postoperative drainage number of days: the greater the quantity of fluids, the greater the number of days (p = 0.001). Patients who had drain removed during the first seven days had an average of 1,500 ml infused. Patients who had an average of 3,000 ml of fluid had drainage of 10 days. Perfusion > 3,500 ml = postoperative drainage number of days ≥ 10 días., Conclusions: In the present series a statistically significant relationship was found between the TOFM and PODND. A meticulous surgical technique and an anesthesia procedure that carefully assesses fluid balance could decrease PODND.