Search

Introduction: Pharyngocutaneous fistula (PCF) remains the most frequent complication following total laryngectomy (TL). Pharyngeal closure with a surgical stapler (SAPC) has been proposed as an effective closure technique that decreases the rate of PCF, reduces surgical time, decreases the length of hospital stay, and shortens the time required before safely initiating oral feeding.Methods: This study involved a systematic review and meta-analysis of patients with laryngeal cancer who underwent TL and with subsequent stapler pharyngeal closure, in order to analyse the current literature regarding the role of SAPC after TL.Results: The incidence of PCF in the stapler-assisted suture group (SASG) was 9.5% (95% CI 8.2-15.9%), with a mean absolute deviation of 1.12, while in the hand-suture group (HSG) group the incidence was 23.4% (95% CI 23-26.1%), with a mean absolute deviation of 5.71 (p = 0.01).Conclusions: SAPC may decrease the risk of PCF in patients following TL. Based on the current data, SAPC appears to shorten the surgical time and the length of hospital stay. Nevertheless, prospective randomized trials are required to validate these findings.

Resumen La cirugia transoral de la orofaringe ha presentado una importante evolucion en los ultimos anos, al ampliarse las opciones quirurgicas disponibles (TORS, TOUSS, TOLS), la capacidad de resecar lesiones cada vez mas extensas y el numero de pacientes que se beneficia de ellas. Este hecho ha provocado una evolucion en la reconstruccion de los defectos quirurgicos tras cirugia transoral. Este articulo tiene como objetivo la revision de las posibles tecnicas reconstructivas, las indicaciones y factores que tener en cuenta previamente a la cirugia, ademas de proponer un protocolo para valorar la necesidad de reconstruccion transoral sobre la base de la profundidad del defecto, la estadificacion y el tratamiento previamente recibido.

The acquisition of driver mutations in non-tumoral cells appears to be very important during the carcinogenesis of adenocarcinoma (ADC). Recent studies suggest that cancer-related mutations may not necessarily be present only in malignant cells, but also in histologically “healthy cells”.Objective: to demonstrate the presence of EGFR or KRAS mutations in non-tumoral lung cells in subjects with ADC and negative mutational status.Results: mutations in EGFR or KRAS oncogenes were identified in the normal lung in 9.7% of the subjects. Exon 21 substitution L858R in EGFR was detected in two cases while the exon 19 deletion E746-A750 in the EGFR, the G12C and G12D substitutions in the KRAS were detected once. One patient presented three different mutations in the normal lung parenchyma (EGFR_L858R, KRAS_G12C and KRAS_G12D). The negative-mutation status of the tumor and the mutations detected in the “normal lung” were confirmed using highly sensitive and specific TaqMan PCR (CAST-PCR). No differences were found in terms of progression, progression-free survival or overall survival during the 18 months follow-up.Conclusions: These results confirm the presence of driver mutations in the histologically normal lung parenchyma cells in the absence of mutations coexisting with the primary tumor.

Introduction: In two previous cohorts we demonstrated that EGFR/KRAS mutations can be present in non-tumoral lung tissue (NTLT) regardless tumor genomic status. In cohort one (J Clin Med. 2019) the presence of these mutations was associated with a worse prognosis (disease-free survival), while in cohort two the presence of NTLT mutations in EGFR and KRAS was demonstrated even in the absence of mutations in the primary tumor (no differences in prognosis were found due to small sample size). The objective of this study is to analyze the 5-year prognosis of both cohorts and assess whether the presence of driver-mutations in NTLT is associated with a higher overall mortality in patients with localized ADC. We present the preliminary results Methods: 78 patients were included (47 from the first cohort and 31 from the second one). After tumor genotyping, the EGFR/KRAS status of the NTLT was performed with real-time PCR Results: two patients did not continued the follow-up. The remaining completed the 36-months follow-up and 77% have completed the 5-year follow-up at the time of the analysis. 13 (16.7%) patients had mutations in the EGFR and/or KRAS in the NTLT (M-NTLT group). At 60 months, 53.8% of M-NTLT group patients had distant recurrence vs 32.3%. Overall mortality was higher in the M-NTLT group: average survival of 40.5 months vs 54.8 (-14.3 months, Log-rank p=0.003). These results are independent of the type of mutation, cancer treatment and preoperative stage Conclusion: based on two single-center cohorts, we can conclude that in patients with localized ADC, having EGFR or KRAS mutations in NTLT is associated with a higher risk of death. These data reaffirm the results of our previous studies

While the incidence of thrombotic complications in critically ill patients is very high, in patients under non-invasive respiratory support (NIS) is still unknown. The specific incidence of thrombotic events in each of the clinical scenarios within the broad spectrum of severity of COVID-19, is not clearly established, and this has not allowed the implementation of thromboprophylaxis or anticoagulation for routine care in COVID-19. Patients admitted in a semi-critical unit treated initially with NIS, especially Continuous-Positive Airway Pressure (CPAP), were included in the study. The cumulative incidence of pulmonary embolism was analyzed and compared between patients with good response to NIS and patients with clinical deterioration that required orotracheal intubation. 93 patients were included and 16% required mechanical ventilation (MV) after the NIS. The crude cumulative incidence of the PE was 14% (95%, CI 8-22) for all group. In patients that required orotracheal intubation and MV, the cumulative incidence was significantly higher [33% (95%, CI 16-58)] compared to patients that continued with non-invasive support [11% (CI 5-18)] (Log-Rank, p = 0.013). Patients that required mechanical ventilation were at higher risk of PE for a HR of 4.3 (95%CI 1.2-16). In conclusion, cumulative incidence of PE is remarkably higher in critically patients with a potential impact in COVID-19 evolution. In this context, patients under NIS are a very high-risk group for developing PE without a clear strategy regarding thromboprophylaxis.

Despite good outcomes of COAn observational, prospective, nonrandomized study.One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors (Previous studies reported good oncologic outcomes and low complication rates with CO

Transoral surgery of the oropharynx has seen an important evolution in recent years, expanding the surgical options available (TORS, TOUSS, TOLS). The capacity to resect increasingly extensive lesions and the number of patients who benefit from them. This fact has led to an evolution in the reconstruction of surgical defects after transoral surgery. This article aims to review the possible reconstructive techniques, indications and factors to be taken into account prior to surgery, proposing a protocol to assess the need for transoral reconstruction based on the depth of the defect, the staging, and previous treatment.

Introduction Pharyngocutaneous fistula is the most frequent complication after total laryngectomy. Its incidence varies between 9%–25% in post primary total laryngectomy patients, to 14%–57% in salvage laryngectomy post radiotherapy or post chemotherapy+radiotherapy. The pectoralis major myofascial flap (PMMF) is postulated as a useful tool to decrease the incidence of this complication. Materials and method Retrospective analysis of a group of patients treated by salvage laryngectomy, associated or not with pharyngeal closure reinforcement with PMMF. Results Twenty patients were included, 18 males (90%) and 2 females (10%), in 10 of whom the PMMF was used. The average age was 66.65 years. Seventeen (85%) had a laryngeal tumour and 3 (15%) had a hypopharyngeal tumour. Eight (80%) patients in the non-PMMF group had postoperative fistula, whereas only 2 (20%) patients in the PMMF group had a fistula during the postoperative period (P=.005). The mean time for fistula closure was significantly shorter in the cases where PMMF flap was used (16±11 days vs. 76.8±67 days, P=.001), as was hospital stay (19.6±18 days vs. 83.9±77 days, P=.001). Conclusion The use of PMMF in our series is associated with a lower rate of post salvage laryngectomy fistulas in patients treated primarily by organ preservation protocol for laryngeal/hypopharyngeal cancer. In turn, it promotes local healing by decreasing the mean duration of fistula closure and the mean hospital stay.

Hyponatremia is the most common electrolyte disorder in hospitalized patients, being associated with increased morbidity and mortality in different clinical conditions. However, the prevalence and impact of this electrolytic disorder in patients hospitalized for an exacerbation of COPD still remains unknown. The aim of the present study was to clarify these points. A total of 424 patients hospitalized due to a COPD exacerbation were consecutively included, showing a frequency of hyponatremia of 15.8% (hyposmolar in most cases). Even though patients with and without hyponatremia showed a similar age, comorbidities, lung function impairment, presence of previous exacerbations, hospitalizations, most of the comorbidities and the overall severity index (APACHE II), their clinical outcomes were worse. Indeed, their hospitalization length, mechanical ventilation requirements and deaths (both during admission and within the months following discharge) were higher than those of non-hyponatremic patients. A sodium threshold lower than 129.7 mEq/L exhibited the better discriminatory power for death prediction. We conclude that hyponatremia (especially if severe) is a predictive marker for a bad clinical course in COPD exacerbations and therefore, patients with this electrolyte abnormality should be carefully monitored.