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International audience; Free-flap mandibular reconstruction is a highly specialized procedure associated with severe complications necessitating re-interventions and re-hospitalizations. This surgery is expensive in terms of health workers' time, equipment, medical devices and drugs. Our main objective was to assess the direct hospital cost generated by osseocutaneous free-flap surgery in a multicentric prospective micro-costing study. Direct medical costs evaluated from a hospital perspective were assessed using a micro-costing method from the first consultation with the surgeon until the patient returns home, thus confirming the success or failure of the free-flap procedure. The mean total cost for free-flap intervention was 34,009€ (5151-119,604€), the most expensive item being the duration of hospital bed occupation, representing 30-90% of the total cost. In the event of complications, the mean cost increased by 77.3%, due primarily to hospitalization in ICU and the conventional unit. This surgery is effective and provides good results but remains highly complex and costly.

Resume Introduction Le lambeau libre micro-anastomose de fibula a une place de choix dans la reconstruction des defects mandibulaires en cancerologie, permettant une bonne rehabilitation fonctionnelle. Notre etude est une evaluation morphologique du site donneur et receveur, et un enregistrement des sequelles sur site donneur. Patients et methodes Il s’agissait de patients pris en charge consecutivement au Centre Oscar-Lambret pour mandibulectomie interruptrice avec reconstruction par lambeau libre de fibulaentre decembre 2003 et septembre 2008. Une evaluation par deux medecins examinateurs non operateurs a ete effectuee selon des echelles adaptees. Cette meme evaluation-patient a ete realisee par auto-questionnaire. Resultats Vingt-trois patients, sans recidive, participant a l’etude, ont ete inclus parmi les 49 reconstructions mandibulaires realisees dans notre centre sur cinq ans. Le taux de satisfaction est de 73 % au niveau du site receveur et de 70 % sur le site donneur avec une concordance patient-expert de 47 % sur le site receveur et 49,5 % sur le site donneur. Les principales donnees perturbees au niveau du site donneur etaient une diminution d’amplitude de cheville (43 %), une baisse de la force en flexion (39 %), une gene a la course (35 %), une gene a la marche (26 %). Les facteurs de risque lies a l’insatisfaction etaient une perte de poids superieure a 5 % a l’admission pour le site receveur (patient p = 0,012/expert p = 0,046), et la presence d’une greffe pour le site donneur (patient p = 0,04/expert p = 0,035). Conclusion Les patients operes par lambeau libre de fibula presentent des taux de satisfaction eleves, mais avec un retentissement sur le site donneur non negligeable.

Summary Introduction Micro-anastomosed free fibula flap is an attitude of choice in mandibular defect repair in oncology, enabling effective functional rehabilitation. The present study assessed donor and recipient site morphology and donor-site sequelae. Patients and methods The study consecutively recruited patients undergoing mandibular resection with free fibula flap reconstruction in our centre between December 2003 and September 2008. Assessment on adapted scales was performed by two independent expert physicians and patient self-assessment. Results Out of 49 mandibular reconstructions performed in the centre over the 5-year study period, 23 patients free of recurrence were included. Satisfaction rates were 73% for the recipient site and 70% for the donor-site, with patient/expert agreement of 47% and 49.5% respectively. Donor-site impact was mainly in terms of reduced ankle range of motion (43% of cases) and flexion strength (39%) and discomfort in running (35%) and walking (26%). Risk factors for dissatisfaction were more than 5% weight loss at admission for recipient site dissatisfaction (patient, P = 0.012; expert, P = 0.046), and skin graft for donor-site dissatisfaction (patient, P = 0.04; expert, P = 0.035). Conclusion Free fibula flap was associated with high satisfaction rates, but non-negligible donor-site impact.

Background. The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease Methods. We studied the patterns of care in the French-Belgian Groupe d'Etude des Tumeurs de la Tete Et du Cou (GETTEC) through a questionnaire-based survey. Results. Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND. Conclusions. Omission of ND based on computed tomographic scan and positron emission tomography-based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus-related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context. © 2012 Society of Surgical Oncology.

The toxicity associated with concomitant chemoradiation for the management of laryngeal and pharyngeal carcinoma has been well documented. Minimally invasive surgical techniques offer the potential to extirpate the malignancy as a single-modality therapy and provide essential information that may direct subsequent treatment. In selected patients, radiation doses may be reduced and systemic chemotherapy may be withheld after tumor extirpation. Transoral laser microsurgery has proven effective, although inability to manipulate and suture tissue by this modality limits ablation and reconstruction of extensive defects. Transoral robotic surgery is a relatively new technique that provides several unique advantages, which include a 3-dimensional magnified view, ability to see and work around curves or angles, and the availability of 2 or 3 robotic arms that can be used to reconstruct extensive defects using either local, regional, or free flaps. Preliminary data suggest that transoral robotic surgery may provide a technique for ablation and reconstruction of pharyngeal defects that may be superior to other transoral techniques. It may also provide a means for personalizing therapy for oropharyngeal and supraglottic carcinoma.

Resume La chirurgie robotisee est en plein essor dans de nombreuses specialites chirurgicales. En chirurgie oncologique tete et cou, cette nouvelle procedure pourrait etre une bonne alternative chirurgicale, en esperant diminuer la morbidite liee a certaines techniques plus conventionnelles. L’objectif de cet article est d’etablir un etat des connaissances acquises dans ce domaine avec une revue de la litterature. Nous soulignons les limites et perspectives avec un regard particulier sur les aspects de surete de fonctionnement. Le robot chirurgical applique en chirurgie endoscopique ORL est un outil prometteur sous reserve, cependant, du developpement attendu de nouvelles fonctions comme un systeme de navigation ou un retour de force couples au robot. Le bon developpement de ce nouvel outil dependra egalement de la qualite des travaux et programmes de recherche dans ce domaine.

Reconstruction after extensive resection of the tongue remains a surgical challenge. Free soft-tissue transfer is now favored for head and neck reconstruction following cancer resection. However, the choice of either free tissue transfer (FTT) or of the pedicled Pectoralis Major Musculocutaneous Flap (PMMF), the workhorse in head and neck reconstruction, remains controversial. The purpose of this study is to assess the post-operative outcomes after radical ablative surgery and reconstruction for patients with a tongue cancer. We conducted a retrospective comparison of two different reconstruction techniques. From January 2000 to December 2006, 70 consecutive patients with tongue cancer had been treated with curative intent by extensive ablative surgery and soft-tissue reconstruction. Sixty percent of tumors were T3 or T4. We compared the post-operative outcomes of both populations: 25 patients underwent FTT and 45 underwent pedicled PMMF. Fifty-seven men and 13 women with a mean age of 55 years constitute the study population. The two groups were comparable in terms of age, gender, and addiction. The choice of flap technique was independent of the ASA scale (p=1.00), the weight of comorbidities (p=0.13), previous radiation therapy (p=0.09), the T-stage (p=0.44) or N-stage (p=0.21). Apart from the rate of flap necrosis, which occurred significantly more often in the PMMF group (p=0.02), post-operative complication rates did not differ between the two groups. The success rate of FTT was 96% (24/25). The duration of the post-operative stay was longer after use of the pedicled flap technique, but the difference did not reach statistical significance (mean duration in days: 23.2 vs. 18.1; p=0.10). Both groups did not differ as regards duration of use of a feeding tube (p=0.84) or of tracheostomy (p=0.54). Local disease-free survival was also similar (p=0.65). The two groups were similar in terms of patients' characteristics. The reliability of free flaps was higher than that of PMMF. The assessment of our practice in the case of extensive tongue defect suggests that reconstruction with free soft-tissue transfer, whenever feasible, should be the first-choice treatment option.

Prognosis was very poor as soon as a local failure developed. Up-front treatment should be optimized to control this rare disease. We propose producing and reporting recommendations via a concerted oncologic physician referral network.Squamous cell carcinoma (SCC) in young people is rare and the literature is confusing. This study was carried out to assess the demographics, clinical features, and treatment outcome in a cohort of patients aged 35 years or less with SCC of the oral tongue (SCCOT).This was a multicenter retrospective study. Fifty-two patients treated between 1990 and 2000 were identified. Descriptive statistics were analyzed to assess demographic and tumor variables.The WHO performance status was excellent for all patients. Thirty-seven were classified as T1-T2 and 38 were N0. All of them except one were treated with curative intent. Treatment failures were observed in 25 patients (48%). Four patients could be successfully salvaged after SCCOT recurrence or progression. The disease-free survival (DFS) was 52% at 5 years. The 5-year overall survival (OS) rate was 64%. Factors that affected the OS were invasion of the floor (p=0.009), cross over of the midline (p=0.02), positive lymph nodes (p=0.02), and the lack of disease control (p=0.0001).

Hospital stays constitute the main component of costs of cancer treatment. We conducted a prospective study to identify the determinants of the length of stay (LOS) after head and neck cancer surgery (HNCS). Patients who underwent major HNCS with opening of mucosa and with curative intent were enrolled. Data were collected for patient characteristics, type of tumour, surgical procedures and postoperative outcome. LOS defined as the interval between the day of admission for surgery until hospital discharge or death was determined by the Kaplan-Meier method. Independent determinants of LOS were identified using a Cox model. All 260 patients were included. Median LOS was 26 days (range, 3-178). In the multivariate model, four variables remained associated with increased LOS: American Society of Anaesthesiologist's score equal to 3 (hazard ratio 1.62 [1.23-1.99]), duration of surgical procedure >220 min., (HR=1.37 [1.22-1.56]), SSI (HR=2.09 [2.02-2.54]), occurrence of SSI caused by multi-resistant pathogen (HR=2.92 [2.78-3.77]) and occurrence of PP (HR=2.09 [1.78-2.81]). The present results highlighted the long duration of LOS after head and neck cancer surgery. Two variables (duration of surgical procedure and occurrence of nosocomial infections) were associated with LOS and might be improved by appropriate strategies.

Squamous cell carcinomas (SCC) localized at the lateral buccopharyngeal junction are frequent occurrences in our experience. This anatomical site gives the tumor ample space to spread in different directions, making tumor management all the more difficult. We focused our study on this localization to underline their specificities and evaluate our practices. In the Department of Head and Neck Oncology at the Centre Oscar Lambret, 57 patients with lateral bucco-pharyngeal junction SCC were treated from 1995 to 2000. Epidemiological data were extracted from the medical chart. Description of the tumor was based on clinical and imaging data. Treatment modalities frequently combined surgery, radiotherapy and chemotherapy. Protocol was adapted with the health status and the aggressiveness of the disease. Follow-up and survival rates are outlined below. Fifty men and seven women with a mean age of 57 years constitute the patient population. Forty-nine out of 57 presented a history of smoking, and 44 out of 46 presented a history of alcoholism. Patient overall clinical status, social and family background were also discussed. Thirty-one of fifty-seven tumors were categorized as T1 or T2. Forty-five out of fifty-seven presented limited lymph-node involvement. Tumor extension, growth pathology and degree of differentiation were described. Twenty-eight out of fifty-seven had undergone primary surgery. Primary radiotherapy with or without chemotherapy was delivered to the others. The modality of the different treatments and their results were specified. The 3-year disease-free survival rate was 52.7% and the 3-year overall survival rate was 48.2%. The mean survival rate was 3 years. Univariate analysis was performed on all occasions. Gender (P = 0.008), surgery first versus non-surgical treatment first (P = 0.03), spread beyond the midline (P = 0.03), and small tumors T1 T2 versus T3 T4 (P = 0.003) were predictive factors of overall survival. A Multivariate analysis showed that the type of treatment (surgery first versus no primary surgery P = 0.006), and the T (T1, T2 versus T3, T4 P = 0.005) were the two predictive factors of the overall survival. Because of the small size of the population studied, the retrospective nature of the study and the scarcity of the publications on the subject, results must be carefully interpreted. For example, surgery must be proposed whenever deemed possible. It is in an independent factor in our series. All the statuses linked to the population type, tumor extension and tumor differentiation are also discussed.

Lymph node metastases of squamous cell carcinomas in the neck can appear cystic. Without a clinically apparent primary tumour they can classically be considered to originate in a branchial cleft. We report two cases of cystic squamous cell carcinoma with histopathologic criteria of branchial cleft carcinoma. After a review of the literature, diagnostic strategies, histopathologic features, and therapeutic options for this very controversial clinical situation are discussed. We conclude by suggesting that Martin's criteria, largely used to differentiate between a cystic metastasis of a squamous cell carcinoma and a very theoretical branchial cleft carcinoma should be abandoned for lack of applicability.

Background. In the north of France, a delay in primary consultation has been noted among patients with head and neck cancer. This group is often correlated with lower socioeconomic status and a lack of medical information. Therefore, the choice to seek consultation is often influenced by symptoms such as pain and change in the size of tumors in the neck. We studied this delay in seeking consultation, focusing on psychosocial variables such as professional and social background, the involvement of a spouse/partner, and the presence of anxiety and depression. Methods. Two rating scales were administered to 50 patients with large tumors (T3/T4) and 50 patients with small tumors (T1/T2), and the results were compared. These rating scales were as follows: (1) a 17-item questionnaire assessing sociodemographic data, presenting symptoms, factors generating the consultation, and reasons for delay; and (2) the Hospital Anxiety and Depression Scale (HADS). Results. Both groups were predominantly male and working-class. Significant differences were observed in time since symptom onset and in conscious delay in seeking medical attention. The group with large tumors was characterized by lower involvement of a spouse/partner, conscious delay before first consultation, greater social isolation, fewer medical visits, and lower HADS anxiety scores. The group with small tumors sought consultation sooner and was characterized by greater involvement of a spouse/partner, correlated with significant anxiety. Depression was not a factor influencing delay within either group. Conclusions. The interpersonal relationship with a spouse/partner seemed to be essential in the dynamics surrounding consultation. Anxiety, rather than socioeconomics status, was a discriminating factor in the delay in seeking consultation. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005

Background. The goal of this prospective study was to determine the incidence of wound infection (WI) after clean uncontaminated head and neck cancer procedures and after emergency tracheotomies. Methods. Two hundred twelve clean procedures without tracheotomy or opening of mucosa (neck dissections, large skin resections, thyroidectomies, parotid gland resections, and explorative cervicotomies) were studied at Oscar Lambret Cancer Center over a 24-month period. Results. WI rate was 6.6% (14 of 212). In a univariate analy- sis, only one variable was significantly related to the likelihood of WI: previous anticancer chemotherapy. All but one patient who had had previous chemotherapy demonstrated WI (14 of 15). Conclusions. After previous chemotherapy, the WI rate in clean uncontaminated head and neck surgery was as high as 90%. In this case, antibiotic prophylaxis should be evaluated. A 2004 Wiley Periodicals, Inc. Head Neck 26: 513-517, 2004

Background: Primary mucosal melanomas of the head and neck (MMHN) are rare and carry a poor outcome. The impact of different treatments on survival is not yet clearly established. Methods: Twenty patients treated from 1991 to 2004 at a single referral center were retrospectively reviewed. Results: Primary sites were oral mucosa in 14 cases, paranasal sinuses in three cases, and nasal cavities in three cases. The sex ratio was equal to 1, and the median age at diagnosis was 63 years (range, 17–77 y). At presentation, one patient had lymph node metastases, one patient had distant metastases, and one patient had both. Surgery was performed with curative intent in 19 cases (and achieved clear margins in 14 cases). Postoperative radiation therapy was delivered in four cases. The actuarial 2-year and 5-year survival rates were 13/19 and 7/16. The risk factors for death were male gender (RR = 9.3 [1.2–72], P = .024) and positive margins (RR = 21 [1.9–47], P = .013). In addition, we observed three metachromous cancers (one breast cancer, one kidney cancer and one lymphoma) during the follow-up period. Conclusion: The present study suggests that obtaining clear margins must be the goal in the treatment of MMNH.

Summary We describe herein an association of a nevoid basal cell carcinoma syndrome and an angiosarcoma arising in muscle of neck. This inextirpable tumour showed a rapid progression. The patient died 3 months after diagnosis despite two lines of chemotherapy. This association was not previously described.

To assess the initial experience for transoral robotic surgery (TORS), as observed in the French TORS group.A multi-institutional prospective cohort study.Seven tertiary referral centers.One hundred thirty consecutive patients who were scheduled for a TORS between October 2008 and March 2011 were included. The operative times, conversion rates, morbidity, and alternatives were described. The serious adverse effects encountered were analyzed, and recommendations for avoiding them are specified.Most of the patients (65%) had a laryngeal (supraglottic) and/or hypopharyngeal resection. Thirty-nine of the 130 patients receiving TORS would have had a transoral laser resection as their alternative surgery. The tumor exposure was suboptimal in 26% of the cases. Six of the 130 patients needed conversion to an open approach. There were 15 postoperative hemorrhages and 2 deaths due to posthemorrhage complications in patients with significant comorbidities at 9 and 18 days after the surgery. The median setup and procedure times were 52 ± 46 and 90 ± 92 minutes, respectively. The learning curve was characterized by better selection and management of potential patients.The visualization offered by the robotic assistance allowed transoral resections of tumors that were difficult to resect or unresectable by laser surgery. Self-assessment of surgical exposure and a decrease in the need to convert to an open procedure over time suggested improvement in TORS-related surgical skills. Nevertheless, strict patient selection is essential. Even with a minimally invasive approach, some patients will need a tracheostomy for safety reasons.

Background: Totally Implantable Venous Access Port Systems (TIVAPS) are widely used in oncology, but complications are frequent, sometimes necessitating device removal and consequently delays in chemotherapy. The aim of this study was to investigate possible risk factors for morbidity. Methods: A total of 815 consecutive cancer patients (median age: 56.2 years [0.8e85.2]; 522 female) were enrolled in this observational, single-centre study between May 2nd 2006 and April 30th 2007. TIVAPS implantation involved principally cephalic or external jugular vein access. Patients were followed up for one year unless the device was removed earlier. Results: The overall morbidity rate was 16.1% (131/815). Complications necessitated device removal in 55 patients a mean of 3.7 months [0.2e12.0] after implantation. These comprised TIVAPS-related infection (19), port expulsion (14), catheter migration (6), venous thrombosis (5), mechanical problems (3), skin disorders (2), pain (2), drug extravasation (2) infection unrelated to TIVAPS (1) and inflammation (1). No patient died during the study. The factor most strongly predictive of complications was the interval between insertion and first use of the TIVAPS, ranging from 0 to 135 days (median: 8.0 days). The morbidity rate was 24.4% when this interval was 0e3 days, 17.1% when it was 4e7 days and 12.1% when it exceeded 7 days (p < 0.01; Chi 2 test). The median interval was 6 days (0e53) and 8 days (0e135), respectively, in patients with and without complications (p < 0.001). Conclusion: To reduce complications, an interval of at least 8 days between placement of the TIVAPS and its first use may be advisable. 2011 Elsevier Ltd. All rights reserved.

Objective: Assess the learning curve of transoral robotic surgery (TORS) observed in the French TORS group, gathering 7 different tertiary referral centers. The oncologic results are presented separately.Method: A multi-institutional prospective record was done between 2008 and 2010. A total of 76 consecutive patients scheduled for a TORS have been included. The benefits observed with this technique, the operative times, conversion rate, and morbidity are described. The pitfalls encountered are detailed and responses are formulated to avoid them.Results: Most patients had a laryngeal (supraglottic) and/or hypopharyngeal resection (65%). 30/76 patients operated by TORS would have had a transoral laser resection as alternative surgery. Tumor exposure was suboptimal in 24% of cases. Two out of 76 conversions in open-approach were necessary. In the beginning, there were 2 deaths due to complications after hemorrhage in patients with high co-morbidities. The median-time of set-up and procedure were respectivel...

Summary Few studies reported both functional and sensitive long-term evaluations after tongue reconstruction. The aim of this study was to assess functional outcomes and sensitive recovery after tongue reconstruction with fasciocutaneous free flap (FCFF) or musculocutaneous pedicled flap (MCPF) without nerve anastomosis. We enrolled 30 patients having no recurrence from a consecutive series of 79 tongue reconstructions as part of a cancer treatment. All patients were submitted to functional and sensitive tests. The functional study included intelligibility, tongue motility, food, and swallowing scores. Flap sensibility was evaluated too. Male-to-female sex ratio was 6.5 with a mean age of 52 years old. The lesions were mainly advanced (T3–T4 73%). Mobile tongue and base of tongue resection was carried out in 43% of cases, and resection was limited to the oral tongue for 53%. Twenty-one FCFF and nine MCPF were performed. The mean follow-up was 2 years and 11 months. Swallowing (slightly impaired 63%), food (normal 40%), and intelligibility (excellent 77%) assessments were satisfactory. Spontaneous sensory recovery was regularly observed (mean response 62%). The two groups FCFF and MCPF were similar regarding population and tumors characteristics. Functional results were higher in case of FCFF (food score p = 0.05; intelligibility p = 0.04). No difference was observed on sensitive recovery. This study emphasizes good functional results either for swallowing or intelligibility, with higher scores for the FCFF, strengthening the opinion that FCFF is the best choice for tongue reconstruction whenever possible.

Partial laryngectomy is an old but well-accepted surgical treatment for selected carcinomas of the larynx. Actually, the transcervical approach remains the most popular even if the transoral laser approach is useful in some cases. Transoral robotic surgery is a new promising surgical procedure in head and neck oncology as an alternative to conventional surgery with decreased morbidity. The aim of this study is a description of the state of the art by a review of the literature. We emphasize limits and future prospects on this topic with a special focus on dependability.

There are few data focusing on postoperative course after major head and neck cancer surgery in the elderly compared with the younger population. The aim of this study was to assess the impact of age on postoperative outcomes. At hospital admission, we prospectively collected data from 261 patients separated into two groups with regard to their age (those >or= 70 years and those < 70 years). Twenty-nine of them were over 70 years old. Median length of stay was similar in both populations (22 vs. 21 days, p=0.66). Incidence of severe postoperative complications was similar: surgical site infection (6/29 vs. 89/232, p=0.77), pneumonia (4/29 vs. 29/232, p=0.13) and infection caused by multi-resistant pathogens (1/29 vs. 14/232, p=0.08). There was no significant increase in postoperative deaths (4/29 vs. 6/232, p=0.12). The impact of age on postoperative deaths was assessed after adjustment for potential risk factors. In a logistic regression model, postoperative death risk remained insignificantly increased in the elderly (adjusted Odds Ratio=3.3 [0.7-14.9], p=0.22). In our experience, the postoperative course in elderly patients is not significantly different from that than in younger patients.

International audience; Public health guidelines aim to limit the consumption of alcoholic beverages worldwide and the subsequent health burden. In particular, alcohol consumption is an avoidable risk factor for cancer. In human beings, ethanol in alcoholic drinks is mainly oxidised in the liver by alcohol dehydrogenases to acetaldehyde, and is further detoxified to acetate by aldehyde dehydrogenases. Functional variants in genes involved in alcohol metabolism result in differences between individuals in exposure to carcinogenic acetaldehyde, suggesting a possible interaction of genetic susceptibility and alcohol exposure in cancer. We reviewed available studies of the combined effects of alcohol drinking and genetic polymorphisms on alcohol-related cancer risk. Most available data were for polymorphisms in alcohol and folate metabolism. We give an overview of published studies on the combined effects of alcohol drinking and polymorphisms in genes for alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH), cytochrome P450 2E1, and methylene-tetrahydrofolate reductase on the risk of alcohol-related cancer. Current data lend support to a role of polymorphisms ADH1B and ALDH2 combined with alcohol consumption in cancer. Other available data are insufficient or inconclusive, highlighting the need for additional studies.

The optimal management of adult soft-tissue sarcomas is not clearly established. To assess prognostic factors and survival, the experience of 45 recent successive cases was reviewed. Data were collected from a retrospective database (1993–2005) and statistically analyzed. Rhabdomyosarcomas were excluded. The mean age was 50.1 years; there were 24 men and 21 women. The main histological subtypes were undifferentiated sarcoma (14) and angiosarcoma (10); 21 tumours were grade 3 (46%). The most frequent primary sites were neck muscles (15, 33%) and scalp (11, 24%). At presentation, 5 (20%) cases with lymph-node involvement and another 11 cases (24%) with distant metastasis were observed. The treatment was with curative intent in 33 cases (73%). This entailed surgery, with adjuvant radiotherapy in 15 cases and adjuvant chemotherapy in 5 cases. The 5-year overall survival was 52% (±8%). In univariate analysis, the poor prognostic factors were high grade, initial metastasis or lymph nodes, absence of surgery, and number of surgical procedures. In multivariate analysis, two factors remained significant: grade (P = 0.006) and absence of surgery (P = 0.005). After taking into account grade and metastasis at presentation, quality of surgery has prognostic value. The primary aim of a multidisciplinary approach to these tumours must favour complete resection.

The aim of this study was to determine the risk factors for the mortality during the first 30 days after a major head and neck cancer surgery. Two hundred and sixty one consecutive surgical procedure were prospectively studied at Oscar Lambret Cancer Centre within a 36-months period. Twenty variables were recorded for each patient. The significant risk factors for postoperative mortality were assessed by univariate and multivariate analysis. Overall 30-days mortality rate was 3.83% [95% CI 3.13-4.53]. In univariate analysis identified four risk factors: female gender (odd ratio 4.25 [95% CI 1.03-17.56]), age equal or superior than 70 (odd ratio 5.06 [95% CI 1.35-18.36]), current alcohol addiction (odd ratio 3.65 [1.02-13.06]) and laryngeal location (odd ratio 4.23 [CI 95% 1.18-3.38]). In multivariate analysis only female gender and laryngeal location remained significant. The incidence of postoperative mortality was 1.63% for patients without risk factor and was 6.41% for those with one or two risk factors. This model identifies easily high-risk patients for major head and neck cancer surgery. A multicenter validation is necessary.

There are many options to treat larynx cancers. Throughout the 20th century, surgical research has provided many partial surgery techniques (either open surgery or endoscopic CO2 surgery). In parallel, the modification of radiotherapy schedules has notably improved the local control with definitive irradiation. The appearance of active chemotherapy regimens has also modified the concept of treatment for advanced disease, allowing a decrease in the total indications of laryngectomy, although this remains the treatment of choice in some cases. The selection of the most appropriate treatment is based on a multidisciplinary approach. Early diseases may be treated by open surgery, endoscopic laser CO2 surgery or irradiation. Some advanced diseases may be treated by partial surgery, but the majority are theoretically candidates for radical surgery when resectable. In many instances, but not in all, chemotherapy-based larynx-preserving protocols may avoid performing such mutilating surgery. When inoperable, larynx cancers are better treated by combined chemotherapy and irradiation when the performance status of the patient is compatible with such an intensive regimen.

We evaluated the incidence, risk factors and consequences of wound infection (WI) following major head and neck cancer surgery in an open non-comparative study.The study group, comprising 95 patients who underwent clean-contaminated procedures with opening of the upper aerodigestive tract for biopsy-proven squamous cell cancer, were studied over a 1-year period. Antibiotic prophylaxis was amoxicillin and clavulanic acid. More than 20 variables were prospectively recorded for each patient. The mean follow-up was 30 months.The overall WI rate was 50.5% (48/95). Most pathogens isolated from samples were gram-negative rods. In univariate analysis, we found three risk factors for WI: alcohol consumption (P = 0.07), a hypopharyngeal location (P = 0.02) and laryngectomy stoma (P = 0.01). WI were associated with postoperative fever (P = l.5 x 10(-11)), postoperative antibiotic therapy (P = 1.5 x 10(-5)) and postoperative death (P = 0.043). Patients without WI had a median postoperative hospital stay of 15 days compared with 29 days for those with WI (P0.001). Healing of WI was achieved after a median time of 48 days. WI delayed postoperative radiation therapy in 21 out of 33 evaluable patients. But overall survival, and local and metastatic failures were similar with and without WI.WI are associated with a heavy postoperative morbidity, but have no prognostic impact on cancer control.

Adult head and neck soft tissue sarcomas (AHNSTS) are rare, and data concerning treatment results are spare. To assess clinico-pathological characteristics, management prognostic factors, and survival of AHNSTS, we reviewed our experience of 28 recent successive new cases. Data were collected from a retrospective database (1997-2002). Aggressive fibromatosis, dermatofibrosarcoma, Kaposi sarcoma, chondrosarcoma and osteogenic sarcoma were excluded. Univariate analysis for prognostic factors was performed with chi2 test with Yates correction. The median age was 45.7 years (range: 18-86). The male/female ratio was 15/13. The most common subtypes was rhabdomyosarcoma (seven cases). Twenty-two patients presented with previous inadequate resection performed elsewhere before admission. The most common location was neck muscles (11 cases). Nineteen patients had surgery (complete resection in 13 cases). Associated treatments were neoadjuvant chemotherapy, adjuvant chemotherapy and postoperative radiotherapy in respectively, 4, 3 and 10 cases. The 2-year overall survival was 56%. Rhabdomyosarcomas (p = 0.005) and inadequate resection (p = 0.04) were associated with poor outcome. Large resection of AHNSTS in a multimodality approach may afford the best chance of disease control.

From 1980 to 1998, 65 patients whose glottic lesions were classified T1 or T2 were operated with a reconstructive anterior frontal laryngectomy with epiglottoplasty such as described by Tucker (Arch Otolaryngol Head Neck Surg 115:1341–1344). This procedure consists of resection of the two vocal cords, in some cases one arytenoid, the anterior commissure with a part of the thyroid cartilage, the anterior part of both false vocal cords, and of 1 cm of the subglottis. The epiglottis is grasped downward to close the larynx. There were no per or postoperative deaths. Our functional results confirm those reported in the previous publications. The mean time of removal of the nasogastric tube was about 12 days and the patients were generally satisfied about their residual voice. Decannulation was performed after satisfactory peroral feeding, generally about 2 weeks postoperatively. Three patients only required subsequent procedures which can be considered due to functional failures. There were four recurrences, which means a 5-year actuarial local control rate of 94%. This operation takes place as part of our surgical treatment policy of laryngeal carcinomas, considering that this surgery is like an extensive frontolateral laryngectomy. In case of an infiltrating tumor or in case of invasion to the arytenoid cartilage, we perform a supracricoid partial laryngectomy with crico-hyoido-epiglottopexy (the Majer-Piquet’s procedure).