Lateral hypopharyngectomy with laryngeal preservation reconstructed with inlay fascio-cutaneous free flaps: clinical and functional outcomes.

IF 2.1 4区 医学 Q2 OTORHINOLARYNGOLOGY Acta Otorhinolaryngologica Italica Pub Date : 2024-09-15 DOI:10.14639/0392-100X-N3071
Davide Lancini, Claudia Montenegro, Davide Mattavelli, Alberto Grammatica, Vittorio Rampinelli, Gabriele Zigliani, Cesare Piazza
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Abstract

Objective: Lateral hypopharyngectomy (LH) is one of the organ-preservation surgical strategies available for treatment of selected naïve early squamous cell carcinoma (SCC), as well as for rarer non-SCC tumours and persistent/recurrent/second primaries after chemoradiation of the lateral wall of the piriform sinus. Its reconstructive methods have been the subject of different approaches without a general consensus. The aim of the present study is to describe a retrospective series of LH reconstructed by inlay fascio-cutaneous free flaps, reporting on oncological and functional outcomes.

Methods: Patients who underwent LH at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy, between 2017 and 2023 were retrospectively reviewed. Clinical history, tumour histotype, postoperative complications, functional, and oncological outcomes were collected.

Results: Seven patients (6 males, 1 female) were included. In all, 29% had a naïve neoplasm, while 71% had recurrent disease. The final histology included 3 SCC, 2 synovial sarcomas, one liposarcoma, and one single-site mucosal metastasis from cutaneous melanoma. Negative margins were achieved in 6 patients (86%). All patients had swallowing rehabilitation by speech therapists and were able to safely eat a free diet at discharge, except for one who needed a percutaneous endoscopic gastrostomy to support nutritional oral intake. After a mean follow-up of 34.3 months, all patients except one are alive.

Conclusions: Our study showed that, in selected cases, it is possible to radically remove lateral hypopharyngeal tumours with laryngeal preservation and free flaps inlay reconstruction, with a low rate of complications and acceptable functional and oncological results.

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用镶嵌式筋膜-皮肤游离瓣重建保留喉部的侧下咽切除术:临床和功能效果。
目的:下咽侧壁切除术(LH)是一种保留器官的手术策略,可用于治疗经选择的幼稚早期鳞状细胞癌(SCC),以及较罕见的非 SCC 肿瘤和蝶窦侧壁化疗后的顽固/复发/第二原发性肿瘤。其重建方法一直众说纷纭,尚未达成普遍共识。本研究的目的是描述一系列通过镶嵌筋膜-皮肤游离皮瓣重建 LH 的回顾性研究,报告肿瘤学和功能方面的结果:方法:对2017年至2023年间在意大利布雷西亚大学耳鼻咽喉头颈外科接受LH手术的患者进行回顾性研究。收集了临床病史、肿瘤组织类型、术后并发症、功能和肿瘤结果:共纳入7名患者(6男1女)。结果:共纳入 7 名患者(6 男 1 女),其中 29% 患有新发肿瘤,71% 患有复发性疾病。最终组织学检查结果包括3例SCC、2例滑膜肉瘤、1例脂肪肉瘤和1例皮肤黑色素瘤单发粘膜转移瘤。6名患者(86%)达到了阴性边缘。所有患者都接受了语言治疗师的吞咽康复治疗,出院时都能安全地自由进食,只有一名患者需要经皮内镜胃造口术来支持口腔营养摄入。经过平均 34.3 个月的随访,除一名患者外,其他患者均健在:我们的研究表明,在经过选择的病例中,可以通过保留喉部和游离皮瓣镶嵌重建的方式彻底切除侧下咽肿瘤,并发症发生率低,功能和肿瘤效果均可接受。
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来源期刊
Acta Otorhinolaryngologica Italica
Acta Otorhinolaryngologica Italica OTORHINOLARYNGOLOGY-
CiteScore
3.40
自引率
10.00%
发文量
97
审稿时长
6-12 weeks
期刊介绍: Acta Otorhinolaryngologica Italica first appeared as “Annali di Laringologia Otologia e Faringologia” and was founded in 1901 by Giulio Masini. It is the official publication of the Italian Hospital Otology Association (A.O.O.I.) and, since 1976, also of the Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale (S.I.O.Ch.C.-F.). The journal publishes original articles (clinical trials, cohort studies, case-control studies, cross-sectional surveys, and diagnostic test assessments) of interest in the field of otorhinolaryngology as well as clinical techniques and technology (a short report of unique or original methods for surgical techniques, medical management or new devices or technology), editorials (including editorial guests – special contribution) and letters to the Editor-in-Chief. Articles concerning science investigations and well prepared systematic reviews (including meta-analyses) on themes related to basic science, clinical otorhinolaryngology and head and neck surgery have high priority.
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