Brazilian Journal of Otorhinolaryngology最新文献_第9页

Staging of oral cavity cancer in the 8th edition of the TNM classification: The role of computed tomography in the assessment of depth of invasion and extranodal extension 第8版TNM分类中口腔癌的分期：计算机断层扫描在评估浸润深度和结外延伸中的作用

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101645

Leticia de Franceschi , João Manoel Miranda Magalhães Santo , Anniely Mourão de Abreu , Marco Aurélio Vamondes Kulcsar , Claudio Roberto Cernea , Marcio Ricardo Taveira Garcia , Rogerio Aparecido Dedivitis , Leandro Luongo Matos

Objective

Suggest and validate pre-surgical tomographic evaluation criteria for OCC based on the pathological DOI criteria.

Methods

A retrospective cohort study was conducted with 80 patients with tongue and floor of mouth tumors, T1 and T2, followed from 2009 to 2015. Patients were initially classified according to the 7th edition of the TNM (TNM-7) using pathological samples and then reclassified based on the updated 8th edition of the TNM (TNM-8) criteria. The same was done radiologically, using extrapolation and adaptation of the pathological criteria to tomographic evaluation. The results of pathological staging were compared and correlated with the main clinical outcomes. The same was done with the radiological results. To evaluate the pre-surgical accuracy of tomographic staging, radiological and pathological results were compared.

Results

Regardless of the criteria (TNM-7 or TNM-8), it was observed that Computed Tomography (CT) with venous contrast may be used to guide the initial staging. Strong positive correlation was observed between tumor thickness and DOI at both CT and pathology. Considerable upstaging was observed in the sample of assessed patients for both criteria. In the comparison between tomographic and pathological T classifications, moderate correlation was observed in relation to thickness and DOI.

Conclusion

Computed tomography can be used to evaluate the depth of preoperative invasion in oral cavity tumors according to the criteria established in the present study.

Level of evidence

Level III.

目的提出并验证基于病理性DOI标准的OCC术前层析评价标准。方法对2009 ~ 2015年收治的舌底肿瘤T1、T2患者80例进行回顾性队列研究。患者最初根据第7版TNM （TNM-7）使用病理样本进行分类，然后根据更新后的第8版TNM （TNM-8）标准进行重新分类。同样在放射学上进行，使用外推和适应病理标准来进行断层扫描评估。将病理分期结果与主要临床结果进行比较。放射学结果也是如此。为了评估术前断层扫描分期的准确性，我们比较了放射学和病理学结果。结果无论TNM-7或TNM-8的诊断标准如何，计算机断层扫描（CT）静脉造影可用于指导初始分期。CT和病理显示肿瘤厚度与DOI呈正相关。在两个标准的评估患者样本中观察到相当大的占上风。在层析和病理T分类的比较中，观察到厚度和DOI之间的中度相关性。结论根据本研究建立的标准，计算机断层扫描可用于评估口腔肿瘤术前浸润深度。证据等级：III级。

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引用次数: 0

Outcome of subtotal parathyroidectomy for surgical treatment of hyperparathyroidism after renal transplantation 肾移植后甲状旁腺次全切除术治疗甲状旁腺功能亢进的疗效

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101623

Murilo Catafesta das Neves , Ana Beatriz Ribeiro Fonseca , Camila Akemi Yamashiro Koike , Davi Knoll Ribeiro , Mayra Messias Lera , Rodrigo Oliveira Santos

Objective

To evaluate the efficacy of STPX as a definitive treatment for Hyperparathyroidism after Renal Transplantation (HPT-RT) and determine whether there is a relationship between percentage intraoperative Parathyroid Hormone (ioPTH) decay levels and Parathyroid Hormone (PTH) values on the first postoperative day and surgical success.

Methods

This retrospective study analyzed the medical records of prospectively followed patients diagnosed with HPT-RT submitted to STPX in two tertiary hospitals (Brazilian Unified Health System ‒ SUS) for two years. Patients were allocated in two groups according to operative success (SG ‒ normalization of ionized Calcium [iCa] and PTH six months after surgery) or operative failure (FG ‒ persistence of high iCa and PTH). The percentage ioPTH decay levels and the postoperative PTH absolute values on the first postoperative day were evaluated in both groups.

Results

Of the total sample of 31 patients, surgical treatment was successful in 27 cases (87%). No statistically significant differences were observed between the groups for the percentage ioPTH decay levels (SG = 71.51% vs. FG = 70.4%), as well as for the PTH absolute values on the first postoperative day (SG = 52.69 pg/mL vs. FG = 54.55 pg/mL).

Conclusion

Subtotal parathyroidectomy is an effective and safe procedure for treating HPT-RT; however, the use of PTH levels remains subjective and cannot be considered as a predictor of surgical success.

目的评价STPX作为肾移植术后甲状旁腺功能亢进（HPT-RT）的最终治疗方法的疗效，探讨术中甲状旁腺激素（ioPTH）下降百分比及术后第一天甲状旁腺激素（PTH）值与手术成功率之间的关系。方法回顾性分析两家三级医院（巴西统一卫生系统- SUS）两年内住院的诊断为HPT-RT的患者的病历。根据手术成功（SG -术后6个月离子化钙[iCa]和甲状旁腺激素正常化）或手术失败（FG -高iCa和甲状旁腺激素持续存在）将患者分为两组。观察两组患者术后第1天ioPTH衰减百分比及术后PTH绝对值。结果31例患者手术治疗成功27例（87%）。两组间ioPTH衰减百分比（SG = 71.51% vs. FG = 70.4%）和术后第一天PTH绝对值（SG = 52.69 pg/mL vs. FG = 54.55 pg/mL）差异无统计学意义。结论甲状旁腺次全切除术是治疗HPT-RT有效、安全的方法；然而，甲状旁腺激素水平的使用仍然是主观的，不能被认为是手术成功的预测因素。

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引用次数: 0

The practice of oral feeding after total laryngectomy by Brazilian head and neck surgeons 巴西头颈部外科医生全喉切除术后口服喂养的实践

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101644

Johanna Benali , Tareck Ayad , Fabio Pupo Ceccon , Carlos Chiesa-Estomba , Jerome R. Lechien , Mateus Morais Aires , Leonardo Haddad , Gerrit Viljoen , Nicolas Fakhry

Objective

To evaluate the initiation of oral feeding in patients following TL by a group of Brazilian head and neck surgeons.

Methods

Online survey – 75 responders from Brazil.

Results

40.5% of the respondents introduced water and 41.9% of them introduced liquid diets between days 7 and 9 after TL without surgical complications or previous radiotherapy. Semi-solid feeds were started between days 10 and 14 in 47.3% of the patients and a free diet was begun after day 15 in 79.7% of them. There was statistically significant difference in the initiation of liquid feeds between different groups of TL patients, with earlier initiation in TL patients who had not undergone prior radio(chemo)therapy (p = 0.01419), with even greater differences when complex closure of the pharynx was needed (p = 0.00001), but not regarding the moment of a free diet introduction.

Conclusion

Most respondents in this Brazilian cohort prefer to wait at least 7-days before beginning oral feeding after TL without previous radiotherapy or surgical complications, with a significant number of respondents postponing feeds in patients who had undergone salvage TL and pharyngolaryngectomy.

Level of evidence

Level IV.

目的评价一组巴西头颈部外科医生对TL术后患者开始口服喂养的情况。方法对来自巴西的75名应答者进行在线调查。结果在术后7 ~ 9天内，40.5%的应答者使用水，41.9%的应答者使用流质饮食，无手术并发症或既往放疗。47.3%的患者在第10 ~ 14天开始半固体饲料，79.7%的患者在第15天之后开始自由饮食。不同组TL患者开始液体喂养的时间差异有统计学意义，未接受过放化疗的TL患者开始液体喂养的时间更早（p = 0.01419），当需要进行复杂的咽闭合时差异更大（p = 0.00001），但在引入免费饮食的时刻差异更大。结论在巴西的这个队列中，大多数受访者倾向于在TL术后至少等待7天再开始口服喂养，之前没有放疗或手术并发症，而在接受过补救性TL和咽咽喉切除术的患者中，有相当数量的受访者推迟了进食。证据等级：四级。

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引用次数: 0

Overview of care for head and neck Cancer cases in Brazilian Cancer Centers during the COVID-19 pandemic 2019冠状病毒病大流行期间巴西癌症中心头颈癌病例护理概况

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101638

Sergio Gonçalves , Marco Aurélio Vamondes Kulcsar , Leandro Luongo de Matos , José Guilherme Vartanian , Genival Barbosa de Carvalho , Fernando Luiz Dias , Terence Pires de Farias , Emilio Tosto Neto , Carlos Roberto dos Santos , Lucas Gomes Silva , Afonso do Carmo Javaroni , Gyl Henrique Albrecht Ramos , Beatriz Godoy Cavalheiro , José Carlos de Oliveira , Rafael de Cicco , Luiz Eduardo Barbalho de Mello , Bartolomeu Cavalcanti de Melo Junior , Luiz Roberto Medina dos Santos , Rafael Nunes Goulart , Luiz Paulo Kowalski

Objective

To assess the impact of the COVID-19 pandemic on Brazilian Head and Neck (H&N) oncology reference services.

Methods

This cross-sectional study evaluated data on the number of outpatient consultations, operations and infected physicians collected in 13 Brazilian Cancer Centers.

Results

10% of the H&N surgeons had COVID-19 infection. Significant reduction in the average number of new treated cases (39.9%), consultations (63.1%) and surgeries (35.1%) was observed in April 2020 compared with those of the same period in 2019.

Conclusion

There was significant impairment in the delivery of care to H&N cancer patients during a month of pandemic. The observed reduction is expected to persist in the coming months and will require institutional efforts to adequately meet the demand imposed during the pandemic period.

Level of evidence

Level IV.

目的评估新冠肺炎疫情对巴西头颈部肿瘤参考服务的影响。方法本横断面研究评估了13个巴西癌症中心收集的门诊会诊、手术和感染医生的数据。结果10%的H&；N外科医生感染了COVID-19。与2019年同期相比，2020年4月的平均新病例数（39.9%）、会诊数（63.1%）和手术数（35.1%）均显著下降。结论在流感大流行的一个月期间，对H&；N癌症患者的护理有明显的损害。观察到的减少预计将在未来几个月持续下去，需要机构努力充分满足大流行期间的需求。证据等级：四级。

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引用次数: 0

Sentinel lymph node biopsy in early oral cavity tumors: Evaluation of the oncologic efficacy compared to elective neck dissection 早期口腔肿瘤前哨淋巴结活检：与选择性颈部清扫相比的肿瘤学疗效评价

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101639

Marco Roberto Seferin , Fábio Roberto Pinto , Chin Shien Lin , Ana Kober Nogueira Leite , Paulo Vitor Sola Gimenes , Rogerio Aparecido Dedivitis , Marco Aurélio Vamondes Kulcsar , Claudio Roberto Cernea , Leandro Luongo Matos

Objective

To describe the oncological results of a prospective study in the use of sentinel lymph node biopsy as part of the surgical treatment of squamous cell carcinoma T1/T2N0 of the oral cavity in comparison to the results of patients submitted to levels I, II and III SND.

Methods

It was a prospective study in which seventy patients were divided into two groups, 35 being submitted to SND and the other 35 to SLB.

Results

In the SND group, locoregional recurrence occurred in 17.1%, with a 2.9% development of distant metastasis and 8.8% evolved with a second primary tumor. In the SLB, locoregional recurrence was observed in 7 patients (20.0%), 5.7% developed distant metastasis, and 5.7% had a second primary tumor. There was no significant difference between the two groups for both overall (p = 0.521) and disease-free survival (p = 0.753).

Conclusion

A SLB is reliable for the management of clinically negative neck in patients with oral T1/T2N0 squamous cell carcinoma.

Level of evidence

Level III.

目的描述前哨淋巴结活检作为口腔鳞状细胞癌T1/T2N0手术治疗的一部分的前瞻性研究的肿瘤学结果，并将其与I级、II级和III级SND患者的结果进行比较。方法采用前瞻性研究方法，将70例患者分为两组，35例接受SND治疗，35例接受SLB治疗。结果SND组局部复发率为17.1%，远处转移2.9%，伴第二原发肿瘤8.8%。在SLB中，7例（20.0%）出现局部复发，5.7%发生远处转移，5.7%发生第二原发肿瘤。两组患者的总生存率（p = 0.521）和无病生存率（p = 0.753）均无显著差异。结论SLB治疗口腔T1/T2N0型鳞状细胞癌临床阴性颈部是可靠的。证据等级：III级。

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引用次数: 0

Cancer in the head and neck region and its face under the perspective of users of a public reference hospital in Recife, state of Pernambuco, Brazil 巴西伯南布哥州累西腓一家公立参考医院用户视角下的头颈部和面部癌症

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101601

Angélica Lopes Frade, Beatriz Santos Borges, Fátima Cristina Mendes Matos, Aurora Karla de Lacerda Vidal

Objective

This study aimed to identify and analyze the difficulties experienced by head and neck (H&N) cancer patients, who are users of the Brazilian public health system (SUS), from their perspective of diagnosis to post-treatment.

Methods

Qualitative case series carried out using individual semi- structured interviews. Data were collected from October 2019 to March 2020 and interpreted by content analysis.

Results

Three categories emerged from the analysis: “difficulties in the diagnosis phase”, “conflicts experienced during treatment” and “post-treatment difficulties/sequelae”. Corroborating the literature, it was found that the difficulties faced by cancer patients are present in all stages of the disease: from access to prevention health services and diagnosis to post-treatment, influenced by late diagnosis, treatment side effects, and disease comorbidities.

Conclusion

It is essential to carry out studies addressing changes in the family, professional and personal scope of cancer patients, aiming to provide them with comprehensive care and health professionals with understanding about what this disease represents in the life of these individuals.

Level of evidence

Level IV.

目的本研究旨在识别和分析巴西公共卫生系统（SUS）使用者头颈部（H&；N）癌症患者从诊断到治疗后的困难。方法采用个人半结构化访谈进行定性病例系列研究。数据于2019年10月至2020年3月收集，并通过内容分析进行解释。结果分析得出“诊断阶段的困难”、“治疗过程中的冲突”和“治疗后的困难/后遗症”三个类别。证实文献发现，癌症患者面临的困难存在于疾病的各个阶段：从获得预防保健服务和诊断到治疗后，受晚期诊断、治疗副作用和疾病合并症的影响。结论针对癌症患者的家庭、职业和个人范围的变化开展研究是必要的，旨在为他们提供全面的护理，并使卫生专业人员了解这种疾病在这些个体的生活中代表着什么。证据等级：四级。

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引用次数: 0

Incidence of contralateral cervical metastasis in laryngeal tumors 喉肿瘤对侧宫颈转移的发生率

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101609

Arthur Paredes Gatti , Juliana Cristina Pacheco , Nicolas Galat Ahumada , Carlos Neutzling Lehn , Fernando Walder

Objective

To evaluate if patients with laryngeal SCC homolateral cN+ and contralateral cN− should be submitted to bilateral neck dissection.

Methods

The team reviewed medical records from 135 patients with a diagnosis of laryngeal malignancy between March/2009 and September/2017, analyzing gender, age, tobacco and alcohol comsumption, primary tumor site, neck dissection laterality, clinical and pathological contralaterality, staging, tumor recurrence or late metastasis and survival

Results

We observed that 40.74% were pN+ on at least one side after neck dissection, which 87.27% performed bilateral neck dissection. Of these, 66.67% did not have contralateral metastasis, 87.5% had no previously clinically evident metastasis.

Conclusion

Patients contralateral cN− have a risk <20% for occult metastasis and should not routinely go through bilateral neck dissection.

Level of evidence

Level III.

目的探讨喉鳞癌同侧cN+和对侧cN -患者是否应行双侧颈清扫术。方法回顾性分析2009年3月至2017年9月135例喉恶性肿瘤患者的病历，分析其性别、年龄、烟酒消费、原发肿瘤部位、颈清扫侧边性、临床病理对侧性、分期、肿瘤复发或晚期转移及生存率。结果：40.74%的患者在颈清扫后至少一侧为pN+，其中87.27%的患者行双侧颈清扫。其中66.67%未发生对侧转移，87.5%既往无明显临床转移。结论对侧cN -患者发生隐匿转移的风险为20%，不应常规行双侧颈部清扫术。证据等级：III级。

引用次数: 0

Evaluation of oncological outcomes in patients with oral cavity cancer treated in a low-volume hospital 小容量医院治疗口腔癌患者的肿瘤预后评估

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101621

Sara de Souza Bettioli , Agnaldo José Graciano , Ana Lavratti Borga , Carlos Augusto Fischer

Objective

To evaluate the results of OCC patients treated in low-volume regional hospitals.

Methods

This is a retrospective longitudinal study conducted with patients diagnosed with OCC and operated on in a low-volume hospital between January 2003 and December 2018.

Results

174 patients with OCC were treated at the institution ‒ an average of 11 patients/year. The most common tumor location was the tongue (48.2%), followed by the lip (18.2%). Squamous cell carcinomas were the most frequent (94.7% of patients). Adjuvant radiotherapy and chemotherapy were performed in 46.7% and 31.9% of patients, respectively. Almost 21% of patients had some postoperative complication. Specific survival of 62.6% and global survival of 58.2% after 3-years were similar to the results reported in high-volume centers. Disease-free survival was 45.8% in the same period.

Conclusion

Low-volume hospitals qualified for oncological treatments can present outcomes similar to those of high-volume centers, and are thus a regional option for patients with OCC.

Level of evidence

Level III.

目的评价小容量地区医院治疗OCC患者的效果。方法对2003年1月至2018年12月在一家小容量医院诊断为OCC并进行手术的患者进行回顾性纵向研究。结果174例OCC患者在该院接受治疗，平均11例/年。最常见的肿瘤部位是舌头（48.2%），其次是嘴唇（18.2%）。鳞状细胞癌最为常见（占94.7%）。辅助放疗和化疗分别占46.7%和31.9%。近21%的患者有术后并发症。3年后的特异性生存率为62.6%，总体生存率为58.2%，与大容量中心报告的结果相似。同期无病生存率为45.8%。结论具备肿瘤治疗条件的小容量医院的治疗效果与大容量医院相似，因此是OCC患者的区域性选择。证据等级：III级。

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引用次数: 0

Knowledge about head and neck cancer among adolescents 青少年对头颈癌的了解

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-06-04 DOI: 10.1016/j.bjorl.2025.101608

Vinicius M. Vasconcellos , Leandro Luongo Matos , Flavio Carneiro Hojaij , Edevaldo Miguel Alves , Beatriz Costa N. Martins , Arthur C. Nava

Objective

To assess knowledge about head and neck cancer among adolescents from private schools, aged between 13 and22 years.

Methods

200 questionnaires were applied among students, about the profile of adolescents and their knowledge about head and neck neoplasms, treatment, and teaching in schools on this topic. The results were analyzed both quantitatively and qualitatively.

Results

Only 55 students (29.9%) identified HPV as a risk factor for the disease. 137 students (74.5%) identified the brain as an organ treated by head and neck surgery. As for the therapeutic strategies used for the treatment of neoplasms in the region, only 67 students (36.4%) are aware. On the topic of teaching in schools, 153 students (83.1%) relate to some deficiency in the approach and learning.

Conclusion

Knowledge about head and neck cancer is insufficient. It is necessary to introduce in the curriculum basic cancer education in biology classes. The expansion of acquirements about cancer can provide better care and the ability to identify risk factors, initial signs, and symptoms of the disease, as well as the incorporation of healthy habits in families because these students can propagate valid information in their environment.

Level of evidence

Level IV.

目的了解私立学校13 ~ 22岁青少年头颈癌相关知识。方法对200名学生进行问卷调查，了解青少年对头颈部肿瘤的了解情况、治疗方法和学校教学情况。结果进行了定量和定性分析。结果只有55名学生（29.9%）认为HPV是该疾病的危险因素。137名学生（74.5%）认为大脑是通过头颈部手术治疗的器官。对于该地区肿瘤的治疗方法，只有67名（36.4%）学生知道。在学校教学的话题上，153名学生（83.1%）表示在方法和学习方面存在一些不足。结论对头颈部肿瘤认识不足。在生物课课程中引入肿瘤基础教育是必要的。扩大对癌症的了解可以提供更好的护理和识别疾病的风险因素、初始体征和症状的能力，并将健康习惯纳入家庭，因为这些学生可以在他们的环境中传播有效的信息。证据等级：四级。

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引用次数: 0

Evaluation of clinical outcomes after partial horizontal laryngectomy 部分水平喉切除术后临床效果的评价

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-29 DOI: 10.1016/j.bjorl.2025.101614

Daniel Abreu Rocha , Gustavo Fernandes de Alvarenga , Daniel Marin Ramos , Leandro Luongo de Matos , Rogerio Aparecido Dedivitis , Marco Aurélio Vamondes Kulcsar , Claudio Roberto Cernea

Objective

Evaluate the oncological and functional outcomes of patients submitted to HPL for the treatment of LSCC.

Methods

A retrospective descriptive study of patients submitted to HPL, performed at a cancer referral center, between January 2011 and December 2017.

Results

We evaluated 37 patients. The major pathological staging of the primary tumor was pT3 (35.1%), followed by pT2 (32.4%). Five patients required adjuvant radiotherapy; 62.2% of the patients were decannulated by the end of the treatment; 10.8% weren’t decannulated; 8.1% underwent a retracheostomy, and 18.9% had total laryngectomy. From the patients submitted to total laryngectomy, 3 cases were due to rehabilitation failure, 2 due to recurrence and 2 cases due to postoperative suture dehiscence. About 89% of the patients resumed oral feeding following the procedure; 86.4% didn’t present disease recurrence; 31 patients survived without disease; 3 died from disease-related causes, and 3 from unrelated causes.

Conclusion

HPL is an alternative procedure to total laryngectomy, presenting adequate rates of local control and overall survival while also maintaining laryngeal function. The main challenge to HPL remains achieving an ideal selection of patients.

Level of evidence

Level IV.

目的评价HPL治疗LSCC患者的肿瘤和功能预后。方法对2011年1月至2017年12月在癌症转诊中心接受HPL治疗的患者进行回顾性描述性研究。结果对37例患者进行评估。原发肿瘤病理分期以pT3分期为主（35.1%），其次为pT2分期（32.4%）。5例患者需要辅助放疗；治疗结束时，62.2%的患者脱胎换骨；10.8%未脱管；8.1%行气管再造口术，18.9%行全喉切除术。在接受全喉切除术的患者中，康复失败3例，复发2例，术后缝合开裂2例。约89%的患者术后恢复口服喂养；86.4%无疾病复发；31例无病存活；3人死于疾病相关原因，3人死于无关原因。结论hpl是一种可替代全喉切除术的手术方法，在维持喉功能的同时可获得足够的局部控制率和总生存率。HPL的主要挑战仍然是实现理想的患者选择。证据等级：四级。

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引用次数: 0