China ; Head and Neck Neoplasms ; surgery ; Humans ; Reconstructive Surgical Procedures

Child ; Female ; Head and Neck Neoplasms ; Humans ; Multiple Endocrine Neoplasia Type 2b ; Proto-Oncogene Proteins c-ret ; genetics

OBJECTIVETo evaluate the efficacy of pedicled supraclavicular artery island flaps for head and neck reconstruction.

METHODSReconstructive surgeries for head and neck oncologic defects were performed with the pedicled supraclavicular artery island flaps in 10 patients from May 2013 to December 2014 and the cases were review. Among them, 6 were performed for hypopharyngeal cancer, 2 for oral tongue cancer, 1 for oral base cancer and 1 for cervical esophageal cancer. The size of the flaps was measured in (5-8) cm × (6-12) cm.

RESULTSSeven flaps survived, one flap failured and two flaps had partial necrosis. Donor sites were closed primarily without morbidity.

CONCLUSIONThe pedicled supraclavicular artery island flap is an easy harvesting and reliable for head and neck reconstruction, especially suitable for otolaryngo-head and neck surgeon and maxillofacial surgeon in the local hospital.

Arteries ; Esophageal Neoplasms ; surgery ; Head ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Mouth Neoplasms ; surgery ; Neck ; surgery ; Reconstructive Surgical Procedures ; Surgical Flaps ; Tongue Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETry to use free jejunum flaps reconstruction and laryngeal preservation for squamous cell carcinoma (SCC) in the pharyngoesophageal junction.

METHODSThirteen patients who underwent resections of SCC in the pharyngoesophageal junction with free jejunal interposition from August 2007 to December 2012 were reviewed. Of them, 8 had T3 lesions, 4 had T4 lesions, and one had radiation failure with rT2 lesion. Ten patients were treated with postoperative radiotherapy with a average dosage of 56 Gy.

RESULTSThe 3 year over all survival rate was 47.9% and disease-specific survival rate was 34.2%. The surgical complications occurred in 9 patients (9/13), including one death and one flap failure. Five patients (5/13) had permanent tracheal canulation, 10 patients (10/13) resumed oral feeding and all patients achieved reasonable speech.

CONCLUSIONFree jejunum interposition can be used to reconstruct surgical defect of SCC in the pharyngoesophageal junction, thus preserving the larynx and ensuring a better quality of life for the patients.

Anastomosis, Surgical ; Carcinoma, Squamous Cell ; surgery ; Esophagus ; Humans ; Jejunum ; surgery ; Larynx ; Larynx, Artificial ; Neck ; Postoperative Complications ; Quality of Life ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Survival Rate

OBJECTIVETo investigate the relationship between HPV-DNA status and p16 protein expression in oropharyngeal squamous cell carcinoma (OSCC) and their clinical significance.

METHODSSixty-six patients with oropharyngeal squamous cell carcinomas treated in the Cancer Hospital of Chinese Academy of Medical Sciences from Jan. 1999 to Dec. 2009 were included in this study. Their formalin-fixed and paraffin-embedded tumor tissue blocks met the eligibility criteria and were used in this study. A "sandwich" technique was used to prepare paraffin sections for HPV-DNA analysis. HPV-DNA was detected using the SPF10 LiPA25 version 1 assay. The expression of p16 protein was detected by immunohistochemistry. The survival rates of patients with different HPV-DNA and p16 protein status were analyzed.

RESULTSHPV-DNA was detected in 11 (16.7%) of all specimens. Expression of p16 protein was detected in 9 of the 11 patients with HPV-positive tumors, and in 12 patients of 55 HPV-negative tumors. The expression of p16 protein was highly correlated with the presence of HPV-DNA (P < 0.001). The tumors were classified into three groups based on the p16 protein expression and HPV-DNA status: group A (9 patients): HPV(+) and p16 protein(+); group B (14 patients): HPV-DNA(+)/p16 protein(-) or HPV-DNA(-)/p16 protein(+); and group C (43 patients): HPV-DNA(-)/p16 protein(-). The 3-year OS rates of these 3 groups were 100%, 77.8% and 42.0% (P = 0.001), and their DSS rates were 100%, 77.8% and 46.4%, respectively(P = 0.004).

CONCLUSIONSIn oropharyngeal squamous cell carcinomas, p16 protein expression is highly correlated with the presence of HPV-DNA, and might be a surrogate marker for HPV-positive OSCC. Combination of p16 protein and HPV-DNA status detection may help to more accurately stratify oropharyngeal carcinomas and predict their prognosis.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; genetics ; metabolism ; virology ; Cyclin-Dependent Kinase Inhibitor p16 ; metabolism ; DNA, Viral ; isolation & purification ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Oropharyngeal Neoplasms ; genetics ; metabolism ; virology ; Papillomaviridae ; Papillomavirus Infections ; genetics ; metabolism ; Survival Rate

OBJECTIVETo evaluate the application of digital and three-demention (3D) print technique in reconstruction of complex jaw defect after removal of maxillofacial cancer.

METHODSFrom May 2013 to January 2015, 10 cases were enrolled in the study, 3 were maxillary defects and 7 were mandibular defects. The process included preoperative computer aided design, template and model manufacture with 3D Printer, intraoperative ablation and shaping of fibula based on template, flap suture and vessel anastomosis.

RESULTSAll the cases were successfully operated according to preoperative computer aided design, and all the fibulas and skin islands survived. All the cases had regular diet 2 weeks after surgery and showed satisfying appearance.

CONCLUSIONDigital and 3D print technique has good practicability in reconstruction of complex jaw defect with free fibula.

Bone Transplantation ; Computer-Aided Design ; Fibula ; Humans ; Jaw Neoplasms ; surgery ; Mandible ; pathology ; Maxilla ; pathology ; Printing, Three-Dimensional ; Reconstructive Surgical Procedures ; Surgical Flaps

OBJECTIVEResection of local advanced hypopharyngeal cancer often results in laryngeal preservation impossible. Free flaps were used to reconstruct and to preserve functional larynx.

METHODSRetrospective review of 11 patients who underwent resections of extended squamous cell carcinoma of hypopharynx from September 2005 to September 2011. Of 11 patients, 5 had T3 lesions and 6 had T4 lesions; 2 underwent radiotherapy before surgery and other 9 had postoperative radiotherapy (60 Gy). A total of 12 free flaps, including 10 radial forearm flaps and 2 anterolateral thigh flaps, was used in the 11 patients for laryngo pharyngeal reconstruction.

RESULTSThe 3 year over all survival rate and disease-specific survival rate were 43.6% and 48.0%, respectively. The incidence of surgical complications was 72.7%, including 1 with carotid blow-up, 2 flap failure, 3 fistula, and 1 stenosis. The rate of decannulation was 72.7%, 90.9% patients were with oral feeding and 81.8% patients achieved reasonable speech.

CONCLUSIONFree flaps can be used to reconstruct a functional larynx in local advanced hypopharyngeal carcinoma, ensuring a better quality of life for patients.

Adult ; Female ; Free Tissue Flaps ; Humans ; Hypopharyngeal Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin Transplantation ; methods

OBJECTIVETo analyze the clinical characteristics, prognosis and molecular biological changes of tonsillar squamous cell carcinoma (TSCC).

METHODSRetrospective analysis of 61 TSCC cases treated from January 1999 to December 2012. Demographic data and clinical charts, including histologic grade of tumor, treatment and outcome of the patients, were reviewed.Human papillomavirus (HPV)-DNA were detected using SPF10-DNA enzyme immunoassay and LiPA genotyping method. Expressions of p16 and p53 proteins were examinated by immunohistochemistry. Survival rate was calculated with SPSS 19.0 software using the Kaplan-Meier method.

RESULTSThere were 55 males and 6 females, with a median age of 57 years. Of the 61 TSCC, 21 were with well differentiation, 19 with moderate differentiation and 21 with poor differentiation, including 7 patients at stage II, 10 at stage III and 44 at stage IV. HPV-positive rate of TSCC was 29.5% (18/61) and high-risk HPV-16 subtype accounted for 72.2% (13/18). The percentage of famel patients in HPV-positive TSCC was higher than HPV-negative TSCC (22.2% vs 4.7%).HPV-positive TSCC was more common in non-smoking patients (50.0% vs 79.1%, χ(2) = 5, 155, P = 0.023) and non-drinking patients (27.8% vs 51.2%, χ(2) = 4.346, P = 0.037). HPV-positive TSCC mostly presented with high expression of p16 protein (88.9% vs 16.3%, χ(2) = 28.481, P = 0.000), and low expression of p53 protein (72.7% vs 46.5%, χ(2) = 5.028, P = 0.025). The prognosis of patients with HPV-associated TSCC was significantly better than non-HPV-associated TSCC, and The 3-year and 5-year overall survival rates of patients with HPV-positive TSCC were higher than those of patients with HPV-negative TSCC (87.7% vs 49.5% and 78.9% vs 33.0%, respectively).

CONCLUSIONHPV-associated TSCC had unique clinicopathological and molecular biological features, showing better prognosis compared to HPV-negative TSCC.

Carcinoma, Squamous Cell ; Female ; Genes, p16 ; Genotype ; Human papillomavirus 16 ; Humans ; Immunohistochemistry ; Male ; Papillomaviridae ; Papillomavirus Infections ; Prognosis ; Retrospective Studies ; Smoking ; Survival Rate ; Tonsillar Neoplasms ; metabolism ; virology ; Tumor Suppressor Protein p53 ; metabolism

OBJECTIVETo investigate the risks for occult carcinoma in contralateral nodules for unilateral papillary thyroid carcinoma.

METHODSThe study included 157 consecutive cases of unilateral papillary thyroid carcinoma with benign nodules in the contralateral lobe identified by preoperative ultrasound or fine-needle aspiration from January 2011 to December 2013. The patients received total thyroidectomies and neck lymph node dissections. The frequency and predictive factors for contralateral occult carcinoma in these patients were analyzed.

RESULTSA total of 68 patients (43.3%) had occult papillary thyroid carcinoma in the contralateral lobe and the maximum diameter of contralateral occult papillary carcinoma ranged from 0.1 to 1.2 cm, including ≤ 0.5 cm in 56 patients, 0.5-1.0 cm in 9 patients and >1.0 cm in 3 patients respectively. In univariate analysis, occult carcinoma in the contralateral lobe was associated with patient age (χ(2) = 7.266, P = 0.007) and pathologically multifocality in the ipsilateral lobe (χ(2) = 5.090, P = 0.024), but not with family history, tumor size, thyroid function, Hashimoto's thyroiditis, perithyroidal invasion, multifocality in the ipsilateral lobe, clinically or pathologically node-negative neck. In multivariate Logistic an analysis, age (OR = 1.054, P = 0.001) and multifocality in the ipsilateral lobe on final pathology (OR = 2.443, P = 0.021) were independent predictive factors for contralateral occult papillary thyroid carcinoma.

CONCLUSIONSOccult carcinoma is common in the contralateral "benign" nodules in patients with unilateral papillary thyroid carcinoma especially in young patients or the cases with multifocal tumors.

Biopsy, Fine-Needle ; Carcinoma ; diagnosis ; Carcinoma, Papillary ; diagnosis ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Neck ; Thyroid Neoplasms ; diagnosis ; Thyroidectomy

OBJECTIVETo study the patterns of cervical lymph node metastasis of medullary thyroid carcinoma.

METHODSNinety-one patients with medullary thyroid carcinoma first treated between January 1999 and October 2014 were analyzed retrospectively. Of 91 patients, 39 cases presented with clinical negative node (cN0) and 52 cases with clinical positive node (cN+). Central compartment dissection was performed in all cases. Lateral neck dissection was performed in 52 cN+ cases (71 sides). All neck dissection specimens were obtained and analyzed for lymph node (LN) involvement with respect to neck levels. The distribution of LN with metastasis was studied in cN+ patients and the following factors were used to study the predictive value of central compartment LN metastasis: sex, age, family history, tumor size, bilateral tumor, multifocality of the tumor, extracapsular spread, and remote metastasis. Univariate analysis with the χ(2) test was used to analyze the statistical correlation between central compartment LN metastasis and other clinical factors. Multiple logistic regression analysis was used to identify the factors related to central compartment metastasis.

RESULTSNeck and bilateral neck metastasis rates were 73.6%, 19.8% respectively. Metastasis rates in central compartment and superior mediastinal region were 68.1% and 27.5% respectively. The central compartment metastasis rate was 33.3% in cN0 patients and 94.2% in cN+ patients. The superior mediastinal metastasis rate was 2.6% in cN0 patients and 46.2% in cN+ patients. Extracapsular spread was an independent predictive factor for central compartment metastasis (χ(2)=15.592, P=0.000, OR=12.876). The incidences of LN metastases at level II, III, IV, V were 62.9%,84.5%,83.1%,50.0% in cN+ patient, respectively. Multi-sites were involved. The possibility of lateral neck metastasis was higher when preoperative value of calcitonin was higher than 300 ng/L (66.7% vs 28.6%, χ(2)=5.771, P=0.016).

CONCLUSIONSCervical lymph node metastasis of medullary thyroid carcinoma is higher. Central compartment dissection is necessary in cN0 patients with extracapsular spread. Neck dissection from level II to level VII was necessary in cN+ patients. Preoperative value of calcitonin maybe can predict the lateral neck metastasis incidence.

Carcinoma ; Carcinoma, Neuroendocrine ; diagnosis ; pathology ; therapy ; Head and Neck Neoplasms ; diagnosis ; pathology ; therapy ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Mediastinal Neoplasms ; Neck ; Neck Dissection ; Retrospective Studies ; Thyroid Neoplasms ; diagnosis ; pathology ; therapy