OBJECTIVETo explore the surgical methods and evaluate the long-term result of laryngectomy in patients with supraglottic laryngeal cancer.

METHODS182 patients with supraglottic laryngeal carcinoma underwent operation from 1979 to 1999, with stage I 11, stage II 45, stage III 49 and stage IV 77 lesions. The choice of surgical procedure was decided with the disease condition of the larynx. The surgical procedures proposed by TD Wang were adhered to as: minor partial laryngectomy 36, major partial laryngectomy 85, subtotal partial laryngectomy with laryngoplasty 22 and total laryngectomy 39.

RESULTSThe ultimate rate of larynx preservation was 78.6% (143/182) with 69.8% (88/126) in stage III and IV diseases. The decannulation rate was 81.8% in cases with preservation of laryngeal function. The overall 3- and 5-year survival rates were 82.9% and 67.3%, with 76.88% and 57.4% in the advanced (stage III and IV) cases who survived with preserved laryngeal function. They were 82.5% and 67.0% in similar advanced cases who were treated by total laryngectomy. The difference in the survival rates between these two groups was not statistically significant.

CONCLUSIONIt is suggested that preservation of the laryngeal function be possible for advanced supraglottic laryngeal carcinoma without compromising the remote survival rate. To improve the rate of larynx preservation, one should follow the surgical methods suggested.

Adult ; Aged ; Female ; Humans ; Laryngeal Neoplasms ; mortality ; surgery ; Laryngectomy ; Male ; Middle Aged ; Survival Rate ; Treatment Outcome

OBJECTIVETo study the feasibility, surgical technique and results of laryngeal function preservation in surgical treatment for medial wall pyriform sinus cancer.

METHODSFrom 1992 to 1999, 31 patients with medial wall pyriform sinus cancer including stage I 1, II 4, III 14 and IV 12 lesions were treated. Partial resection of pyriform sinus and partial laryngectomy were performed, then, the remains of epiglottis and uni-pedicled sternohyoid myofascial flap were used to restore the defects of larynx. At last, the remaining hypopharyngeal mucosa was sutured to cover the wound of hypopharynx and for artificial rebuild-up. All patients received postoperative radiotherapy.

RESULTSThe 3- and 5-year survival rates were 62.1% and 43.6% respectively, with 77.4% patients having laryngeal functions (voice, respiration and deglutition) completely restored and 32.6% partially restored (voice and deglutition).

CONCLUSIONConservative surgery so introduced is feasible for selected medial wall pyriform sinus cancer patients with the lesion completely resected.

Adult ; Aged ; Feasibility Studies ; Female ; Humans ; Hypopharyngeal Neoplasms ; mortality ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Pharyngectomy ; methods

Objective To investigate the effect of esketamine combined with erector spinae plane block(ESPB)on the quality of early postoperative recovery in patients undergoing thoracoscopic pulmonary surgery.Methods Ninety patients who underwent thoracoscopic lung surgery(thoracoscopic radical resec-tion of lung cancer,thoracoscopic lobectomy or segmentectomy)from May 2022 to July 2023 were selected,47 males and 43 females,aged 18-64 years,BMI 18-25 kg/m2,ASA physical statusⅠorⅡ.According to random number table method,the patients were divided into two groups:the ESPB group(group C)and the esketamine combined with ESPB group(group D),45 patients in each group.Patients in the two groups completed ultrasound-guided ESPB,followed by sufentanil anesthesia induction and patient-controlled intra-venous analgesia(PCIA)in group C,while esketamineanesthesia induction,maintenance,and PCIA in group D.The intraoperative dosage of anesthetics,numerical rating scale(NRS)score during activity 1 hour,6,12,24,and 48 hours after operation,the number of PCIA compressions within 24 hours after op-eration,the number of rescue analgesia after operation,the recovery time of anesthesia,the incidence of postoperative nausea and vomiting within 2 days after operation and the adverse reactions related to esket-amine were recorded.The 40-item recovery quality scale(QoR-40)score was used to evaluate the quality of recovery of patients 1 day before operation and 2 days after operation.The hospital anxiety and depression scale(HADS)was used to assess patients anxiety and depression 1 day before surgery and at discharge.Results Compared with group C,the dosage of propofol and remifentanil intraoperatively,the incidence of postoperative nausea and vomiting were decreased(P＜0.05),the QoR-40 score was increased 2 days after operation,HADS score at discharge was decreased in group D(P＜0.05).Conclusion Esketamine combined with ESPB is safe and effective for patients undergoing thoracoscopic lung surgery.The periopera-tive analgesia is perfect,the adverse reactions are few,and the quality of early recovery is high,which pro-vides a new anesthesia choice for such surgery.

Objective To analyse the memory function and MRI changes in local-advanced nasopharyngeal carcinoma patients before-and after-radiation.Methods Clinical data,dosimetric data,digital span score and MRI of 14 cases with nasopharyngeal carcinom treated in Zhejiang Cancer Hospital from November 2015 to August 2016 were retrospectively analysed.There were 1 case at T2 stage,7 cases at T3 and 6 at T4.They received IMRT or TOMO therapy concurrent with 2 cycles Nedaplatin after 2-3 cycles PF/TP induction chemotherapy.Results The IMRT dosimetric data of 9 cases were available.For hippocampus and temporal lobe,the mean volume was (15.17 ± 2.17) and (95.07 ± 12.26) cm3,respectively,while the mean dose was (1 154.06 ±771.63) and (1 306.61 ±603.69) Gy,and the max dose (3 797.61 ± 1 450.98) and (5 394.17 ± 982.28) Gy,respectively.The equivalent uniform dose (EUD) was (2 233.28 ±872.73) Gy for hippocampus and (3 113.11 ±603.69) Gy for temporal lobe.10 patients received digit span score before-and 3 months after-radiotherapy.The mean score of forward digit span was 8.8 ± 1.8 before radiation and 8.1 ± 1.59 at 3 months after radiation(P ＞ 0.05),while thatof backward digit span decreased from 6.2 ± 1.04 before radiation to 5.3 ± 2.36 at 3 months after radiation (t =3.25,P ＜ 0.05).9 patients' MRI were available.Volume reduction of temporal lobe was observed (t =4.57,P ＜ 0.01) by voxel-based morphometry (VBM).Conclusions Radiation-induced injury to hippocampus and temporal lobe is inevitable in local-advanced nasopharyngeal carcinoma patients.There might be some connection between memory loss and temporal lobe volume atrophy after radiotherapy.Enrollment of larger sample analysis is expected.

Objective To analyze the radiation doses to the head, body, and tail of the hippocampus in intensity-modulated radiotherapy(IMRT)for nasopharyngeal carcinoma(NPC). Methods Ten NPC patients treated with IMRT were selected,and the head, body, and tail of both hippocampi were delineated on T1-weighted images. The doses to the hippocampus were then analyzed. WAIS-CR speech test results were tested by paired sample t-test. Results The mean doses to left and right hippocampi were 1 147±976 cGy and 1 011±602 cGy, respectively. The mean doses to the head, body, and tail of the left hippocampus were 1 739± 1 317 cGy, 890± 982 cGy, and 547± 688 cGy, respectively(P=0.042);the mean doses to the head,body,and tail of the right hippocampus were 1 691±942 cGy,744±483 cGy,and 531±603 cGy,respectively(P=0.002).The dose to the hippocampus decreased from the head to the tail, and the irradiated volume also decreased as the dose varied. Conclusions The dose to hippocampus decreases from the head to the tail in NPC patients treated with IMRT,which is worthy of attention.

Objective To analyze the exposed dose of hippocampus(HC)of T3,T4nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy(IMRT). Methods The bilateral HCs were delineated and were divided into head(HH),body(HB)and tail(HT)for 62 nasopharyngeal carcinoma patients treated with IMRT.The dose parameters of HC were then analyzed. Results The mean dose of left and right HC was(1 127±704)cGy,(1 173±762)cGy. The mean dose of left HH,HB and HT was(1 732±1029)cGy,(820±632)cGy,(423±366)cGy(P=0.000);while the mean dose of right HH, HB and HT was(1 985±1101)cGy,(837±531)cGy,(432±343)cGy(P=0.000).The exposed dose and the volume exposed in different dose of HH were obviously higher than those of HB and HT.The dose parameters of HH,HB and HT decreased in turn. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus correlated with high exposed dose of HC. Conclusions The exposed dose of HH,HB and HT was different in nasopharyngeal carcinoma patients treated with IMRT.The exposed dose of HH was the highest,which should be emphasized especially. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus suggest high exposed dose of HC.

Objective:To analyze the feasibility of hippocampal-avoidance (HA) prophylactic cranial irradiation (PCI) in small cell lung cancer patients (SCLC)(limited stage) after chemotherapy and thoracic radiation.Methods:From June 2016 to March 2019, 40 eligible SCLC patients were recruited and randomly divided into the routine PCI ( n=22) and hippocampal-avoidance PCI (HA-PCI) groups ( n=18). The HA zone was contoured according to the criteria of RTOG 0933. Volumetric-modulated arc therapy (VMAT) was adopted in the HA-PCI group. After radiotherapy, Hopkins verbal learning test (HVLT) and MRI were performed. Results:The average hippocampus volume was (4.01±1.57) cm 3, the average HA volume was (20.13±4.14) cm 3, HA D 100% was (7.19±0.38) Gy and HA D max was (14.38±1.18) Gy. During HVLT, 1-month-after-PCI vs. before-PCI (trial3, trial4, learning, percent retained), 1-month-after-PCI vs. after-PCI (trial3, learning), HA-PCI cohort showed advantages over PCI in HVLT scores. The average follow-up time was (17.00±8.47) months. Two patients with brain metastases which were out of the HAZ received routine PCI. Conclusions:PCI using VMAT technology to protect hippocampus is feasible in dosimetry. The test results indicate that the protective effect of hippocampus protection on memory is worthy of further promotion in clinical practice.