Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma? / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma? Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2014 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Head and neck squamous cell carcinoma  neck dissection  chemoradiotherapy  surgery  salvage Resumen : Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Kerry D Olsen, Jesus E Medina, Marc Hamoir, Vinidh Paleri, Vanni Mondin, Alessandra Rinaldo, Juan P Rodrigo, Carlos Suárez, Carsten C Boedeker, Michael L Hinni, Luiz P Kowalski, Afshin Teymoortash, Jochen A Werner, Robert P Takes, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3111-9. DOI (Digital Object Identifier) : 10.1007/s00405-014-2893-x PMID : 24515917 En línea : https://link.springer.com/article/10.1007%2Fs00405-014-2893-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3775 Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma? [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2014. Obra : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Head and neck squamous cell carcinoma  neck dissection  chemoradiotherapy  surgery  salvage Resumen : Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Kerry D Olsen, Jesus E Medina, Marc Hamoir, Vinidh Paleri, Vanni Mondin, Alessandra Rinaldo, Juan P Rodrigo, Carlos Suárez, Carsten C Boedeker, Michael L Hinni, Luiz P Kowalski, Afshin Teymoortash, Jochen A Werner, Robert P Takes, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3111-9. DOI (Digital Object Identifier) : 10.1007/s00405-014-2893-x PMID : 24515917 En línea : https://link.springer.com/article/10.1007%2Fs00405-014-2893-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3775

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Salvage surgery for head and neck cancer: a plea for better definitions / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Salvage surgery for head and neck cancer: a plea for better definitions Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2014 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Mención de responsabilidad : Alvaro Sanabria, Luiz P Kowalski, Ashok R Shaha, Carl E Silver, Jochen A Werner, Magis Mandapathil, Robert P Takes, Primož Strojan, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2014 Jun;271(6):1347-50. DOI (Digital Object Identifier) : 10.1007/s00405-014-2924-7 En línea : https://link.springer.com/article/10.1007%2Fs00405-014-2924-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3785 Salvage surgery for head and neck cancer: a plea for better definitions [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2014. Obra : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Mención de responsabilidad : Alvaro Sanabria, Luiz P Kowalski, Ashok R Shaha, Carl E Silver, Jochen A Werner, Magis Mandapathil, Robert P Takes, Primož Strojan, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2014 Jun;271(6):1347-50. DOI (Digital Object Identifier) : 10.1007/s00405-014-2924-7 En línea : https://link.springer.com/article/10.1007%2Fs00405-014-2924-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3785

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Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroidectomy  laryngeal nerve injuries  neuromonitoring  meta-analysis  systematic review Resumen : Neuromonitoring in thyroid surgery has been employed to make nerve identification easier and decrease the rates of laryngeal nerve injuries. Several individual randomized controlled trials (RCTs) have been published, which did not identify statistical differences in the rates of recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN) injuries. The objective of this report is to perform meta-analysis of the combined results of individual studies to measure the frequency of RLN and EBSLN injuries in patients who underwent thyroidectomy with routine neuromonitoring in comparison with common practice of search and identification. RCTs comparing routine neuromonitoring versus no use in patients who underwent elective partial or total thyroidectomy were evaluated. Outcomes measured were temporary and definitive palsy of the RLN and EBSLN. A systematic review and meta-analysis was done using random effects model. GRADE was used to classify quality of evidence. Six studies with 1,602 patients and 3,064 nerves at risk were identified. Methodological quality assessment showed high risk of bias in most items. Funnel plot did not reveal publication bias. The risk difference for temporary RLN palsy, definitive RLN palsy, temporary EBSLN palsy, and definitive EBSLN palsy were −2 % (95 % confidence interval −5.1 to 1); 0 % (−1 to 1); −9 % (−15 to −2) and −1 % (−4 to 2), respectively. Quality was rated low or very low in most outcomes due to methodological flaws. Meta-analysis did not demonstrate a statistically significant decrease in the risk of temporary or definitive RLN injury and definitive EBSLN injury with the use of neuromonitoring. The neuromonitoring group had a statistically significant decrease in the risk of temporary EBSLN injury. Mención de responsabilidad : Alvaro Sanabria, Adonis Ramirez, Luiz P Kowalski, Carl E Silver, Ashok R Shaha, Randall P Owen, Carlos Suárez, Avi Khafif, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Aug;270(8):2175-89. DOI (Digital Object Identifier) : 10.1007/s00405-013-2557-2 PMID : 23681545 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2557-2 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3714 Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2013. Obra : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroidectomy  laryngeal nerve injuries  neuromonitoring  meta-analysis  systematic review Resumen : Neuromonitoring in thyroid surgery has been employed to make nerve identification easier and decrease the rates of laryngeal nerve injuries. Several individual randomized controlled trials (RCTs) have been published, which did not identify statistical differences in the rates of recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN) injuries. The objective of this report is to perform meta-analysis of the combined results of individual studies to measure the frequency of RLN and EBSLN injuries in patients who underwent thyroidectomy with routine neuromonitoring in comparison with common practice of search and identification. RCTs comparing routine neuromonitoring versus no use in patients who underwent elective partial or total thyroidectomy were evaluated. Outcomes measured were temporary and definitive palsy of the RLN and EBSLN. A systematic review and meta-analysis was done using random effects model. GRADE was used to classify quality of evidence. Six studies with 1,602 patients and 3,064 nerves at risk were identified. Methodological quality assessment showed high risk of bias in most items. Funnel plot did not reveal publication bias. The risk difference for temporary RLN palsy, definitive RLN palsy, temporary EBSLN palsy, and definitive EBSLN palsy were −2 % (95 % confidence interval −5.1 to 1); 0 % (−1 to 1); −9 % (−15 to −2) and −1 % (−4 to 2), respectively. Quality was rated low or very low in most outcomes due to methodological flaws. Meta-analysis did not demonstrate a statistically significant decrease in the risk of temporary or definitive RLN injury and definitive EBSLN injury with the use of neuromonitoring. The neuromonitoring group had a statistically significant decrease in the risk of temporary EBSLN injury. Mención de responsabilidad : Alvaro Sanabria, Adonis Ramirez, Luiz P Kowalski, Carl E Silver, Ashok R Shaha, Randall P Owen, Carlos Suárez, Avi Khafif, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Aug;270(8):2175-89. DOI (Digital Object Identifier) : 10.1007/s00405-013-2557-2 PMID : 23681545 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2557-2 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3714

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Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroid gland  laryngeal nerve injuries  neuromuscular monitoring  thyroidectomy  tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713 Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2013. Obra : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroid gland  laryngeal nerve injuries  neuromuscular monitoring  thyroidectomy  tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713

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Superselective neck dissection : rationale, indications, and results / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Superselective neck dissection : rationale, indications, and results Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Neck dissection  selective neck dissection  superselective neck dissection neck metastases  neck levels Resumen : It has been established that an appropriately indicated selective neck dissection can achieve the same oncologic results as more extensive dissections. An even more modified selective neck dissection, termed superselective neck dissection, involves the compartmental removal of the fibrofatty tissue contents within the defined boundaries of two or fewer contiguous neck levels. Evidence from retrospective studies suggests that superselective neck dissection (SSND) is oncologically sound for two indications: elective treatment of the clinically N0 neck and salvage treatment of persistent lymph node disease after chemoradiotherapy. While there is broader support for the former scenario, evidence that SSND may constitute optimal treatment in the latter is in conformity with the trend toward developing surgical techniques that provide better functional outcomes without compromising efficacy. Mención de responsabilidad : Carlos Suárez, Juan P Rodrigo, K Thomas Robbins, Vinidh Paleri, Carl E Silver, Alessandra Rinaldo, Jesus E Medina, Marc Hamoir, Alvaro Sanabria, Vanni Mondin, Robert P Takes, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Nov;270(11):2815-21. DOI (Digital Object Identifier) : 10.1007/s00405-012-2344-5 PMID : 23321797 En línea : https://link.springer.com/article/10.1007%2Fs00405-012-2344-5 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3715 Superselective neck dissection : rationale, indications, and results [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2013. Obra : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Neck dissection  selective neck dissection  superselective neck dissection neck metastases  neck levels Resumen : It has been established that an appropriately indicated selective neck dissection can achieve the same oncologic results as more extensive dissections. An even more modified selective neck dissection, termed superselective neck dissection, involves the compartmental removal of the fibrofatty tissue contents within the defined boundaries of two or fewer contiguous neck levels. Evidence from retrospective studies suggests that superselective neck dissection (SSND) is oncologically sound for two indications: elective treatment of the clinically N0 neck and salvage treatment of persistent lymph node disease after chemoradiotherapy. While there is broader support for the former scenario, evidence that SSND may constitute optimal treatment in the latter is in conformity with the trend toward developing surgical techniques that provide better functional outcomes without compromising efficacy. Mención de responsabilidad : Carlos Suárez, Juan P Rodrigo, K Thomas Robbins, Vinidh Paleri, Carl E Silver, Alessandra Rinaldo, Jesus E Medina, Marc Hamoir, Alvaro Sanabria, Vanni Mondin, Robert P Takes, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Nov;270(11):2815-21. DOI (Digital Object Identifier) : 10.1007/s00405-012-2344-5 PMID : 23321797 En línea : https://link.springer.com/article/10.1007%2Fs00405-012-2344-5 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3715

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When is reoperative surgery not indicated for recurrent head and neck squamous cell carcinoma? / Álvaro Enrique Sanabria Quiroga  

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