08:10 Uhr
O01:
Perioperative predictors of early surgical revisions and flap-related complications following microvascular free tissue transfer in head and neck reconstruction
John-Patrik Burkhard (Bern | CH)
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Autor:innen:
John-Patrik Burkhard (Bern | CH)
Jelena Pfister (Bern | CH)
Claudia Lädrach (Bern | CH)
Manuel Waser (Bern | CH)
Benoît Schaller (Bern | CH)
Radu Olariu (Bern | CH)
Dominique Engel (Bern | CH)
Lukas Löffel (Bern | CH)
Roland Giger (Bern | CH)
Patrick Wüthrich (Bern | CH)
Objectives: The aim of this study was to identify perioperative predictors on early surgical revision and flap-related complications in free tissue Transfer for head and neck reconstruction.
Materials and Methods: Intraoperative amount of fluid and of vasopressors, and other relevant perioperative parameters were recorded in 131 patients undergoing head and neck microvascular reconstruction and compared with early surgical complications, defined as interventions within 30 days after initial surgery. The relationship between perioperative variables and the different complication categories was determined using an optimized multiple logistic regression.
Results: The administration of diuretics (OR 3.93 [95% CI 1.75, 9.14], p=0.001) as a treatment for perioperative fluid overload and the type of flap (2.90 [1.19, 7.18], p=0.019) was associated with a higher risk of early surgical revisions. Perioperative fluid overload (1.00 [1.00, 1.00], p=0.039) is significantly related to flap-related complications. We found no effect of intraoperative administration of vasopressors on early surgical revisions (1.00 [1.00, 1.00], p=0.8) or on flap-related complications (norepinephrine 1.00 [1.00, 1.00], p=0.6, dobutamine 1.00 [0.99, 1.01], p=0.5).
Conclusion: Perioperative fluid overload is associated with higher risks of early surgical revision and flap-related complications. In contrast, the administration of vasopressors seemed to have no effect on either surgical revision rate nor flap-related complications.
08:18 Uhr
O02:
Predicting Factors for Oncological and Functional Outcome in Hypopharyngeal Cancer
Miranda Visini (Bern | CH)
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Autor:innen:
Miranda Visini (Bern | CH)
Roland Giger (Bern | CH)
Lukas Anschütz (Bern | CH)
Olgun Elicin (Bern | CH)
Mohamed Shelan (Bern | CH)
Objectives:Hypopharyngeal squamous cell carcinoma (HPSCC) is a rare but aggressive malignancy, with low survival rates and high incidence of tumor and treatment-related morbidity. This study aims to analyze the long-term oncologic and functional outcomes of a large cohort of patients and to determine prognostic factors.
Methods:The records of all patients diagnosed with HPSCC and treated with curative intent between 2003 and 2015 at our tertiary referral center were reviewed. Patient and initial disease characteristics, features and complications of primary treatment, recurrence patterns and corresponding treatments and the oncologic and functional long-term outcome were determined.
Results:For a total 179 patients, primary radiotherapy (RT) was the predominant treatment modality (78%), whereas 22% underwent primary surgery. The median, 2-year and 5-year overall survival (OS) for the study cohort was 47 months, 64% and 43%, respectively. The 2- and 5-year relapse-free survival (RFS) was 52% and 36%. The median survival after first and second relapse was seven and six months, respectively. The median RFS after first relapse and salvage treatment was nine months. A nodal status of ≥ cN2 (HR=1.89, CI:1.21-3.05, p < 0.005) and any other primary tumor localization than pyriform sinus (HR=1.60, CI: 1.04-2.42, p < 0.05) were identified as independent risk factors for shorter OS and RFS. Regarding functional outcome, the 2- and 5-year laryngectomy-free-survival was 55% and 37%, respectively.
Conclusion:In this large cohort with long-term follow-up, any other primary tumor localization than pyriform sinus and ≥ cN2 were identified as risk factors for reduced OS and RFS in HPSCC.
08:26 Uhr
O03:
Fear of recurrence in patients with head and neck cancer: risk factors and implications for post-treatment follow-up
Julia Sophie Riggauer (Bern | CH)
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Autor:innen:
Julia Sophie Riggauer (Bern | CH)
Daniela Blaser (Bern | CH)
Olgun Elicin (Bern | CH)
Brigitta Gahl | CH)
Roland Giger (Bern | CH)
Simon Müller (Camperdown NSW | AU)
Objective: Although fear of cancer recurrence (FoR) is highly prevalent in survivors of head and neck squamous cell carcinoma (HNSCC) and impacts quality of life, it is rarely addressed in follow-up (FU) visits. This study investigated clinical and sociodemographic associations with FoR that would allow to recognize patients at risk.
Materials and methods: We conducted a cross-sectional survey among HNSCC survivors with complete response after curatively intended treatment. The survey included a 7-item FoR questionnaire that provides criteria for elevated FoR as well as a total FoR score value (range 7 to 40), and explored patients’ preferences regarding follow-up. Sociodemographic and clinical data were extracted from medical charts.
Results: Elevated FoR was present in 37% of the 101 included patients, who had significantly higher FoR overall scores than patients without elevated FoR (21.7 vs. 13.0, p < 0.001). Females and patients ≤ 65 years showed significantly higher FoR overall scores than males and patients > 65 years (score difference 3.40 [p=0.022] and 4.25 [p=0.002]). Recurrence or second primary malignancy during follow-up increased relative risk for elevated FoR (RR 1.7, p=0.046). Patients who preferred regularly imaging in FU had higher FoR overall scores (mean (SD): 17 [7.1] vs. 13 [4.2], p=0.034). Tumor stage and treatment modality were not associated with elevated FoR or FoR overall score.
Conclusion: FoR in HNSCC patients is associated with female sex, young age and history of past recurrence or second primary malignancy. Systematic screening and sensitization of clinicians is recommended to identify and adequately treat patients at risk.
08:34 Uhr
Q&A Session Presentations O01-O03
08:40 Uhr
O04:
Surgery as Single-Modality Treatment for Early-Stage Olfactory Neuroblastoma: An Institutional Experience, Systematic Review and Meta-analysis
Gregori Binz (Zürich | CH)
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Autor:innen:
Gregori Binz (Zürich | CH)
Christian Meerwein (Zürich | CH)
Georgios Nikolaou (Zürich | CH)
Michael Soyka (Zürich | CH)
David Holzmann (Zürich | CH)
Goals: Olfactory neuroblastoma (ONB) is a rare neuroendocrinetumor and accounts for approximately 3-6% of all sinunasal malignancies. Traditionally, the combination of surgical tumor resection and radiation therapy (RT) has been considered as “gold standard” in treatment protocols intended to cure.
Methods: We conducted a systematic review of the literature, a retrospective institutional case series and an individual patient data meta-analysis on only surgically treated ONB patients.
Results: The screening of over 3238 studies revealed 33 studies on 128 patients with purely surgically treated ONB, suiting for individual patient data meta-analysis. Our analysis revealed a disease-free survival (DFS) and overall survival (OS) of 67.7% and 75.4% at 5 years and 57.1% and 71.9% at 10 years, respectively. Univariate analysis showed that Kadish stage C/D and Hyams grading III//IV significantly affected OS (P 0.000 and P 0.000) and DFS (P 0.000 and P 0.002). For low-risk patients with absence of risk factors, the DFS was 80.6% at 5 years and 67.8% at 10 years, respectively. At our institution, a total of 10 patients was treated with surgery alone and remained alive and free of disease at last follow-up (median follow-up 83 months, IQR 32-123).
Conclusion: Surgery alone is an equivalent alternative to combined treatment in carefully selected low-risk ONB patients with better outcome measures than previously reported. The decision in favor of surgery as a single-modality treatment should be discussed at an interdisciplinary tumor board, and the question of microscopically clear surgical margins must be defined and addressed.
08:48 Uhr
O05:
Surgical margins in 3D planned mandibular resections for Squamous Cell Carcinomas of the oral cavity
Mona Lamy (Lausanne | CH)
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Autor:innen:
Mona Lamy (Lausanne | CH)
Stefano La Rosa (Lausanne | CH)
Martin Broome (Lausanne | CH)
Objectives : 3D planned mandibular resections using cutting guides and pre-planned plates are now widely used in oncological surgery. The main advantages are gain of time, precision and aesthetic outcomes. The drawbacks include costs, time for planning and printing the surgical tools. This time between the radiological data and the surgery may allow a tumour progression, rendering the custom-made guides useless. There is no consensus regarding surgical margins that should be planned to ensure a safe oncologic outcome. The purpose of this retrospective study is to evaluate if the planned margins are adequate.
Materials, methods : Inclusion criteria were: Squamous Cell Carcinomas of anterior and lateral floor of mouth with mandibular invasion (T4); mandibular resection using 3D planning and cutting guides. Between June 2015- December 2019, 17 patients met the criteria. Time between the planning and the surgery was recorded. We decided to use a margin of 1cm on the pre-operative CT-scans on each side of the tumours on our planning in all patients. We then measured the distance of the bone resection on the pathological specimen.
Results : All 17 patients had safe bone surgical margins (R0). The average time from the scanners used for the planning to the surgery was 33 days.
Conclusion : All the cutting guides could be used. The anatomo-pathological results showed safe oncological margins and no patients required a further resection. A 1cm margin during 3D planning for mandibular resections with 3D printed cutting guides, in patients with T4 Squamous Cell Carcinomas can therefore be considered safe.
08:56 Uhr
O06:
Radiofrequenzablation von Schilddrüsenknoten – erste Erfahrungen aus dem Luzerner Kantonsspital
Nadja Angela Stenz (Luzern | CH)
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Autor:innen:
Nadja Angela Stenz (Luzern | CH)
Maria del Sol Pérez Lago (Luzern | CH)
Michael Lehner (Wels | AT)
Gunesh Rajan (Luzern | CH)
Stefan Fischli (Luzern | CH)
Ziele
Die Radiofrequenzablation benigner Schilddrüsenknoten hat in den letzten Jahren als Behandlungsalternative zunehmend an Bedeutung gewonnen. Diese Arbeit stellt die ersten Ergebnisse der bisher durchgeführten Radiofrequenzablationen an unserem Zentrum zusammen.
Methoden
Retrospektiv wurden die Daten von 11 Patienten erfasst, bei welchen 12 benigne Schilddrüsenknoten ab Juni 2019 mittels Radiofrequenzablation am Luzerner Kantonsspital behandelt wurden. Die Grösse der benignen Schilddrüsenknoten im Ultraschall sowie der Hormonstatus wurden vor Radiofrequenzablation sowie in regelmässigen Abständen nach der Intervention kontrolliert. Zusätzlich wurden die peri-/postinterventionellen Komplikationen analysiert.
Resultate
Das Knotenvolumen konnte von 7.87±5.67 mL prätherapeutisch auf 3.53±3.28 mL (p = 0.002) und 1.99±1.75 mL (p = 0.028) 3 bzw. 10 Monate posttherapeutisch reduziert werden. Entsprechend einer Volumenreduktionsrate von 59.97% bzw. 77.73% nach 3 bzw. 10 Monaten. Bereits 1 Monat postoperativ kam es bei 63.63% Patienten zu einer Normalisierung der Schilddrüsenfunktion und 10 Monate postoperativ lag die Rate der Patienten mit normalen Hormonwerten bei 87.5%. In einem Fall kam es zu einer Weichteilinfektion, welche chirurgisch versorgt werden musste, bei einer Patientin kam es zu einer passageren Minderbeweglichkeit der Stimmlippen.
Schlussfolgerungen
Basierend auf unseren ersten Daten sehen wir als interdisziplinäres Schilddrüsenzentrum die Radiofrequenzablation als eine effektive Behandlungsmethode von Schilddrüsenknoten bei relevanter Volumenreduktion, guter Rate postinterventioneller Normalisierung der Hormonwerte sowie Erhaltung der Schilddrüsenfunktion.
09:04 Uhr
Q&A Session Presentations O04-O06
09:10 Uhr
O07:
Seconde localisation de carcinome épidermoïde opéré au Robot da Vinci : résultats oncologiques et fonctionnels.
Federico Soldati (Lausanne | CH)
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Autor:innen:
Federico Soldati (Lausanne | CH)
Karma Lambercy (Lausanne | CH)
Christian Simon (Lausanne | CH)
Objectifs
Etude rétrospective de patients présentant une seconde localisation de carcinome épidermoïde prise en charge par chirurgie trans-orale au robot Da Vinci. Analyse des résultats oncologiques et fonctionnels (FOSS) à long terme.
Matériel et Méthode
Etude rétrospective d’une série de patients présentant une deuxième localisation de carcinome épidermoide de la sphère ORL opérés par TORS au CHUV entre 2013 et 2017.
Inclusion des lésions néoplasiques secondaires oropharyngées et susglottiques, opérables au DaVinci, FOSS score disponible à plus de 3 mois de la chirurgie.
Exclusion des patients ayant bénéficié d’un suivi inférieur à 6 mois, patients ayant nécessité une pharyngo-laryngectomie totale par la suite.
Evaluation pré et post-opératoire au robot Da Vinci de la fonction de déglutition selon le score de FOSS.
Résultats
Nous présentons les résultats de 17 patients traités par TORS pour une seconde localisation de carcinome epidermoide situé au niveau de la base de langue (8), amygdale (6), sus-glottique (1) et du palais mou (2). Les 17 cas ont été réséqué en R0.
Les complications opératoires étaient l’hémorragie (1), tracheotomie pour extubation impossible dans un contexte d’oedème (1), sténose cicatritielle (1). Suivi de la fonction de déglutition par FOSS moyenne de 39 mois, 10 patients sur 17 patients gardent à long terme une FOSS score stable.
Conclusion
La chirurgie robotique trans-orale permet d’obtenir des résultats oncologiques et fonctionnels satisfaisants. Les complications sont rares et non spécifiques au Robot. Notre série de cas, bien documentée, révèle une stabilité du FOSS score à long terme, la fonction de déglutition est préservée.
09:18 Uhr
O08:
The Lateral Arm Flap for Reconstruction of Medium-size Defects in Head & Neck Surgery- a Case Series and how we do it
Marco Hösli (Luzern | CH)
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Autor:innen:
Marco Hösli (Luzern | CH)
Ilario Fulco (Aarau | CH)
Stephan Haerle (Luzern | CH)
Aim
Most common head and neck reconstruction free flaps are the radial forearm flap (RFF) and the anterolateral thigh (ALT) flap. In our opinion, these flaps are not ideal for medium-sized defects as they are too thin or too bulky. The lateral arm flap (LAF) is an excellent alternative.
Material and methods
Fourteen patients were included in this case series. All patients were pre-discussed in an interdisciplinary tumor-board, and the surgical resection was determined. A free lateral arm flap was raised and used for reconstruction tumor resection. Patients were followed up regularly.
Results
Data was collected regarding flap survival, complication rate, (neo-)adjuvant radiation or chemotherapy, outcome of speech and swallowing, and quality of life.
Conclusion
The lateral arm flap provides pliable, thin fasciocutaneous tissue, is safe and versatile and can be considered for medium-sized soft tissue defects in head and neck microsurgical reconstruction. Donor-side morbidity is low, as there is no functional impairment.
09:26 Uhr
O09:
Minimally invasive Management of Parapharyngeal Tumors
Manuel Schoch (Luzern | CH)
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Autor:innen:
Manuel Schoch (Luzern | CH)
Gunesh Rajan (Luzern | CH)
Introduction
Traditionally tumors of the parapharyngeal space (PPST) are resected through transcervical, transparotideal or even transmandibular approaches with subsequent morbidity such as facial nerve palsy, first bite syndrome, salivary cutaneous fistula or mandibular non-union among other disadvantages like long operation times and prolonged recovery. Therefore we would like to discuss the option of treating these tumors through transoral-endoscopic or robotic techniques.
Methods
It is a retrospective study with 6 patients treated from Mai 2019 to January 21 with a PPST at the department of Otolaryngology, Head Neck Surgery in a tertiary teaching hospital.
Results
Average follow-up is 9 months (3- 21 months) after surgery. 3 patients were male, 3 were females. Tumor resection was performed via TORS in 3 patients and endoscopically in 3 patients. Mean operation time 114 minutes (51-178). No perioperative or postoperative complications occurred in the cohort. Minor complications such as wound dehiscence was found in 2 patients. Histology demonstrated pleomorphic adenoma in all cases. No evidence of residual tumor was found in the follow up MRI so far.
Conclusion
We conclude that the transoral resection of PPST via TORS or endoscopical techniques is a safe and effective surgical approach to these kind of tumors.
09:34 Uhr
Q&A Session Presentations O07-O09