Treatment Of Cervical Metastases Research Articles

Неповоротний гортанний нерв, обумовлений аномальним ходом правої підключичної артерії (arteria lusoria), у пацієнтки з рецидивуючим папілярним тиреоїдним раком: перший в Україні документований клінічний випадок

Актуальність. Аберантна права підключична артерія (аrteria lusoria, AL) є рідкісною судинною аномалією дуги аорти в людини, що спостерігається з частотою 0,1–2,5 % та має важливе клінічне значення через поєднану аномалію ходу нижнього гортанного нерва (неповоротний гортанний нерв, НГН), імовірність пошкодження якого в тиреоїдній хірургії різко зростає. Уперше в Україні детально описаний клінічний випадок передопераційної діагностики AL, інтраопераційної ідентифікації НГН та проаналізований сучасний стан розробки питання. Мета: на прикладі історії пролікованої пацієнтки з папілярним тиреоїдним раком та аналізу світової літератури показати важливість дослідження анатомії дуги аорти з імовірним утворенням AL, що, у свою чергу, викликає ембріональне аномальне формування НГН із високим ризиком його пошкодження при операціях на щитоподібній залозі. Матеріали та методи. Наведений випадок рецидивуючого папілярного раку щитоподібної залози в молодої жінки, яка була двічі оперована (тотальна тиреоїдектомія з лівобічною радикальною дисекцією шиї, правобічна латеральна та центральна редисекція шиї), перед другою операцією при комп’ютерній томографії виявлена аномалія правої підключичної артерії. Запідозрена наявність правобічного НГН, що було підтверджено під час операції за допомогою електрофізіологічного нейромоніторингу. Аналіз відповідної світової літератури засвідчив актуальність питання, відсутність вітчизняних аналогів. Результати. На підставі отриманих при комп’ютерній томографії (із 3D-реконструкцією великих судинних структур шиї) зображень було встановлене аберантне відгалуження правої підключичної артерії від дистальної частини дуги аорти— AL. Було припущене існування нервової аномалії— НГН праворуч. Шляхом застосування електронейромоніторингу та дисекції правого блукаючого нерва під час операції судинно-нервова аномалія була підтверджена, що дозволило уникнути хірургічних ускладнень у вигляді порушення функції гортані, успішно провести хірургічне лікування шийних метастазів тиреоїдного раку. Висновки. Плануючи операції на щитоподібній залозі, слід мати на увазі можливість існування судинної аномалії дуги аорти з відповідним ризиком пошкодження нижнього гортанного нерва, що має неповоротний хід. Рентгенологічне або сонографічне обстеження може виявити аберантне розташування правої підключичної артерії, а застосування електронейромоніторингу— знайти НГН для уникнення його пошкодження при операціях на шиї.

P07.05 * THE ROLE OF SURGERY IN PALLIATIVE TREATMENT OF METASTASES INVOLVING THE CERVICAL SPINE. OUR EXPERIENCE AND REVIEW OF THE LITERATURE

INTRODUCTION: Spinal column is the most common site of skeletal metastases. Cervical spine involvement may occur in 10% of cases. In cervical spine metastases the surgery may have an important role in multidisciplinary palliative treatment. Pain control, neurological improvement, the restoration of cervical spine stability and the very soon mobilization were effective in improving quality of life of these patients with minimally invasive surgical technique. CASE REPORTS: CASE 1) A 68 year-old man with an history of prostate cancer was admitted to our observation with intractable cervical pain. Cervical CT scan and MRI revealed a lesion involving C2. Surgical treatment: biopsy and vertebroplasty of C2 (transoral approach). The post-operative course was uneventful; neck pain relief was reported. Pathological examination was: metastases from prostate cancer. CASE 2) A 51 year-old man with an history of lung cancer was admitted to our observation with radicular pain of the right arm. Cervical CT scan and MRI revealed a vertebral body destruction of C4. Surgical treatment: complete C4 anterior corpectomy and fusion (Ulrich ADD-plus). Uneventful procedure; pain relief was reported. Pathological examination was: metastases from lung cancer. CASE 3) A 49 year-old woman with an history of breast cancer was admitted to our observation with cervical radiculopathy. Cervical CT scan and MRI revealed a vertebral body destruction of C7. Surgical treatment: complete C7 anterior corpectomy and fusion (Ulrich ADD-plus). Uneventful procedure; pain relief was reported. Pathological examination was: metastases from breast cancer. CONCLUSIONS: Minimally invasive surgery may be considered in multidisciplinary palliative treatment. In our cases the surgery has really improved the quality of life of the patients (relief of pain, stabilization of cervical spine). A review of the literature confirmed that in selected cases surgical treatment of cervical metastases is feasible and associated to low rate of morbility.

Surgical outcome and strategy for cervical metastasis

Objective To investigate surgical strategy and outcome for cervical metastasis in different anatomical segments.Methods Data of 31 patients,who had undergone surgical treatment for cervical metastasis from 2001 to 2009,were retrospectively analyzed.Two anatomical regions were defined:upper cervical spine (C1 and C2)and subaxial cervical spine plus cervicothoracic junction (C3-T1).VAS score,Frankel grade,Tomita score and Karnofsky performance scale were used to evaluate pain,neurological status,expected survival time and general health.The improvement of symptoms,survival time and characteristics of surgical strategies for different anatomical regions were analyzed.Results Twenty-four patients were followed up successfully.An effective recovery in neck pain and quality of life was found after operation.The median survival time was 45.0 months.In upper cervical spine group,the surgical strategies included posterior occipitocervical fixation combined with 125I seed brachytherapy and other surgical methods,and the median survival time 48.0 months) of patients who underwent 125I seed brachytherapy was longer than that 22.0 of patients treated with other surgical methods.In C3-T1 metastasis group,patients who underwent combined anterior-posterior approach total spondylectomy had a longer survival time than those treated with anterior corpectomy.Conclusion Surgical treatment can effectively relief neck pain,maintain or improve neurological function and improve quality of life.Doctors should choose different surgical strategies according to anatomical region of cervical metastasis.For upper cervical spine,the main purpose of surgery is to stabilize the cervical spine; the posterior occipitocervical fixation is usually chosen,and the 125I seed brachytherapy is useful in local control of metastasis.For subaxial cervical spine and cervicothoracic junction,the anterior corpectomy is usually chosen,and a combined anterior-posterior approach total spondylectomy can be used for patients with corresponding conditions. Key words: Cervical vertebrae; Neoplasm metastasis; Surgical procedures, operative

第5回頭頸部癌化学療法研究会]舌癌T1・T2症例に対する頸部リンパ節の制御について

第5回頭頸部癌化学療法研究会]舌癌T1・T2症例に対する頸部リンパ節の制御について

Surgical treatment in head and neck cancer

Three topics currently important in head and neck surgery are voice-conserving surgical treatment of laryngeal cancer, the role of modified radical neck dissection in the treatment of cervical metastases, and reconstruction and rehabilitation of the head and neck cancer patient. The laser has become an accepted modality for the treatment of early vocal cord cancer and has local control rates comparable to other treatment methods. Partial laryngectomy can conserve voice and yield excellent local control rates. The modified radical neck dissection has been shown to yield rates of local recurrence no greater than radical neck dissection for N0 and N1 neck disease associated with laryngeal cancer. Vocal rehabilitation following total laryngectomy has been revolutionized by the tracheoesophageal puncture procedure. Most patients can be expected to acquire voice using tracheoesophageal puncture following total laryngectomy. Free flaps have improved the functional results of many major head and neck surgical procedures and offer the possibility of better results in the future. However, more conventional reconstructive techniques, including local flaps, continue to have a role in head and neck surgery.

Analysis of radical neck dissections in the treatment of cervical metastases

Abstract A report of the total experience and end results of 519 radical neck dissections in 441 patients treated from 1940 through 1958 is presented. The primary cancer was located in the oral cavity in 36 per cent, in the laryngopharyngeal area in 43 per cent and in the thyroid in 6 per cent. Sixty per cent presented metastases at the first examination. Bilateral nodal enlargement was present at the initial examination in 9 per cent. Single nodal involvement was recorded in 46 per cent and multiple nodes in the same neck in 31 per cent. The histology was predominantly differentiated squamous cell carcinoma (85 per cent). Thirty-one cases of adenocarcinoma include twenty-seven thyroid tumors. The absolute five year survival for the entire group (single and bilateral) of 441 patients is 32.4 per cent and for the determinate group 35 per cent. An operative mortality of 5.2 per cent is reported. In the group requiring single neck dissections the absolute five year survival is 38 per cent and for the determinate group 41.6 per cent. In the 107 patients with bilateral metastases, 81 had bilateral neck dissection. Three of these were performed simultaneously, with one patient surviving over five years. The postoperative mortality for this group was 2.4 per cent. Five of the sixteen patients who survived after bilateral neck dissection had thyroid cancers, in eight it was located in the larynx, and in one each in the hypopharynx, tonsil and soft palate. End results are presented for six types of procedures employed in this series. The combined procedure of resection of the primary lesion in continuity with radical neck dissection in which no palpable nodes are present offers the best results. In the group of 441 patients, histologic examination of the neck dissection specimens revealed no evidence of metastatic cancer in the lymph nodes in fifty-three patients. Retrospective evaluation of so-called “elective” neck dissections (thirty-four patients) yielded positive nodes in 23 per cent.

Analysis of radical neck dissections in the treatment of cervical metastases

A report of the total experience and end results of 519 radical neck dissections in 441 patients treated from 1940 through 1958 is presented. The primary cancer was located in the oral cavity in 36 per cent, in the laryngopharyngeal area in 43 per cent and in the thyroid in 6 per cent. Sixty per cent presented metastases at the first examination. Bilateral nodal enlargement was present at the initial examination in 9 per cent. Single nodal involvement was recorded in 46 per cent and multiple nodes in the same neck in 31 per cent. The histology was predominantly differentiated squamous cell carcinoma (85 per cent). Thirty-one cases of adenocarcinoma include twenty-seven thyroid tumors. The absolute five year survival for the entire group (single and bilateral) of 441 patients is 32.4 per cent and for the determinate group 35 per cent. An operative mortality of 5.2 per cent is reported. In the group requiring single neck dissections the absolute five year survival is 38 per cent and for the determinate group 41.6 per cent. In the 107 patients with bilateral metastases, 81 had bilateral neck dissection. Three of these were performed simultaneously, with one patient surviving over five years. The postoperative mortality for this group was 2.4 per cent. Five of the sixteen patients who survived after bilateral neck dissection had thyroid cancers, in eight it was located in the larynx, and in one each in the hypopharynx, tonsil and soft palate. End results are presented for six types of procedures employed in this series. The combined procedure of resection of the primary lesion in continuity with radical neck dissection in which no palpable nodes are present offers the best results. In the group of 441 patients, histologic examination of the neck dissection specimens revealed no evidence of metastatic cancer in the lymph nodes in fifty-three patients. Retrospective evaluation of so-called “elective” neck dissections (thirty-four patients) yielded positive nodes in 23 per cent.