Anatomía quirúrgica en el carcinoma de paladar blando. Revisión bibliográfica

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Abstract

RESUMEN Introducción y objetivo: Describir las características clínicas y anatómicas, y el tratamiento quirúrgico que incluye varias técnicas de cirugía reconstructiva de carcinomas de paladar blando. Método: Realizamos una revisión narrativa sobre los carcinomas de paladar blando. Hicimos una revisión sobre los tumores del paladar blando señalando detalles anatómicos y la mayoría de las técnicas quirúrgicas reconstructivas empleadas para la extirpación del carcinoma del paladar blando. Conclusiones: La incidencia de carcinoma orofaríngeo está aumentando en todo el mundo esencialmente debido a la creciente prevalencia del virus del papiloma humano. Inicialmente, los tumores del paladar blando son silenciosos y debemos sospechar que eviten el diagnóstico tardío. El desarrollo de la cirugía transoral ha promovido el tratamiento quirúrgico en estos tumores y permite un mejor manejo y la necesidad de terapia adyuvante. La reconstrucción es obligatoria cuando la resección es superior al 50% del paladar blando

Translated abstract

ABSTRACT Introduction and objetive: To describe clinical and anatomical features, and surgical treatment including several techniques of reconstructive surgery of soft palate carcinomas. Method: We conducted a narrative review about soft palate carcinomas. We made a review on soft palate tumours pointing out anatomical details and most employed reconstructive surgical techniques for soft palate carcinoma´s removal. Conclusions: The incidence of oropharyngeal carcinoma is increasing world-wide esentially due to increasing prevalence of human papillomavirus. Initially, soft palate tumours are silent and we should suspect them to avoid late diagnosis. Transoral surgery development has promoted surgical treatment in these tumours and allows better management and need for adjuvant therapy. Reconstruction is mandatory when resection is over 50% of the soft palate.

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Transoral robotic resection and reconstruction for head and neck cancer.

Michelle S Teng, Nicolle Packer, Anthony Smith … (2011)

To evaluate the patterns of failure, survival, and functional outcomes for patients treated with transoral robotic surgery (TORS) and compare these results with those from a cohort of patients treated with concurrent chemoradiation (CRT). Prospective non-randomized case control study. Between April 2007 and April 2009, 30 patients with head and neck squamous cell carcinoma were treated with primary TORS and adjuvant therapy as indicated on an institutional review board-approved protocol. Patients were evaluated before treatment, after treatment, and at subsequent 3-month intervals after completing treatment to determine their disease and head and neck-specific functional status using the Performance Status Scale for Head and Neck Cancer and the Functional Oral Intake Score (FOIS). Functional scores were compared to a matched group of head and neck patients treated with primary CRT. The TORS patient population included 73% stage III-IV and 23% nonsmokers. The median follow-up was 20.4 months (range, 12.8-39.6 months). The 18-month locoregional control, distant control, disease-free survival, and overall survival were 91%, 93%, 78%, and 90%, respectively. Compared to the primary CRT group, TORS was associated with better short-term eating ability (72 vs. 43, P = .008), diet (43 vs. 25, P = .01), and FOIS (5.5 vs. 3.3, P < .001) at 2 weeks after completion of treatment. In contrast to TORS patients who returned to baseline, the CRT group continued to have decreased diet (P = .03) and FOIS (P = .02) at 12 months. Our early experience in treating selected head and neck cancers with TORS is associated with excellent oncologic and functional outcomes that compare favorably to primary CRT. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

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Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines

H Mehanna, Josie M. M. Evans, Jeannette M. Beasley … (2016)

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. There has been significant debate in the management of oropharyngeal cancer in the last decade, especially in light of the increased incidence, clarity on the role of the human papilloma virus in this disease and the treatment responsiveness of the human papilloma virus positive cancers. This paper discusses the evidence base pertaining to the management of oropharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care. Recommendations • Cross-sectional imaging is required in all cases to complete assessment and staging. (R) • Magnetic resonance imaging is recommended for primary site and computed tomography scan for neck and chest. (R) • Positron emission tomography combined with computed tomography scanning is recommended for the assessment of response after chemoradiotherapy, and has a role in assessing recurrence. (R) • Examination under anaesthetic is strongly recommended, but not mandatory. (R) • Histological diagnosis is mandatory in most cases, especially for patients receiving treatment with curative intent. (R) • Oropharyngeal carcinoma histopathology reports should be prepared according to The Royal College of Pathologists Guidelines. (G) • Human papilloma virus (HPV) testing should be carried out for all oropharyngeal squamous cell carcinomas as recommended in The Royal College of Pathologists Guidelines. (R) • Human papilloma virus testing for oropharyngeal cancer should be performed within a diagnostic service where the laboratory procedures and reporting standards are quality assured. (G) • Treatment options for T1–T2 N0 oropharyngeal squamous cell carcinoma include radical radiotherapy or transoral surgery and neck dissection (with post-operative (chemo)radiotherapy if there are adverse pathological features on histological examination). (R) • Transoral surgery is preferable to open techniques and is associated with good functional outcomes in retrospective series. (R) • If treated surgically, neck dissection should include levels II–IV and possibly level I. Level IIb can be omitted if there is no disease in level IIa. (R) • If treated with radiotherapy, levels II–IV should be included, and possibly level Ib in selected cases. (R) • Altering the modalities of treatment according to HPV status is currently controversial and should be undertaken only in clinical trials. (R) • Where possible, patients should be offered the opportunity to enrol in clinical trials in the field. (G)

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Time trends in the prevalence of HPV in oropharyngeal squamous cell carcinomas in northern Spain (1990-2009).

Juan Rodrigo, Daniëlle A M Heideman, Juana García-Pedrero … (2014)

Recent studies support an important role for human papillomavirus (HPV) in oropharyngeal squamous cell carcinomas (OPSCC), although the incidence varies widely depending on the geographic location and time period studied. The aim of this study was to determine the proportion of HPV in a large cohort of OPSCC in northern Spain in the years 1990-2009. Clinical records and paraffin embedded tumor specimens of 248 consecutive patients surgically treated for OPSCC (140 tonsillar and 108 base of tongue) between 1990 and 2009 were retrieved. OPSCC cases were histomorphologically evaluated, and protein expression of p16 and p53 was analyzed by immunohistochemistry. Detection of high-risk HPV DNA was performed by GP5+/6+-PCR and in situ hybridization (ISH). Thirty cases (12%) were positive for p16 immunostaining, of which eight (3.2% of the total series) were found positive for HPV type 16 by genotyping of GP5+6+-PCR products. All HPV GP5+/6+-PCR-positive tumors were p53-immunonegative, seven had a basaloid morphology and seven were also positive by HPV ISH. Presence of HPV correlated inversely with tobacco and alcohol consumption (p < 0.001), but not with age of onset of OPSCC. Overall survival was better in the HPV-positive group, although not statistically significant (p = 0.175). OPSCC patients in northern Spain demonstrated a low involvement of HPV, increasing (although not significantly, p = 0.120) from 1.8% in 1990-1999 to 6.1% of cases in 2000-2009.

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Journal

Journal ID (publisher-id): orl

Title: Revista ORL

Abbreviated Title: Rev. ORL

Publisher: Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )

ISSN (Electronic): 2444-7986

Publication date (Print and electronic): December 2020

Volume: 11

Issue: 4

Pages: 427-437

Affiliations

[2] Manresa orgnameFundació Althaia España

[1] Logroño orgnameHospital San Pedro orgdiv1Servicio de Otorrinolaringología España

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Publisher ID: S2444-79862020000400005 Publisher ID: S2444-7986(20)01100400005

SO-VID: bf69977f-9a88-43b4-8731-4801a43c9b28

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Date received : 17 May 2020

Date accepted : 22 May 2020

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Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 11

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Anatomía quirúrgica en el carcinoma de paladar blando. Revisión bibliográfica Translated title: Surgical anatomy of soft palate carcinoma. A systematic review

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Most cited references 25

Transoral robotic resection and reconstruction for head and neck cancer.

Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines

Time trends in the prevalence of HPV in oropharyngeal squamous cell carcinomas in northern Spain (1990-2009).

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