PURPOSE Sentinel node (SN) biopsy is accurate in operable oral and oropharyngeal cT1-T2N0 cancer (OC), but, to our knowledge, the oncologic equivalence of SN biopsy and neck lymph node dissection (ND; standard treatment) has never been evaluated. METHODS In this phase III multicenter trial, 307 patients with OC were randomly assigned to (1) the ND arm or (2) the SN arm (experimental arm: biopsy alone if negative, or followed by ND if positive, during primary tumor surgery). The primary outcome was neck node recurrence-free survival (RFS) at 2 years. Secondary outcomes were 5-year neck node RFS, 2- and 5-year disease-specific survival (DSS), and overall survival (OS). Other outcomes were hospital stay length, neck and shoulder morbidity, and number of physiotherapy prescriptions during the 2 years after surgery. RESULTS Data on 279 patients (139 ND and 140 SN) could be analyzed. Neck node RFS was 89.6% (95% CI, 0.83% to 0.94%) at 2 years in the ND arm and 90.7% (95% CI, 0.84% to 0.95%) in the SN arm, confirming the equivalence with P < .01. The 5-year RFS and the 2- and 5-year DSS and OS were not significantly different between arms. The median hospital stay length was 8 days in the ND arm and 7 days in the SN arm ( P < .01). The functional outcomes were significantly worse in the ND arm until 6 months after surgery. CONCLUSION This study demonstrated the oncologic equivalence of the SN and ND approaches, with lower morbidity in the SN arm during the first 6 months after surgery, thus establishing SN as the standard of care in OC.

The aims of this retrospective study were to evaluate prosthetic voice restoration by tracheoesophageal puncture (TEP) in laryngectomized patients and to identify clinical factors correlated with functional outcomes. Between 2000 and 2008, 103 patients who underwent total laryngectomy or pharyngolaryngectomy (TPL) were included in our study. Functional outcomes were recorded 6 months postoperatively, and results were scored from 0 to 2 for oral diet and speech intelligibility. Lifetime of voice prosthesis and early and late complications were recorded. The impact of several clinical factors on functional outcomes, prosthetic valve lifetime and complications was assessed in univariate analysis. A total of 87 patients (84%) underwent TEP and speech valve placement (79 primary and 8 secondary punctures). Hypopharyngeal tumors (P = 0.005), circular TPL (P = 0.003) and use of a pectoralis major myocutaneous flap (P = 0.0003) were significantly associated with secondary TEP. Successful voice rehabilitation was obtained by 77 of 82 evaluable patients (82%). A high level of comorbidity (ASA score > or = 3; P = 0.003) was correlated to speech rehabilitation failure. The median device lifetimes were 7.6 and 3.7 months for Provox I and II speech valves, respectively. Minor leakage around the valve occurred in 26% of the patients. Late complications occurred in 14 patients (16%) including: severe enlargement of the fistula (n = 3), prosthesis displacement (n = 7) and granulation tissue-formation (n = 4). In conclusion the use of voice prosthesis showed a high success rate of vocal rehabilitation with an acceptable complication rate.

this large retrospective study suggests that postoperative radiotherapy improves the locoregional control of HNMM. The higher rate of distant metastasis was due to more advanced disease in the SRT group.

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The aim of this retrospective study is to review the experience of our institution in performing microvascular head and neck reconstruction between 2000 and 2004. During this period, 213 free flaps, including 146 radial forearm free flaps, 60 fibular flaps and 7 scapular flaps, were performed. Free flap success rate and complications were reported. The pre-treatment factors influencing these results were subsequently analyzed. Functional and aesthetic outcomes were evaluated by the same clinician. There were 14 free flap failures, giving an overall free flap success rate of 93.4%. Salvage surgery for recurrent cancer was the only factor correlated with a higher risk of free flap failure (P = 0.0004). The local complication rate was 20.9%. High level of comorbidity (P = 0.009), salvage surgery for recurrent cancer (P = 0.03) and hypopharyngeal surgery (P = 0.002) were associated with a higher risk of local complications. An unrestricted oral diet and an intelligible speech were recovered by respectively 76 and 88% of the patients. Microvascular free flaps represent an essential and reliable technique for head neck reconstruction and allow satisfactory functional results.