Study of Postlaryngectomy Stomal Recurrence

Keim, W. Franklin; Shapiro, M. J.; Rosin, H.

doi:10.1001/archotol.1965.00750050190014

Cited by 108 publications

(67 citation statements)

References 2 publications

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“…Prognostic significance of this factor is controversial, as it is most frequently related to higher tumour stage as well as poorer overall performance status of patients and thus may not be an independent prognostic factor. It should be noted that the procedure alone may result in tumour cell implantation and, consequently, the development of recurrence [32,46,47,49]. The performed analysis and the above-cited literature reports indicate that individual prognostic factors, when considered alone, may sometimes lack prognostic significance.…”

Section: Discussionmentioning

confidence: 87%

“…Meredith et al [22] suggest irradiation of the pre-existing tracheostomy region. In the literature reports, the recurrence rates in patients who have undergone emergency tracheostomy range between 27% and 71% [7,43,46,47,48]. Prognostic significance of this factor is controversial, as it is most frequently related to higher tumour stage as well as poorer overall performance status of patients and thus may not be an independent prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

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Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Mucha-Małecka¹,

Składowski²,

Lange³

2015

pjp

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The aim of the study was to assess the prognostic value of postoperative histopathological factors as well as the clinical usefulness of the modified risk score for recurrence. In a group of 197 patients with laryngeal cancer who underwent surgery followed by radiation therapy, partial resection was performed in 21.5% of patients and total resection in 78.5%. The majority of patients had T3 or T4 (74%) and N0 (63%) cancer. Macroscopically positive margins were reported in 10% of patients after partial resection and in 7% of patients after total resection, whereas microscopically positive margins were observed in 31% and 20% of cases, respectively. Extracapsular extension was observed in 22% of patients. In order to estimate local and nodal recurrence risk rates, criteria developed by Peters were used. Five-year local control (LC) was achieved in 88% of patients, disease-free survival (DFS) in 68% of patients and overall survival (OS) in 73% of patients. In the case of macroscopically positive margins, the 5-year DFS was 33% lower compared to radical surgery and 25% lower in the case of microscopically positive margins. The 5-year DFS was reduced by 29% due to extracapsular extension. Cox model analysis indicated that the degree of recurrence risk was the most potent independent prognostic factor for postoperative radiation therapy in laryngeal cancer. Negative histopathological factors influencing results of combined treatment of laryngeal cancer include macro-and microscopically positive margins, neck lymph node involvement and extracapsular extension.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Mucha-Małecka¹,

Składowski²,

Lange³

2015

pjp

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“…Tumor recurrence may develop adjacent to the stoma and grow from the mucocutaneous junction of the tracheostomy or the scar in the skin. Stomal recurrence has usually been associated with extensive tumors that extend into the submucosa of the subglottis and often erode through cartilage into the extralaryngeal tissues (29,30).…”

Section: Stomal/peristomal Recurrencementioning

confidence: 99%

Laryngectomy whole organ serial sections Histological Parameters Correlated with Recurrence Rate

Vermund¹,

Krajči²,

Eide³

et al. 2004

Acta Oncologica

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“…The final histology was consistent with FVPC. (Figures 3 and 4) He is loco regionally controlled and is on follow up on eltroxin suppression for more than 2 years post his salvage surgery.Keim [2] introduced the concept of recurrence in the tracheostoma as a diffuse neoplastic infiltration, at the junction between the trachea stump and the skin in relation to laryngeal cancers. The true rates of tracheostomal recurrences are unknown because many series classify these as part of local recurrences.…”

mentioning

confidence: 99%

“…Keim [2] introduced the concept of recurrence in the tracheostoma as a diffuse neoplastic infiltration, at the junction between the trachea stump and the skin in relation to laryngeal cancers. The true rates of tracheostomal recurrences are unknown because many series classify these as part of local recurrences.…”

mentioning

confidence: 99%

A Unique Case of a Tracheostomal Recurrence in a Thyroid Carcinoma

Krishnamurthy

2013

Indian J Surg Oncol

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Sir, A majority of patients with thyroid carcinoma have tumors with a well differentiated histology and an excellent overall prognosis. Aerodigestive tract invasion by well-differentiated thyroid carcinoma occurs infrequently; (6-13 %) such tumors are associated with increased incidences of loco-regional recurrence, distant metastasis, and decreased survival. It is therefore believed that control of locally invasive well-differentiated thyroid carcinoma is an important clinical endeavor [1]. Tracheostomal recurrences have traditionally been described in relation to laryngeal cancers. We present a unique case of tracheostomal recurrence in a patient of thyroid carcinoma, to the best of our knowledge; this is a first of a kind report.A 50-year-old man initially presented to us in June 1998 with a firm nodular thyromegaly 4×2 cm and a 2×2 left level 3 neck adenopathy with associated hoarseness of voice of approximately 6 months duration. A total thyroidectomy and a partial tracheal resection was performed in view of infiltration of the left lateral wall of the second and third tracheal cartilages. A window tracheostomy was fashioned then with an intention to close it at a later date. A left functional neck dissection was also performed in addition to a central compartment dissection. The post operative histopathology was suggestive of follicular variant of papillary carcionoma thyroid (FVPC) with extrathyroidal spread to the surrounding soft tissues and trachea and metastatic spread in 2 out the 14 cervical lymph nodes. The tracheal cut margins showed microscopic positivity for tumor; he was hence given adjuvant 60Grey of external beam radiotherapy. (EBRT) He was then kept on follow up on eltroxin suppression after ablation of the residual thyroid, the whole body I-131 scan being negative. He was subsequently lost to follow up; the window tracheostomy could not be closed as planned.Eleven years later he presented to us with an ulcerated nodule of size 5×4 cm at 1'o clock position of the tracheostoma, gradually increasing over 2 years with occasional bleeding episodes. (Figure 1a) Biopsy from the nodule confirmed it as a Sisson Type 2 tracheostomal recurrence. A CT scan revealed the tracheostomal ulcer infiltrating the laryngeal cartilages and pharynx. (Figure 2a) Chest skiagram revealed multiple bilateral pulmonary metastasis. (Figure 2b)The tracheostomal nodule and the pulmonary lesions were non functional on I-131 scan.He underwent a total laryngectomy including the tracheostomal recurrence and a pectoralis major myocutaneous flap for pharyngeal closure augmentation. The final histology was consistent with FVPC. (Figures 3 and 4) He is loco regionally controlled and is on follow up on eltroxin suppression for more than 2 years post his salvage surgery.Keim [2] introduced the concept of recurrence in the tracheostoma as a diffuse neoplastic infiltration, at the junction between the trachea stump and the skin in relation to laryngeal cancers. The true rates of tracheostomal recurrences are unknown because many seri...

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Study of Postlaryngectomy Stomal Recurrence

Cited by 108 publications

References 2 publications

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Laryngectomy whole organ serial sections Histological Parameters Correlated with Recurrence Rate

A Unique Case of a Tracheostomal Recurrence in a Thyroid Carcinoma

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