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Transoral robotic surgery total laryngectomy is a promising procedure. We conducted a systematic review to study the indications, surgical techniques and complications of this procedure.
Methods
We followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.
Results
We concluded with 5 studies and 27 surgeries. The main indications of transoral robotic surgery total laryngectomy were selected recurrent laryngeal squamous cell carcinomas, dysfunctional larynx, and specific primary non-squamous cell carcinoma laryngeal cancers. The rate of pharyngocutaneous fistula was 20 per cent overall. In every reported cancer case, the specimen was excised within negative surgical margins. The average time of the procedure was 282.6 minutes.
Conclusion
Transoral robotic surgery total laryngectomy is a safe procedure of high value. The preservation of strap muscles and hyoid bone as well as the sacrifice of less mucosa compared to the traditional technique reduces the risk of certain complications and improves the swallowing outcome.
This study aimed to evaluate the effect of neck dissection on survival and complication rates in patients with no clinical or radiological evidence of cervical nodal disease (N0) undergoing salvage laryngectomy.
Methods
A retrospective study was conducted of patients with squamous cell carcinoma of the larynx following primary radiotherapy that required salvage laryngectomy. Disease-free and overall survival rates were compared over three years using Kaplan–Meier analysis. Pharyngocutaneous fistula rate, hospitalisation length and the requirement for further surgical intervention were also compared across cohorts.
Results
Twenty-three cases met the inclusion criteria (17 neck dissections, 6 undissected). No significant differences in survival outcomes were identified. One patient who underwent neck dissection for advanced, recurrent transglottic squamous cell carcinoma showed evidence of occult lymph node metastases. Fistula rates did not differ significantly between dissected and non-dissected groups; however, two patients required surgical repair of post-operative pharyngocutaneous fistula following neck dissection.
Conclusion
In this study, elective neck dissection did not appear to alter survival outcomes or complication rates during salvage laryngectomy. Given the small but significant risk of occult neck metastases, its true value remains unclear.
Sinonasal malignant melanoma is a relatively rare malignancy with poor prognosis, and effective treatments remain elusive. This analysis aimed to explore whether post-operative radiotherapy conferred any survival advantages in patients with this disease when compared with surgery alone.
Methods
Published studies were identified by searching four electronic databases. The endpoints evaluated were: rates of overall survival, disease-free survival and local control.
Results
Twenty-eight studies including 1392 patients were identified. The results indicated that post-operative radiotherapy led to a significantly better three-year overall survival rate (p = 0.02), and suggested a borderline significant benefit for five-year overall survival (p = 0.05), when compared with surgery alone. However, no statistical advantage was found for disease-free survival, local control or one-year overall survival.
Conclusion
This meta-analysis indicated that adjuvant radiotherapy prolonged survival, but showed no benefit for disease-free survival or local control.
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