Biomedical subjects
Publications and source records attributed to B Semczuk.
A twenty-year scientific cooperation has been discussed (1979-1998) between four clinics for laryngology at Medical Universities in Cracow, Poznań, Warsaw and Lublin. The results of research concerning the epidemiology, diagnostics and treatment of the carcinoma of the larynx are presented.
In a group of 579 patients with laryngeal carcinoma treated surgically in years 1988-1989 in four departments of otorhinolaryngology of the Medical Academies in Poznań, Warsaw, Cracow and Lublin, 72% survived 3 years without recurrence and 59% survived 5 years. Similar results were obtained in years 1986-1987. The authors discuss in detail the reasons for failures of the surgical treatment, i.e.: supraglottic localization of the cancer, its extensiveness in the larynx, the stage of clinical development, general condition of the patient, effectiveness of the operation, regularity of postsurgical examination, the degree of histological malignancy, blood transfusion during the operation, distant metastases, little efficiency of medical service in early diagnosis of laryngeal cancer, avoiding postsurgical radiation, subjective factors of the patients and the choice of the optimal method of the treatment. Few patients can be cured if the initial treatment fails.
An extremely rare case of prostatic carcinoma metastasis to the larynx has been reported. After laryngectomy and subsequent prostatectomy the patient was discharged in a good general and local condition.
In the group of 578 patients with larynx cancer that underwent surgical treatment in four clinics of Medical Academies between 1986-87 a comparable analysis of the efficiency of surgical treatment depending on age of the operated patients was carried out. It was found that the difference between age average and the general state of patients was statistically highly important: Statistically significant was also the dependence between the patients' age and the postoperative complications; close to importance was also the dependence between the age and the survival period of patients. 68% of operated patients up to 65 year of age had five-year survival period without any symptoms; but in the group of patients over 65 years of age the analogical survival value was 51%.
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In 4 ENT Clinics of Medical Academies in Poznań, Warszawa, Kraków, Lublin 2620 laryngeal cancer patients were operated upon during the years 1980-1987. The treatment failure occurred in 760 cases (29%). The following possible to discover factors were probably responsible for unsuccessful results: senility, other concomitant diseases (especially cardiac), prolonged diagnostic procedure, no up to date diagnostic methods, giving up the radiotherapy (38% of cases), upper laryngeal localization of tumors (87%), advanced extents T3 and T4 (83%), advanced clinical stages of cancer (III degrees and IV degrees 85%), lack of surgical radicality especially in neck dissection, unsuccessful neck dissection behind the accessory nerve, omittance of taking the specimens to the pathomorphologic examinations from the marginal part of the operational field in 25% of patients. The early recurrences in these places in apart of patients spoke for the presence of the neoplasmatic cells in this region.
A group of 578 patients with larynx cancer underwent surgical treatment in four Otolaryngological Clinics of Medical Universities in Poznań, Warsaw, Cracow and Lublin between 1986-1987. Within this group, 75% of operated patients had a three--year survival rate without symptoms, and 58% of patients had a five-year survival rate. A detailed evaluation of causes of failures in surgical treatment dealt with e.g. the initial placement of the cancer including entrance margins of larynx in a rich net of lymphatic vessels, extensiveness of organs, the degree of clinical progressions, general physical condition of a patient, radicality of treatment, regularity of check-ups after the operation, high degree of histological malignancy unfavourable configuration of TNM feature blood transfusions, the appearance of remote metastases low efficiency in the early diagnostics of larynx cancer, subjective conditions of patients, discontinuation of complementary irradiation.
The article presents long-term results of operative treatment of 128 patients with bilateral vocal cord paresis. The best functional results, for all the 128 operated cases, were obtained with the use of the method of intralaryngeal submocous chordectomy, with partial arytenoidectomy performed according to the technique of laryngeal microsurgery. However, considerably poorer results were obtained in those cases where the classic Surjan method was used, or our own modifications of this method.
In a group of 227 children endoscopic assessment of the auditory tube function and its pharyngeal opening anatomy was performed. The mentioned group was isolated from 2965 undergoing adenoidectomy. Preoperative endoscopy revealed impaired functioning of the auditory tube and also abnormal appearance of its pharyngeal opening in 71.3% of cases. Within the group adenoidectomy wasn't effective in 32 patients.
Investigations of larynx cancer rate of Lublin population were carried out in the years 1991-1994. Factors of the community rates in each year and in five-years age group were determined. 681 suffering people were examined clinically. The clinical stage and degree of organ involvement were appointed.
In 4 ENT Clinics of Medical Akademies in Poznań, Warszawa, Kraków, Lublin 2620 laryngeal cancer patients were operated upon during the years 1980-1987. The treatment failure occurred in 760 cases (29%). The following possible to discover factors were probably responsible for unsuccessful results: prolonged diagnostic procedure, upper laryngeal localization of tumors, advanced extents T3 and T4 (83%), advanced clinical stages of cancer (III degree and IV degree 85%), lack of surgical radicality especially in neck dissection. The early recurrencies in these places in apart of patients spoke for the presence of the neoplasmatic cells in this region.
We have analysed the causes of failure of surgical treatment of the patients with laryngeal carcinoma. Among 269 patients operated in different stages of the disease, 100 (37.0%) of them showed in retrospective analysis negative result of the treatment, that is the recurrence and/or death. The local recurrence have been discovered in 30 (30.0%) of the patients, approximately after 11 months, and the metastases in local lymphatic nodes in 19 (19.0%) of the patients--approximately after 13 months. The distant metastases appeared in 13 (13.0%) of the patients, approximately after 22 months following the operation. Twelve of the patients (12.0%) died of the other reasons. The majority of the patients were at the III-rd stage of the disease (87.0%), but also the patients with changes in the upper part of larynx (92.0%). Among the operated patients whose time of survival was the shortest, there were the patients in the III-rd stage of clinical advancement and with the changes localised in several parts of larynx including the highest part of larynx.
Three and five years survival rates in a group of 3440 patients surgically treated for carcinoma of the larynx in four ENT Departments in the years 1977-86 were presented. 5 years survival rate was obtained in 70% of patients treated only surgically, and in 46% patients treated with surgery combined with radiotherapy.
In the Otolaryngology Clinic of the Medical Academy in Lublin in the 21 year period (1971-1991) there were performed 2488 microsurgical operations of the larynx. The authors analyse their own clinical material paying particular attention to relative precancer states, early diagnosis of laryngeal cancer and an increase of the number of preinvasive cancer (cancer in situ) diagnoses. The authors postulate that indications for clinical diagnostic and therapeutic procedures should be considerably extended in diseases of the larynx. There should be used an operating microscope which will considerably shorten hospitalization period of patients and significantly contribute to an increase of the percentage of early diagnoses of cancer of the larynx.
A group of 287 laryngeal carcinoma patients was discussed, who were operationally treated over the period of ten years (1974-1983). Three- and five-year-long symptomless survivals were presented taking into account: age, sex, environment, habits, development of cancer on the base of precancerous conditions, primary localisation, progression of cancer in the larynx, presence of nodular metastases and a degree of clinical progression. In a group of 206 patients treated only operationally there were 65% of 5-year-long symptomless survivals, in a group 61 patients treated by the combined method--33%, and finally in a group of patients with recurrence after irradiation treated operationally there were only 25% of 5-year-long survivals.
During the years 1977-1986 84 patients with the parotid tumor were treated in ENT Clinic in Lublin. 16.6% of tumors were malignant. The surgical procedure was performed in 74 cases (84.5%). There were the removal of tumor with or without the parotid gland resections. In all cases of resection the facial nerve was saved. In malignant tumor cases the radiotherapy followed the surgery. 13 patients with poor health conditions were treated without surgery. The early and late results were described.
In the radiologic assessment of extension tumors of parotid glands CT method was used and for comparative purposes sialography was performed. In comparative analysis there was assessed CT method and its usefulness in the preoperative assessment of tumor extension.
In the years 1985-1990 within the group of 2769 patients operated upon for laryngeal cancer in four medical centres (Kraków, Poznań, Warszawa, Lublin), a clinical analysis on surgical treatment failures was performed. The most significant reasons of failures were: the highly advanced age of patients, coexistent diseases, in particular the cardiopulmonary disease; poor information of neoplastic diseases (carcinomas) and delayed referral to the doctor; lack of consent for surgical treatment; old fashioned diagnostic methods; prolonged period of making diagnosis; increasing number of patients with supra-glottic localization including the hypo-pharynx and piriform recess; a considerable degree of organ ++cancer advancement and substantial clinical advancement; not radical excision of neck glands; intra-surgical blood transfusion; micrometastases to lymphatic glands; immunity collapse; discontinuance of post-surgical radiation on affected parts; lack of lymphadenectomy backward from accessory nerve ; massive cancer metastases to lymph nodes; high histologic malignancy with characteristic carcinous invasiveness; and finally, surgical and post-surgical early and late complications ranginy within our material from 25% to 29% of surgical patients. Basing on the above mentioned analysis, the authors developed indications for surgical treatment of laryngeal cancer.