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Giuseppe Spriano

Publications and source records attributed to Giuseppe Spriano.

11 recordsLinked to original sources
PubMed2026

Mitomycin C in the Endoscopic Treatment of Airway Stenosis: A Systematic Review and a Meta-Analysis.

OBJECTIVE: To assess the efficacy of adjuvant MMC in the endoscopic treatment of airway stenoses. DATA SOURCES: PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Google Scholar databases. REVIEW METHODS: A literature search was conducted following PRISMA guidelines. The PICOS tool was used to determine the eligibility criteria for this study. A single arm meta-analysis was performed for stenosis resolution, the rate of patients requiring multiple endoscopic procedures, and the rate of patients requiring other surgical treatments. RESULTS: A total number of 358 patients (median age: 48.0 years; 95% CI 44.8-50.8) were included. The median follow-up was 25.2 months (n = 244/358; 95% CI 15.4-38.3). Overall, the cumulative stenosis resolution rate was 76.37% (n = 187/254; 95% CI 59.72-89.64), the rate of patients requiring multiple endoscopic procedures was 52.33% (n = 131/260; 95% CI 32.03-72.25), and the rate of patients requiring other surgical treatments was 4.08% (n = 26/310; 95% CI 0.37-11.48). The median intervention-free interval was 366 days (n = 155/358; 95% CI 270-696). CONCLUSIONS: Current evidence does not allow definitive conclusions regarding the efficacy of adjuvant MMC in reducing recurrence or prolonging intervention-free intervals in airway stenosis. Further well-designed prospective studies are needed to clarify the role of MMC and to inform evidence-based guidelines for patient selection and treatment use. LEVEL OF EVIDENCE: NA.

Humans↗
PubMed2007

Infrahyoid fascio-myocutaneous flap as an alternative to free radial forearm flap in head and neck reconstruction.

BACKGROUND: The use of microvascular free flaps is currently the favored method for the reconstruction of defects after resection of head and neck cancer. The flap most commonly used for head and neck reconstruction is the free radial forearm flap, but the less popular infrahyoid flap represents a good alternative in selected cases. This flap has proven to be helpful in the reconstruction of a wide range of moderate-sized head and neck defects. METHODS: We reviewed a series of 13 patients with defects resulting from cancer of the head and neck, who underwent infrahyoid flap reconstruction as an alternative to free radial forearm flap. The series includes 12 squamous cell carcinomas arising from the oral cavity and oropharynx, and 1 Merkel cell carcinoma of the submental skin. In the harvesting of the flap, the technical modifications recently suggested by Dolivet et al were used in all cases. Furthermore, another technical change has been introduced so creating a new infrahyoid facio-myocutaneous flap (IHFMCF). The surgical technique is described in detail. RESULTS: No total or partial flap necrosis was experienced. All reconstructions healed quickly without wound complications and with good functional results. The healing process in the donor site was excellent in every case with good aesthetic results. CONCLUSIONS: The IHFMCF is a versatile, reliable, and convenient flap suitable for repairing small and medium-sized defects of the oral cavity and oropharynx and obviates the need for a microvascular reconstruction.

Adult↗
PubMed2006

Venous flow-through flap as an external monitor for buried radial forearm free flap in head and neck reconstruction.

Postoperative monitoring of buried free flaps in head and neck reconstruction can be extremely difficult or impossible. The authors describe a series of 11 cases over a 21-month period, of buried radial forearm free flaps used in head and neck reconstruction. To monitor the main buried flap a small venous flow-through flap is supplied by and attached to the cephalic vein of a radial forearm free flap. This small venous skin flap is inset separately from the main paddle, so that it is visible at the external surface of the neck, furnishing information about the perfusion of the entire flap.

Forearm↗
PubMed2006

Functional outcome of supracricoid partial laryngectomy with cricohyoidopexy: radiation failure vs previously untreated cases.

OBJECTIVE: To evaluate the postoperative course and functional outcomes achieved in patients treated with supracricoid partial laryngectomy (SPL) with cricohyoidopexy. DESIGN: Retrospective analysis. SETTING: National Cancer Institute "Regina Elena." PATIENTS: Eighty-two consecutive patients who underwent SPL with cricohyoidopexy between September 1, 1988, and June 30, 2005, were evaluated. The patient cohort was divided into 2 groups: one affected by untreated laryngeal cancer and the other with laryngeal recurrence after radiotherapy. MAIN OUTCOME MEASURES: The postoperative complications and functional outcomes of both patient groups were evaluated and statistically compared. RESULTS: No statistical differences were found between the functional results of the 2 groups of patients analyzed. CONCLUSION: Although a slightly delayed recovery of physiological functions of the larynx could be termed a disadvantage of SCL with cricohyoidopexy after radiotherapy, this operation is a reliable and useful procedure for selected patients with recurrent cancer who would otherwise have been operated on and received a total laryngectomy.

Adult↗
PubMed2006

Thyroglobulin assay during thyroxine treatment in low-risk differentiated thyroid cancer management: comparison with recombinant human thyrotropin-stimulated assay and imaging procedures.

BACKGROUND: Circulating human thyroglobulin (TG) measurement has a pivotal role in the management of patients affected by differentiated thyroid cancer (DTC). Undetectable thyrotropin (TSH)-stimulated serum TG after thyroid ablation (i.e., thyroidectomy and radioiodine) implies the absence of residual or relapsing DTC. Recently, high-cost recombinant human TSH (rhTSH) was proposed for TG stimulation to avoid uncomfortable thyroxine (T(4)) withdrawal. However, only a small fraction of relapsing DTC patients showed undetectable TG under T(4) treatment (onT(4)-TG) by high-sensitivity assays. The present study was undertaken to compare onT(4)-TG with the rhTSH-stimulated TG assay (rhTSH-TG), (131)I scanning and neck ultrasound (US) with fine-needle aspiration biopsy. METHODS: We enrolled 117 patients with histologically proven DTC treated by total thyroidectomy and radioiodine. Inclusion criteria were: complete tumour excision, no radioiodine uptake outside of the thyroid bed at post-treatment scan and undetectable onT(4)-TG 3 months after primary treatment. At 1 year after radioiodine treatment, all patients underwent onT(4)-TG assay, rhTSH-stimulated TG assay, (131)I scanning and neck US. Based on histology, clinical data and long-term follow-up, persistent/relapsing disease was confirmed in 14 patients. RESULTS: onT(4)- and rhTSH-TG were positive in 10 and 12 patients, respectively and two patients converted from undetectable to detectable TG after rhTSH administration. Neck US was positive in 10 patients and a combination of US with onT(4)- and rhTSH-TG assays showed positivity in 13 and 14 out 14 patients, respectively. A radioiodine scan was positive in six patients, all with positive onT(4)- and rhTSH-TG levels. Globally, the negative predictive value of the onT(4)- and rhTSH-TG assays was 99% and 100%, respectively, and 104 rhTSH stimulations had to be performed to detect one local recurrence with negative onT(4)-TG. CONCLUSIONS: Our preliminary data need further confirmation on larger groups of patients, but seem to indicate that onT(4)-TG assay by a high-sensitivity method combined with neck US may avoid rhTSH stimulation in low-risk DTC patients after surgery and radioiodine thyroid ablation.

Adolescent↗
PubMed2005

A case of cervical metastases from temporal bone carcinoid.

BACKGROUND: Carcinoids are neuroendocrine tumors that typically occur in the gastrointestinal tract and lung and less frequently in the head and neck region. Whereas the metastatic potential of laryngeal carcinoid is well documented, only one case of metastasis of temporal bone carcinoid to the cervical lymph nodes has been reported. We present the case of a 55-year-old woman with cervical metastases almost 3 years after a primary diagnosis of temporal bone carcinoid. METHODS: The patient had undergone a subtotal petrosectomy for a temporal bone carcinoid and, 29 months later, revision surgery for a local recurrence. Four months later, multiple laterocervical swelling appeared, and the patient underwent modified radical neck dissection. RESULTS: Histologic examination after the neck dissection was suggestive of lymph node metastases from a carcinoid tumor. Immunohistochemical analysis of the lymph node metastases showed neoplastic cells positive for keratin, vimentin, chromogranin, and neuron-specific enolase and negative for thyroglobulin, calcitonin, S-100, and parathyroid hormone. The patient was treated with intensity-modulated radiation therapy and neck irradiation. CONCLUSIONS: We believe that temporal bone carcinoids have metastatic potential not predictable by histologic features. Surgical excision is the treatment of choice for patients with temporal bone carcinoids, with the approach and technique determined by the extent of the mass. Moreover, before planning surgery and during follow-up, neck node status must be carefully detected.

Carcinoid Tumor↗
PubMed2004

Mandibular reconstruction with frozen autologous mandibular bone and radial periosteal fasciocutaneous free flap: preliminary report.

The authors present a new method of mandibular reconstruction with frozen autologous mandibular bone. Vascular supply to the neomandible is ensured by the periosteal layer of a microvascular radial periosteal fasciocutaneous free flap, placed so as to envelop the bone and cover the surgical defect. The use of the periosteal layer of the radius to provide new blood vessels to the frozen mandible is an original technical feature that we describe. We describe 2 cases of oral carcinoma involving the mandible, treated with mandibular resection and reconstruction. This technique allows good functional and aesthetic results, avoiding more serious complications related to the use of composite free flaps harvested from distant anatomic donor sites.

Aged↗
PubMed2003

Elective treatment of the neck in squamous cell carcinoma of the larynx: clinical experience.

BACKGROUND: In head and neck cancer, the best prophylactic treatment for the N0 neck is a subject of debate. Some authors propose lateral selective lymph node dissection (levels II-IV) on the basis of the probability of finding occult metastases in those lymph nodes. A more extensive procedure including Vth level is considered unnecessary because of the low incidence of metastases in the posterior triangle. METHODS: We retrospectively evaluated 346 N0 patients affected by laryngeal carcinoma and consecutively treated at the Department of Otorhinolaryngology of the Ospedale di Circolo, Varese, Italy. The patients underwent elective selective neck dissection (levels II-V) for a total of 602 dissected heminecks. RESULT: Seventy heminecks (11.6%) were pN+, and in 10 of 70 cases (14.3%) level V was involved; in 5 of 10 metastases were isolated. CONCLUSION: Our retrospective study confirms the probabilistic criteria of the incidence of occult metastasis by level in laryngeal cancer. On the basis of our data Vth level nodes, although very rarely, 10 of 604 (1.6%), are involved with laryngeal cancer. Our approach to routinely dissect Vth level nodes is discussed.

Adult↗
PubMed2002

Supracricoid partial laryngectomy as salvage surgery after radiation failure.

BACKGROUND: Radiotherapy is often chosen as the definitive treatment for early stage laryngeal carcinoma. Total laryngectomy is the main procedure for failures. Endoscopic treatment of recurrences by CO(2) laser has found limited application. Partial laryngectomy through an external approach has been proposed as salvage surgery, and the vertical partial laryngectomy (VPL) is the most mentioned surgical technique in the literature, although there are, to date, very few reports regarding the use of the supracricoid partial laryngectomy (SCPL) as salvage surgery after radiation failure. OBJECTIVES: The aim of the study is to check the feasibility of SCPL with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) in patients with laryngeal recurrence after radiation failure and to evaluate the oncologic results, morbidity, and functional outcome. METHODS: Fifteen consecutive patients were treated with salvage intent by SCPL from January 1992 to December 1998. CHEP and CHP were performed in 11 and 4 patients, respectively. Five patients underwent homolateral surgical neck dissection, and one underwent bilateral neck dissection. All patients had a temporary tracheostomy, and two patients required percutaneous endoscopic gastrostomy (PEG) to ensure feeding. Functional rehabilitation started 2 weeks after the operation. RESULTS: The results have been evaluated in terms of oncologic outcome and functional preservation. Twelve patients are alive with a minimum follow-up of 36 months and 3 patients died after 36 days, 6 and 14 months after surgery, the first and second patient from heart failure and the third from lung metastasis. Respiratory function was recovered in all cases. Oral intake began 12 days after surgery, and in 14 cases satisfactory swallowing was recovered 30 days after surgery. An acceptable quality of the voice was achieved by most patients, and a high rate of local immediate complications was solved in all cases. CONCLUSIONS: SCPL represents an effective technique as salvage treatment of laryngeal cancer after exclusive radiotherapy; there is a good functional recovery with acceptable morbidity and good oncologic long-term control.

Aged↗
PubMed2002

Pectoralis major myocutaneous flap for hypopharyngeal reconstruction.

The reconstruction of total or subtotal defects after surgical treatment for hypopharyngeal cancer is a challenging problem in head and neck surgery. The authors discuss reconstructive surgery performed in 37 patients affected by advanced hypopharyngeal cancer using the pectoralis major myocutaneous flap. In 22 cases of total pharyngolaryngectomy, the reconstructive procedure originally proposed by the authors was based on the use of a pectoralis major myocutaneous flap directly sutured to the pharyngeal and esophageal stumps and the prevertebral fascia, which eventually represented the posterior wall of the neohypopharynx. In 15 cases of subtotal pharyngolaryngectomy, the posterior wall of the neohypopharynx consisted of a residual strip of pharyngeal mucosa. In each patient, removal of the tumor and reconstruction were performed during the same operation, with only a few complications. Neither flap necrosis nor strictures were encountered; five patients had pharyngeal fistula and one patient died because of massive pneumonia. Although the use of microvascular free flaps is a reliable procedure, the pectoralis major myocutaneous flap is still applicable for hypopharyngeal reconstruction, thanks to its feasibility and low complication rate. The other reconstructive options require surgical transgression of the abdomen and/or thorax in patients affected by malnutrition and other chronic systemic disorders.

Adult↗