Biomedical subjects

L K Lam

Publications and source records attributed to L K Lam.

76 records · Page 5Linked to original sources

PubMedDate not supplied

Recurrence of laryngeal or hypopharyngeal primary tumor after radical neck dissection for postradiotherapy neck nodal metastases.

BACKGROUND: When the primary tumor in the larynx or hypopharynx responds well to radiotherapy, nodal metastasis in the neck may persist or recur. The primary site is usually left alone when no lesion is evident, but its long-term control is uncertain. METHODS: Radical neck dissection was performed in 23 patients who had nodal metastasis, while the primary tumor in the larynx or hypopharynx was controlled after radiotherapy. The primary site was left alone and kept under surveillance. RESULTS: Seven patients (30%) had recurrence at the primary site on follow-up. Two significant risk factors for development of recurrences at the primary site were identified; the neck node staging at presentation (p < 0.03) and presentation with persistent neck lymph nodes (p < 0.03). The 2-year survival of those patients with recurrences at the primary site was 29%. CONCLUSION: Radical neck dissection alone was justified, but close surveillance of the primary site after surgery is mandatory, especially for those patients with high-risk factors.

Adult↗

PubMedDate not supplied

Prognosis of recurrent laryngeal carcinoma after laryngectomy.

BACKGROUND: Recurrence is common after total laryngectomy for advanced laryngeal carcinoma. The aim of the present study was to review the prognosis of recurrent laryngeal carcinoma after total laryngectomy. METHODS: The records of 165 patients who developed recurrences after total laryngectomy for laryngeal squamous cell carcinoma between January 1971 and December 1990 were reviewed. RESULTS: Of the 165 patients who developed recurrences, 34 (21%) patients had surgical salvage. The sites of recurrence of these 34 operable patients included 11 pharyngeal, 3 tracheostomal, 15 nodal, 2 pharyngeal with nodal, and 3 pulmonary metastasis. Pharyngeal recurrence had the highest salvage rate, followed by nodal and pulmonary recurrence. All patients with tracheostomal had recurrence after salvage surgery. After the surgical salvage, the tumor recurrence rate was 44% and the 5-year actuarial survival rate was 42%. Of the other 131 patients who had palliative treatment without surgical salvage, the 5-year actuarial survival rate was 2%. CONCLUSIONS: The present study showed that patients who had surgical salvage for recurrent tumor after total laryngectomy had satisfactory prognosis. Close follow-up of patients after initial operation is essential to detect recurrence early, while surgical salvage is still feasible.

Actuarial Analysis↗

PubMedDate not supplied

Long-term results of voice rehabilitation after total laryngectomy using primary tracheoesophageal puncture in Chinese patients.

PURPOSE: Prosthetic voice restoration is an increasingly popular method of postlaryngectomy voice rehabilitation. Despite its success in non-tonal languages, the efficacy of tracheoesophageal speech in tonal languages was largely unknown. The aim of the present study was to evaluate the long-term results of voice rehabilitation using a Blom-Singer valve (BSV) in the tonal language of Cantonese. PATIENTS AND METHODS: The records of 159 patients who underwent total laryngectomy and primary tracheoesophageal puncture (TEP) between May 1985 and December 1994 were retrospectively reviewed. Tracheoesophageal speech was regarded as functional if effective communication could be made during face-to-face conversation and telephone conversation. Any TEP-related complications were noted. Perioperative factors that might contribute to nonfunctional speech were subjected to statistical analysis. RESULTS: Six hospital mortalities were excluded from speech analysis. Of the remaining 153 patients, the median follow-up was 25 months, ranging from 3 to 113 months. Seventy-three patients had closure of tracheosophageal fistulae (TEF), and the main causes were ineffective voice production, dislodgment, and tracheostomal stenosis. Only 15 of them acquired functional speech before closure. The other 80 patients used a BSV as the chief modality of voice rehabilitation, with functional results achieved in 64 patients. None of the perioperative factors were found to be statistically significant in relation to nonfunctional speech. CONCLUSION: Primary TEP is an established method of voice rehabilitation after total laryngectomy. In our series, 52% patients achieved functional tracheoesophageal speech using a BSV.

Esophagus↗

PubMedDate not supplied

Mandibular invasion in carcinoma of the lower alveolus.

PURPOSE: Efforts to conserve the mandible in resection for oral cancer tend to bring the resection margin progressively closer to the tumor front. This study of the manner of mandibular invasion by carcinoma of the lower alveolus provides added information regarding the behavior of the cancer within the bone. MATERIALS AND METHODS: Twenty-four resected specimens of squamous carcinoma of the lower alveolus were studied with x-rays and step-serial whole-organ histological sections. RESULTS: In 19 of the 21 specimens showing bone invasion, the spread was in the form of a broad front. Insinuation of tumor beyond the tumor front was extensive in 9 of 13 tumors showing deep mandibular invasion. Horizontal subcortical spread took place in 5 of 18 specimens for a distance of up to 1 cm. Perineural spread along the inferior alveolar nerve was found in 4 of 13 specimens in which the tumor extended to the canal; tumor spread along the canal, without neural involvement, was never seen. Preoperative orthopantomogram correctly estimated the extent of mandibular invasion in 16 of 24 patients. CONCLUSIONS: The tumor front of mandibular invasion by carcinoma of the lower alveolus is usually broad. In the absence of deep invasion, which is defined by invasion reaching the alveolar canal, there is little or no insinuation of cancer cells beyond the tumor front, and no spread along the alveolar canal. Marginal mandibulectomy can be applied more widely, taking a margin of 1 cm in all directions.

Alveolar Process↗