A New Classification System to Predict Functional Outcome after Laryngectomy and Laryngopharyngectomy

(1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL; II: TLPP; III: TLTP and (ii) surgical treatment (A: primary resection; B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease; (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%; p = 0.001 and 51.4% vs. 14.8%; p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p < 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p < 0.001). Absence of PCF (odds ratio (OR) 3.29; p = 0.003), presence of complications (OR 3.47; p = 0.004), and no need for pharyngeal reconstruction (OR 4.44; p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome; (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome.

Download Full-text

Adult craniopharyngioma: The role of extent of resection in tumor recurrence and long-term functional outcome

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105711 ◽

2020 ◽

Vol 192 ◽

pp. 105711 ◽

Cited By ~ 4

Author(s):

Saravanan Sadashivam ◽

Girish Menon ◽

Mathew Abraham ◽

Suresh Narayanan Nair

Keyword(s):

Functional Outcome ◽

Tumor Recurrence ◽

Extent Of Resection

Download Full-text

Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty

Journal of Neurosurgery Pediatrics ◽

10.3171/ped-08/01/057 ◽

2008 ◽

Vol 1 (1) ◽

pp. 57-62 ◽

Cited By ~ 76

Author(s):

Matthew J. McGirt ◽

Kaisorn L. Chaichana ◽

April Atiba ◽

Ali Bydon ◽

Timothy F. Witham ◽

...

Keyword(s):

Spinal Cord ◽

Functional Outcome ◽

Spinal Deformity ◽

Spinal Cord Tumor ◽

Extent Of Resection ◽

Neurological Function ◽

Karnofsky Performance Scale ◽

Duration Of Symptoms ◽

Intramedullary Spinal Cord

Object Gross-total resection of pediatric intramedullary spinal cord tumor (IMSCT) can be achieved in the majority of cases while preserving long-term neurological function. Nevertheless, postoperative progressive spinal deformity often complicates functional outcome years after surgery. The authors set out to determine whether laminoplasty in comparison with laminectomy has reduced the incidence of subsequent spinal deformity requiring fusion after IMSCT resection at their institution. Methods The first 144 consecutive patients undergoing resection of IMSCTs at a single institution underwent laminectomy with preservation of facet joints. The next 20 consecutive patients presenting for resection of IMSCTs underwent osteoplastic laminotomy regardless of patient or tumor characteristics. All patients were followed up with telephone interviews corroborated by medical records for the following outcomes: 1) neurological and functional status (modified McCormick Scale [MMS] score and Karnofsky Performance Scale [KPS] score); and 2) development of progressive spinal deformity requiring fusion. The incidence of progressive spinal deformity and the long-term neurological function were compared between the laminectomy and osteoplastic laminotomy cohorts. The means are expressed ± the standard deviation. Results Overall, the patients' mean age was 8.6 ± 5 years, and they presented with median MMS scores of 2 (interquartile range [IQR] 2–4). A > 95% resection was achieved in 125 cases (76%). There were no differences (p > 0.10) between patients treated with osteoplastic laminotomy and those treated with laminectomy in terms of the following characteristics: age; sex; duration of symptoms; location of tumor; incidence of preoperative scoliosis (Cobb angle > 10°: 7 [35%] with laminoplasty compared with 49 [34%] with laminectomy); involvement of the cervicothoracic junction (7 [35%] compared with 57 [40%]); thoracolumbar junction (4 [20%] compared with 36 [25%]); tumor size; extent of resection; radiation therapy; histopathological findings; or mean operative spinal levels (7.5 ± 2 compared with 7.5 ± 3). Nevertheless, patients who underwent osteoplastic laminotomy had better median preoperative MMS scores than those treated with laminectomy (2 [IQR 2–2] compared with 2 [IQR 2–4]; p = 0.04). A median of 3.5 years (IQR 1–7 years) after surgery, only 1 patient (5%) in the osteoplastic laminotomy cohort required fusion for progressive spinal deformity, compared with 43 (30%) in the laminectomy cohort (p = 0.027). Adjusting for the inter-cohort difference in preoperative MMS scores, osteoplastic laminotomy was associated with a 7-fold reduction in the odds of subsequent fusion for progressive spinal deformity (odds ratio 0.13, 95% confidence interval 0.02–1.00; p = 0.05). The median MMS and KPS scores were similar between patients who underwent osteoplastic laminotomy and those in whom laminectomy was performed (MMS Score 2 [IQR 2–3] for laminotomy compared with 2 [IQR 2–4] for laminectomy, p = 0.54; KPS Score 90 [IQR 70–100] for laminotomy compared with 90 [IQR 80–90] for laminectomy, p = 0.545) at a median of 3.5 years after surgery. Conclusions In the authors' experience, osteoplastic laminotomy for the resection of IMSCT in children was associated with a decreased incidence of progressive spinal deformity requiring fusion but did not affect long-term functional outcome. Laminoplasty used for pediatric IMSCT resection may decrease the incidence of progressive spinal deformity requiring subsequent spinal stabilization in some patients.

Download Full-text

Anterior clinoidal meningiomas: functional outcome after microsurgical resection in a consecutive series of 106 patients

Journal of Neurosurgery ◽

10.3171/2009.3.17685 ◽

2009 ◽

Vol 111 (5) ◽

pp. 1078-1090 ◽

Cited By ~ 48

Author(s):

Hischam Bassiouni ◽

Siamak Asgari ◽

I. Erol Sandalcioglu ◽

Volker Seifert ◽

Dietmar Stolke ◽

...

Keyword(s):

Visual Acuity ◽

Functional Outcome ◽

Tumor Recurrence ◽

Tumor Resection ◽

Progression Rate ◽

Consecutive Series ◽

Presenting Symptoms ◽

Long Term Treatment ◽

Microsurgical Resection

Object In this study, the authors' goal was to analyze a series of patients treated microsurgically for an anterior clinoid process (ACP) meningioma in regard to long-term functional outcome. Methods The authors retrospectively analyzed clinical data in a consecutive series of 106 patients who underwent microsurgical treatment for an ACP meningioma at 2 neurosurgical institutions between 1987 and 2005. The main presenting symptoms of the 84 female and 22 male patients (mean age 56 years) were visual impairment in 54% and headache in 28%. Physical examination revealed decreased visual acuity in 49% and a visual field deficit in 26%. Tumors were primarily resected via a pterional approach. Meningioma extensions invading the cavernous sinus, present in 29% of the patients, were not removed. Complete tumor resection (Simpson Grade I and II) was achieved in 59% of the cases. Results Postoperatively, visual acuity improved in 40%, was unchanged in 46%, and deteriorated in 14%. A new oculomotor palsy was observed in 8 patients (8%). Clinical and MR imaging data were available in 95 patients for a mean postsurgical period of 6.9 years (1.5–18 years) and revealed tumor recurrence in 10% and tumor progression after subtotal resection in 38%. Clinical deterioration on long-term follow-up consisting primarily of ophthalmological deficits was observed in 14% of the cases. Conclusions Acceptable functional results can be achieved after microsurgical resection of ACP meningiomas; however, long-term treatment remains challenging due to a high tumor recurrence and progression rate.

Download Full-text

An extent of resection threshold for seizure freedom in patients with low-grade gliomas

Journal of Neurosurgery ◽

10.3171/2016.12.jns161682 ◽

2018 ◽

Vol 128 (4) ◽

pp. 1084-1090 ◽

Cited By ~ 20

Author(s):

David S. Xu ◽

Al-Wala Awad ◽

Chad Mehalechko ◽

Jeffrey R. Wilson ◽

Lynn S. Ashby ◽

...

Keyword(s):

Operating Characteristic ◽

Seizure Control ◽

Characteristic Curve ◽

Tumor Resection ◽

Extent Of Resection ◽

Class I ◽

Seizure Freedom ◽

Low Grade ◽

Newly Diagnosed

OBJECTIVESeizures are the most common presenting symptom of newly diagnosed WHO Grade II gliomas (low-grade glioma [LGG]) and significantly impair quality of life. Although gross-total resection of LGG is associated with better seizure control, it remains unclear whether an extent of resection (EOR) “threshold” exists for long-term seizure control. Specifically, what proportion of FLAIR-positive tissue in patients with newly diagnosed LGG must be removed to achieve Engel Class I seizure freedom? To clarify the EOR threshold for long-term seizure control, the authors analyzed data from a consecutive series of patients with newly diagnosed LGG who presented with seizures and subsequently underwent microsurgical resection.METHODSThe authors identified consecutive patients with newly diagnosed LGG who presented with seizures and were treated at the Barrow Neurological Institute between 2002 and 2012. Patients were dichotomized into those who were seizure free postoperatively and those who were not. The EOR was calculated by quantitative comparison of pre- and postoperative MRI. Univariate analysis of these 2 groups included the chi-square test and the Mann-Whitney U-test, and a multivariate logistic regression was constructed to predict the impact of multiple independent variables on the likelihood of postoperative seizure freedom. To determine a threshold of EOR that optimizes seizure freedom, a receiver operating characteristic curve was plotted and the optimal point of discrimination was determined.RESULTSData from 128 patients were analyzed (male/female ratio 1.37:1; mean age 40.8 years). All 128 patients presented with seizures, usually generalized (n = 57, 44.5%) or simple partial (n = 57, 44.5%). The median EOR was 90.0%. Of 128 patients, 46 (35.9%) had 100% volumetric tumor resection, 64 (50.0%) had 90%–99% volumetric tumor resection, and 11 (8.6%) had 80%–89% volumetric tumor resection. Postoperatively, 105 (82%) patients were seizure free (Engel Class I); 23 (18%) were not (Engel Classes II–IV). The proportion of seizure-free patients increased in proportion to the EOR. Predictive variables included in the regression model were preoperative Karnofsky Performance Scale score, seizure type, time from diagnosis to surgery, preoperative number of antiepileptic drugs, and EOR. Only EOR significantly affected the likelihood of postoperative Engel Class I status (OR 11.5, 95% CI 2.4–55.6; p = 0.002). The receiver operating characteristic curve generated based on Engel Class I status showed a sensitivity of 0.65 and 1 – specificity of 0.175, corresponding to an EOR of 80%.CONCLUSIONSFor adult patients with LGG who suffer seizures, the results suggest that seizure freedom can be attained when EOR > 80% is achieved. Improvements in both the proportion of seizure-free patients and the durability of seizure freedom were observed beyond this 80% threshold. Interestingly, this putative EOR seizure-freedom threshold closely approximates that reported for the overall survival benefit in newly diagnosed hemispheric LGGs, suggesting that a minimum level of residual tumor burden is necessary for both disease and symptomatic progression.

Download Full-text

Functional Outcome of Limb Salvage Surgery by Megaprosthesis for Malignant Bone Umours-Mid and Long Term Follow Up

International Journal of Current Research and Review ◽

10.31782/ijcrr.2020.122335 ◽

2020 ◽

Vol 12 (23) ◽

pp. 189-194

Author(s):

Manish R Shah ◽

Manisha M Shah ◽

Aditya K. Agrawal ◽

Malkesh D Shah ◽

Sarvang M Desai

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Long Term Follow Up

Download Full-text

Survival and function following pharyngo-laryngo-oesophagectomy in Wales: a twelve-year case series

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000207 ◽

2021 ◽

pp. 1-5

Author(s):

D R Edwards ◽

L Pope ◽

S Berry

Keyword(s):

Functional Outcome ◽

Locally Advanced ◽

Case Series ◽

Disease Free Survival ◽

Late Toxicity ◽

Hypopharyngeal Cancer ◽

Voice Rehabilitation ◽

Retrospective Case ◽

And Function

Abstract Objective Treatment of locally advanced hypopharyngeal cancer can cause significant morbidity and late toxicity. Pharyngo-laryngo-oesophagectomy can achieve adequate surgical margins, but data on survival and functional outcome are limited, especially in Wales. This study aimed to describe mortality, morbidity and functional outcome following pharyngo-laryngo-oesophagectomy in a Welsh population. Method This study was a retrospective case note review of pharyngo-laryngo-oesophagectomy cases in Wales over 12 years. Results Fifteen patients underwent pharyngo-laryngo-oesophagectomy; all but one underwent gastric pull-up. Median survival and disease-free survival were 17 months (range, 2–53 months) and 14 months. Censored 3-month, 1-year and 3-year survival was 93, 71 and 50 per cent, respectively. Common Terminology Criteria for Adverse Events grading of long-term dysphagia was 1 in 58 per cent, 2 in 33 per cent and 3 in 8 per cent, and 87.5 per cent achieved a ‘moderate’ or ‘good’ voice rehabilitation. Conclusion These results demonstrate favourable survival and reasonable functional outcome following pharyngo-laryngo-oesophagectomy, suggesting pharyngo-laryngo-oesophagectomy should be considered in all appropriate surgical candidates.

Download Full-text

Functional outcome of tendoachilles following Ponseti’s tenotomy for treatment of congenital talipes equino varus in children older than two years

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173941 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1057

Author(s):

Sunny Agarwal ◽

Suresh B. ◽

Mathew Varghese ◽

Vishesh Khanna ◽

Mandeep Singh Bajaj

Keyword(s):

Functional Outcome ◽

Previous Treatment ◽

Long Term Results ◽

Walking Ability ◽

Functional Evaluation ◽

Age Group ◽

History Of ◽

Previously Treated ◽

Congenital Talipes

Background: Long term results of tenotomy and Ponseti technique are established worldwide. However, functions of Tendoachilles following Ponseti’s tenotomy in these cases i.e. idiopathic/neglected/operated/relapsed clubfeet (after casting or surgical correction) are not established. Tendoachilles regeneration after tenotomy has been confirmed on USG and MRI but only a few studies have done functional evaluation of tendoachilles. This study was done to evaluate the functional outcome of tendoachilles after tenotomy in patients older than two years presenting with CTEV. This study also assessed the influence of age and any previous treatment on tenotomy.Methods: In this study, 42 children (68 clubfeet) were seen in the two year study period. Children between 2-13 years coming to the outpatient department for treatment using the Ponseti’s method were followed during and after completion of treatment for 2 years. Patients were divided into two groups-first according to age and second according to previous treatment. Clinical evaluation of tendoachilles regeneration was done by evaluating the child’s ability to stand on tip of toes on single leg and walking ability.Results: The ability to stand on tip of toes after removal of the final cast was delayed maximum in the previously operated patients (9.5 weeks), lesser in patients who were previously treated by casting (7.3 weeks) and least in neglected patients (7 weeks). It also increased as the age increased (2-5 years age group required 7.4 weeks whereas 11-13 years age group required 16 weeks). Neglected patients started walking earlier (4.6 weeks) as compared to patients treated conservatively (4.8 weeks) or operatively (7.2 weeks). Younger children started walking earlier (age 2-5 years required 4.7 weeks whereas 11-13 years age group required 12 weeks). Conclusions: Functional evaluation of tendoachilles showed that all children who had tenotomy could walk and stand on tip of toes irrespective of age and previous treatment. However, older child and children having history of previous treatment, required longer time for recovery.

Download Full-text