Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
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Careful selection of patients eligible for extensive head and neck cancer surgery is extremely important. A reliable predictor for postoperative outcomes in the vulnerable elderly population is not yet available. The concept of frailty describes a clinical state of increased vulnerability and can be assessed using frailty tests, such as the Groningen Frailty Indicator. In the current study, the influence of Groningen Frailty Indicator-measured frailty on clinical outcome was investigated in elderly patients surgically treated for head and neck cancer. ⋯ Analysis of frailty could identify elderly patients who might suffer more than expected during the postoperative period after head and neck cancer surgery. In this study, frailty was not identified as a new predictor of complications after head and neck cancer surgery.
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Review Meta Analysis
Resection of subsequent pulmonary metastases from treated head and neck squamous cell carcinoma: systematic review and meta-analysis.
Pulmonary metastasectomy involves the surgical removal of pulmonary nodules. It is a recognised therapeutic modality for the treatment of metastatic disease. There is no consensus as to the role of pulmonary metastasectomy in squamous cell carcinoma of the head and neck. The objective of this study was to determine whether, in selected patients, resection of subsequent pulmonary metastases prolongs survival in patients already treated for head and neck squamous cell carcinoma and to identify independent risk factors that influence 5-year survival of patients undergoing pulmonary metastasectomy. ⋯ This systematic review provides level 2a evidence of the effectiveness of pulmonary metastasectomy for metachronous pulmonary metastases from head and neck squamous carcinoma, which may offer prolonged survival for selected patients. Poor prognostic factors for pulmonary metastasectomy in this cohort of patients include the presence of lymph node metastasis at the diagnosis of the original tumour, squamous cell carcinoma of the oral cavity, incomplete pulmonary resection and the presence of multiple pulmonary nodules.
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Randomized Controlled Trial
Safety and efficacy of pre-incisional peritonsillar lornoxicam in paediatric post-tonsillectomy pain: a prospective double-blind, placebo-controlled, split-body clinical study.
To evaluate the risk of peri-operative bleeding and re-intervention with peritonsillar lornoxicam infiltration in paediatric tonsillectomy. ⋯ The lack of significant complications suggests that pre-incisional peritonsillar lornoxicam followed by intravenous paracetamol rescue analgesia may be safe for tonsillectomy in children. To avoid conflict with intra-operative bleeding, postoperative infiltration of lornoxicam is recommended.
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To analyse post-tonsillectomy haemorrhage (PTH) rates related to technique for dissection and haemostasis. ⋯ All hot techniques resulted in a higher risk for late PTH compared with cold steel dissection +cold haemostasis. The risk for RTT was higher for all hot techniques except for coblation, while ultrascision resulted in a lower risk for early PTH. An early PTH was associated with an increased risk for late PTH.