1) The document compares endoscopic versus open surgery for sinonasal and anterior skull base tumors. It finds that endoscopic surgery provides comparable oncologic outcomes to open surgery, with lower morbidity, faster recovery, and shorter hospital stays.
2) A review of studies found no difference in margins or survival between the two approaches. Endoscopic surgery was associated with significantly shorter hospital stays.
3) Complications were also lower with endoscopic surgery. While open surgery remains necessary in some complex cases, endoscopic surgery is presented as a valid alternative for most sinonasal and anterior skull base malignancies.
Carcinoma Larynx; Evidence based management
Staging - Surgery - Adjuvant therapy - Organ Preservation - Altered fractionation, chemotherapy - Radiotherapy (RT) techniques, Role of IMRT
Carcinoma Larynx; Evidence based management
Staging - Surgery - Adjuvant therapy - Organ Preservation - Altered fractionation, chemotherapy - Radiotherapy (RT) techniques, Role of IMRT
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
3. Contraindication
• Facial soft tissue/ Ant wall of Frontal bone
• Orbital Apex / Lat to optic tract/ B/L Optic nerve
• Cavernous sinus / ICA
• Tumours needing Dissection along the cranial Nerve
• Gross Brain involvement
• LONDON CANCER ALLIANCE and castelnuvo
(paper)
10. En bloc Resection
En bloc excision of the entire tumor is not necessary rather en
bloc excision of the area of invasion is performed.
• Olfactory Neuroblastoma
11. Retrospective review of patients with sinonasal
malignancy managed via endoscopic techniques
from September 1998 to December 2007 was
conducted.(University of Texas)
Despite concerns of piecemeal resection
resulting in higher recurrence rates, The overall
and local recurrence rates were 31 and 17%,
respectively.
12. Brain involvement can never be cleared with margins.
In short the sinonasal and anterior skull base tumours the margins are close
and usually ‘gross total resection’ is possible at best.
Dural margins are assessed with frozen section
14. Not the same
The 5-year disease-specific survival rate for all tumor types was 60%.
Overall survival at 5 years
Esthesioneuroblastoma (78%)
Low grade sarcomas (69%)
High-grade sarcomas (57%)
Adenocarcinoma (52%)
Salivary malignancies (46%)
Squamous cell carcinoma (44%)
Undifferentiated/ anaplastic carcinoma (37%)
Mucosal melanoma (18%)
15. HPR
•Endoscopic endonasal surgery represents an
oncologically sound alternative to opensurgery in
selected patients with sinonasal malignancies with lower
morbidity, faster recovery, and better quality-of-life
outcomes.
16. HPR - SARCOMA
Retrospective review of the literature on sinonasal
sarcomas from 1987-2017. Data were analyzed for
demographics, treatment type, stage, and histopathologic
type. Kaplan-Meier analysis was used to assess and
17. On univariate analysis T stage, overall stage, treatment
type, histopathologic subtype, and presence of distant
metastasis significantly affected survival.
On multivariate analysis overall stage alone significantly
predicted overall survival. Open vs. endoscopic surgery,
total radiation dose, and presence of neck metastasis did
18. A monocentric(France) retrospective study was carried out
from May 2002 to December 2013, including 43 patients
with intestinal-type adenocarcinoma of the ethmoid sinus.LR
and ESS were performed in, respectively, 23 and 20 patients.
The two groups were comparable in terms of age,
occupational dust exposure, histopathological sub- types,
and T stage based on the pathological assessment of the
specimen
19.
20. ESS is a valid option even for local advanced tumours in
close vicinity to the anterior skull base.
The intraoperative assessment of tumour extensions is
more relevant than CT scan and MRI to determine the
feasibility of this surgical approach.
A complete centripetal removal of the ethmoid labyrinth is
mandatory to circumscribe the ADC origin frequently
21. Retrospective review of the medical records of
25 patients with sinonasal mucosal melanoma
(SNM) treated by either OR or ER. - Cleveland
clinic
22.
23.
24. The proportion who achieved negative surgical margins on resection
(54% [n = 7] vs 58% [n = 7]) (P = .82) were similar between two
groups .
Overall all median survival (12.7 and 1.9 years) (P = .87) and
disease-free survival (1.9 and 1.2 years) (P = .72) were modest and
did not differ between OR and ER groups
25. Thirty-six studies containing 609 patients were included.
Meta- analysis of (a) all patients, (b) Kadish C/D only, and (c)
Hyams III/IV only, failed to show a difference in locoregional
control and metastasis- free survival between approaches.
Endoscopic approach showed improved overall survival (OS) for all
3 groups (p = .001, .04, and .001, respectively), and higher disease-
specific survival (DSS) for all patients (p = .004) and Hyams III/IV
only (p = .002).
26. 3)Bleeding
The giant JNA’s remodel the adjacent greater wing of
sphenoid and the orbital apex expanding the inferior orbital
fissure and spread intracranially alongside the cavernous
sinus.
The treatment of choice is complete excision with drilling
of the sphenopalatine region. This can be done via external
or endoscopic approaches.
27. 4) Repair1.Villaret AB, Yakirevitch A, Bizzoni A, et al. Endoscopic transnasal
craniectomy in the management of selected sinonasal malignancies.
Am J Rhinol Allergy 2010; 24:60–5.
2.Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive
technique after endoscopic expanded endonasal approaches: vascular
pedicle nasoseptal flap. Laryngoscope 2006;116(10):1882–6.
For the first intradural layer of duraplasty, the graft has to be at least
30% larger than the dural defect
The second layer, intracranial and extradural, needs to be precisely sized
and tacked between the previously under- mined dura and the residual
ASB bone
For the third layer of the skull base reconstruction it is also possible to
use a mucoperiosteum/mucoperichondrium pedi- cled nasoseptal flap
(Hadad-Bassagasteguy flap)
29. prospective cohort study, after histological confirmation and a staging
imaging protocol, patients deemed suitable were offered the option of
an entirely endoscopic resection as an alternative to craniofacial
resection. The procedure was performed under frozen section
control.
Hospital stay was a mean of 5 days, with no significant postoperative
complications
30. A retrospective analysis of patients treated by an exclusive endoscopic
approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to
2006 managed by two surgical teams at the Departments of
Otorhinolaryngology of the University of Brescia, and the University of
Pavia/Insubri Varese, Italy.
n=184.
EEA in 134 patients and the CEA in 50 patients.
The most frequent histotypes encountered were adenocarcinoma
(37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma
(12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma
(7.1%)
31. The distribution of tumors in relation to T category
52 (28.2%) T1 (49 and 3 in the EEA and CEA group,
respectively), 26 (14.2%) T2 (25 EEA and 1 CEA),
32 (17.4%) T3 (20 EEA and 12 CEA),
17 (9.2%) T4a (9 EEA and 8 CEA), and
35 (19%) T4b (12 EEA and 23 CEA
32.
33.
34. The 5-year disease-specific survival was 81.9 for the
entire patient cohort, varying from 91.4 % for the EEA
group to 58.8 % for the CEA group (p 0.0004).
In the EEA group, 5-year disease-specific survival was
94.4 for adenocarcinoma, 60.7 for squamous cell
carcinoma, and 100% for adenoid cystic carcinoma (p
0.03)
Conversely, in the CEA group, 5-year disease-specific
survival was 57.9 for adenocarcinoma, 53.3 for
squamous cell carcinoma, and 100% for adenoid cystic
carcinoma (p 0.8).
36. A retrospective chart review was performed of patients with
sinonasal or skull base malignancies treated with endoscopic
or endoscopic-assisted resections at a tertiary care institution
from 2002 to 2010.
Patient data were collected on symptoms, tumor type,
operative technique, and postoperative course.
Baseline risk factors, overall and disease-free survival data,
and surgical outcomes were compared between the two
groups.
37.
38.
39.
40. The 5-year overall survival was 87.4% (SE ± 5.3) in the endoscopic group vs
76.8% (SE ± 8.3) for open approaches (p = 0.351), disease-specific survival
was 94.7% (SE ± 3.7) vs 87.7% (SE ± 6.7; p = 0.258); and locoregional
control rate was 89.5% (SE ± 5.0) vs 77.2% (SE ± 10.4; p = 0.251).
41. The National Cancer Database was queried for cases of sinonasal
squamous cell carcinoma (SNSCC) with- out cervical or distant
metastases that were treated surgically between 2010 and 2014.
They were split into 2 groups based on surgical approach: open or
endoscopic. Demo- graphics, facility and insurance type, stage, tumor
characteristics, postoperative treatment, 30-day readmission rate, 30-
and 90-day mortality, and overall survival (OS) were compared
between the 2 groups.
Propensity score matching (PSM) was used to mimic a randomized,
controlled trial.
42.
43.
44. Margins
No difference in the rate of positive margins, both
before and after matching, between the endoscopic and
open groups. This suggests that the ability to attain an
R0 resection is comparable between surgical techniques.
There have been no previous studies comparing margin
status for endoscopic vs open resection specifically for
SNSCC
Hospital stay was significantly shorter in patients treated
with endoscopic resection (endoscopic: 2.50 days; open:
4.67 days; p < 0.0001).
45. Shorter stay
Endoscopic surgery to be associated with a significantly
shorter length of stay (in the matched cohort of this
study, length of stay was 2.54 days for endoscopic
surgery and 4.69 days for open surgery).
This is a major advantage of endoscopic surgery, given
that a shorter hospital stay is associated with not only
lower cost, but also a decreased risk of hospital-
associated morbidity such as healthcare- associated
infections
46. Conclusion
A PSM cohort of 652 patients with SNSCC treated
with endoscopic or open resection revealed no
difference in OS between matched groups, and
significantly shorter hospital stay in the endoscopic
surgery group.
47. Complications
TER patients had shorter operating room times, lower
intraoperative blood loss, shorter ICU stays, and shorter
hospital stays. There were no differences for the rates of true
en bloc resection (minimally ascertainable in either group),
negative margins, or disease-specific mortality.
There were no significant differences in disease- specific
mortality or recurrences.
49. Endoscopic vs Open Sino
Nasal & Anterior Skull
Base Surgery
Ajay Manickam
50. Thank You
I will not be ashamed to say “I know not,” nor
will I fail to call in my colleagues when the skills
of another are needed for a patient’s recovery.”