👤 Nicolas Fakhry

Few studies have compared chemoradiotherapy with primary surgery for T3 laryngeal cancers. This retrospective study compared two parallel consecutive patient cohorts: one treated surgically at the Sant'Orsola Hospital (Bologna, Italy) and the other managed with chemoradiotherapy at the Conception Hospital (Marseille, France). The study included 106 patients, 66 treated with chemoradiotherapy and 40 managed surgically. In Kaplan-Meier analysis, 2- and 5-year disease-free survival rates were 75% and 70% in the chemoradiotherapy group versus 85% at both time points in the surgery group (p = 0.22). Cox regression, adjusted for follow-up, age, sex, and cN stage, showed no significant differences in disease-free (p = 0.46), overall (p = 0.36), or disease-specific survival (p = 0.95). Tracheostomy dependence was higher after surgery (62.5% vs. 30.30%, p = 0.002), with no difference in gastrostomy dependence. Surgical and nonsurgical approaches achieved comparable oncologic outcomes with a lower rate of tracheostomy dependence in the nonsurgical group. Show less

In 2017, an innovative partnership was established between the ENT department of La Conception Hospital in Marseille and a city-hospital network (ILHUP) to facilitate early discharge after total laryngectomy (TL) and total pharyngo-laryngectomy (TPL). The main objective was to compare the home discharge rate versus transfer to a rehabilitation facility before and after implementation of this partnership. This single-center retrospective study included 205 patients who underwent TL/TPL between January 2012 and December 2023, divided into two groups: group 1 (n = 93) and group 2 (n = 112) before and after implementation of the city-hospital network. The home discharge rate in Group 2 was significantly higher than in Group 1 (55.4% vs. 40.9%, p = 0.039). Within group 2, mean length of hospital stay (23.8 vs. 26.12 days, p = 0.295) and two-month readmission rate (4.8% vs. 10%, p = 0.321) were similar between patients discharged home and those transferred to rehabilitation facilities. Multivariate analysis showed that implementation of the city-hospital network partnership was the only factor independently associated with an increased home discharge rate (p = 0.018). Implementation of a partnership with a city-hospital network significantly increased the home discharge rate after total (pharyngo-) laryngectomy without compromising patient safety. Show less

To establish typical clinical and radiological profiles of primary low-grade parotid cancers in order to tailor therapeutic strategy. Retrospective study of 57 patients operated on for primary parotid cancer between 2010 and 2021, with review of preoperative MRI and histopathology according to a standardized scoring grid. To study prognostic factors and determine the preoperative clinical and radiological profile of low-grade cancers. Good prognostic factors for specific survival were: staging ≤ cT3 (p = 0.014), absence of adenopathy on cN0 MRI (p < 0.001), superficial lobe location (p = 0.033), pN0 (p < 0.001), absence of capsular rupture (p = 0.004), as well as the absence of peri-tumoral nodules (p = 0.033), intra-parotid adenopathies (p < 0.001), vascular emboli (p < 0.001), peri-neural sheathing (p = 0.016), nuclear atypia (p = 0.031), and necrosis (p = 0.002). It was not possible to define a reliable clinical and radiological profile for low-grade cancers (sensitivity 38%, specificity 79%). Our study demonstrated multiple factors of good prognosis, but it was not possible to define a clinical and radiological profile of patients likely to benefit from more limited surgery, nor to diagnose, a priori, low-grade cancers. Show less