Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Donor aortic graft improves reconstruction after partial laryngectomy

22.05.2012
Novel grafts reduces need for permanent tracheotomy, maintain voice and swallowing function

Massachusetts General Hospital (MGH) surgeons have developed a new technique for reconstructing the larynx after surgery for advanced cancer. In the May Annals of Otology, Rhinology and Laryngology, they describe how this approach – which uses cryopreserved aortas from deceased donors to replace removed larynx tissue – allowed patients to avoid a permanent tracheotomy and maintain voice and swallowing function with no need for immunosuppressive medications.

The pioneering surgery was a collaborative effort between Steven Zeitels, MD, director of the MGH Center for Laryngeal Surgery, and John Wain, MD, surgical director of the MGH Lung Transplantation Service.

"Without this new reconstructive technique, most of these patients would have required a total laryngectomy," says Zeitels, corresponding author of the report. "I don't believe anything like this has been achieved before – especially for larynx cancer reconstruction in patients whose tumors recurred after radiotherapy."

Although small laryngeal tumors can be successfully removed through minimally invasive laser surgery or treated with radiation, advanced tumors require more invasive procedures to remove the affected area, especially when chemotherapy and radiation have failed as initial treatment. In these situations, problems with the healing of tissues previously exposed to radiation and the lack of reliable reconstructive techniques have meant that a majority of patients having partial laryngectomy still needed a permanent tracheotomy – an opening through the neck and into the trachea – resulting in substantial voice and swallowing dysfunction. Since the quality of life would probably be better with removal of the entire larynx, patients and their surgeons often chose a total laryngectomy.

To address the reconstructive limitations of partial laryngectomy, Zeitels and Wain developed an approach using the body's largest blood vessel, the aorta, to reconstruct the larynx. The MGH surgeons first used a previously frozen aortic graft for reconstruction after partial laryngectomy for recurrent cancer in 2009. Over the next two years, they performed the procedure on 15 patients, 8 of whom had previously received radiation therapy. All of these procedures were performed in one operation, combining both the tumor removal and reconstruction at the same time, and no immunosuppressive medications were needed.

Of that initial group of patients, all were able to have their postoperative tracheotomy tubes removed and resume breathing normally. All resumed speaking without the need for assistive devices, although their vocal quality depended on how much tissue had been removed, and all but one recovered and maintained swallowing function. Two patients had recurrence of their advanced tumors that required subsequent total laryngectomy. No stents were needed to keep patients' airways open, unlike in pilot trials using similar aortic grafts to reconstruct the trachea, which have had limited success.

"The shape of the aorta, which approximates that of the removed laryngeal tissue, and its ability to serve as a surface for healing within the airway are unique characteristics of these grafts that other forms of reconstruction do not provide," says Wain.

Zeitels adds, "The success of this procedure is remarkable, since the aortic tissue has held up extremely well against the stresses of a non-sterile environment, exposure to refluxing stomach fluids and the mechanical forces of swallowing and coughing. Given the success in this extremely challenging surgical scenario, it's likely that there will be many other uses for cryopreserved vascular grafts as supportive structures and tissue patches for surgery in other parts of the body."

Zeitels is the Eugene B. Casey Professor of Laryngeal Surgery, and Wain is an assistant professor of Surgery at Harvard Medical School. The study was supported, in part, by grants from the Voice Health Institute, the V Foundation and the Eugene B. Casey Foundation.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $750 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology and photomedicine.

Mike Morrison | EurekAlert!
Further information:
http://www.massgeneral.org/

More articles from Health and Medicine:

nachricht 3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg

nachricht Better equipped in the fight against lung cancer
16.05.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Explanation for puzzling quantum oscillations has been found

So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics

Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...

Im Focus: Dozens of binaries from Milky Way's globular clusters could be detectable by LISA

Next-generation gravitational wave detector in space will complement LIGO on Earth

The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...

Im Focus: Entangled atoms shine in unison

A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.

The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...

Im Focus: Computer-Designed Customized Regenerative Heart Valves

Cardiovascular tissue engineering aims to treat heart disease with prostheses that grow and regenerate. Now, researchers from the University of Zurich, the Technical University Eindhoven and the Charité Berlin have successfully implanted regenerative heart valves, designed with the aid of computer simulations, into sheep for the first time.

Producing living tissue or organs based on human cells is one of the main research fields in regenerative medicine. Tissue engineering, which involves growing...

Im Focus: Light-induced superconductivity under high pressure

A team of scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg investigated optically-induced superconductivity in the alkali-doped fulleride K3C60under high external pressures. This study allowed, on one hand, to uniquely assess the nature of the transient state as a superconducting phase. In addition, it unveiled the possibility to induce superconductivity in K3C60 at temperatures far above the -170 degrees Celsius hypothesized previously, and rather all the way to room temperature. The paper by Cantaluppi et al has been published in Nature Physics.

Unlike ordinary metals, superconductors have the unique capability of transporting electrical currents without any loss. Nowadays, their technological...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Save the date: Forum European Neuroscience – 07-11 July 2018 in Berlin, Germany

02.05.2018 | Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018

12.04.2018 | Event News

 
Latest News

Supersonic waves may help electronics beat the heat

18.05.2018 | Power and Electrical Engineering

Keeping a Close Eye on Ice Loss

18.05.2018 | Information Technology

CrowdWater: An App for Flood Research

18.05.2018 | Information Technology

VideoLinks
Science & Research
Overview of more VideoLinks >>>