Purpose: To assess the role of preoperative CT-based skeletal muscle mass depletion on postoperative clinical outcomes and survival in patients who underwent total laryngectomy for cancer. Methods: Patients operated on between January 2011 and March 2020 were retrospectively included. Skeletal muscle area and intra- and inter-muscular fat accumulation were measured at the third lumbar vertebral level on preoperative CT scans. Skeletal muscle mass depletion was defined based on pre-established cut-off values. Their association with postoperative morbidity, length of stay (LOS), costs, and survival was assessed. Results: A total of 84 patients were included, of which 37 (44%) had preoperative skeletal muscle mass depletion. The rate of postoperative fistula (23% vs. 35%, p = 0.348), cutaneous cervical dehiscence (17% vs. 11%, p = 0.629), superficial incisional surgical site infections (SSI) (12% vs. 10%, p = 1.000), and unplanned reoperation (38% vs. 37%, p = 1.000) were comparable between the two patient groups. No difference in median LOS was observed (41 vs. 33 days, p = 0.295), nor in treatment costs (119,976 vs. 109,402 CHF, p = 0.585). The median overall survival was comparable between the two groups (3.43 vs. 4.95 years, p = 0.09). Conclusions: Skeletal muscle mass depletion alone had no significant impact on postoperative clinical outcomes or survival.

Background/Objectives: Intraoperative radiotherapy (IORT) has been used for decades to improve local control in advanced and recurrent head and neck cancers by delivering a concentrated dose of radiation directly to the tumor bed during surgery. Despite its potential advantages, IORT remains controversial due to its high complication rates and logistical complexity. This systematic review aims to assess the current evidence on IORT in head and neck oncology, evaluating its indications, effectiveness, and limitations. Methods: A systematic literature review was conducted in accordance with Cochrane systematic review method and reported following PRISMA guidelines. Databases, including Medline, Embase, Cochrane, and Web of Science, were searched for studies evaluating IORT in head and neck cancer. Outcomes of interest included local control rates, overall survival, complications, and treatment logistics. Data were weighted based on patient numbers, and statistical analyses included weighted means and comparative tests. Results: Included in this review are 47 studies that included 2330 patients. The studies were highly heterogeneous, limiting definitive conclusions. IORT was mainly used in stage III/IV or recurrent tumors, with an average dose of 14.7 Gy (range: 1–40 Gy). The five-year local control was 47% to 82%. Complication rates included wound necrosis (22,3%), fistulas 34 (17.8%), and carotid blow-out (14.5%). Logistical constraints remain a major limitation. Conclusions: The heterogeneous data and logistic challenges of IORT in head and neck oncology have limited its use, and the benefits remain uncertain.

Background: Sleep apnoea is associated with increased postoperative morbidity and worsens after surgery under general anaesthesia. A thermoplastic mandibular advancement device (MAD) might prevent postoperative sleep apnoea worsening. This randomised, controlled, single-blind trial tested the hypothesis that a thermoplastic MAD would reduce apnoea–hypopnoea index (AHI) on the first postoperative night after general anaesthesia. Methods: One hundred patients undergoing various elective orthopaedic procedures on the lower limb under general anaesthesia were randomly allocated to two groups: use of a thermoplastic MAD during the first postoperative night (intervention) or no MAD during the first postoperative night (control). All patients underwent respiratory polygraphy on the first postoperative night. The primary outcome was the AHI on the first postoperative night. Secondary outcomes included the obstructive apnoea index, mixed apnoea index, central apnoea index, hypopnoea index, oxygen desaturation index, and self-reported tolerance of the device (on a numeric rating scale from 0 to 10, where higher scores indicate better tolerability), all measured during the first postoperative night. Results: The mean [95% confidence interval] AHI was similar in the MAD and control groups (9 [6–12] and 11 [7–15] events·h⁻¹, respectively; p = 0.26). There were no significant between-group differences in the secondary outcomes. The median (interquartile range) score for MAD tolerance was 7.5 (5.0, 8.5). Conclusions: In conclusion, a thermoplastic MAD did not demonstrate to reduce AHI after general anaesthesia for lower limb orthopaedic surgery on the first postoperative night. However, this finding should be interpreted cautiously, as dexamethasone administered to all participants may have reduced postoperative respiratory events or increased nocturnal wakefulness, thereby artificially lowering the apnoea–hypopnoea index calculated.