Add files using upload-large-folder tool

721/ops_codes.txt

@@ -0,0 +1 @@
+Direkte diagnostische Pharyngoskopie[1-611.0 ] Direkte diagnostische Laryngoskopie[1-610.0 ] Diagnostische Ösophagogastroskopie[1-631 ] Anlage perkutan-endoskopische Gastrostomie [PEG][5-431.2 ] Laryngektomie mit Pharyngektomie mit Rekonstruktion mit lokaler Schleimhaut[5-303.11 ] Radikale zervikale Lymphadenektomie [Neck dissection] radikal modifiziert 6 Regionen[5-403.22 B] Revision Tracheostomie[5-316.x ] Anlegen ösophagotracheale Fistel zur Einlage Stimmprothese[5-429.0 ] Einlegen einer Stimmprothese[5-319.9 ]

721/surgery_description.txt

@@ -0,0 +1 @@
+Laryngectomy with partial pharyngectomy and reconstruction, Neck dissection

721/surgery_report.txt

@@ -0,0 +1 @@
+First, after intubation via the existing tracheostoma, perform a pharyngo-/laryngoscopy: enter with the small bore tube under dental protection after inspecting the inconspicuous oral vestibule. An inconspicuous oral cavity including the floor of the mouth, tongue and soft palate is revealed. The oropharynx shows inconspicuous tonsil regions and posterior pharyngeal wall. The vallecula appears submucosally bulging, but there is still no exophytic tumor growth. The epiglottis is extremely displaced, there is an extensive, almost completely submucosal tumor that completely consumes the larynx. Careful inspection. The posterior wall of the hypopharynx and the lateral wall, including the piriform sinus, are completely free on the left, as is the free esophageal entrance; parts of the lateral wall of the hypopharynx are also free on the right. The piriform sinus is fixed and infiltrated by the tumor. Extensive extralaryngeal growth is palpated on the right side. Flexible esophagogastroscopy is now performed: an extensive scar is seen in the case of extensive gastrointestinal bleeding in 2010. With normal conditions in the gastric region and excellent diaphanoscopy, the stomach is now punctured without any problems and the PEG tube is inserted using the thread pull-through method without any problems. Inconspicuous esophagus on reflection. The patient is now repositioned. First of all, an apron flap is created by cutting around the old tracheostoma over a large area. Cut through the skin and subcutaneous tissue. Creation of the apron flap taking into account the platysma salt layer. Exposure of the sternocleidomastoid muscle on both sides. The extralaryngeal tumor growth can now be easily palpated. The thyroid gland is clearly enlarged but symmetrical and soft, and the infrahyoid muscles are not infiltrated. Initially start by detaching the tumorous process from the left side. To do this, first perform the neck dissection in the anterior region. Expose the submandibular gland. Exposure of the digastric muscle. Exposure and preservation of the facial vein. Dissection of the internal jugular vein. Exposure and preservation of the hypoglossal nerve. Exposure and preservation of the extremely strong superior thyroid artery. Exposure of the common carotid artery. The neck preparation is turned medially towards the tumor. This is followed by exposure of the thyroid cartilage horn. Release and ligation of the laryngeal bundle. Careful dissection and release of the piriform sinus. Exposure and release of the hyoid. This is clearly free on the left side. Dissection of the infrahyoid musculature. Dissection of the trachea on the left side. Left-sided resection of the thyroid isthmus. The pharynx is now entered between the thyroid cartilage and the hyoid, in the area of the left-sided vallecula, transition to the pharyngeal side wall. Free conditions here after inspection. Gradually widen the pharyngotomy and widen the mucosal incision. For a better overview, the lingual artery must be ligated and removed. It can now be seen that the epiglottis is also free on the left side. The vallecula is clearly tumor-free. Therefore, the mucosal incision is now extended along the aryepiglottic fold on the left and in the area of the vallecula. Successive release of the tumor. On the right side, the tumor appears to have at least contact with the hyoid, so the lateral right third is now resected. Now perform a parallel resection of the cervical sheath on the right side. The procedure is basically the same as on the opposite side. Expose the submandibular gland. Expose the digastric muscle. Exposure of the internal jugular vein. The facial vein moves towards the tumor and is removed after ligation. Careful dissection and preservation of the hypoglossal nerve. The superior thyroid artery also runs into the tumor conglomerate and is also removed after ligation. Exposure of the common carotid artery. Exposure of the prevertebral fascia. Medial and caudal, also relatively right-sided resection of the thyroid isthmus. The thyroid isthmus is preserved on the specimen, but is not infiltrated macroscopically. The former tracheostoma is now completely excised. This is also inflammatory in depth, but without evidence of direct tumor infiltration. Now, after complete mobilization and exposure of the cervical vascular sheath, the tumour is resected. Circumscribed right paralaryngeal open tumor, but with clear and safe separation from the soft tissue of the neck. Otherwise, regular soft tissue remains on all sides of the tumor. Complete resection of the tumor with resection of the right-sided piriform sinus. The mucosa of the posterior wall can be completely preserved, also free esophageal entrance, no postcricoid growth. A small, exophytic, ulcerated area can be seen in the area of the right-sided piriform sinus, otherwise completely submucosal tumor. Removal of the trachea, taking the tracheostoma with it, and removal of the tumor macroscopically clearly in sano. The mucosal margin samples are now imaged circularly. Moderate grade dysplasia, but no higher grade dysplasia or CIS was diagnosed in the postcricoid region and the right-sided hypopharynx. Completely free conditions on the left side. Therefore, no further resections were performed here. After inspection, the subglottic area was clear and wide. A Provox prosthesis is now fitted. Due to the inflammatory changes in the tracheostoma, conditions were somewhat more difficult, also due to the deep-seated trachea. The Provox prosthesis is inserted as cranially as possible. This is technically successful without any problems. The neck dissection is then completed. In principle exactly the same procedure. First on the left side. Exposure of the accessorius nerve. Release the accessorius triangle while carefully protecting the nerve. Release of level V with careful protection of the cervical plexus branches. Isolated ligation of a strong inflow to the thoracic duct. This can be easily visualized. Absolutely dry conditions here and no further measures. Complete exposure of the internal jugular vein beforehand. Careful wound inspection and turning to the opposite side. Level VI was removed en bloc with the preparation. Same procedure on the right side. Exposure of the accessorius nerve. Clearing of the accessorius triangle with careful protection of the nerve. Release of V a with careful protection of the cervical plexus branches. Ligation of the transverse cervical artery and coagulation of the right occipital artery. Careful wound inspection and hemostasis. Careful, two-layer pharyngeal suture with 3.0 mucosal suture, submucosal and inverting. Finally, good invasion of the 1st pharyngeal suture and tight conditions. Good mucosal conditions with preserved submucosal tissue. Mobilization of the detached thyroid gland is now performed, allowing a wide and large soft tissue mantle to be created on the pharyngeal tube. Suturing with 2.0 Vicryl. Final wound inspection. Insertion of a 10 Redon drain and cervical two-layer wound closure. Insertion of the tracheostoma. Clearly more difficult conditions here. Due to the inflammatory conditions in the area of the trachea and the relatively short tracheal stump, there is a slight tilting of the Provox prosthesis. Otherwise intact conditions on all sides. At the end of the operation, reintubation to a 10 mm tracheoflex cannula without any problems. Finally, also at the patient's request, removal of a left buccal atheroma, which has been present for many years. Also several atheroma-specific lesions distributed over the head. A curved skin incision is now made in the case of disturbing findings on the left buccal side. Cut through the skin. Excision of the directly subcutaneous mass, macroscopically and clinically clearly corresponding to an atheroma. Careful release strictly at the atheroma capsule. Therefore, protect the surrounding soft tissue. Meticulous hemostasis followed by careful, two-layer wound closure and completion of the procedure at this point without any indication of complications. Conclusion: Intraoperatively R0-resected cT4a cN2b glottic laryngeal carcinoma. Please perform a postoperative X-ray gruel swallow on the 9th postoperative day if the wound conditions are normal. In the area of the trachea, first wait for the wound to heal completely and then assess the Provox prosthesis.

722/history_text.txt

@@ -0,0 +1 @@
+Patient with histologically confirmed squamous cell carcinoma of the left hypopharynx with invasion into the larynx. The above-mentioned operation was therefore indicated. The patient was also informed in detail about defect coverage using a microvascular pedicled flap.

722/icd_codes.txt

@@ -0,0 +1 @@
+Bösartige Neubildung: Hypopharynx, mehrere Teilbereiche überlappend[C13.8 ] Hypopharynxkarzinom[C13.9 ]

722/ops_codes.txt

@@ -0,0 +1 @@
+Direkte diagnostische Laryngoskopie[1-610.0 ] Radikale zervikale Lymphadenektomie [Neck dissection] selektiv [funktionell] 5 Regionen[5-403.04 R] Selektive Neck dissection in 5 Regionen[5-403.04 L] Permanente Tracheotomie[5-312.0 ] Laryngektomie mit Pharyngektomie mit Rekonstruktion mit freiem mikrovaskulär-anastomosierten Transplantat[5-303.14 ] Deckung mit freiem Radialis-Lappen Kopf und Hals[5-858.70 R] Entnahme von Spalthaut am Oberschenkel[5-901.0e R] Großflächige freie Spalthauttransplantation am Unterarm[5-902.48 L] Wechsel eines vaskulären Implantates[5-394.3 ]

722/surgery_description.txt

@@ -0,0 +1 @@
+Resection, Neck dissection, Free flap (Radial)

722/surgery_report.txt

@@ -0,0 +1 @@
+First, pharyngoscopy and laryngoscopy again: The exophytic tumor is seen in the area of the hypopharyngeal side wall, passing over the anterior hypopharyngeal wall on the left to the postcricoid region and occupying it almost completely. The tumor also invades the left laryngeal skeleton via the arytenoid fold, thus confirming the indication for surgery. The patient is now repositioned: First neck dissection and tumor resection: creation of an apron flap in typical subplatysmal fashion. Then neck dissection on the right side: exposure of the digastric and omohyoid muscles. Dissection of the lymph node fat packet from the sternocleidomastoid muscle. Exposure of the cervical vascular sheath, internal jugular vein, common carotid artery. Internal carotid artery, external. Exposure of vagus nerve, hypoglossal nerve and accessorius nerve. Successive removal of the lymph nodes and fatty tissue from levels II-V, also by preserving branches of the cervical plexus. Neck dissection on the left side: This shows a conglomerate of cranial lymph nodes in level II, showing the omohyoid muscle and digastric muscle. The latter has grown together with the conglomerate and is also resected. Underlying the hypoglossal nerve. This runs through the middle of the lymph node conglomerate and must also be resected. Parts of the sternocleidomastoid muscle must also be resected in the cranial area. The internal jugular vein is also involved in the tumor process and must also be resected. It is exposed caudally and ligated twice. The lymph node conglomerate along the carotid artery and vagus nerve is then removed. Here, the mass must be dissected with some effort, particularly in the area of the bifurcation, but there is no tumor infiltration. Cranial exposure of the internal jugular vein and removal and double ligation of the vein also cranially in the vicinity of the jugular foramen. The accessorius nerve can be exposed and preserved here. Overall, level II-V evacuation as part of radical neck dissection. Subsequent tumor resection: First remove the level VI package, this is sent separately for histology. Then separation of the infrahyoid muscles from the hyoid bone. Subsequently detachment of the suprahyoid muscles from the hyoid bone. Exposure of the right superior cornu and separation of the piriform sinus. Separate the thyroid gland caudally and strike it caudo-laterally on both sides. On the left, the superior cornu is not released as it is located close to the tumor. Then enter the pharyngeal space above the level of the hyoid bone. Expose the tumor. The tumor is successively removed with a safety margin of at least 1.5 mm on all sides. This initially results in a partial pharyngectomy with laryngectomy. Laryngeal skeleton is released caudally with attached tumor and pharyngeal tube. Caudal creation of a tracheotomy and reintubation. Caudal suture of the trachea. The tumor preparation is then detached by cutting around a cranial tongue. The tumor specimen is marked with a suture. In addition, a caudal margin sample is taken and sent for frozen section. Unfortunately, carcinoma in situ infiltrate can still be seen in the left lateral, cranial and caudal tumor specimen. There is also carcinoma in situs in the area of the caudal margin sample. Therefore, margin samples are necessary at several locations. Extensive margin samples are taken approx. 1 cm wide caudally, laterally on the left and cranially. These are marked remote from the tumor and on the lateral suture. No more tumor infiltrates are visible here during the assessment. This ultimately results in a subtotal pharyngectomy. Due to the situation, defect coverage with a microvascular radial flap is now indicated. Provox prosthesis is not possible or sensible due to the overall situation and the proximity of the end of the defect to the potential Provox prosthesis site. However, a left myotomy has already been performed as part of the operation. The muscles of the cricopharyngeal muscle on the left side were completely severed over a length of 3-4 cm. Careful attention was paid to intact mucosa. This is followed by careful hemostasis and irrigation of the entire wound area. Now remove the left forearm flap: Marking of the defect size including skin monitor. Defect size 1.5 x 10 cm. Cut around the flap, initially ulnarly. Subsequently, dissection of the skin with some attached subcutaneous tissue and placement of a subcutaneous incision for skin monitoring. Extend the incision cranially to the crook of the elbow. Release of the skin monitor with subcutaneous tissue and superficial venous system. Release of the flap from radial, subfascial. Distal exposure of the radial artery. This is clamped for several times, here no changes in saturation, which is always 97-100 %. Subsequently, the radial artery is removed and treated cranially and caudally with 4-0 prolene sutures as a puncture. Successive elevation of the flap with deep pedicle, which was previously exposed under the brachioradialis muscle. Outgoing vessels are bipolarly coagulated and treated with clips. Exposure of a radial vein and cephalic vein through the antecubital fossa, which offers two outlets. Removal of the flap. The veins are ligated and the artery is treated with 6-0 Vascufil sutures. Spray the flap with heparin solution. Then successive insertion of the flap into the defect in the pharyngeal area. Incision of the skin at the esophageal entrance to improve the massage through the upper esophagus. Successive suturing of the flap with 3-0 or 4-0 Vicryl single-button sutures. This results in tension-free complete closure of the defect. The stalk is inserted cranially into the right side of the neck. Conditioning of the superior thyroid artery. Anastomosis with the conditioned radial artery using 8-0 Ethilon single-button sutures. After opening the clamps, good arterial flow, good venous return. V. radialis is anastomosed with an outlet from the A. facialis using a 2-0 coupler. Here too, good venous return after opening the clamp, positive smear phenomenon. A further vein which is branching off from the internal jugular vein is anastomosed with a branch from the cephalic vein, also using a 2.5 coupler. Again, after opening the clamp, good venous return, positive smear phenomenon. The remaining outlet from the cephalic vein is tilted close to the outlet. This is followed by irrigation of the entire wound area. Careful hemostasis. A Redon drain is inserted into each side of the neck on the right. The thyroid gland is adapted above the caudal part of the flap using 3-0 Vicryl sutures. Likewise the remaining infrahyoid muscles. Skin closure with suturing of the apron flap to the trachea and epithelialization of the tracheostoma. The skin monitor is sutured in place without tension via a small median incision. Good aspect. Tracheal cannula size 10 is placed and fixed with sutures. Closure of the forearm defect: approx. 0.7-0.8 mm thick split skin is removed from the thigh using the dermatome in a typical manner. The cranial parts of the wound on the forearm are sutured in layers. The defect is closed with the split skin, which is successively incorporated while protecting vascular and neuronal structures. Finally, a hydrogel-Mepilex dressing is applied and a loose compress bandage is placed over it and fixed with absorbent cotton. The arm is adjusted to a functional position on a Cramer splint and fixed with a flexible bandage. Loosening of the arm. Arm always well supplied with blood. Saturation between 95 and 100 %. The superficial wound area on the thigh is covered with a hydrocolloid dressing. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. The antibiotic treatment that was started intraoperatively should be continued with Unacid for 2-3 days. Heparin perfusor with 500 E/h, which was started intraoperatively, should be continued postoperatively for at least 5 days. Flap control for at least 5 days according to the scheme via Doppler control and control of the skin monitor. Leave the intraoperatively inserted gastric tube in place, feed via the previously inserted PEG tube for at least 10 days, then swallow porridge and, if necessary, build up the diet. Overall cT4a hypopharyngeal carcinoma with invasion of the left laryngeal skeleton. Under subtotal pharyngectomy, defect coverage by means of microvascularly pedicled radial flap from the left side necessary. Overall, given the size of the tumor, postoperative free chemotherapy is indicated.

723/InvasionFront_CD3_block1_x6_y7_patient723_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 19064.9,
+    "Centroid Y µm": 19589.6,
+    "Num Detections": 31070,
+    "Num Negative": 29095,
+    "Num Positive": 1975,
+    "Positive %": 6.357,
+    "Num Positive per mm^2": 679.86
+  }
+}

723/InvasionFront_CD8_block1_x5_y7_patient723_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16416.3,
+    "Centroid Y µm": 18090.4,
+    "Num Detections": 28965,
+    "Num Negative": 27937,
+    "Num Positive": 1028,
+    "Positive %": 3.549,
+    "Num Positive per mm^2": 392.32
+  }
+}

723/TumorCenter_CD3_block1_x5_y9_patient723_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 15991.5,
+    "Centroid Y µm": 22338.2,
+    "Num Detections": 7680,
+    "Num Negative": 5807,
+    "Num Positive": 1873,
+    "Positive %": 24.39,
+    "Num Positive per mm^2": 1884.3
+  }
+}

723/TumorCenter_CD3_block1_x6_y9_patient723_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18540.2,
+    "Centroid Y µm": 22288.2,
+    "Num Detections": 19139,
+    "Num Negative": 15576,
+    "Num Positive": 3563,
+    "Positive %": 18.62,
+    "Num Positive per mm^2": 1556.2
+  }
+}

723/TumorCenter_CD8_block1_x5_y7_patient723_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18840.0,
+    "Centroid Y µm": 26261.1,
+    "Num Detections": 27307,
+    "Num Negative": 26788,
+    "Num Positive": 519,
+    "Positive %": 1.901,
+    "Num Positive per mm^2": 207.14
+  }
+}

723/TumorCenter_CD8_block1_x6_y7_patient723_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 21388.7,
+    "Centroid Y µm": 26236.1,
+    "Num Detections": 31929,
+    "Num Negative": 31201,
+    "Num Positive": 728,
+    "Positive %": 2.28,
+    "Num Positive per mm^2": 273.72
+  }
+}

723/icd_codes.txt

@@ -0,0 +1 @@
+Bösartige Neubildung: Seitenwand des Oropharynx[C10.2 ] Karzinom Tonsille mehrere Teilbereiche überlappend[C09.8 L]

723/ops_codes.txt

@@ -0,0 +1 @@
+Transorale Tumortonsillektomie[5-281.2 ] Transplantat[5-295.04 ] Radikale zervikale Lymphadenektomie [Neck dissection] radikal modifiziert 4 Regionen[5-403.20 B] Temporäre Tracheotomie[5-311.0 ] Perkutan-endoskopische Gastrostomie durch Fadendurchzugsmethode[5-431.20 ] Extraktion mehrere Zähne verschiedener Quadranten[5-230.3 ] Entnahme sonstiges Transplantat mit mikrovaskulärer Anastomosierung Unterarm[5-858.43 L] Entnahme von Spalthaut des Oberschenkels[5-901.0e R] Großflächige freie Spalthauttransplantation am Unterarm[5-902.48 L]

723/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2019,
+  "age_at_initial_diagnosis": 59,
+  "sex": "male",
+  "smoking_status": "non-smoker",
+  "primarily_metastasis": "no",
+  "survival_status": "living",
+  "survival_status_with_cause": "living",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 27,
+  "adjuvant_treatment_intent": "curative",
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "yes",
+  "adjuvant_systemic_therapy_modality": "fluorouracil + cisplatin",
+  "adjuvant_radiochemotherapy": "yes"
+}

723/patient_pathological_data.json

@@ -0,0 +1,20 @@
+{
+  "patient_id": "723",
+  "primary_tumor_site": "Oropharynx",
+  "pT_stage": "pT2",
+  "pN_stage": "pN1",
+  "grading": "hpv_association_p16",
+  "hpv_association_p16": "positive",
+  "number_of_positive_lymph_nodes": 3.0,
+  "number_of_resected_lymph_nodes": 55,
+  "perinodal_invasion": "no",
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": "0.2",
+  "histologic_type": "SCC_Basaloid",
+  "infiltration_depth_in_mm": 5.0
+}

723/surgery_description.txt

@@ -0,0 +1 @@
+Tumor resection, Bilateral neck dissection (Level I-V), Free flap (Radial), Defect coverage

723/surgery_report.txt

@@ -0,0 +1 @@
+PEG insertion (<CLINICIAN_NAME>): Placement of the PEG tube after flexible gastroesophagoscopy and performance of positive diaphanoscopy in the usual manner using the thread pull-through method. Removal of the left radial lobe (<CLINICIAN_NAME>): Palpatory identification of the distal radial artery. Marking of the flap borders 9x7 cm on the distal forearm proximal to the retinaculum floxorom with an S-shaped incision running proximally into the cubital fossa. Cutaneous and subcutaneous incision starting proximally, identification and visualization of the venous confluence in the cubital fossa. The cephalic vein is well developed on this side. There are now already 2 large veins to the anastomosis in the cubital fossa. Now identify the external ramus of the radial nerve and leave the peritendineum of the tendon of the brachioradialis muscle and incise down to the forearm fascia, incise the fascia and then lift the flap fascially to the end of the flexor carpi radialis muscle. Care is taken to leave the peritendineum on the flexor tendon and to spare the ulnar artery. The ulnar artery is spared, the radial artery is identified distally, palpated and clamped. Clamping of the vessels with the HDS clamp, after 5 minutes under good oxygen saturation measured by pulse oximetry on the palate, the vessels are removed with subsequent Ethibond 0 ligation. The successive detachment of the flap pedicle from the flexor pollicis longus muscle was performed. Larger perforators were treated with clips. The ulnar, brachial and radial arteries are identified proximally. The flap is then placed on the radial artery and 2 large veins in the cubital fossa are also placed, which are suitable for anastomosis. The flap is irrigated with heparin. Regular situation. The flap is now transferred for suturing and the arm is closed proximally in 2 layers with 4-0 Vicryl and 5-0 Ethilon. Distally, the resulting defect is sutured using split skin with 5-0 Ethilon. The previously fitted forearm splint is then applied and flap elevation is completed without complications. Tumor resection by <CLINICIAN_NAME> and <CLINICIAN_NAME>: Insertion of the McIvor oral retractor with the small spatula and adjustment of the site. This shows a coarse, ulcerated mass localized to the left tonsil lobe. Submucosally, the mass extends just above the cranial tonsil pole. The resection margins are determined in the presence of <CLINICIAN_NAME>. Successive tumour resection after mobilization of the upper tumour pole under constant palpatory control. The resection is performed in healthy muscle tissue. Lateral parapharyngeal fat is visualized. Bleeding is stopped with the bipolar coagulation forceps. After cutting around the caudal pole of the tonsil, leaving a strip of the base of the tongue on the tumor resectate, the sutures are marked on all 4 quadrants. The resectate is sent in its entirety on cork for a frozen section histopathological examination. After 1 hour, the feedback is received that the tumor has been resected R0. All tumor margins are free. Subtle hemostasis in the tumor bed using bipolar coagulation forceps. Neck dissection is performed on the left side by <CLINICIAN_NAME>: After infiltration with local anesthetic containing adrenaline, the corresponding arcuate skin incision is made. Sharp dissection through the cutis and subcutis with exposure of the sternocleidomastoid muscle. The large, easily displaceable metastasis is located immediately adjacent to this. This is first exposed on all sides, whereby the neck dissection specimen is successively dissected along the omohyoid muscle, digastric muscle with parts of the caudal parotid gland and the sternocleidomastoid muscle. Open the vascular nerve sheath caudally and dissect cranially. Expose the internal jugular vein and the common carotid artery as well as the vagus nerve in between, which can be spared until the end. Subsequently, successive cranial dissection with successive detachment of the large metastasis from the internal jugular vein, which is ultimately also successful in a healthy layer. The digastric muscle is followed ventrally from its anterior belly via its tendon to the posterior belly and the specimen is thus also dissected laterally. The hypoglossal nerve is preserved. Finally, the metastasis with the caudal parts of the parotid gland is completely detached from the vascular nerve sheath. The accessory nerve can also be preserved intact from region II. The neck dissection is then completed with resection of regions II to V so that the neck dissection specimen can be resected en bloc together with the large metastasis. The submandibular gland is then removed and region I cleared. In addition to the lingual nerve, the enoral defect that will later be used for the flap can also be seen here. Neck dissection on the right by <CLINICIAN_NAME> and PJ: Skin incision on the anterior edge of the sternocleidomastoid muscle. Separation of the cutaneous and subcutaneous tissue. Exposure of the platysma and transection of the platysma. Snaring of the platysma and subplatysmal flap preparation. Ligation of the external jugular vein. Exposure of the auricular nerve and protection of the nerve. Now dissection in depth along the anterior edge of the sternocleidomastoid muscle. Expose the posterior digastric venter muscle and the omohyoid muscle. Insertion of blunt retractors and exposure of the cervical vascular nerve sheath. This is successively freed from the neck preparation. Now remove the neck preparation after visualization and release of the accessorius nerve from cranial to caudal, taking level II a, II b, III, IV and V. Insertion of a 10 Redon drain. Subtle hemostasis using bipolar coagulation forceps. Irrigation with hydrogen and Ringer and two-layer wound closure on the right side of the neck. Now the radialis graft is inserted by <CLINICIAN_NAME>: looping the cranial flap end cervically with a clamp and pulling through the opening. Insertion of the graft into the tumor resection box. Flap fixation and suturing of the flap in single button sutures in the usual manner without complications. Inspection shows good closure with a well-fitting graft. Anastomoses through <CLINICIAN_NAME>: After appropriate suturing of the flap enorally, the stalk is passed outwards and fixed with 2 retaining sutures. The arterial anastomosis is made to the superior thyroid artery on the left side. Venous drainage is then ensured by the two existing veins, which are connected to the internal jugular vein in an end-to-side manner. The tracheotomy is then created by <CLINICIAN_NAME>: horizontal skin incision just below the cricoid over 2 cm. Separation of the cutaneous and subcutaneous tissue. Dissection into the fatty tissue and exposure of the infralaryngeal musculature, which is split in the middle and the thyroid isthmus is exposed. Undermining of the thyroid isthmus. Bipolar coagulation and transection with the scissors. Identification of the anterior tracheal wall and entry into the 2nd and 3rd intertracheal ring space. Incision of the tracheostoma in the usual manner using epithelializing single-button sutures. Insertion of a 9 mm tracheostomy tube and completion of the tracheostomy without complications.

724/InvasionFront_CD3_block13_x3_y3_patient724_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 11069.1,
+    "Centroid Y µm": 6946.3,
+    "Num Detections": 14597,
+    "Num Negative": 14222,
+    "Num Positive": 375,
+    "Positive %": 2.569,
+    "Num Positive per mm^2": 232.21
+  }
+}

724/InvasionFront_CD3_block13_x4_y3_patient724_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13542.8,
+    "Centroid Y µm": 6821.4,
+    "Num Detections": 16663,
+    "Num Negative": 16173,
+    "Num Positive": 490,
+    "Positive %": 2.941,
+    "Num Positive per mm^2": 262.94
+  }
+}

724/InvasionFront_CD8_block13_x3_y3_patient724_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 12593.3,
+    "Centroid Y µm": 8495.5,
+    "Num Detections": 14581,
+    "Num Negative": 14193,
+    "Num Positive": 388,
+    "Positive %": 2.661,
+    "Num Positive per mm^2": 235.73
+  }
+}

724/InvasionFront_CD8_block13_x4_y3_patient724_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 15092.0,
+    "Centroid Y µm": 8545.5,
+    "Num Detections": 18394,
+    "Num Negative": 17929,
+    "Num Positive": 465,
+    "Positive %": 2.528,
+    "Num Positive per mm^2": 235.37
+  }
+}

724/TumorCenter_CD3_block13_x3_y3_patient724_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 12568.3,
+    "Centroid Y µm": 13892.6,
+    "Num Detections": 17257,
+    "Num Negative": 16477,
+    "Num Positive": 780,
+    "Positive %": 4.52,
+    "Num Positive per mm^2": 389.72
+  }
+}

724/TumorCenter_CD3_block13_x4_y3_patient724_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 15067.0,
+    "Centroid Y µm": 14117.5,
+    "Num Detections": 16907,
+    "Num Negative": 16161,
+    "Num Positive": 746,
+    "Positive %": 4.412,
+    "Num Positive per mm^2": 380.65
+  }
+}

724/TumorCenter_CD8_block13_x3_y3_patient724_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 10844.3,
+    "Centroid Y µm": 8045.7,
+    "Num Detections": 15828,
+    "Num Negative": 15406,
+    "Num Positive": 422,
+    "Positive %": 2.666,
+    "Num Positive per mm^2": 212.6
+  }
+}

724/TumorCenter_CD8_block13_x4_y3_patient724_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13268.0,
+    "Centroid Y µm": 7695.9,
+    "Num Detections": 15200,
+    "Num Negative": 14851,
+    "Num Positive": 349,
+    "Positive %": 2.296,
+    "Num Positive per mm^2": 181.79
+  }
+}

724/history_text.txt

@@ -0,0 +1 @@
+Patient with histologically confirmed, extensive carcinoma located in the right hypopharynx and infiltrating the larynx over a wide area, including thyroid cartilage, extending cranially to the tonsil lobe. CT clearly shows thyroid cartilage infiltration by the tumor. Therefore, the above mentioned surgery is indicated.

724/icd_codes.txt

@@ -0,0 +1 @@
+Bösartige Neubildung: Hypopharynx, mehrere Teilbereiche überlappend[C13.8 ] Larynxkarzinom[C32.9 ] Karzinom Hypopharynx mehrere Teilbereiche überlappend[C13.8 ] Halslymphknotenmetastasen[C77.0 ]

724/ops_codes.txt

@@ -0,0 +1 @@
+Permanente Tracheostomaanlage[5-312.0 ] Laryngektomie mit Pharyngektomie mit Rekonstruktion mit freiem mikrovaskulär-anastomosierten Transplantat[5-303.14 ] Radikale zervikale Lymphadenektomie [Neck dissection] selektiv [funktionell] 4 Regionen[5-403.03 B] Spalthaut Entnahmestelle sonstige[5-901.0x R] Wechsel Herzklappe onA[5-352.y ] Endarteriektomie einer Gefäßprothese an Arterien der Hand[5-381.28 L] Offen chirurgische Implantation von einem großlumigen ungecoverten Stent in künstliche Gefäße (Zusatzkode)[5-38e.0e ] Transorale radikale Resektion des Pharynx [Pharyngektomie] mit Rekonstruktion mit freiem mikrovaskulär-anastomosierten Transplantat[5-296.04 ] Radikale zervikale Lymphadenektomie [Neck dissection] selektiv [funktionell] 5 Regionen[5-403.04 B] Offene pharyngozervikale Ösophagomyotomie[5-420.11 ]

724/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2013,
+  "age_at_initial_diagnosis": 53,
+  "sex": "male",
+  "smoking_status": "smoker",
+  "primarily_metastasis": "no",
+  "survival_status": "deceased",
+  "survival_status_with_cause": "deceased tumor specific",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 42,
+  "adjuvant_treatment_intent": null,
+  "adjuvant_radiotherapy": "no",
+  "adjuvant_radiotherapy_modality": null,
+  "adjuvant_systemic_therapy": "no",
+  "adjuvant_systemic_therapy_modality": null,
+  "adjuvant_radiochemotherapy": "no"
+}

724/patient_pathological_data.json

@@ -0,0 +1,20 @@
+{
+  "patient_id": "724",
+  "primary_tumor_site": "Hypopharynx",
+  "pT_stage": "pT4a",
+  "pN_stage": "pN2b",
+  "grading": "G3",
+  "hpv_association_p16": "not_tested",
+  "number_of_positive_lymph_nodes": 2.0,
+  "number_of_resected_lymph_nodes": 49,
+  "perinodal_invasion": "yes",
+  "lymphovascular_invasion_L": "yes",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "Ris1",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": null,
+  "histologic_type": "SCC_Basaloid",
+  "infiltration_depth_in_mm": 45.0
+}

724/surgery_description.txt

@@ -0,0 +1 @@
+Pharyngectomy, Neck dissection, Free flap (Radial), Tracheotomy

724/surgery_report.txt

@@ -0,0 +1 @@
+<CLINICIAN_NAME>: Induction of anesthesia and intubation by the anesthesiologist, then first of all, insertion of the small bore tube and examination of the tumor. It can be seen that the tumor already starts at the lower tonsil pole on the right side and extends along the hypopharyngeal side wall and posterior wall into the piriform sinus, filling it completely and infiltrating the larynx laterally. Then sterile washing and draping and creation of an apron flap in the usual manner. Start with the neck dissection on the right side. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle and the submandibular gland. Then locate the accessorius nerve and clear levels II b, III, IV and V while sparing the plexus branches. Exposure of the hypoglossal nerve and evacuation of the medial upper neck preparation. Then evacuation of the neck level VI and separate insertion of the neck level VI. Then turn to the opposite side and perform the neck dissection on the left side in the same way. Several large, coarse metastases are visible on the right side. On the left side only unspecifically enlarged lymph nodes. Then detachment of the cervical vascular sheath from the tumor and from the larynx. Detachment of the tumor from the spinal column. This is achieved without any problems using blunt dissection. Perform a median pharyngotomy at the level of the epiglottis. Then grasp the epiglottis and pull the epiglottis through the pharyngotomy. Carefully incise the mucosa along the aryepiglottic fold, first on the left side, then on the right side, observing the tumor margins. Release the laryngeal preparation in the posterior part. Then perform the tracheotomy. Enter the trachea between the 1st and 2nd tracheal cartilage. The patient has had a history of thyroidectomy, so that no thyroid gland was present. Suturing of the lower skin to the trachea. Then placement of a feeding tube under visualization. Locate the esophagus and remove the laryngeal specimen and the tumor specimen. An approx. 3 cm wide strip of mucosa remains in the upper part of the pharynx, but this becomes significantly smaller in the lower area, so that primary closure of the pharynx does not appear possible and the decision is therefore made to sew in a radialis graft in any case. In the meantime, suture marks are placed on the tumor specimen and the entire specimen is guided to the frozen section. Unfortunately, resection is necessary in 2 places, once in the area of the epiglottis and then at the caudal edge of the deposit. This is done by taking a resection specimen, which goes to the final histology and then new frozen sections. Both new frozen sections are tumor-free, so that an R0 situation can be confirmed intraoperatively. Therefore, lifting of the radialis graft and insertion of the graft as well as anastomosis of the vessels by <CLINICIAN_NAME>. Parallel removal of the split skin from the right thigh and suturing of the split skin to the forearm. Application of a Mepilex dressing. Fixation of the Mepilex dressing with Mersilene sutures. Application of a Kramer splint. Completion of the operation without complications. <CLINICIAN_NAME>: Now removal of the forearm flap from the left forearm: After measuring the defect, the flap dimensions are 13 to 14 cm in length and at least 8 to 9 cm in width. Record the flap with a skin monitor on the left forearm. Then first cut around the flap ulnarly. Dissect the skin, leaving subcutaneous tissue in the area of the planned subcutaneous bridge to the skin monitor, which is cut around. Continue the incision into the crook of the elbow. The flap is lifted ulnarly subfascially while preserving the ulnar artery. Then, after locating the superficial venous system and including it in the flap pedicle, lift the flap subfascially from the radial side. Locate the vascular pedicle under the brachioradialis muscle and follow it to the elbow. Locate the radial artery caudally and clamp. First lift the flap from the radial subfascial. Subsequently, the radial artery is removed. This is treated distally and proximally with 4-0 Prolene sutures. Lift the flap subfascially along the flap pedicle, taking the subcutaneous tissue with it to the skin monitor. Individual vessels are bipolarly coagulated or clipped. In the antecubital region, visualization of the radial artery of the confluence with the brachial artery and the outlet of the interosseous artery. Subsequent exposure of the cephalic vein, which splits into 2 vein ends, with connection to the deep vein system. The radial artery splits into smaller veins in the area of the confluence, which is not suitable for anastomosis and is separated and supplied with a clip. Another caudal vein, which arises from the subcutaneous tissue of the skin monitor, can initially be retained. The flap is removed. Veins are ligated. The artery is treated with 6-0 Vascufil sutures. Flush the flap with heparin solution. Subsequent insertion of the flap: First myotomy laterally to facilitate passage of food later. Subsequent suturing of the flap successively with Vicryl 3-0 single button sutures to the remaining mucosal bridge in the case of a subtotal pharyngeal defect. Defect extends to the palatal arch in the area of the uvula. Flap suturing is successful at all points without tension. Partial duplication of the suture to secure it. Subsequent conditioning of the vessels. The radial artery is anastomosed with the lingual artery using 8-0 single Ethilon button sutures. After opening the clamp, good arterial flow and good venous return. An outlet of the cephalic vein is then conditioned and anastomosed with the facial vein using a 3.0 coupler. Here too, after opening the clamp, good venous flow. Positive smear phenomenon. The other end is anastomosed with the external jugular vein using a 2.5 mm coupler; here too, good flow conditions after opening the clamp. Positive smear phenomenon. Then careful hemostasis. Irrigation of the entire wound area. Repositioning of the apron flap. Suture the apron flap to the trachea without tension. The skin monitor is integrated into the skin on the right side with a right-sided vascular connection. Redon drains were inserted on both sides, guided on the right. Finally, insertion of a size 10 tracheal cannula, which is fixed with sutures. The site for Doppler control is marked on the right side in the area of the external jugular vein. The procedure is completed without complications. Patient goes to the intensive care unit for postoperative monitoring. Please continue antibiotics for 2 to 3 days, which were started intraoperatively with clindamycin. Feeding via the PEG tube for at least 10 days, then gruel and, if necessary, diet build-up. Provox was not applied intraoperatively due to the flap situation and can still be applied at intervals. Please check the flap via skin monitor and Doppler sonography according to the scheme. Continue heparin perfusor 500 units per hour for 5 days. Overall cT4a cN2/4b oropharyngeal/hypopharyngeal/laryngeal carcinoma on the right. Postoperative radiochemotherapy should certainly be discussed.

725/InvasionFront_CD3_block22_x5_y6_patient725_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 17016.0,
+    "Centroid Y µm": 26660.9,
+    "Num Detections": 25201,
+    "Num Negative": 25033,
+    "Num Positive": 168,
+    "Positive %": 0.6666,
+    "Num Positive per mm^2": 64.78
+  }
+}

725/InvasionFront_CD3_block22_x6_y6_patient725_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 19714.6,
+    "Centroid Y µm": 26685.9,
+    "Num Detections": 25830,
+    "Num Negative": 25727,
+    "Num Positive": 103,
+    "Positive %": 0.3988,
+    "Num Positive per mm^2": 38.82
+  }
+}

725/InvasionFront_CD8_block22_x5_y6_patient725_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 19214.8,
+    "Centroid Y µm": 14817.2,
+    "Num Detections": 22554,
+    "Num Negative": 22414,
+    "Num Positive": 140,
+    "Positive %": 0.6207,
+    "Num Positive per mm^2": 56.23
+  }
+}

725/InvasionFront_CD8_block22_x6_y6_patient725_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 21838.4,
+    "Centroid Y µm": 14767.2,
+    "Num Detections": 24186,
+    "Num Negative": 24102,
+    "Num Positive": 84,
+    "Positive %": 0.3473,
+    "Num Positive per mm^2": 32.7
+  }
+}

725/TumorCenter_CD3_block22_x5_y6_patient725_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16641.2,
+    "Centroid Y µm": 15666.7,
+    "Num Detections": 29751,
+    "Num Negative": 29713,
+    "Num Positive": 38,
+    "Positive %": 0.1277,
+    "Num Positive per mm^2": 13.06
+  }
+}

725/TumorCenter_CD3_block22_x6_y6_patient725_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 19239.8,
+    "Centroid Y µm": 15716.7,
+    "Num Detections": 32293,
+    "Num Negative": 32284,
+    "Num Positive": 9,
+    "Positive %": 0.0279,
+    "Num Positive per mm^2": 3.08
+  }
+}

725/TumorCenter_CD8_block22_x5_y6_patient725_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18915.0,
+    "Centroid Y µm": 24986.8,
+    "Num Detections": 29454,
+    "Num Negative": 29333,
+    "Num Positive": 121,
+    "Positive %": 0.4108,
+    "Num Positive per mm^2": 41.69
+  }
+}

725/TumorCenter_CD8_block22_x6_y6_patient725_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 21513.6,
+    "Centroid Y µm": 25061.7,
+    "Num Detections": 30038,
+    "Num Negative": 30013,
+    "Num Positive": 25,
+    "Positive %": 0.0832,
+    "Num Positive per mm^2": 8.65
+  }
+}

725/icd_codes.txt

@@ -0,0 +1 @@
+Bösartige Neubildung: Hypopharynx, mehrere Teilbereiche überlappend[C13.8 ]

725/ops_codes.txt

@@ -0,0 +1 @@
+Direkte diagnostische Pharyngoskopie[1-611.0 ] Direkte diagnostische Laryngoskopie[1-610.0 ] Radikale zervikale Lymphadenektomie [Neck dissection] radikal modifiziert 4 Regionen[5-403.20 B] Laryngektomie mit Pharyngektomie mit Rekonstruktion mit freiem mikrovaskulär-anastomosierten Transplantat[5-303.14 ] Entnahme freier Radialis-Lappen[5-858.23 L] Deckung mit freiem Radialis-Lappen Kopf und Hals[5-858.70 L] Entnahme von Spalthaut an Oberschenkel und Knie[5-901.0e R] Großflächige freie Spalthauttransplantation am Unterarm[5-902.48 L] Permanente Tracheotomie[5-312.0 ] Perkutan-endoskopische Gastrostomie durch Fadendurchzugsmethode[5-431.20 ] Diagnostische Ösophagogastroskopie bei normalem Situs[1-631.0 ] Mikrochirurgische Technik (Zusatzkode)[5-984 ]

725/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2018,
+  "age_at_initial_diagnosis": 55,
+  "sex": "male",
+  "smoking_status": "smoker",
+  "primarily_metastasis": "yes",
+  "survival_status": "living",
+  "survival_status_with_cause": "living",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 59,
+  "adjuvant_treatment_intent": "palliative",
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "yes",
+  "adjuvant_systemic_therapy_modality": "cetuximab + carboplatin",
+  "adjuvant_radiochemotherapy": "yes"
+}

725/patient_pathological_data.json

@@ -0,0 +1,20 @@
+{
+  "patient_id": "725",
+  "primary_tumor_site": "Oropharynx",
+  "pT_stage": "pT2",
+  "pN_stage": "pN1",
+  "grading": "G3",
+  "hpv_association_p16": "negative",
+  "number_of_positive_lymph_nodes": 1.0,
+  "number_of_resected_lymph_nodes": 31,
+  "perinodal_invasion": "no",
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": "0.1",
+  "histologic_type": "SCC_Basaloid",
+  "infiltration_depth_in_mm": NaN
+}

725/surgery_description.txt

@@ -0,0 +1 @@
+Total LE with partial pharyngectomy, Bilateral neck dissection, Defect coverage, Free flap (Radial), Provox prosthesis, PEG placement