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642/icd_codes.txt

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+Karzinom Hypopharynx mehrere Teilbereiche überlappend[C13.8 R]

642/surgery_description.txt

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+Resection, Bilateral neck dissection, Tracheotomy, Defect coverage, Free flap (Radial)

642/surgery_report.txt

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+First insertion with the small water tube and inspection of the tumor region. Then insertion of the tonsil plug. It is noticed that there is a suspicious lesion on the posterior pharyngeal wall relatively far cranially in the oropharynx; this is biopsied and sent for a frozen section. This also shows squamous cell carcinoma, which was not previously described. This area is connected submucosally with 2 further suspicious areas that were previously described, 1x in the hypopharynx at the entrance to the piriform sinus and 1x at the transition between the oropharynx and hypopharynx. All these lesions are connected submucosally. Then sterile washing and draping and start with transoral tumor resection. Cut around the tumor with the monopolar needle. Lift off the prevertebral fascia and dissect as far caudally as possible. If the overview is restricted, switch to a transcervical approach. For this purpose, create an apron flap in the usual manner. Expose the cervical vascular sheath. Securing the cervical sheath. Exposure of the left part of the hyoid bone and the superior laryngeal nerve. Expose the pharyngeal muscles and then enter with the small bore tube and determine the site where the pharyngotomy will be performed. It can be seen that the tumor is at the entrance to the piriform sinus and is therefore also partially under the thyroid cartilage. Exposure of the upper horn of the thyroid cartilage and detachment of the piriform sinus from the thyroid cartilage on this side. The upper horn of the thyroid cartilage and a small part of the thyroid cartilage must be resected in order to reach the tumor properly. Then enter the pharynx and resect the tumor with a safety margin of 0.5 to 1 cm. The specimen is placed en bloc on cork and marked for histology. All margins free in the frozen section, i.e. intraoperative R0 situation on the specimen. Measure the defect 12 x 6 cm and mark on the forearm. Start preparation of the radialis graft by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Exposure of the cephalic vein. Exposure of the brachiocephalic muscle. Showing the venous star in the crook of the elbow. Visualization of the venous confluence. Visualization of the radial superficial ramus nerve. Exposure of the radial artery. Removal of the radial artery. Lifting of the radialis graft from the tendons. Then dissection of the pedicle up to the crook of the elbow. Removal of the pedicle, including 2 deep veins and 1 superficial large cephalic vein. In the meantime, parallel neck dissection on the right side by <CLINICIAN_NAME> and <CLINICIAN_NAME>. After creation of the apron flap by <CLINICIAN_NAME>, perform a neck dissection on the right side Level II to V. Exposure of the anterior border of the sternocleidomastoid muscle. Exposure of the accessorius nerve. Exposure of the omohyoid muscle. Tracing the omohyoid to the hyoid bone. Visualization of the cervical vascular sheath of the internal jugular vein. Exposure of the submandibular gland and the posterior venter of the digaster. The borders are thus shown. Now detach the neck preparation from level II b, II, III, IV and V, preserving all non-lymphatic structures. The vagus nerve and carotid artery are exposed and spared. The accessor nerve is exposed and also spared. The plexus branches are clearly visible in depth and level V is cleared. No evidence of chyle fistula. Left Start of neck dissection by <CLINICIAN_NAME> and takeover of <CLINICIAN_NAME>. Exposure of the cervical vascular sheath after the borders, i.e. sternocleidomastoid, omohyoid, submandibular and accessory gland and digastric muscle, have been exposed. Neck levels II to V were then removed. Plexus branches were spared, hypoglossus spared and accessorius nerve spared, cervical nerve spared. Then suturing of the radialis graft, first from the transoral, then from the transcervical side and removal of the pedicle to the left side. End-to-side anastomosis between the cephalic vein and internal jugular vein and coupler between the facial vein and a deep vein of the radialis graft and anastomosis between the radial artery and facial artery. Insertion of Redon drains, one on each side, and two-layer wound closure. Flap control according to the usual scheme, antibiotics for at least 24 hours.

643/InvasionFront_CD3_block15_x6_y8_patient643_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 21263.7,
+    "Centroid Y µm": 29609.3,
+    "Num Detections": 19497,
+    "Num Negative": 18072,
+    "Num Positive": 1425,
+    "Positive %": 7.309,
+    "Num Positive per mm^2": 584.08
+  }
+}

643/InvasionFront_CD8_block15_x5_y8_patient643_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16554.0,
+    "Centroid Y µm": 19646.6,
+    "Num Detections": 19555,
+    "Num Negative": 18993,
+    "Num Positive": 562,
+    "Positive %": 2.874,
+    "Num Positive per mm^2": 223.97
+  }
+}

643/InvasionFront_CD8_block15_x6_y8_patient643_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 19032.2,
+    "Centroid Y µm": 19471.1,
+    "Num Detections": 17537,
+    "Num Negative": 17288,
+    "Num Positive": 249,
+    "Positive %": 1.42,
+    "Num Positive per mm^2": 103.86
+  }
+}

643/TumorCenter_CD3_block15_x5_y8_patient643_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16316.4,
+    "Centroid Y µm": 23487.6,
+    "Num Detections": 20389,
+    "Num Negative": 19693,
+    "Num Positive": 696,
+    "Positive %": 3.414,
+    "Num Positive per mm^2": 272.2
+  }
+}

643/TumorCenter_CD3_block15_x6_y8_patient643_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18940.0,
+    "Centroid Y µm": 23612.5,
+    "Num Detections": 16845,
+    "Num Negative": 16303,
+    "Num Positive": 542,
+    "Positive %": 3.218,
+    "Num Positive per mm^2": 257.6
+  }
+}

643/TumorCenter_CD8_block15_x5_y8_patient643_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18840.0,
+    "Centroid Y µm": 19964.4,
+    "Num Detections": 19592,
+    "Num Negative": 19181,
+    "Num Positive": 411,
+    "Positive %": 2.098,
+    "Num Positive per mm^2": 164.43
+  }
+}

643/TumorCenter_CD8_block15_x6_y8_patient643_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 21388.7,
+    "Centroid Y µm": 20039.4,
+    "Num Detections": 18307,
+    "Num Negative": 18042,
+    "Num Positive": 265,
+    "Positive %": 1.448,
+    "Num Positive per mm^2": 110.4
+  }
+}

643/history_text.txt

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+In the patient, a cT2 cN0 squamous cell carcinoma was histologically confirmed <2014> in the area of the right edge and base of the tongue. With persistent pain in this area and unremarkable panendoscopy <2014>, computed tomography showed a cM0 situation. In our interdisciplinary tumor conference, the primary surgical procedure was recommended.

643/icd_codes.txt

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+Zungenrandkarzinom[C02.1 R]

643/ops_codes.txt

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+Partielle Resektion der Zunge durch Pharyngotomie mit Rekonstruktion mit freiem mikrovaskulär-anastomosiertem Transplantat[5-251.22 ] Transorale partielle Glossektomie mit Rekonstruktion mit freiem mikrovaskulär-anastomosierten Transplantat[5-251.02 ] Radikal modifizierte Neck dissection in 4 Regionen[5-403.20 B] Permanente Tracheotomie[5-312.0 ] Entnahme eines freien Lappens am Oberschenkel mit mikrovaskulärer Anastomosierung[5-904.0e R] Wechsel eines vaskulären Implantates[5-394.3 ] Laterale Pharyngotomie[5-290.3 ]

643/patient_clinical_data.json

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+{
+  "year_of_initial_diagnosis": 2014,
+  "age_at_initial_diagnosis": 61,
+  "sex": "male",
+  "smoking_status": "smoker",
+  "primarily_metastasis": "no",
+  "survival_status": "deceased",
+  "survival_status_with_cause": "deceased",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 7,
+  "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"
+}

643/patient_pathological_data.json

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+{
+  "patient_id": "643",
+  "primary_tumor_site": "Oral_Cavity",
+  "pT_stage": "pT2",
+  "pN_stage": "pN2b",
+  "grading": "G3",
+  "hpv_association_p16": "not_tested",
+  "number_of_positive_lymph_nodes": 2.0,
+  "number_of_resected_lymph_nodes": 42,
+  "perinodal_invasion": "yes",
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R1",
+  "resection_status_carcinoma_in_situ": "Ris0",
+  "carcinoma_in_situ": "yes",
+  "closest_resection_margin_in_cm": "0",
+  "histologic_type": "SCC_Conventional-Keratinizing",
+  "infiltration_depth_in_mm": 16.0
+}

643/surgery_description.txt

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+Resection, Neck dissection, Microvascular transplant

643/surgery_report.txt

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+After enoral inspection and confirmation of the extent of the tumor, transoral resection is performed after exposure of the tumor as described above on the dorsal right edge of the tongue with transition and infiltration of the glossotonsillar groove. Cut around the tumor from a safety distance of 1.5 to 2 cm, especially in the area inside the tongue. Dorsal resection up to just below the midline, no deep or more extensive infiltration in the area of the base of the tongue. However, poor overview here. Partial resection of the posterior floor of the mouth. Exposure of the submandibular gland, but no infiltration here, but tumor cones behind the gland in depth. Therefore, after resection of the enoral part, including the right-sided tonsil and resection of the glossotonsillar groove, the decision was made to proceed transcervically. For this purpose, submandibular incision and cervical separation of skin and subcutaneous tissue. Separation and dissection of the platysma. Exposure and preservation of the external jugular vein and auricular nerve. Exposure of the sternocleidomastoid muscle, omohyoid muscle. Exposure of the submandibular gland and digastric muscle. First perform the neck dissection. Clear out the anterior neck preparation, carefully preserving the superior thyroid artery, the cervical artery, the facial vein and the hypoglossal nerve. Free preparation of the internal jugular vein, visualization of the accessorius nerve, clearing of the accessorius triangle and clearing of level V with careful protection of the cervical plexus branches. Macroscopically, no suspicious nodules on the right cervical side. Now release the submandibular gland and complete level Ib. Enter via the posterior floor of the mouth enorally. Separation of the digastric muscle, widening of the access to the enoral side, step-by-step good overview of the tumor and taking along circumscribed muscles of the floor of the mouth as the tumor cone grows. Resection of the tumor transcervically in toto. The specimen shows a clear safety margin on all sides, especially in the area deep to the tongue. Only in the area of the glossotonsillar groove and the posterior floor of the mouth is there a safety margin of approx. 1 cm on the specimen, otherwise significantly more. It was therefore decided to take marginal samples in this area. Taking marginal samples from the preparation. In the frozen section diagnostics, these are free of dysplasia and tumor, so that a safe R0 resection can be assumed here. With a tumor measuring an average of 4 cm on the specimen, a cT2 extension is clinically just present. Measure the defect of the posterior floor of the mouth, the edge of the tongue, the base of the tongue and the tonsil lobe. Neck dissection of the left side is then performed first. Here also submandibular incision. Separation of skin and subcutaneous tissue. Exposure and preservation of the external jugular vein, exposure of the limiting musculature. Clearing of levels II to IV with careful preservation of the superior thyroid artery, the facial vein, the cervical artery, the hypoglossal nerve, the accessory nerve and the internal jugular vein. No macroscopically conspicuous nodules here either. Inclusion of the caudal capsule of the submandibular gland. Finally, careful wound irrigation with Ringer's solution and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Perform a plastic tracheostomy. Horizontal incision below the cricoid cartilage. Cut through the skin and subcutaneous tissue. Exposure of the infrahyoid musculature. Exposure of the cricoid cartilage, exposure of the anterior surface of the trachea, insertion between the 2nd and 3rd tracheal ring. Creation of a visor tracheotomy and insertion of the tracheostoma in the usual manner. Subsequent problem-free transfer to a size 8 low cuff cannula which is suture-fixed. Now to cover the defect. Elevation of the ALT from the right, here after doppler sonographic identification of the main perforator and two secondary perforators. Marking of the graft measuring 11 x 6 cm in total. Medial incision. Cutting through the fascia lata. Reliable identification of the rectus femoris muscle. Subfascial release. Identification of the pedicle vessel. Subsequent identification of the main perforator. Successive free preparation of the main perforator in the sense of a perforator flap. Isolation to the strong pedicle vessel. The sonographically identified secondary perforators are branches of the main perforator. Therefore, take along the main perforator, take along parts of the fascia lata, otherwise cut around the graft. Isolation on perforator and pedicle vessel. Conditioning of the pedicle vessels, elevation of a strong accompanying vein as well as a narrower second vein, and placement of the properly vital graft after the supply and return vessels have been treated. Careful wound inspection and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Subsequent successive incorporation of the graft from the enoral and transcervical sides. This finally succeeds sufficiently with a good fit. Conditioning of the superior thyroid artery. Performing the arterial anastomosis with 8-0 Ethilon, this is sufficient and successful. Immediate regular venous return via the main vein. No flow via the second vein. Therefore occlusion of the vein. Conditioning of the superior thyroid vein. Measuring a coupler size 3.0 and performing the anastomosis with the coupler system. Subsequently, regular graft perfusion, regular pedicle pulsation and positive spreading phenomenon. Subsequent careful wound inspection and, if the wound is dry, insertion of a 10-gauge Redon drain. Positioning of the drain and careful two-layer wound closure and completion of the procedure without any indication of complications. Conclusion: Intraoperative R0 resected at least cT2 cN0 tongue margin carcinoma on the right. The patient received intraoperative intravenous antibiotics with Unacid 3 g, which should be continued for 24 hours postoperatively. If the enoral graft heals properly, attempt to swallow and gradually build up the diet from the 7th postoperative day.

644/InvasionFront_CD3_block6_x3_y5_patient644_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 12243.5,
+    "Centroid Y µm": 13068.1,
+    "Num Detections": 18583,
+    "Num Negative": 16982,
+    "Num Positive": 1601,
+    "Positive %": 8.615,
+    "Num Positive per mm^2": 681.86
+  }
+}

644/InvasionFront_CD3_block6_x4_y5_patient644_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 14892.1,
+    "Centroid Y µm": 13193.0,
+    "Num Detections": 19033,
+    "Num Negative": 18450,
+    "Num Positive": 583,
+    "Positive %": 3.063,
+    "Num Positive per mm^2": 258.71
+  }
+}

644/InvasionFront_CD8_block6_x3_y3_patient644_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 12643.3,
+    "Centroid Y µm": 7296.1,
+    "Num Detections": 17506,
+    "Num Negative": 16865,
+    "Num Positive": 641,
+    "Positive %": 3.662,
+    "Num Positive per mm^2": 266.05
+  }
+}

644/InvasionFront_CD8_block6_x4_y3_patient644_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 15266.9,
+    "Centroid Y µm": 7496.0,
+    "Num Detections": 21226,
+    "Num Negative": 20182,
+    "Num Positive": 1044,
+    "Positive %": 4.918,
+    "Num Positive per mm^2": 405.96
+  }
+}

644/TumorCenter_CD3_block6_x3_y3_patient644_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 11194.1,
+    "Centroid Y µm": 7646.0,
+    "Num Detections": 9796,
+    "Num Negative": 8788,
+    "Num Positive": 1008,
+    "Positive %": 10.29,
+    "Num Positive per mm^2": 672.17
+  }
+}

644/TumorCenter_CD3_block6_x4_y3_patient644_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13717.7,
+    "Centroid Y µm": 7670.9,
+    "Num Detections": 11229,
+    "Num Negative": 10190,
+    "Num Positive": 1039,
+    "Positive %": 9.253,
+    "Num Positive per mm^2": 594.1
+  }
+}

644/TumorCenter_CD8_block6_x3_y3_patient644_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 11269.0,
+    "Centroid Y µm": 8070.7,
+    "Num Detections": 21016,
+    "Num Negative": 20533,
+    "Num Positive": 483,
+    "Positive %": 2.298,
+    "Num Positive per mm^2": 194.81
+  }
+}

644/TumorCenter_CD8_block6_x4_y3_patient644_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13792.7,
+    "Centroid Y µm": 8070.7,
+    "Num Detections": 19548,
+    "Num Negative": 19237,
+    "Num Positive": 311,
+    "Positive %": 1.591,
+    "Num Positive per mm^2": 128.72
+  }
+}

644/history_text.txt

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+Patient with histologically confirmed squamous cell carcinoma of the tongue margin/tongue body/base of tongue with infiltration of the extralingual soft tissues up to the submandibular gland on the right or just in front of the hyoid bone laterally, CT findings p16 negative, therefore surgical treatment indicated.

644/icd_codes.txt

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+Karzinom Oropharynx mehrere Teilbereiche überlappend[C10.8 B] Halslymphknotenmetastasen[C77.0 B]

644/ops_codes.txt

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+Direkte diagnostische Pharyngoskopie[1-611.0 ] 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] Entnahme von Spalthaut des Unterschenkels[5-901.0f R] Spalthaut bei Verbrennungen und Verätzungen Empfängerstelle Unterarm[5-925.08 L] Wechsel vaskuläres Implantat Gefäße onA[5-394.3 ] Perkutan-endoskopische Gastrostomie durch Fadendurchzugsmethode[5-431.20 ] Temporäre Tracheotomie[5-311.0 ]

644/patient_clinical_data.json

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+{
+  "year_of_initial_diagnosis": 2018,
+  "age_at_initial_diagnosis": 48,
+  "sex": "male",
+  "smoking_status": "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": 32,
+  "adjuvant_treatment_intent": "curative",
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "yes",
+  "adjuvant_systemic_therapy_modality": "chemotherapy",
+  "adjuvant_radiochemotherapy": "yes"
+}

644/patient_pathological_data.json

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+{
+  "patient_id": "644",
+  "primary_tumor_site": "Oropharynx",
+  "pT_stage": "pT3",
+  "pN_stage": "pN3",
+  "grading": "G3",
+  "hpv_association_p16": "negative",
+  "number_of_positive_lymph_nodes": 1.0,
+  "number_of_resected_lymph_nodes": 45,
+  "perinodal_invasion": "yes",
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "yes",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": "0.1",
+  "histologic_type": "SCC_Conventional-Keratinizing",
+  "infiltration_depth_in_mm": 25.0
+}

644/surgery_description.txt

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+Tumor resection, Neck dissection, Defect coverage, Free flap (Radial), Tracheostomy, Endoscopy

644/surgery_report.txt

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+First, pharyngoscopy and laryngoscopy again after nasotracheal intubation of the patient by the anesthesia colleagues: The exophytic tumor is seen, which extends to the glossoalveolar groove laterally at the back, infiltrating under the floor of the mouth in the direction of the submandibular space. Infiltration also towards the base of the tongue and here the midline is reached but not crossed. Overall indication for tumor resection, neck dissection and coverage with a radial flap. The apron flap is lifted first and a tracheostoma is created. Tracheotomy: Horizontal incision just below the cricoid cartilage. Cut through the skin and subcutaneous tissue. Identification of the infralaryngeal musculature and division of the musculature in the midline. Push the musculature to the side and identify the cricoid cartilage. Sharp dissection of the cricoid cartilage and undermining of the thyroid isthmus. Bipolar coagulation of the thyroid isthmus and transection of the same. Identification of the anterior wall of the trachea. Careful removal of tissue from the anterior wall of the trachea. Tracheal incision in the 2nd to 3rd intratracheal ring space and creation of an epithelialized tracheostoma in the usual manner. Re-intubation with the 8-bore tracheostomy tube. PEG insertion: PEG insertion using the thread pull-through method. This is successful without any problems if the diaphanoscopy is positive. Tumor resection: First of all, cervical exposure of the cervical vessels as well as the hypoglossal nerve and vagus nerve. Snaring of these structures using Vessel-Loups. Vessels are dissected away from the soft tissue as far as the cranial side. The digastric muscle is severed and cut laterally and then resected at the lateral end. The mandible is exposed after pushing the soft tissues including the branch of the mouth cranially. The entire soft tissue is pushed away from the mandible with the periosteum from the angulus to the symphysis. Infrahyoid muscles are detached from the hyoid bone and dissected as a Remmert flap pedicled to the superior thyroid artery and the cervical artery and beaten downwards. The hyoid bone is then resected in the midline and included in the tumor resection together with all overlying soft tissue. The entire external musculature is resected in the midline. The entire dorsal body of the tongue, including the floor of the mouth and the largest parts of the sublingual gland, is resected transorally, except for the tip of the tongue. Resection also includes the areas of the tongue beyond the midline from the body of the tongue to the base of the tongue. The periosteum is also removed transorally from the lower jaw, the entire soft tissues and muscles of the floor of the mouth are also resected. The lingual nerve is also resected. In the further course of the operation, the hypoglossal nerve is also resected medial to the exit of the cervical nerve. The tumor is clearly resected macroscopically in healthy tissue and removed in toto. Multiple suture markings are made on the tumor, which is sent to the frozen section. Marginal samples of the mucosa are taken from the alveolar ridge to the floor of the mouth at the front, a further marginal sample of the mucosa from the middle of the tongue to the body with underlying soft tissue and soft tissue basally on the rest of the hyoid bone. All marginal samples and the marked tumor are sent for frozen section. Here, tumor in healthy tissue as well as marginal samples, thus R0 resection. Careful hemostasis and irrigation of the wound area and resection areas. The lingual artery and facial artery were already prepared as possible vascular anastomoses during the resection. The superior thyroid artery was included in the Remmert flap. Neck dissection on both sides by <CLINICIAN_NAME>: skin incision and dissection through the subcutaneous fatty tissue. Subplatysmal dissection of the apron flap. Beginning on the right side. Exposure of the anterior border of the sternocleidomastoid muscle and dissection in depth. Finding the accessorius nerve and exposing it. Dissection of the omohyoid muscle and finding the submandibular gland. Elevation of the submandibular gland and protection of the marginal ramus. Exposure of the posterior venter of the digastric muscle up to region II b. Now expose and locate the accessorius nerve and protect it. Dissection of the internal jugular vein and its multiple outlets, including the facial vein. These are initially preserved, but then turned downwards to serve later as possible connecting vessels. Dissection of the jugulofacial angle and removal of multiple conspicuous lymph nodes. Protection of the hypoglossal nerve. Now dissection of the lateral neck preparation in regions II to V, sparing the vagus nerve and cervical plexus. The various branches of the external carotid artery are dissected in order to serve both as a Remmert flap and as connecting vessels. The lingual artery on the right side is removed. The cervical artery was also spared. On the left side, here too the anterior border of the sternocleidomastoid muscle is exposed and the accessorius nerve is located, protected and preserved. Exposure of the omohyoid muscle and the submandibular gland. Elevation of the gland, preserving the mandibular ramus and dissection on the digastric muscle posteriorly. Dissection along and on the internal jugular vein in a cranial direction. Here too, protect all outlets and the cervical vein. Follow the cervical vein to the hypoglossal muscle and preserve it. Now carefully dissect the lateral neck preparation and detach it while preserving the cervical plexus. It is cleared up to the omohyoid muscle, no chyle flow can be seen. There is also no increased bleeding. Now clear out the medial neck preparation, sparing all structures. The vagus nerve could also be visualized and preserved during the operation. The radial flap was then sutured into the defect. Successive suturing of the radial flap from the transcervical and transoral sides, partly after the sutures have been placed. The flap is successfully sutured in an anatomically three-dimensional manner so that both the lateral pharyngeal wall and floor of the mouth can be covered without tension, as well as the tongue and base of the tongue and the transition to the vallecula. The stalk is passed through the right side of the neck. Dissection of the facial vein, which has several outlets. Dissection of the facial artery. Anastomosis here, after conditioning the vessels with the radial artery. After opening the clamps, good arterial flow, good venous return. A branch of the facial vein is then anastomosed with the cephalic vein using a 3.5 mm coupler. The deep confluent vein is then anastomosed with another outlet from the facial vein using a 2.5 mm coupler. In each case, after opening the clamps, good venous flow and positive exclusion phenomenon. Overall, good blood flow after assessment of the flap. Extensive irrigation of the wound area. After further mobilization, the Remmert flap is sutured on the right side above the hyoid bone for volume augmentation. Subsequent careful hemostasis and irrigation of the wound area. Then wound closure in layers, with insertion of two flaps on the right and a Redon drain on the left and epithelialization of the tracheostoma. An 8 mm tracheostomy tube was then inserted and fixed in place. The defect on the forearm was primarily closed cranially and covered caudally with split skin, which was taken from the thigh on the right side. Defect augmentation using a Remmert flap from the right. Elevation of the radial forearm flap on the left by <CLINICIAN_NAME>: Palpatory identification of the distal radial artery. Marking of the flap borders 14 cm x 8 cm on the distal forearm, proximal to the flexor retinaculum, with an S-shaped incision running proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue starting proximally. Identification and visualization of the venous confluence in the cubital fossa. Identification of the cephalic vein and dissection of the vein distally with integration into the radial graft margin. Identification of the ramus externus of the radial nerve and elevation of the radial portion, leaving the peritendineum of the tendons of the brachioradialis muscle intact. Subsequent ulnar incision down to the forearm fascia. Incision of the fascia and subsequent subfascial elevation of the ulnar edge of the graft up to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendineum on the flexor tendons and to spare the ulnar artery. Identification of the distal radial artery and trial clamping with a vascular clamp. After 5 minutes with good oxygen saturation measured by pulse oximetry (measured on the index finger), the vessels are removed with subsequent ligation (Prolene 6.0). Successive detachment of the flap pedicle from the M. pronator quadratus and M. flexor pollicis longus with ligation of the outgoing perforators using a vessel clip into the cubital fossa. Exposure and protection of the radial nerve on the medial side of the brachioradialis muscle. Exposure of the brachial artery, V. mediana cubiti, A. ulnaris. First removal of the radial artery, then of two veins of the superficial venous system. Vascular ligation by means of a bypass ligature (artery) and vascular clip (veins). Subtle hemostasis in the area of the wound bed using bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm. Covering of the graft bed with split skin from the right thigh in the usual manner. Suturing of preparation swabs. Application of a wound dressing and a forearm splint. Completion of the graft lift without complications. Finally, attachment of the forearm. Good saturation and blood circulation of the left forearm at the end of the operation. Completion of the procedure without complications. The patient is ventilated and transferred to the intensive care unit for monitoring. Please continue postoperative antibiotics with Unacid, as started intraoperatively, for one week. Nutrition via the inserted PEG tube for approx. 10 days, followed by an X-ray broth swallow and, if necessary, diet build-up. If necessary, initiate swallowing training in the voice and speech department. Control of the flap according to the scheme for 5 days by means of clinical checks and Doppler checks. Anastomosis area marked with right cervical suture. Awaiting the final histology. Then presentation at the interdisciplinary tumor conference to indicate radiochemotherapy if necessary.

645/InvasionFront_CD3_block7_x3_y6_patient645_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 11374.6,
+    "Centroid Y µm": 14626.5,
+    "Num Detections": 15319,
+    "Num Negative": 15117,
+    "Num Positive": 202,
+    "Positive %": 1.319,
+    "Num Positive per mm^2": 102.16
+  }
+}

645/InvasionFront_CD3_block7_x4_y6_patient645_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 14030.1,
+    "Centroid Y µm": 14617.3,
+    "Num Detections": 17765,
+    "Num Negative": 17346,
+    "Num Positive": 419,
+    "Positive %": 2.359,
+    "Num Positive per mm^2": 173.62
+  }
+}

645/InvasionFront_CD8_block7_x3_y6_patient645_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 12259.8,
+    "Centroid Y µm": 15296.0,
+    "Num Detections": 13330,
+    "Num Negative": 13240,
+    "Num Positive": 90,
+    "Positive %": 0.6752,
+    "Num Positive per mm^2": 46.97
+  }
+}

645/InvasionFront_CD8_block7_x4_y6_patient645_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 15017.0,
+    "Centroid Y µm": 15691.7,
+    "Num Detections": 15536,
+    "Num Negative": 15289,
+    "Num Positive": 247,
+    "Positive %": 1.59,
+    "Num Positive per mm^2": 105.42
+  }
+}

645/TumorCenter_CD3_block7_x3_y6_patient645_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 10969.2,
+    "Centroid Y µm": 15142.0,
+    "Num Detections": 15284,
+    "Num Negative": 14899,
+    "Num Positive": 385,
+    "Positive %": 2.519,
+    "Num Positive per mm^2": 163.27
+  }
+}

645/TumorCenter_CD3_block7_x4_y6_patient645_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13767.7,
+    "Centroid Y µm": 14892.1,
+    "Num Detections": 14467,
+    "Num Negative": 14061,
+    "Num Positive": 406,
+    "Positive %": 2.806,
+    "Num Positive per mm^2": 187.51
+  }
+}

645/TumorCenter_CD8_block7_x3_y6_patient645_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 10744.3,
+    "Centroid Y µm": 15167.0,
+    "Num Detections": 20008,
+    "Num Negative": 19946,
+    "Num Positive": 62,
+    "Positive %": 0.3099,
+    "Num Positive per mm^2": 25.66
+  }
+}

645/TumorCenter_CD8_block7_x4_y6_patient645_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13367.9,
+    "Centroid Y µm": 15117.0,
+    "Num Detections": 21217,
+    "Num Negative": 21125,
+    "Num Positive": 92,
+    "Positive %": 0.4336,
+    "Num Positive per mm^2": 36.93
+  }
+}

645/history_text.txt

@@ -0,0 +1 @@
+During a panendoscopy, the patient was found to have at least cT2 cN2b tongue margin carcinoma on the left side. Secondary findings included mediastinal lymphoma with tracheal invasion. After healing of extensive peritonitis and prior treatment of the lymphoma, the patient now presented for definitive treatment. Due to the secondary diseases, our interdisciplinary tumor conference decided that surgery was the treatment of choice.

645/icd_codes.txt

@@ -0,0 +1 @@
+Karzinom Zunge mehrere Teilbereiche überlappend[C02.8 L]

645/ops_codes.txt

@@ -0,0 +1 @@
+Transorale partielle Resektion der Zunge mit Rekonstruktion mit freiem mikrovaskulär-anastomosiertem Transplantat[5-251.02 ] Partielle Resektion der Zunge durch Pharyngotomie mit Rekonstruktion mit freiem mikrovaskulär-anastomosiertem Transplantat[5-251.22 ] Radikal modifizierte Neck dissection in 4 Regionen[5-403.20 B] Permanente Tracheotomie[5-312.0 ] Entnahme eines freien Lappens am Oberschenkel mit mikrovaskulärer Anastomosierung[5-904.0e R] Wechsel eines vaskulären Implantates[5-394.3 ]

645/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2014,
+  "age_at_initial_diagnosis": 54,
+  "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": 97,
+  "adjuvant_treatment_intent": "curative",
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "yes",
+  "adjuvant_systemic_therapy_modality": "cisplatin",
+  "adjuvant_radiochemotherapy": "yes"
+}

645/patient_pathological_data.json

@@ -0,0 +1,20 @@
+{
+  "patient_id": "645",
+  "primary_tumor_site": "Oropharynx",
+  "pT_stage": "pT3",
+  "pN_stage": "pN2b",
+  "grading": "hpv_association_p16",
+  "hpv_association_p16": "positive",
+  "number_of_positive_lymph_nodes": 7.0,
+  "number_of_resected_lymph_nodes": 33,
+  "perinodal_invasion": "yes",
+  "lymphovascular_invasion_L": "yes",
+  "vascular_invasion_V": "yes",
+  "perineural_invasion_Pn": "yes",
+  "resection_status": "RX",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": null,
+  "histologic_type": "SCC_Conventional-Keratinizing",
+  "infiltration_depth_in_mm": 25.0
+}

645/surgery_description.txt

@@ -0,0 +1 @@
+Transoral and trans-cervical tumor resection, Neck dissection, Free flap (ALT)

645/surgery_report.txt

@@ -0,0 +1 @@
+First of all, after intubation and preparation by the anesthesia colleagues, positioning of the patient. Inspection of the primary tumor region. An exophytic, exulcerated tumor is found in the area of the left edge of the tongue and the soft palate with involvement of the posterior floor of the mouth. Palpation reveals that the majority of the tumor is growing submucosally into the tongue. The tumor clearly extends beyond the midline in the area of the base of the tongue, but with sufficient residual distance to the opposite side. In addition, the tumor is clearly growing towards the floor of the mouth and cervically. Transoral tumor resection is therefore performed first. Removal of the soft palate section, taking the tonsil lobe with it, resection of the posterior floor of the mouth and resection of the exophytic tumor section up to the area of the edge of the tongue. This resection is completely covered with margin samples, which are diagnosed as tumor- and dysplasia-free in the frozen section diagnostics. Now continue the tumor resection from the transcervical side. Submandibular skin incision, separation of skin and subcutaneous tissue, dissection of the platysma. Exposure of the sternocleidomastoid muscle, exposure of the omohyoid muscle, exposure of the hardened submandibular gland and the digastric muscle. The tumor can be palpated under the submandibular gland with infiltration of the lateral floor of the mouth. Due to the depth, first expose the vessels. Evacuation of the anterior neck preparation with removal of the facial vein and preservation of the superior thyroid artery. Exposure of the carotid artery and the internal jugular vein of the vagus nerve in the area of the internal jugular vein Level II and III, several macroscopically clearly suspicious nodules can be seen, but these can be separated from the accessorius nerve. Removal of the metastases in toto. Cranial dissection, resection of the digastric muscle. Release of the submandibular gland while sparing the ramus marginalis mandibulae. Palpation shows the tumor infiltrating the floor of the mouth up to just before the hyoid, here moderately displaceable, therefore involving the left half of the hyoid. Cranial dissection along the carotid artery. Separation of the facial artery and lingual artery. The hypoglossal nerve also appears to be pulling into the tumor conglomerate and is removed. Now successive extension of the pharyngotomy over the tonsillar lobe and the lateral floor of the mouth, continuing over the pharyngeal side wall up to the level of the vallecula. Resection as described of the hyoid with attached external floor of mouth muscles. Resection of the tumor within the tongue, leaving a muscle cuff on the tumor so that the final tumor can be resected macroscopically in sano; only at one point was there a muscle tear above the tumor capsule during dissection, which is marked. An extensive resection is performed to cover this area. Covering of the tumor in the marginal area and in the previously described muscular part with marginal samples, these are also diagnosed as tumor-free and dysplasia-free, so that a R0 situation can finally be assumed. Measurement of the defect. At the same time, the right-sided neck dissection was performed and the antero-lateral thigh graft was lifted to perform the neck dissection. A submandibular skin incision is also made here. Cutting through skin and subcutaneous tissue. Separation of the platysma. Dissection. Exposure of the sternocleidomastoid muscle and the omohyoid muscle. Exposure of the submandibular gland and digastric muscle. Release of the anterior neck preparation with careful protection of the hypoglossal nerve and the superior thyroid artery as well as the facial vein. Free preparation of the internal jugular vein. Exposure and preservation of the accessory nerve, evacuation of the accessory triangle and level V with careful protection of the cervical plexus branches. Final wound inspection and wound irrigation and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. To elevate the antero-lateral thigh graft after doppler sonographic identification of a main perforator and three secondary perforators, the graft measuring a total of 15 x 10 cm with soft palate and tongue base configuration is indicated. Medial incision. Cut through skin and subcutaneous tissue. Exposure of the rectus femoris muscle. Strictly subfascial dissection. Identification of the pedicle vessel, which runs relatively cranially. The ramus descendens is relatively weak. Identification of the fasciocutaneous perforator, the secondary perforators run intramuscularly, complete resection of the graft. Partial entrainment of the fascia lata. Inclusion of a sufficient muscle cuff. Isolation to the pedicle vessel. Isolation on the artery and vein and, if the blood supply to the graft is normal, removal of the graft. Subsequent careful hemostasis. Insertion of a 10-gauge Redon drain and careful two-layer wound closure and adaptation of the skin edges. Subsequent successive insertion of the graft, primarily via the tanscervical area. Overall very good fit. Reconstruction of the entire tongue and reconstruction of the largely resected base of the tongue with good volume filling. Transoral completion in the area of the soft palate and floor of the mouth. Overall intact conditions on all sides. Cervical anastomosis conditions significantly more difficult due to the position of the anastomosis and the now somewhat obstructive muscle cuff. Conditioning of the detached lingual artery, arterial anastomosis performed with 8-0 Ethilon with good flow under markedly difficult suturing conditions with pronounced arteriosclerosis in the area of the graft vessel. Overall, however, intact anastomosis with immediate regular venous return. Conditioning of the facial vein in the stump area. Sizing of a coupler size 3.5 and insertion of the venous anastomosis without any problems using the coupler system. Subsequent regular graft perfusion. The muscle cuff can now be well integrated into the neck, resulting in a good position of the anastomosis, but also complete filling of the neck. Therefore, a caudal rubber flap is inserted later. Careful two-layer wound closure. Finally, the tracheotomy is performed. In this case, post-tracheotomy at the beginning of the year. Opening of the skin scar, cutting of scars. Exposure of the anterior surface of the trachea. Reopening of the trachea in the former area between the 1st and 2nd tracheal ring, followed by insertion of the muco-cutaneous anastomosis and problem-free reintubation onto a size 8 low cuff cannula, which is suture-fixed. The procedure was then completed with a vital graft. Conclusion: Intraoperative R0 resected cT4a cN2b tongue margin and tongue base carcinoma on the left. If the graft heals properly, the first attempts at swallowing can be started from the 8th postoperative day. Left cervical swelling due to the clear muscle cuff, please consult the surgeons before manipulation. Due to the extent of the tumor, adjuvant RCT appears to be urgently required.  

646/InvasionFront_CD3_block12_x5_y2_patient646_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 17315.8,
+    "Centroid Y µm": 10219.6,
+    "Num Detections": 18188,
+    "Num Negative": 16958,
+    "Num Positive": 1230,
+    "Positive %": 6.763,
+    "Num Positive per mm^2": 540.05
+  }
+}

646/InvasionFront_CD3_block12_x6_y2_patient646_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 19864.5,
+    "Centroid Y µm": 10494.4,
+    "Num Detections": 21503,
+    "Num Negative": 18714,
+    "Num Positive": 2789,
+    "Positive %": 12.97,
+    "Num Positive per mm^2": 1160.0
+  }
+}

646/InvasionFront_CD8_block12_x5_y2_patient646_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16791.1,
+    "Centroid Y µm": 8420.5,
+    "Num Detections": 16913,
+    "Num Negative": 16187,
+    "Num Positive": 726,
+    "Positive %": 4.293,
+    "Num Positive per mm^2": 344.62
+  }
+}